HEAL Committee Meeting

37th PARLIAMENT, 2nd SESSION

Standing Committee on Health

EVIDENCE

CONTENTS

Monday, March 24, 2003

¹

1535

The Chair (Ms. Bonnie Brown (Oakville, Lib.))

Mr. Réal Ménard (Hochelaga—Maisonneuve, BQ)

The Chair

Mr. Réal Ménard

The Chair

Mr. Réal Ménard

The Chair

Mr. Réal Ménard

The Chair

Dr. Kenneth Rosenthal (President, and Professor, Department of Pathology and Molecular Medicine, McMaster University, Canadian Association of HIV Researchers)

¹

1540

¹

1545

The Chair

Mr. Art Zoccole (Executive Director, Canadian Aboriginal AIDS Network)

¹

1550

The Chair

Dr. Mark Wainberg (President Elect, and Director, McGill AIDS Centre, International AIDS Society)

¹

1555

º

1600

º

1605

The Chair

Mr. Paul Lapierre (Executive Director, Canadian AIDS Society)

º

1610

º

1615

The Chair

Mr. Ralf Jürgens (Executive Director, Canadian HIV/AIDS Legal Network)

º

1620

º

1625

º

1630

The Chair

Mr. Rob Merrifield (Yellowhead, Canadian Alliance)

Mr. Ralf Jürgens

Mr. Rob Merrifield

Mr. Ralf Jürgens

Mr. Rob Merrifield

Mr. Ralf Jürgens

Mr. Rob Merrifield

º

1635

Dr. Kenneth Rosenthal

Mr. Rob Merrifield

Dr. Kenneth Rosenthal

Mr. Rob Merrifield

Dr. Kenneth Rosenthal

Mr. Rob Merrifield

Dr. Kenneth Rosenthal

º

1640

Mr. Rob Merrifield

The Chair

Mr. Réal Ménard

Mr. Paul Lapierre

Mr. Réal Ménard

Dr. Mark Wainberg

Mr. Réal Ménard

Dr. Mark Wainberg

º

1645

Mr. Réal Ménard

The Chair

Ms. Carolyn Bennett (St. Paul's, Lib.)

Mr. Ralf Jürgens

Ms. Carolyn Bennett

Mr. Ralf Jürgens

Ms. Carolyn Bennett

Dr. Mark Wainberg

Ms. Carolyn Bennett

º

1650

Mr. Ralf Jürgens

Ms. Carolyn Bennett

Mr. Ralf Jürgens

The Chair

Mr. Svend Robinson (Burnaby—Douglas, NDP)

The Chair

Mr. Svend Robinson

The Chair

Mr. Svend Robinson

Mr. Ralf Jürgens

º

1655

Dr. Mark Wainberg

Mr. Svend Robinson

The Chair

Ms. Hedy Fry (Vancouver Centre, Lib.)

Mr. Paul Lapierre

»

1700

Mr. Art Zoccole

Ms. Hedy Fry

Mr. Art Zoccole

Dr. Kenneth Rosenthal

Mr. Ralf Jürgens

The Chair

Mr. James Lunney (Nanaimo—Alberni, Canadian Alliance)

»

1705

Dr. Mark Wainberg

Mr. James Lunney

Dr. Kenneth Rosenthal

Mr. James Lunney

Dr. Kenneth Rosenthal

»

1710

The Chair

Mr. Svend Robinson

Mr. Art Zoccole

»

1715

Dr. Mark Wainberg

»

1720

Mr. Ralf Jürgens

The Chair

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CANADA

Standing Committee on Health

---

NUMBER 026

l

2nd SESSION

l

37th PARLIAMENT

---

EVIDENCE

Monday, March 24, 2003

[Recorded by Electronic Apparatus]

¹  (1535)  

[English]

    The Chair (Ms. Bonnie Brown (Oakville, Lib.)): Good afternoon, ladies and gentlemen. It's my pleasure to welcome you to this meeting of the Standing Committee on Health. This will be the 3rd meeting, I believe, concerning our mini-study on HIV/AIDS and the Canadian strategy thereto.

    Before we begin, one of the members wants one minute to make a little announcement. Mr. Ménard.

[Translation]

    Mr. Réal Ménard (Hochelaga—Maisonneuve, BQ): Madam Chair, there is one thing I want to make sure of, because we have not seen the list of witnesses and the committee work is progressing. On Friday I met a very important organization in Quebec known as COCQ-Sida, representing 36 organizations. I assumed they would be coming, since the Canadian AIDS Society was invited. That is the drawback of not having a steering committee. I insist on hearing them and I cannot understand why we have not communicated with them at this point. They are anxious to appear.

    I thought that it was the last or second-last meeting, and that is what was worrying me. We cannot think of tabling a report without hearing from a witness as important as this group. Anyone who has anything to do with AIDS in Quebec is a member of this group, hence the importance of hearing them. They want to come, but I know that as of Friday, they had not heard from us. So this is a mistake that must be rectified. I don't know whether we can add an additional meeting but we certainly can't table a report without hearing from COCQ-Sida.

[English]

    The Chair: I have two questions, Mr. Ménard. First, is that person present? Second, what is the name of the organization that person would represent?

[Translation]

    Mr. Réal Ménard: The name is COCQ-Sida, the Coalition of Quebec community organizations in the fight against AIDS, and the person to contact is the Director General, Ms. Lyse Pinault. They are located at 1 Sherbrooke Street West. I can't remember the number, but I can find it quite quickly.

[English]

    The Chair: We already have five witnesses who have been given 10 minutes each. If these witnesses think they could bring their presentations down to about eight minutes each, we could maybe accommodate one more witness.

[Translation]

    Mr. Réal Ménard: They are not here today.

[English]

    The Chair: Oh, she's not here. The whole point is moot, then.

[Translation]

    Mr. Réal Ménard: They will have to be invited. We'll have to arrange an additional meeting to hear from them. They aren't here today.

[English]

    The Chair: Well, that can be decided at another time. The plan is for one more meeting to review a report, but not another meeting for witnesses. That is a process issue you'd have to put before the committee, but I don't think it's too polite to discuss process in front of the people who've already come and put their effort into presenting to us. So with everybody's agreement, I think we should move to what's on the agenda for today.

    Mr. Ken Rosenthal.

    Dr. Kenneth Rosenthal (President, and Professor, Department of Pathology and Molecular Medicine, McMaster University, Canadian Association of HIV Researchers): Thank you. I'd like to thank the committee for giving me this opportunity to speak.

    I'm coming as the president of the Canadian Association for HIV Research. This organization represents HIV/AIDS researchers in Canada, whether they're involved in basic science, clinical research, epidemiology, or public health, and social scientists. CAHR also interacts closely with communities and community-based research members. I basically have a few key points I'd like to try to make today.

    The first is that a vibrant, vigorous research effort is essential for effective treatment, support, and prevention of HIV/AIDS in Canada and globally. Research is essential to the Canadian HIV/AIDS strategy. I think patients with cancer or almost any chronic disease recognize that the best care for individuals with chronic diseases, and that includes individuals with HIV/AIDS, occurs where the best research is being conducted. HIV research in Canada has served and continues to serve as a discovery engine: essentially, it provides a means by which our scientists and researchers can push themselves in the area of virology and infectious diseases, immunology, vaccinology, almost all fronts, including clinical sciences, epidemiology, and again, the social sciences.

    It really is, in a sense, like a moon shot. There are a lot of benefits that come from this outside the main goals. For example, we have gained a tremendous amount of insight into how our immune systems work, into how vaccines work, and into infectious diseases. I think all of you can well appreciate that these days infectious diseases are rampant. On my way to the meeting here today I heard that there were additional cases of the SARS disease being diagnosed in Toronto, and it looks as though it may even be affecting some of the physicians who are treating these individuals.

    Furthermore, HIV/AIDS research is critical for building capacity in human infectious diseases. A few years ago I could have counted the number of researchers studying hepatitis C virus in Canada on one finger. It's vital that we support HIV/AIDS research. It gives us the opportunity to do human immunology in infectious diseases, and it will build our capacity to address all these various human infectious diseases we're faced with, such as hepatitis C, SARS, West Nile virus, and any bio-threat agent.

    Thursday and Friday last week I was in Winnipeg evaluating the medical microbiology program at the University of Manitoba. Part of that afforded me the opportunity to see Dr. Plummer and the investigators in the federal lab who were actually working all weekend trying to identify the agent of this pneumonia that is going around. Quite interestingly, Frank Plummer built his reputation, as you know, in HIV/AIDS research, but he's now employed by the federal lab, which is a gorgeous state-of-the-art facility. Even though it's in Winnipeg, it was still able to recruit 17 top-notch international scientists, and that has spawned a doubling of the number of graduate students attending medical microbiology at the University of Manitoba. That gives you an idea of the spin-offs and benefits that come from these efforts.

