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AIDS 2010
Vienna, July 2010
HIV/AIDS and People from Countries where HIV is endemic –
Black people of African and Caribbean descent living in Canada
Findings from the development of a Population Specific HIV/AIDS Status Report
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Presentation Outline1. The Canadian Health
System
2. The Public Health Agency of Canada
3. The Federal Initiative to Address HIV/AIDS in Canada
4. The Population-Specific HIV/AIDS Status Report
5. Demographic Profile – People from HIV Endemic Countries
6. HIV/AIDS Surveillance and Epidemiology
7. Health Determinants and Vulnerability to HIV/AIDS
8. Current HIV/AIDS Research
9. Community Response to HIV/AIDS
10. Conclusions
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The Canadian Health System
•Health is a shared responsibility between federal and provincial/territorial governments
•Under the Canada Health Act, the management, organization and delivery of health services is a provincial/territorial responsibility
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Public Health Agency of Canada
Mission:To promote and protect the health of Canadians through leadership, partnership, innovation and action in public health
Role of the Agency is to:
• Promote health• Prevent and control chronic diseases and injuries• Prevent and control infectious diseases• Prepare for and respond to public health emergencies• Strengthen public health capacity in a manner
consistent with a shared understanding of the determinants of health and of the common factors that maintain health or lead to disease and injury
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Overview of the Federal Initiative to Address HIV/AIDS in Canada
Strategic Areas of Focus
Programs and Policy Interventions, including:• National & Regional Funding • Federal Prisons• First Nations on-reserve
Knowledge Development• Surveillance & Epidemiology • Laboratory Science• Research
Communications & Social Marketing
Coordination, Evaluation & Reporting
Global Engagement
Partners
Public Health
Agency of Canada
Health Canada
Correctional Service of
Canada
Canadian Institutes of
Health Research
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Federal Initiative Key Populations• People living with HIV/AIDS• Gay men and other men who have sex with
men• People who use injection drugs• Aboriginal Peoples• People in prisons• Women• People from countries where HIV is
endemic• Youth-at-risk
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Status Report Structure
• Introduction• Demographic Profile• Status of HIV and AIDS among People from
Countries where HIV is Endemic• Vulnerability to HIV• Current HIV/AIDS Research• The Response to HIV/AIDS among People from
Countries where HIV is Endemic• Conclusion
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HIV-Endemic Countries
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Focus on African and Caribbean HIV-Endemic Countries
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Demographic Profile – People from Caribbean and African
HIV-Endemic Countries
• Comprise 2.3% of Canadian population
• Younger than the general population
• 63% Ontario; 19% Quebec
• 96% Urban (50% in Toronto)
• Between 2001 and 2006 the population increased by 14%
• From 2001 to 2006, 7.9% of new immigrants were from countries where HIV is endemic
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Estimated Proportion of Risk Exposure Categories Among new HIV Infections, by
Time Period, Canada
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
1981-83 1984-86 1987-90 1996 1999 2002 2005 2008
Time period
Per
cen
tag
e
MSM IDU Heterosexual/Non-endemic Heterosexual/Endemic
Source: PHAC Epi Updates, July 2010.
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Geographic Distribution of HIV-Endemic AIDS Cases
Ontario451/ 36.1%
Quebec690/ 55.3%
Atlantic Canada14/: 1.2%
British Columbia37/: 3.1%
Prairie Provinces56/ 4.4%
Number of reported AIDS cases by province and national proportional
distribution for the HIV-endemic exposure subcategory, cumulative to
December 31, 2006 (n=1248)
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Health Determinants and Vulnerability to HIV/AIDS
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Biology, Gender
• Women’s biological susceptibility to HIV/AIDS
is exacerbated by their social and economic
circumstances, and cultural norms
• Sexual and physical violence against women
has a direct impact on their ability to practice
HIV prevention and care
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Migration, Social Support
• Positive HIV diagnosis poses challenges
around disclosure, reunification, fear of
authorities, and access to services
• Many immigrants experience a loss of
support from extended family due to
physical distance
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Culture, Racism
• Racism produces risks for HIV infection and compounds the stigma faced by Black PLWHAs
• Within the Black communities there is stigma towards HIV+ people; homophobia; taboos around sex and death
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Income, Employment, Physical Environments
Relative to the overall Canadian population, Canada’s
Black population is disproportionately affected by:– lower levels of income and higher
unemployment rates– limited access to safe, affordable housing– greater risk of living on the street and being
homeless– over-representation in the offender
community (6% of those in federal facilities)
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Access to Health Services
• The assumption that most people have considerable faith in the health care system and seek its services may not hold for many of those at risk of HIV infection
• Access challenges include:– lack of culturally sensitive and appropriate
information– communication difficulties– lack of awareness of availability of services
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Current HIV/AIDS Research
• 19 research projects focus on people from countries where HIV is endemic were identified; most are taking place at the municipal level in Alberta, Ontario, and Québec
• The following are general areas of investigation:- Knowledge of, and attitude towards, HIV/AIDS- Risk-taking behaviour – contributing factors and mitigating
strategies- Community needs and priorities for HIV/AIDS programs and
services- Strategies for increasing access to programs and services- Strategies to enhance design and delivery of programs and
services
• There is a need to conduct more research on this population, including community-based research
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Community Response to HIV/AIDS Among Black
Canadians
57 projects led by 43 organizationsProject breakdown according to organization categories (n=57)
16
28%
11
20%
17
29%
13
23% HIV/AIDS organizations
HIV/AIDS ethnocultural, ethnoracialorganizations
Ethnocultural, ethnoracial organizations
Other
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Governments’ Response
• Governments have developed HIV/AIDS strategies that identify people from countries where HIV is endemic or ethno-cultural communities as a key population
• In 2007, PHAC initiated a second-generation HIV surveillance system, E-Track, to better understand the dynamics of HIV transmission and the potential areas for prevention programs among this population
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Conclusions
• People from countries where HIV is endemic - Black people of African and Caribbean descent - make up a disproportionate segment of those affected by HIV/AIDS in Canada
• Challenges in collecting and presenting relevant surveillance information regarding ethnicity persist
• There are ongoing challenges in access to services for HIV+ immigrants
• The evolution of HIV is linked to the determinants of health
• There is a need for appropriate culturally sensitive health services and information
• Communities play a critical role in addressing