¹  (1540)  

    My second point is that Canada has developed a cadre of internationally recognized HIV/AIDS researchers, but erosion of funding threatens Canada's competitive edge. I think you heard last week from Dr. Schechter, Louise Binder, and others that a decade ago the Conservative government, not the current Liberal government, picked a number, $42 million, and threw that at the AIDS problem and we are still dealing with that amount of money a decade later. To me, this is a decade of decay.

    Who are these internationally recognized individuals? One of them is apparently going to show up, Dr. Wainberg, an international leader in HIV who has made critical findings of 3TC, a drug that is very effective against the AIDS virus. This is one of the most heavily used drugs to treat HIV-infected individuals. I've mentioned Frank Plummer and the Manitoba group. Allen Ronald was one of the lead investigators there looking at the transition of HIV and showing that STDs facilitate HIV transmission, identifying the maternal to fetal transfer of the disease, and more recently, identifying groups of exposed, but resistant prostitutes, who have given us new insight into resistance mechanisms. Dr. Sékaly in Montreal is playing a lead role in establishing international standards for immune monitoring of vaccines and making insights into the immunology. We have a variety of clinicians who are in the lead in treatment of this disease, and obviously, our social scientists and epidemiologists, Dr. Calzavara, Dr. Alary, and others, who are working in the eastern bloc countries, in Africa, in India, to give us a representation globally.

    Third, in addition to being the president of Canadian HIV research, I am the co-target leader of the HIV vaccine drive under the Canadian Network for Vaccines and Immunotherapeutics, CANVAC. Canadian researchers are in a position to develop a vaccine that prevents HIV/AIDS. If you can, as I do from time to time, just imagine if Canadian researchers developed the vaccine against HIV/AIDS. It is really a possibility, but this requires funding, particularly for clinical development.

    Why do I say Canadians are in a position to develop this vaccine? First, we formed a virtual network in the country called CANVAC, which gives us a critical mass. CANVAC has unique expertise in mucosal immunity and vaccinology. Mucosal immunity is understanding immunity in the mucous membranes of the body. We can talk about that more if you're interested. CANVAC is a world leader in immune monitoring. You're going to be hearing about some novel genetic assays, gene chip assays, that are coming out of CANVAC's core. Canada, notably through the Winnipeg group and their close collaboration with the University of Nairobi in Kenya, has over 20 years of experience working effectively with partners in developing countries. Canada was the fastest country in the world to recruit to the phase three VaxGen trial you may have read about that failed recently. Nevertheless, our patients and clinic trials network was very effective in rolling to that trial and participating in it. Also, as you'll hear shortly from Ralf, we have excellent legal and ethical aspects of HIV vaccine trials through the Canadian HIV trials network.

¹  (1545)  

    Where we're missing in the vaccine area is development money, the money to prepare clinical lots--you have to make clinical lots for vaccine trials, and these cost approximately $1 million to make--and for the clinical testing of these vaccines. This not only involves what we call vaccine preparedness, but we're looking at doing this in Africa and in developing countries, so money is needed to lay the groundwork and infrastructure to test these vaccines, as is the funding for phase one and two trials, let alone phase three trials, which are quite expensive. In fact, there is no infrastructure available in Canada for clinical lot preparation. It's quite interesting that in Ottawa, which has had a vibrant technology sector, a number of firms have left. It turns out that to make a computer chip, you need a very clean room identical in structure to what's needed to adequately produce vaccines. So there is opportunity for an investment that could pay off in the long run. I think you know HIV vaccines only represent a small slice of a huge national vaccine issue that is bubbling through the Canadian Infectious Disease Society and through our physicians.

    The last point I want to make is that Canada needs to bring its domestic commitment to the fight against HIV/AIDS in line with its international obligations. I don't know about you, but I think there have been a few illustrations recently of what I would call good intentions gone bad, people trying to do the right thing, but in the end, it isn't really the right thing. At the Barcelona meeting the Minister for International Cooperation, Minister Whelan, announced that the Canadian government, through the Ministry of International Cooperation, decided to give $55 million to IAVI and international aids efforts. Certainly, we applaud the fact that Canada is contributing and doing its share for these global efforts, but this was done with no consultation with the HIV research community and no recognition that HIV researchers have been working on HIV vaccines for over 20 years in the country.

    This is a situation where we have poor government. It is a lack of connection between different ministries. This should be a situation that gives us a win-win. I almost wish Oprah Winfrey were in the room, because it's an ideal example of where Canadian research advances, and the fact that we have excellent relationships and infrastructure in place in Africa can be utilized to push forward Canadian initiatives. The vaccine for developing countries has to come from somewhere, and it will come from developed countries, with the cooperation and help of our partners in developing countries. We could certainly work to make this a win-win situation. It isn't a huge barrier to have one ministry talk to another ministry. What we do need is some kind of Canadian international vaccine plan and support for these efforts.

    Thank you.

    The Chair: Thank you very much.

    Our second speaker was to be Mark Wainberg from McGill, but he is not here, so we'll move on to Art Zoccole of the Canadian Aboriginal AIDS Network.

    Mr. Art Zoccole (Executive Director, Canadian Aboriginal AIDS Network): [Editor's Note: Witness speaks in his native language]

    To translate, my name is Art Zoccole, I'm a two-spirit Ojibway man from Lac des Mille Lacs first nation in Ontario, and I'm currently the executive director of the Canadian Aboriginal AIDS Network, a coalition of aboriginal AIDS service organizations, aboriginal organizations that have HIV/AIDS programs, and aboriginal people who are living with HIV and AIDS.

    Every day in Canada another aboriginal person is infected by HIV. In every new study where aboriginal people are included it is found that aboriginal people are infected younger, faster, and in greater numbers than non-aboriginal people. Every day those of us who are positive face fear, discrimination, and stigma within our own communities and prejudice against our aboriginal heritage and ancestry outside. For 300 years we have been struggling to assert our rights, our independence, our governance and self-determination, our culture, our beliefs against those imposed upon us. HIV/AIDS is simply another deadly chapter in this ongoing struggle.

    One of the issues for those of us in the aboriginal AIDS movement is our constant refrain for the rest of the world to pay attention. We want the government and the community at large to acknowledge the alarming third-world rates of infection among aboriginal people in this country. We also must be given our resources to approach the epidemic in our way, with our practices and in our cultural context. To many this sounds likes having our bannock and eating it too, but it's not. Less than a month away from the release of the aboriginal HIV/AIDS strategy in Canada, we require the funding of aboriginal population-specific AIDS strategies in all the regions, not just those with provincial government or strong community advocacy organizations.

    We want, while accountable to the larger bodies that fund us, recognition of the principles of OCAP: ownership, control, access, and possession of HIV/AIDS information, programs, and services in and around the aboriginal community. This is to acknowledge that we in the aboriginal community know best how to deal with HIV and AIDS in that community, just as those of us who are gay or two-spirit know best how to approach these issues among ourselves, those of us who are women know what works for women, and so on.

    All these initiatives must be ongoing and sustainable. Too much time, with the current funding approach, is lost to short-term projects that relieve a sense of inaction, but do nothing to build a sustainable aboriginal-driven approach to dealing with this disease on our own terms. Along with regional population-specific strategies, core and operational funding must be allocated to regional aboriginal AIDS service organizations, so we can develop a long-term response in all areas of the country.

    These are things we want. These are demands we will make as long as 26% of new infections in this country are aboriginal, as long as inequity, racism, economic disparity, and disease continue to plague our people. We in the aboriginal community have been beating this particular drum for many years, and we will continue to beat it until we are heard by everyone.

¹  (1550)  

    I knew a person in 1982 who died from AIDS, and I've committed my life and work to this cause. We've gone through a period in Canada where, with the introduction of anti-retrovirals, people began to live longer. Because of the way things are collected in epidemiology and surveillance and because ethnic identifiers are not recorded by certain provinces and territories, the numbers don't really reflect the current situation. We've been through that honeymoon period of the anti-retrovirals, and in the aboriginal community we're now seeing a lot more deaths from HIV and AIDS. I can see that in the future there are going to be more people in Canada who will die from HIV and AIDS.

    Thank you.

    The Chair: Thank you, Mr. Zoccole.

    Dr. Wainberg.

    Dr. Mark Wainberg (President Elect, and Director, McGill AIDS Centre, International AIDS Society): Thank you, Madam Chairman.

    Let me begin by introducing myself and telling you a bit about myself. As some of you may know, I'm one of the past presidents of the International AIDS Society. Probably one of the things that I'm proudest about in my life is having a role in the decision to hold the international AIDS conference in Durban, South Africa, in the year 2000, which was very much a watershed conference, in that it was the conference that focused attention for the first time in a major way on disparities between rich and poor countries with regard to lifesaving drug access. I'm here, of course, to speak to the research agenda, but I wanted you all to know that the international AIDS conference is returning to Canada in August 2006 and will take place in Toronto. I think some of you know we had initially planned that activity for 2004 and deferred it to 2006 in the aftermath of the huge success of the conference in Durban. It became clear that people representing HIV-infected segments of society from all over the world and scientists themselves thought it very appropriate that this meeting be held every second time in a developing country in which HIV is endemic, and so we agreed, with the help of Toronto council and the Metropolitan Toronto Convention Centre, to defer that activity to 2006.

    This means, of course, that Canada will be showcased around the world with regard to our commitment to the HIV epidemic. People will be asking what Canada stands for with regard to its border crossing policies, its immigration policies, and Canadian research accomplishments. I don't need to tell you that with regard to research accomplishments, people are going to be asking us in 2006 what we have done to showcase our country. The investment that is necessary to give birth to successful babies in 2006 has to be made now, and so the request that we are making of you to recommend a doubling of the national AID strategy to $85 million per year is really heartfelt. It's something we keenly feel is necessary in not only enabling us to do a proper job at home with the research we carry out, but also recognizing that so many of us want to develop research exchanges with countries outside our own borders in bilateral ways and have felt enormous frustration at our inablity to have brought this to fruition in a truly efficient manner.

    I'm going to be very blunt now and tell you that one of the agencies that should logically be helping us to bring about more of the bilateral involvements we feel are so important is CIDA. For reasons that really aren't very clear, but certainly distinguish Canada from almost every other developed country in the world, there's a lack of strong bilateral involvement with developing countries with regard to conduct of clinical trials, studies of drug resistance, which is one of the topics very close to my own heart, and establishment, in some cases, of some of the infrastructure necessary for vaccine development. So if any of you have influence in that building across the Ottawa River, that would be excellent.

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    Let me point out as well that while $85 million sounds like a lot of money, we are the country that underfunds research of all types to the greatest extent of any I know of in the developed world. The United States, for example, probably still spends approximately eight times more money per capita on HIV research of all types than we do in this country. One way of looking at it from a Canadian standpoint, if we want to be flag wavers--and I'm certainly a flag waver--is that we get our money's worth. If you add up the number of good papers Canadians put out on an annual basis in the best journals in HIV research, with relatively few resources, we constantly outperform our American colleagues. There are objective ways of setting out these statistics that would prove this to you in a bona fide fashion. But we can't do it forever. We can't keep on carrying out world-class research unless we have the ability to sustain ourselves in our labs with graduate students who know what they're doing, who want to be trained in Canadian labs, and not constantly be in a position where we might lose some of our best and brightest to the U.S. and other countries.

    I think I should say something based on the fact that I have worn an international hat in the past and will again in the future. First, let me say that I distance myself totally from the current conflict in Iraq, but HIV is a subject about which I get very emotional. I hope I'm not losing my control now, but I do often get very emotional when speaking about this topic. It is always worth repeating that three times as many people die of AIDS around the world as died in the World Trade Center disaster of September 11, 2001. Each day, as we speak, countless more people are dying than have died, as another example, from the beginning of the horrible conflict between Israelis and Palestinians.

    Some of us around this table, including myself, often do become emotional about world events, but I do not often hear members of Parliament, Madam Chairman, becoming emotional about the HIV crisis world-wide, given the statistics I've just pointed out to you, as so often happens in regard to many sorts of world conflicts. I suppose the best case was one of your colleagues referring just a couple of weeks ago to Americans in less than pleasant terms. Without wanting to go there or be critical of anybody in that regard, and wanting always to be respectful of our parliamentarians, what is truly the most important epidemic in the history of mankind and what is certainly today the most important problem in all of international public health merits a great deal more passion, I think, than what we've heard on Parliament Hill.

º  (1600)  

    Not all of the problem is yours. A lot of it has to do with the willingness and ability of journalists to cover this story in regard to HIV. Think about it again. Each day three times more people die of HIV/AIDS around the world than died in the horrific events of September 11, 2001 in New York City and Virginia combined. That is startling, that is meaningful. And yet, ask journalists why in today's atmosphere, as an example, there is hardly ever a story about HIV. Maybe with the exception of the week of the international AIDS conference and world AIDS day, in general, AIDS has completely fallen off the front pages. Why? Why is the story in regard to how we defend against terrorism and, of course, this war something anybody wants to focus on at this point in our history? The answer I get from journalists is that people like to read about bombs going off, they don't like to read or find it boring to read about people dying natural deaths on a daily basis, no matter the numbers.

    It may be true that in a strictly legal sense, HIV death is naturally occurring, but let me tell you, it is a crime against humanity, in my judgment, that we, as a world, sit back and do precious little while watching millions of people die year in and year out of a disease that is 100% preventible if people take precautions and can be treated effectively, giving added years of life. On top of that, in the public health context, we know that if we treat, not only are we going to help the people who are today living with HIV disease, we are also going to help the societies in which they live by lowering rates of HIV transmission to people who are yet uninfected, and thus providing long-term benefit to those societies, and ultimately to ourselves as Canadians as well.

    HIV, as you know, and this has been stated ad nauseam, is not a virus that stops at anybody's border. It crosses over, and unfortunately, the world situation is getting a lot worse before it gets better. The numbers of HIV infections around the world continue to go up each and every year, and what we need is research of excellence at home that can enable Canada to make a difference, particularly to make a difference in the context of our playing host to the world HIV/AIDS conference in Toronto in 2006. Believe me, during that week the spotlight will be on Canada. It will be on Canadian scientists, it will be on Canada as a country, with people from around the world asking us what our commitment is, as a country, to the most horrific epidemic the world has ever had to deal with, more horrific in numbers and people dying than all the people who have died of smallpox from the beginning of time, more horrific in lives lost than all the people who have died of the black plague throughout human history. We are talking about something that is unprecedented in its magnitude. Make no mistake, there are other diseases, there always will be other diseases, hepatitis C is an extremely important disease, but in numbers and morbidity and mortality there is nothing that can compete with HIV for demanding top step on the totem pole. We have to bring HIV down from that totem pole, we have to crush it, we have to cripple it, we have to win this battle, because if we, as a world, don't, when dealing with a virus that doesn't stop at any borders, believe me, we Canadians will ultimately have to pay a terrible toll, a much more exacting price than we have had to pay thus far. We've been lucky so far. We won't be lucky forever, but by helping the world, we can help ourselves.

    Thank you very much.

º  (1605)  

    The Chair: Thank you very much, Dr. Wainberg.

    Our next speaker is Paul Lapierre of the Canadian AIDS Society.

    Mr. Paul Lapierre (Executive Director, Canadian AIDS Society): I've been doing some HIV work for about 10 years, and my worse nightmare just happened today. I always managed not to present directly after Mark, but today that's the case.

[Translation]

    My name is Paul Lapierre and I am Director General of the Canadian AIDS Society. The Canadian AIDS Society is a community organization set up at the beginning of the 1980s; we have 115 members. These community organizations may consist solely of volunteers, or may be as large as the AIDS Committee of Toronto, AIDS Vancouver and CPAVIH in Quebec.

    The Canadian AIDS Society aims to represent the community perspective. I quickly understood that the Canadian AIDS Society cannot be a single voice. In order to fight against AIDS and HIV, we have to work with a number of partners. We all have a role to play in this struggle. It is important for us to define and determine the expertise of the various partners and to work together.

º  (1610)  

[English]

    As we all know, there are 50,000 Canadians living with HIV and AIDS. There are still 4,000 new infections every year, and as I've already mentioned, HIV/AIDS is still preventible. So what are we doing? Are we failing? What are the challenges?

    I was reading some estimates in order to get prepared for today's presentation. I was told that treatment, on average, costs $150,000 a year, and those numbers need to be updated. We are also reaching an important level when it comes to treatment. A new treatment should be made available soon in Canada that will cost, on average, $30,000 per Canadian per year. What does that mean? The indirect cost of loss of productivity through premature deaths among Canadians is estimated at $600,000 per person. That has been calculated by the experts and is currently being updated. I looked at other developed countries. In Australia the prevalence rate is 60% lower than here, and the government over there invests 52% more when it comes to HIV and AIDS. Some countries have been successful by being willing to take initiatives. Why is it that in Canada we still don't have accurate, effective, safe-needle injection sites and proper, effective needle exchange programs? I think we need to be creative, we need to be outside the box.

    I'm very glad to be here today. I think we have reached a point in the fight on HIV and AIDS where the stars are slowly lining up in a good direction. We need a better government response to HIV and AIDS. The strength of the Canadian strategy on HIV and AIDS has been the community, but 10 years down the road there will be more and more clients coming into all our agencies, complexity, people with co-infection, people with various disorders, people with families. Have we become bureaucrats at a community level? I don't think so, but the bureaucracy with which we try to operate is becoming a nightmare. I'm afraid we're going to lose the flexibility and the creativity we need to fight the disease.

    What we are really asking for today is a true pan-Canadian strategy. I'm glad to hear that the health committee is looking at the question. A couple of weeks ago we were looking at the standing committee on CPP issues--what is the role of CIDA, what is the role of Industry Canada, what is the role of housing or homelessness initiatives, what do we do with the women's council, what do we do on youth, and so on? CAS and its members and our partners and colleagues have undertaken a major campaign to inform our elected members of Parliament, various departments, and various other agencies that we should all pull together in the fight against HIV and AIDS, not only locally, but also internationally, as was mentioned earlier.

    The current $42 million doesn't cut it any more. The HIV community has been struggling to reach other sources of funding, pharmacies, private sector, and we all know that money is not coming. I drew a comparison between the AIDS walk and the CIBC breast cancer walk, and we are failing. HIV is no longer in the face of Canadians, and still every day Canadians are infected, while it is preventible.

º  (1615)  

    Provincial and territorial government funding varies so much. I don't think we have a clear understanding of the impact in various provinces and territories. I'm glad to be an Ontarian, but am I glad to be a Canadian? That's the ongoing question. What I'm presenting today is an option for a renewed strategy on HIV and AIDS. We talk about more funding, we talk about doubling the strategy, but money is not the only solution. Money is certainly an asset for bringing forward a solution, but we need true partnership. We need to be able to talk together, let go of our personal egos, let go of our jurisdictional issues, let go of our private agendas, and tackle the issues. The issue is HIV. The issue is a virus that is mutating way faster than politicians and communities can work together. We were in the early eighties, I think, ahead of the strategy. Canada was well-known internationally. The community-based movement has developed some models and best practices, and prevention was working, but what has happened 15 years down the road? I think we have fallen behind.

    So we are calling upon you guys, colleagues, partners, to ensure that the report reflects what you've been hearing. I think it's very timely that you met with community members a week ago. You met with some government officials. You're meeting again with other witnesses today. There are tons of Canadians who, unfortunately, you won't have the time to listen to. But there is in our country the strength of our Canadian strategy on HIV and Aids, the volunteer sector. I think we need to acknowledge that.

    That being said, the voluntary sector is not the only sector that requires support, enhancement, or sustainability. When we look at harm reduction techniques, prevention, it will be done in partnership with the community, the medical community, other health care professionals. We need to look at the model that has been developed in Vancouver, where local city officials are also key players in bringing together, hopefully, safe injection facilities.

    We need to acknowledge our differences, the specific needs of the aboriginal organization, the specific cultures we are finding coast to coast to coast. Sending a prevention message within gay communities in Toronto won't have the same impact as sending a prevention message to the Inuit community. We too often target Montreal, Vancouver, and Toronto, but HIV and AIDS are spreading coast to coast to coast. We need to develop those messages tailored to the various communities. Fortunately for us, 15 years ago we could target one community, and we were effective, but today we talk about youth, we talk about women, we talk about street-involved people, homelessness. Everybody is at risk, in my opinion. So we need to target prevention.

    We need to enable our Canadian government and the provincial counterparts with data and surveillance systems. We need to build the momentum we have lost within the research community to encourage young researchers to become involved. There are good initiatives out there. We need to think outside the traditional frame. We need to involve the community at all levels, be it in the prevention message, be it in the policy or advocacy, and I think we all have a role to play. We need to work in partnership. We need to break the silence. We need to break down those silos. We must enhance what I call my continuum, which is the research, including treatment, vaccine, microbicides, drug resistance, treatment failure. Research is very broad, and I think we can champion that. We need to sustain and enhance our prevention messages. We need to sustain and enhance the care, treatment, and support we are giving not only to people infected, but to the whole community that is also affected.

    In closing, my only statement is, why is it that new Canadians are infected? Why is it that Canadians are not securing treatment? Why is it that on the street I'm hearing that treatment is failing? Why is it that we are creating second-class citizens? I think the opportunity is here to make a difference. We met with government officials, we met with the health ministers, and I think there is a momentum we're building, and let's not lose it, to ensure that HIV is, should be, and will be again the priority for all Canadians, including government officials and community-based organizations.

    Thank you.

    The Chair: Thank you, Mr. Lapierre.

    We'll move on now to Mr. Jürgens.

    Mr. Ralf Jürgens (Executive Director, Canadian HIV/AIDS Legal Network): Good afternoon, ladies and gentlemen, and thank you very much for the opportunity to appear in front of this committee.

    I came to Canada in 1989, and I have worked full time on the legal, ethical, and human rights aspects related to HIV since the early 1990s. I taught the first course on HIV and AIDS and the law that was ever offered at a Canadian university. From 1992 to 1994 I was the project coordinator of the expert committee on AIDS in prisons. More recently, in 2001 I was one of two non-governmental representatives on Canada's delegation to the United Nations General Assembly special session on HIV and AIDS.

    I first became involved in the fight against HIV and AIDS when I was a law student at the University of Munich in Germany in 1984. At the time the Government of Bavaria was planning to test all law students for HIV and to exclude those testing positive from continuing their studies. It was thought that people with HIV would die anyway. The government decided that it was not worthwhile to pay for their studies. In the end, after a long fight, the government could be convinced that its proposed policy would have been unjust and discriminatory and that the initial proposal was based on ignorance and fear, rather than on facts.

    This is just one of many examples of how since the beginning of the HIV/AIDS epidemic there has been a second epidemic, one of stigma and discrimination. In fact, when one looks at the experiences of people living with HIV, two things stand out. The first is the diversity of people living with HIV and AIDS, but the second is how often and in how many ways people with HIV and AIDS are stigmatized or discriminated against. No area of the lives of people with HIV is untouched by stigma and discrimination. People with HIV have been prevented from seeking or obtaining the health care and social support they require. Adults with HIV have lost their jobs or have been denied employment, and children with HIV have been denied day care.

    Discrimination against people with HIV or populations affected by HIV is in most instances unwarranted and unjust, and this, in and of itself, is sufficient reason, ethically, for a society to take steps to prevent, redress, and eliminate discrimination. But in addition, discrimination against people with HIV or populations affected by HIV and AIDS has serious consequences. Because of stigma and discrimination, some people are more vulnerable to HIV infection and governments devote less resources to fighting the epidemic. Stress associated with HIV status, secrecy about HIV status, and social isolation because of HIV status all adversely affect the psychological health of people living with HIV. Other consequences include insufficient accommodation of health-related needs at work, reluctance to claim medical or disability benefits, for fear of being harassed or laid off, reluctance to secure health care services because of stigmatizing or discriminatory attitudes and remarks. Finally, the fear of stigma and discrimination may in fact deter many Canadians from seeking HIV testing in the first place.

    In 1998 the Canadian HIV/AIDS Legal Network presented a comprehensive plan to address HIV/AIDS stigma and discrimination in Canada. I left a copy of the plan with the committee. It received a lot of praise in Canada and internationally, the joint United Nations program on HIV included it in its best practice collection, but it has never been implemented. Why has it never been implemented? Because the Canadian strategy on HIV and AIDS is underfunded. Thus, in 2003 HIV/AIDS-related stigma and discrimination continue, and there's some evidence from recent study that suggests stigma and discrimination are, in fact, on the rise.

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    The Canadian strategy on HIV and AIDS was created not long after Canada became my home. As you have heard over the last week, the strategy has had many successes. It has supported the community-based AIDS movement that has provided support to people with HIV across the country. It has supported research that has allowed us to better understand the epidemic and its determinants. It has funded work on the legal and ethical aspects of the disease. It has engaged new partners in the fight against HIV, such as the Correctional Service of Canada. But early in 1993 the then Liberal opposition rightly declared that the funding level of $42.2 million was inadequate.

    You have heard that since then the number of Canadians living with HIV has nearly doubled, to 54,000, and that the epidemic has branched out into vulnerable new populations. You have heard from Louise Binder, a woman living with HIV, about how many women are infected and affected today and about how the new treatments are far from representing a cure. You have heard from Sheena Sargent about how vulnerable young Canadians are. You have heard from Dr. Françoise Bouchard about the epidemic of HIV in Canadian prisons. You have heard from Dr. Martin Schechter about how in some parts in Canada rates of infection among people who inject drugs exceed 40% and that these rates are as high as or higher than in many African countries. You have also heard about rates of infection among gay men and the fact that they are on the rise again. This should not be a surprise to us, because when the epidemic started affecting other populations, we had to shift limited resources to those populations, and we became complacent about the epidemic among gay men. You have heard today from Art Zoccole about the rising number of infections among aboriginal people in Canada.

    Nobody should be surprised at this stark reality. The experts are not surprised. We have been saying for many years that with the level of funding that is currently devoted in Canada to fighting HIV and AIDS, we probably cannot do better. But we could do better if we were given a chance, and we must do better, because, as Prime Minister Jean Chrétien said in his address in reply to the Speech from the Throne, health is a fundamental human right. Canada did sign on to the declaration of commitment adopted in June 2001 by the United Nations General Assembly special session on HIV and AIDS. By becoming a signatory, Canada pledged to provide the political will and the financial resources needed to fight the HIV and AIDS epidemic. By signing on, Canada pledged to establish national prevention targets by 2003, and specifically to reduce HIV/AIDS prevalence among young people by at least 25%. By signing on, Canada pledged to take more action and to devote more resources to eliminating discrimination. It also pledged to accelerate research and to increase its investment in development of vaccines. Finally, by signing on, Canada made a pledge to increase our contribution to the global fight against HIV and AIDS and to move towards a Government of Canada international HIV/AIDS strategy.

    With funding of $85 million, plus additional research funding that would allow Canada to become a leader in the international effort to find a vaccine for HIV, we could come closer to fulfilling our pledge, we could come closer to realizing the fundamental human right to health for all Canadians, instead of continuing to deny it to those most vulnerable to HIV. We would strengthen prevention efforts, including implementing prevention measures, such as needle exchange programs in prisons and safe injection facilities, prevention measures that have already proven to be effective in other countries, but we have not as yet introduced in Canada, at least in part because we do not have adequate funds to do so currently. We would make a concerted effort to fight stigma and discrimination. We would undertake a comprehensive review of laws and policies in Canada to identify and change the laws and policies that hinder, rather than facilitate, prevention and adequate care, support, and treatment for people living with HIV. We would develop and implement a comprehensive research agenda. We would more adequately support community-based AIDS organizations and organizations of people living with HIV, so that those who can best provide services to people living with HIV have the resources they need. We would increase efforts to get treatment to people in Canada who are currently not securing treatment, and are therefore not benefiting from treatment. We would undertake other measures laid out in a five-year strategic plan to fight HIV and AIDS in Canada that is currently being developed.

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    We can made a difference, we have a vision, a vision to reduce the number of HIV infections in Canada, a vision to save lives and to protect, promote, and fulfil the right to health of all Canadians, a pragmatic vision: halving the yearly number of new HIV infections would save 10,000 lives and billions of dollars in medical treatment over five years. With $85 million per year and additional funding for HIV vaccines, we would have a chance to make the difference we all so desperately want to make.

    Thank you very much.

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    The Chair: Thank you, Mr. Jürgens.

    We will now move to the question and answer portion of our meeting, and we'll begin with Mr. Merrifield.

    Mr. Rob Merrifield (Yellowhead, Canadian Alliance): I want to thank you for coming in and sharing your insight into this increasingly important concern that I think Canadians are grappling with. I think they're understanding a little bit better today, and I'd like to get back to some of the questions on the stigma Mr. Jürgens mentioned.

    You're suggesting to the committee that the stigma of HIV is actually increasing, but my sense of it is that we have a more educated population today than 10 years ago. You're saying it's not, and I wonder if you could explain to us why you're getting that perception. Do you have exact examples of why you feel the way you do?

    Mr. Ralf Jürgens: We have undertaken studies on this issue, and I've left copies of them with the committee. It is true that in the late 1980s and early 1990s the Canadian public became more educated about HIV, learned more about the disease, and that the attitudes towards people with HIV changed somewhat, but the more recent studies, undertaken last year for example, show that because there have not been any education campaigns to the general public, Canadians are not confronted with the issue any more, that they are unlearning the lessons we learned in the 1980s and early 1990s.

    There are also new incentives to discriminate against people living with HIV. For example, the incentive of employers today to discriminate may not be the fear of becoming infected, which many Canadians don't have any more, because they understand that HIV is not easily transmitted, but the fact that there are treatments and the treatments are costly. So for employers there are new incentives to discriminate, and people suffer from that stigma and discrimination. As I said, the stigma and discrimination deter people from coming forward for testing in the first place. This is also one of the reasons governments have not taken the fight against HIV as seriously as they take other diseases. There's not the public sympathy.

    Mr. Rob Merrifield: Let's say we're losing the war on stigma, and you're saying it's going into the workplace rather than the general population. We may be winning on general understanding, but the stigma is becoming more economic. Is that the basis of what you're saying? Before you answer that, tell me how you would apply any new dollars to solving that problem. Where would you get the best bang for the dollar?

    Mr. Ralf Jürgens: I did not say we're winning the battle with the public, I said we'd made substantive progress in the late eighties and the early nineties, but the newer studies show that we're unlearning.

    We would implement the plan that was developed and has many recommendations to all levels, the plan that, as I said, has been received with a lot of praise, but not implemented, simply because of the lack of funds.

    Mr. Rob Merrifield: Is that the plan you have over there?

    Mr. Ralf Jürgens: Yes, the document is there.

    Mr. Rob Merrifield: Okay, fair enough. We'll look at that.

    I think the Canadian AIDS Society was saying mutation of the virus is actually taking place. Maybe this is Mr. Rosenthal's area. You sounded excited about the potential of a vaccine coming forward. I am too, if that's the reality of it. I'm wondering if the virus is mutating beyond the vaccine. Are we closer to corralling it? How far away is the reality of the vaccine? What do you see as the roadblocks to getting one?

º  (1635)  

    Dr. Kenneth Rosenthal: This is a very tough challenge, and I'll not try to downplay it. First, you should be aware that HIV-1, the virus we're really talking about, which is causing this global epidemic, exists now in at least eight different genetic subtypes. In fact, we're now aware that these subtypes are undergoing mixtures and recombinations, because they exchange their genetic information, kind of like the flu viruses. So this is an extremely challenging problem. The mutations you're hearing about from Paul are primarily of this nature: if you treat a patient with a battery of drugs, in time the virus will mutate so that it's resistant to these drugs. It's like bacteria mutating to be resistant to antibiotics. We're now aware that these drug-resistant variants of viruses are also being transmitted from person to person. The treatment effort puts us into a situation where the pharmaceutical manufacturers have to outpace the mutation of the virus. That's a tough order for them. It's a very daunting task.

    Also, we can talk about why the virus mutates. It mutates because when it replicates its genetic information, it tends to make errors and it doesn't correct those errors, in a nutshell. The virus is a very diabolical agent to try to beat.

    Mr. Rob Merrifield: To get back to the funding and what it's going to take to move us forward, what are some of the roadblocks? I guess my question comes down to CIHR funding, which is $13.5 million, I believe, out of the $42.2 million. CIHR has a significant number of dollars, and I'm wondering if you feel represented appropriately with those dollars that are coming from them or you feel shortchanged. I'd like your reaction to that.

    Dr. Kenneth Rosenthal: My understanding is that CIHR is not managing all that $13 million of funding, what the strategy identifies as research dollars. You had a breakdown of that, I believe, from Dr. Singh from CIHR.

    Mr. Rob Merrifield: I understand that part of it. I'm wondering how you feel about the number of dollars coming from CIHR.

    Dr. Kenneth Rosenthal: You should be aware that we don't actually have an envelope of money designated for HIV vaccines, other than money that has gone to CANVAC. CANVAC is actually on a declining scale of dollars over time. So although the documents you have indicate about $1.3 million for HIV vaccine development in Canada, which may sound like a lot of money, but is a pittance, in fact, in the coming year the amount of money CANVAC has to spend on HIV vaccine development is under $1 million. That should be compared and contrasted with the U.S. government, which provides $400 million for HIV vaccine research, and the French, who provide $8 million euros to their vaccine research effort. We're talking about $1 million Canadian--it's a joke.

    Mr. Rob Merrifield: Yes, but when you look at the research, I'm sure, with the $400 million that's going to research in the United States, if they come up with a vaccine, we're certainly going to have some advantage from piggy-backing on that. Is that not true?

    Dr. Kenneth Rosenthal: Yes, certainly. There is hope. CANVAC is making collaborative linkages with the HIV Vaccine Trial Network in the States and the ANRS in France, and it is attempting to link with IAVI, which is the International AIDS Vaccine Initiative, and with the Kenyan and African AIDS vaccine initiatives. We are trying to network and partner with these various agencies, so that we can make our unique contribution to the cause.

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    Mr. Rob Merrifield: Okay.

    The Chair: Thank you, Mr. Merrifield.

    Mr. Ménard.

[Translation]

    Mr. Réal Ménard: Let's start with Mr. Lapierre from the Canadian AIDS Society.

    There is one thing I'd like to be certain of so that it is very clear in our report. I have received representations about the excessively bureaucratic approach being taken, particularly in the ACAP program you are familiar with, either the ACAP support program or specific assistance. COCQ-Sida—I hope they'll be appearing soon—noted that groups must invest hours and hours in making reports and replying to monitoring checks when there is obviously no need for this, in view of the amounts involved and the experienced acquired by these groups over the years.

    Have you received similar representations, as director general of your organization?

    Mr. Paul Lapierre: Yes. An unfortunate phenomenon we are now observing is a change in the monitoring mechanisms imposed on community groups as a result of the Auditor General's report and because of certain requirements. Of course we have to be accountable for public funds, that is perfectly legitimate. But they are in the process of setting up a cumbersome bureaucracy and administrative procedures that in some cases make our job difficult.

    Let me give you the example of a community group that spent 130 hours preparing a request for funding that was turned down. In order to improve the situation, the ability of community groups to understand the funding forms should be improved but at the same time officials should be made aware of the need to simplify some of these forms. I do not see any need to justify a telephone bill eight times in an application for funding when it is something we have no control over.

    One must be accountable for the way in which the money is invested and spent but there should also be some creativity in coming up with ways to lighten the administrative burden.

    That being said, I'd like to note that in Alberta, for example, the provincial government, the federal government and community groups have developed a single-funding form that provides access to the ACAP program as well as provincial funds.

    You need to look at the good work being done in certain places.

    Mr. Réal Ménard: Mr. Lapierre, if I may, I'd now like to turn to Mr. Wainberg.

    You know that the committee will be producing a report evaluating the strategy. Concretely, what would you like to see in our report with respect to research and the most likely ways of leading us to the discovery of a made-in-Canada vaccine?

    Dr. Mark Wainberg: First of all, it should be noted that research in Canada is already underway but that it is not adequately subsidized. For the last CIHR competitions, if I remember correctly, approximately 80 per cent of the applications relating to AIDS were not accepted so the project did not receive grants. Of course, in the case of CIHR competitions, the success rate for applications in Canada for any kind of disease was very, very low. This is also true for HIV. It's not because they were not good applications but rather because there was not enough money in the system. If you talk to Mr. Alan Bernstein, the CIHR president, he will tell you that the CIHRs are not adequately subsidized to promote Canadian research as it should be.

    Mr. Réal Ménard: Not all AIDS research is being done in Canadian health research institutes. Are any of the clinical trials you referred to being done outside the institutes?

    Dr. Mark Wainberg: In Canada, most of this work is being done by the CIHRs. I think that one of my colleagues already mentioned that in the private sector, when a march is organized for different kinds of cancer, it is easy to bring together hundreds of thousands of people. It is very difficult to do something similar in the case of AIDS.

    For example, the private agency that we have in this country to subsidize HIV research managed to spend about $1 million last year throughout the country in its work on this disease. In comparison, Canadian agencies that collect money for the fight against cancer probably spend in the neighbourhood of $50 million a year.

    It must be said that the public already has the impression that we have been successful in curing this disease, which is not the case. There is an assumption that we already have medicine and that people are living longer. That is true but it does not take into account the fact that the virus is in constant mutation. The virus has already succeeded in developing resistance to each of the medications we have at our disposal. The virus is constantly mutating and the pharmaceutical companies are unable, as Dr. Rosenthal mentioned, to keep up with it.

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    Mr. Réal Ménard: Do you have anything else to say?

[English]

    The Chair: Mr. Ménard, your five minutes are up.

    Ms. Bennett.

    Ms. Carolyn Bennett (St. Paul's, Lib.): Thanks very much.

    In making a case, have any of you run the numbers around? I think in your presentation you said we should divide by the number of new cases per year, and it would actually save the health care budget of this country a huge amount of money. Obviously, those are the kinds of things that in a committee report would be very helpful for us, to show that by spending a little now, we can save a bunch later. That's the usual way we prove things around here. Sometimes we should just spend the money anyway, even if it doesn't save a penny, but sometimes it's easier to get the money if they can see that over a five-year period or a ten-year period they can save some money. Are those actual numbers available?

    Mr. Ralf Jürgens: Yes, the numbers are available. Our vision would be to halve the number of new infections. Currently, we're talking about 4,000 new infections. I think it's a realistic vision, if Canada engages in a fight against HIV, to halve the number of infections to 2,000. If we did that, we would save 10,000 lives, we would have 10,000 fewer infections over a five-year period. A conservative estimate of the cost of one new infection is $150,000, so the savings would be $1.5 billion over a five-year period. With new treatments, the cost is likely going to go up, so this is a conservative estimate.

    Ms. Carolyn Bennett: In the $85 million you're asking for you included extra money for new vaccines. How much are you asking for for that?

    Mr. Ralf Jürgens: The important thing is that it needs to be extra dollars, because a vaccine effort is a long-term effort. We need to engage in it, we need to invest in vaccine research now. There will not be a vaccine over the next five years. We need to double the funding for the strategy, so that we have the money to prevent infections over that period of time. At the same time we need to engage seriously in a vaccine effort that puts Canada on the map, taking advantage of our competitive advantages in the area.

    My colleagues would be better able to speak to the numbers.

    Ms. Carolyn Bennett: Dr. Wainberg.

    Dr. Mark Wainberg: If you calculate the average cost of providing drugs to HIV-infected people at roughly $15,000 per year now, and if we could prevent 2,000 new cases each year, that translates to $30 million in savings just in drug costs, never mind all the rest--the cost of physician salaries and nurses and the various tests that need to be performed. Over 20 years, as a conservative estimate for treatment, that translates to $600 million in savings. So clearly, we need to do a much better job. We will save money. As Art pointed out, the fact of 26% of new infections among aboriginal Canadians is exactly the kind of thing the world is going to take notice of. At the International AIDS Conference in Toronto they're going to ask us what we have done, as a country, to forestall that problem.

    Ms. Carolyn Bennett: With the UN AIDS group and a working group I remember participating in, best practices in AIDS legislation around the world were supposed to move from a public health approach to a more human rights approach. Could you just help us with that a bit and where you think Canada's AIDS legislation sits?

º  (1650)  

    Mr. Ralf Jürgens: There's a fundamental recognition that HIV is a human rights issue and the failure to fight HIV adequately is a human rights failure. I'm actually a member of the global reference group on HIV/AIDS and human rights of the United Nations, which argues that we need to adopt a rights-based approach to fighting the epidemic, recognizing that it is the most vulnerable people who are most likely to contract HIV and that you cannot cynically deal with this epidemic through a public health approach, but you need to help people realize their human rights.

    Ms. Carolyn Bennett: Do you think that's in our strategy now?

    Mr. Ralf Jürgens: Canada is moving towards that approach.

    The Chair: Thank you.

    Mr. Robinson.

    Mr. Svend Robinson (Burnaby—Douglas, NDP): Thank you very much, Madam Chair.

    I want to thank all the witnesses for their presentations today and, more importantly, for their dedication and commitment in the face of this epidemic, both here in Canada and globally. I feel very proud as a Canadian that we have the kind of leadership we have from our country at all levels of the community, with first nations and others, in this struggle.

    I don't know anyone who couldn't have been moved by the eloquence of Mark Wainberg as he spoke with such passion. I've heard him speak, as he knows, many times over the years on this issue. I have also heard, as we all have, Stephen Lewis speaking with passion and, frankly, with anger about the plight of people living with HIV/AIDS, particularly in sub-Saharan Africa. Stephen is actually going to be here in Ottawa next week speaking at a number of different public forums and on the Hill. I know we all look forward to hearing from him. I certainly hope our committee report will reflect that sense of urgency and outrage as well. I can't speak, obviously, on behalf of the committee, but I certainly will do what I can, and I know there are other members who will do that.

    I just think it's a scandal that the level of funding has remained the same since 1993, absolutely outrageous. I guess I'm the only member of this committee who actually remembers sitting on a subcommittee on HIV/AIDS in 1992, when the Liberals were in opposition, and hearing the powerful and eloquent arguments they made in furious opposition to the then level of funding and promises that when they got into government, things would be different. Here we are a decade later, and nothing's changed. So I'm hoping that perhaps this committee, even though it's a decade late, will be able to make that important recommendation for the increase to $85 million that all of the partners are asking for.

    There are really people on the front lines. Hedy and I were at a ceremony with Paul and some others in Vancouver extending the Queen's Golden Jubilee Medal to people working on the front lines, Glen Hillson, Tom McAulay, many others, and boy, these are heroes.

    The Chair: Mr. Robinson.

    Mr. Svend Robinson: I think I can use my time the way I want to use my time, Madam Chair. I did want to mention, by the way, that I hope the committee will have an opportunity to review the allocation of time. I've raised this issue before.

    The Chair: You might find it more if you gave some time for an answer.

    Mr. Svend Robinson: I do have a couple of brief questions.

    One is with respect to the issue of human rights, an issue that's been highlighted by Dr. Phil Berger on our immigration policies, with the suggestion that some people who are HIV-positive may be too great a burden on the public health system, and so we close the doors on them. Canada's going to be hosting the conference in 2006. Could the witnesses comment on that policy and any recommendations they would like to see this committee make in that regard?

    Mr. Ralf Jürgens: One fundamental issue is that Citizenship and Immigration Canada has admitted that not everyone who is being tested for HIV is receiving adequate counselling. That's an issue of grave concern to us, and it needs to be addressed.

    The second issue is that Canada is not currently taking into consideration the contributions people bring to this country. Canada looks only at the potential financial burden of a person immigrating into Canada. We have started engaging in discussion, and we've been told that in the longer term Canada hopes to take the contributions into account. That is really fundamental. We need to look at people not only with regard to the potential burden in cost of medication they bring, but also recognizing that people living with HIV can and often do make very substantive contributions to Canadian society. So those would be the two main issues we need to make sure are being considered.

º  (1655)  

    Dr. Mark Wainberg: When I was president of the International AIDS Society several years ago, I said to my colleagues the international conference should come back to Canada and Toronto would be an appropriate venue. They were persuaded largely because they were in agreement that many years had passed without the conference being held in North America. At the same time, they were loath to have the conference moved back to the United States, which has never reversed its border crossing policy of discrimination against HIV-infected individuals. We, as Canadians, stood out from that, and so we were able to attract the conference, which was voted on in a bone fide way, and bring it back to this country.

    Now that Immigration Canada has not changed its border crossing policy, but has apparently changed policy in regard to who it will consider eligible for immigration, this has the potential to leave a black stain on our record in the years leading up to this international conference, and it may, in fact, prove to be an embarrassment to Canada. I want to fully endorse what Ralf just said about this type of discrimination being non-acceptable. We absolutely have a right as a country to look at people in the context of the contribution they will make, on balance, to Canadian society, and if someone is HIV-positive, but is nonetheless adjudged to be someone who is going to bring great things to Canada and be part of making a difference, that person should be considered eligible for immigration in the same manner as any other potential immigrant. There are great things such people can bring to this country, and to put forward a blanket policy of discrimination against someone simply because they are HIV-positive does not do us justice and may, in fact, turn to embarrassment in the context of the Toronto 2006 conference.

    Mr. Svend Robinson: Thanks very much. I would just ask that our researchers assist us in preparing the report by getting full background on this subject, so we can make recommendations on it.

    Thank you.

    The Chair: Thank you, Mr. Robinson.

    Ms. Fry.

    Ms. Hedy Fry (Vancouver Centre, Lib.): Thank you very much, Madam Chair.

    I actually am one of these people who doesn't need any convincing at all, I'll tell you that now. It seems to be completely and totally illogical that you have an infection that is increasing by 4,000 a year and we still expect the same amount of money to deal with not only the community support, but prevention, treatment, research, when, moreover, the virus is mutating. It just doesn't make any sense to me.

    But I do want to ask a very practical question. I noticed that you said, and I agree with you fully, one of the reasons there isn't any private sector funding coming in is that everyone thinks this disease is cured, does not affect them, or has decreased in incidence and in virulence. There has to be some way to get that message out. It may be that the question is, which comes first, the chicken or the egg? If you get the message out, it prompts the public to feel they need to be concerned about this particular disease and need to make the government respond to the public's concern etc. Do you have a plan of action, a very pragmatic and practical one, for getting this kind of information out there to the public?

    Mr. Paul Lapierre: When it comes to awareness and education, how much is Health Canada spending on the anti-tobacco strategy, how much did the government spend when they introduced seat belts? We have to invest millions of dollars to change social behaviour. So I think, when I look at the current funding within the strategy when it comes to the awareness, we can do so little with $100,000 per year. It's fine when we target 12 bars in one community with $100,000; the money invested for awareness and prevention is easily manageable. When we look at the scope of HIV now in our country, for putting ads in all newspapers, we're looking at a quarter to three-quarters of a million dollars. It's not only the Globe and Mail or the National Post, we need to use all the media of all the communities. So we need to invest. We're looking at a campaign annually of $1 million just to do some awareness raising. Awareness is the beginning of a process of education and prevention. So to reach out there, the money has to be available.

»  (1700)  

    Mr. Art Zoccole: Just to add to that, we've undertaken a campaign with $60,000 from First Nations and Inuit Health Branch, and what we're able to do is stigma and discrimination fact sheets and posters. We're able to get those to all first nations, Inuit, and Métis communities across Canada. We added on a public service announcement, and we had enough money to take out about ten ads in aboriginal newspapers. So we really stretch the money we get and we are creative in getting that message out to the community. It's that innovation and creativity within all our organizations with the amount of money we get. We rely on volunteers to do the public service announcement, for example.

    Ms. Hedy Fry: Yet you have to reduce to a totally different targeted market than the National Post and the Globe and Mail.

    Mr. Art Zoccole: Yes.

    Dr. Kenneth Rosenthal: World AIDS day in December last year conflicted with the release of the Romanow Report. I just want to acknowledge that CAHR holds it annual meeting in April, and Health Canada has agreed to help with communications on that meeting. In fact, Stephen Lewis is the opening speaker of this year's conference, and we're hoping it will be at least a trial balloon in showcasing what's going on in the research community in Canada.

    Mr. Ralf Jürgens: Unfortunately, sometimes people also just don't care. We have epidemics in the downtown east side of Vancouver that you're very familiar with, very public epidemics. Canadians know prisoners are at increased risk of HIV infection. These are human rights issues. What Canadians do need to understand and sometimes do not understand currently is that this affects all of us. As Ms. Bennett has said, if those issues are not convincing, there are the fiscal issues, it just is going to cost Canadian society a lot. But fundamentally, this is a human rights issue, where some people, simply because they live in a certain area of town and have a disability or because they're incarcerated, are at higher risk of contracting HIV and hepatitis C.

    The Chair: Thank you, Ms. Fry.

    Mr. Lunney.

    Mr. James Lunney (Nanaimo—Alberni, Canadian Alliance): Thank you, Madam Chair.

    It's very interesting to have such an array of experts on this important subject here. You people have certainly been involved in this issue more than most of us in society, and you are people we do look to for answers about what's out there and where we should be going. I appreciate the perspectives you've brought forward.

    I wanted to go back over these figures on research. We're talking about $1.2 million for research as far as vaccine goes. I heard figures like $400 million that the U.S. has been putting into vaccine research; the euros I didn't catch, but it was roughly $100 million Canadian. It greatly outstrips, obviously, what Canada's effort is, but this has been going on for a number of years. We've had 20 years of research into the AIDS virus. What I want to ask is a question I posed to the Health Canada officials the other day, and I'm wondering what's on your radar screens, since you people are scanning the horizon world-wide, I presume, on this. It has been said here that the pharmaceutical manufacturers have to outpace the changes in the virus, and some strains have developed resistance to all of our drugs. What about non-drug strategies? Are you aware of other strategies that are non-drug, non-vaccine, such as electrical therapies, and is there research being done anywhere in the world? Are you aware of anything that shows promise in this realm?

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    Dr. Mark Wainberg: There are always speculations in the press across the world with regard to novel treatment strategies that deviate significantly from the classic approaches we have taken, but the only thing that has made a difference so far is the anti-viral drugs. These are the compounds we use in therapy that have enabled people to live longer and achieve better quality of life. All the rest have turned out to fail, in large part because none of them was scientifically sound to begin with. We, as scientists and physicians, are absolutely united on this point. That doesn't mean to say something else might not work in the future, but so far many of these approaches that have been touted from time to time have been tried and they have done nothing in the long term except create false hope for people infected by HIV.

    That is sad to say, but the fact that the virus mutates so quickly and that the pharmaceutical companies have a job to do doesn't mean anybody is abandoning that effort. To be sure, one of the complicating factors--and I'll be very honest--is that some of the drug companies have, in fact, dropped out, either because they see this effort as too expensive or because they see that the international pressures, once they do have a drug, will be enormous to simply give that drug away for almost nothing, so their attitude is, why bother, why begin? We have to challenge that at every possible level and get pharmaceutical company executives to understand they're in this business for a little bit more than making a profit at the end of the day. I think, slowly, a lot of them are coming to understand that. Internationally, they have brought down the cost of their drugs to a very significant extent. And one can ask--and maybe Stephen Lewis is the person to ask this the next time you speak to him--where the hold-up is. If the drug companies, in some cases internationally, have brought down the prices by 90%, is the hold-up at the level of the United Nations? Where is it exactly? I don't understand it all the time.

    Mr. James Lunney: Thank you.

    I wonder if any of the others have any perspective on this. From someone promoting the vaccine approach I could expect a nice impassioned pitch for that realm. We're looking at the new drug cost being about $30,000. There is a lot of money involved in the treatment of AIDS. I'm wondering if you're aware of research projects. They don't seem to attract the big funding, because they don't attract the big profits either. Has nobody here anything to offer on that?

    Dr. Kenneth Rosenthal: I think we can talk about microbicides or preventive agents, but my understanding from talking to colleagues in industry is that the way our medical enterprise works, it actually favours the development of treatments more than preventions. Microbicides are an area of interest, but my understanding is that there isn't really any significant microbicide work going on in Canada at the moment. This is certainly an important area. In our own work we've been working with innate immune activators, which we've shown, in a small animal model, will protect animals from genital infection by herpes virus, and this may be translatable.

    Mr. James Lunney: That is interesting.

    You also, Dr. Rosenthal, brought up the term mucosal immunity. Would you care to expand on that and explain to us something about mucosal immunity?

    Dr. Kenneth Rosenthal: In a very simplistic way, we're all walking tubes, and most infections we get enter our bodies through contaminated air, like the flu viruses, these respiratory viruses, through contaminated food or water, or through sexual transmission. So they actually initiate infection at the mucous membranes of our body, the lining of our lungs, our gut, our genital tract, and they cause respiratory disease, diarrheal and bowel diseases, and genital or sexually transmitted infections. It turns out that the surface area of your mucous membranes equals about the size of a basketball court. So you imagine every day that basketball court surface area of your body being exposed to the pathogens that surround us. It turns out that we have a separate immune system, which is harder to study, because of its location, that essentially protects our mucous membranes. Part of the vaccine effort in Canada is an attempt to take advantage of the mucosal immune system by introducing vaccines via mucosal routes of administration, rather than using a shot, to induce strong, long-lasting immunity at the mucosal membranes.

    Probably the best example is these exposed, but resistant prostitutes in Nairobi who have been studied extensively by Canadians working in Africa. They don't have immune responses in their blood to the viruses, but they have antibodies and white blood cells that attack the virus in their genital mucosa. We have groups studying this.

    Probably one of the leading candidates globally for an HIV vaccine is held by a company called Merck. Merck actually licenses their vaccine, which is a genetically altered cold virus from McMaster University. The International AIDS Vaccine Initiative actually started out with $5 million from the Canadian government, which might be a good sum for this committee to consider providing to Canadian researchers, for three years, with a tenfold increase three years later. IAVI's lead vaccine candidate comes from Oxford, and one of the lead investigators on that is a young Czech named Thomas Hanke, who did his training here in Canada. So Canadians have already made amazing contributions to the some of the leading efforts going on globally, but these are all happening out of our control.

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    The Chair: Thank you, Mr. Lunney.

    Mr. Robinson.

    Mr. Svend Robinson: Thank you, Madam Chair.

    I'd like to ask Mr. Zoccole if he could talk about the level of support to fight the epidemic in correctional facilities in Canada. We know first nations people are vastly overrepresented in prisons in Canada, and we heard last week from witnesses from the correctional service. To what extent do you believe more should be done?

    Second, Dr. Wainberg, I believe $300,000 is the total amount of the actual program allotted to international collaboration, which looks pretty pathetic. What specific recommendations have the International AIDS Society or you made to the Government of Canada with respect to the level of funding for international collaboration?

    Finally, Mr. Jürgens, there's been ongoing concern within the gay community and beyond about the policies that deny those of us who are gay the right to donate blood. I'm wondering if there has been any advance in that particular file, whether there are any technological reasons, for example, that this policy should not be continued? When I had a friend who needed bone marrow, for example, I immediately went to the hospital to offer to donate some bone marrow and was told, you can't do that: gay man, had sex with a man once since 1977, you're disqualified. Surely there has to be a better way of responding.

    Mr. Art Zoccole: We've had three successful meetings with Corrections over a number of years. The work towards developing a strategy to address issues of aboriginal people who are incarcerated got off to a good start, but because of limited funding that's provided currently through the Canadian strategy, Corrections receives very little funding on this issue. One of the things we've been able to do, which has been very successful and which I may have mentioned already, is the education and prevention and counselling manuals, called Circle of Knowledge Keepers, which have been distributed by Corrections to federal institutions.

    In BC they were able to work towards implementing that program, and just in a short period they identified that it was going to cost $9,000, and that's only one region. One of my dreams is that we get back to the table with Corrections to move forward with implementing that nationally. When you're looking at a long-term solution to addressing the issue of aboriginal people and Corrections, there has been some wonderful work, but what stops us is the lack of funding. One of your recommendations definitely has to be that the money made available to Corrections must be increased substantially. That's just the aboriginal committee. There were a great many ideas. We were coming up with a strategy, we wanted to pilot some tattooing sites, harm reduction initiatives, and we were only able to move on one. We've laid out that work, but we can't do it, because we don't have the human and financial resources.

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    Dr. Mark Wainberg: In regard to the second question, I agree that it's totally inadequate to have $300,000 available in an official way towards international collaboration. The reality is that most of us who do have international collaboration have managed to do this on our own through personal contacts and have a great deal of difficulty coming up with resources in support of these initiatives. The other countries we see as partners in most cases will, of course, be in the developing world. This applies in respect of what we might wish to do with such partners with vaccine initiatives, participating in clinical trials, efforts at fundamental research, and efforts in better understanding and monitoring the problem of HIV drug resistance world-wide.

    The agency to which the Canadian government, in it's current format, has allocated resources for such purposes is CIDA, under the Minister for International Cooperation, which has historically far preferred to adopt multilateral funding policies. Dr. Rosenthal indicated to you that a decision was recently made by that body to provide $50 million to the international AIDS vaccine initiative, which is an international body based in New York, without any guarantees at all that any of that money will flow back to Canada in providing a means for Canadian scientists to become more involved in vaccine research themselves. Many of us were truly astounded and hurt--I would underline hurt--when this announcement was made last summer at the International Conference on AIDS in Barcelona, because the amount of money Canada spends outside our borders in regard to HIV research exceeds by far the amount of money we spend within our borders on all types of HIV research put together.

    We have difficulty understanding such government policy, and as I said before, I would urge you, if you can, to encourage the people at CIDA to pursue bilateral policies that would enable us to partner with groups in developing countries. At present, I have to be honest with you, many of us who want to play this role in teaching people in developing countries how to become more involved in research in their own country, to want to make a difference, feel deprived of our opportunity to play this role internationally.

[Translation]

    I must also say that this is not only true for anglophone countries in Africa but for francophone countries in Africa as well, where we would also like to play a very important role. We could also mention Caribbean countries like Haiti, for example.

[English]

    I think we all feel very strongly about this issue. We are not doing this job well and, in comparison with France, the U.K., the U.S., and almost every other developed country in the world, are not meeting our responsibilities in respect of these bilateral efforts, training programs, and so forth on the international stage.

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    Mr. Ralf Jürgens: Allow me to say two words as someone who was project coordinator of the expert committee on AIDS in prisons. The World Health Organization, the United Nations, many Canadian experts have recommended since the early 1990s that there should be needle exchange programs in prisons and that tattooing equipment should not be considered contraband. Infection in prison happens mainly through injection-drug use and through tattooing. The correctional service has done everything it can to prevent drugs from coming into the institutions, but they are coming into the institutions. This happens everywhere in the world. We need to take the pragmatic measures that have proven effective in Europe. We must have those programs in Canadian prisons.

    With regard to your other question, the policy to exclude gay men from donating blood is clearly discriminatory. There are countries that have started reversing this policy. They exclude anyone who has engaged in risk behaviour, regardless of whether they are gay or heterosexual, and this is what Canada should move towards as well.

    The Chair: Thank you, Mr. Robinson.

    It's my pleasure to thank all of you for coming and for the tremendous expertise this group represents. We're very grateful. I want to assure Dr. Wainberg that his passion is not lost on us. We have been known to take some bold stands in the past, and I'm hoping we can translate some of the passion you showed in your voice and in the facts, along with all the others, into a report. We may have to come up with a strategy to do some educating on our own, as individuals within this group. One of the things, for example, we could do when we get our report written is have a press conference, make sure there are enough copies printed, get them out, use our media contacts to get some publicity, or maybe use our own voices in the House at every opportunity to push this idea. I don't think we're going to find too much opposition within the committee to coming up with a report that recommends what you're looking for, but it will probably require more support from us, as individuals, and from you and the people you serve to make that push into a reality in the form of dollars. I think you and the previous witnesses have touched our souls on this, and you'll probably see some action. So thank you very much for your presentations.

    This meeting is adjourned.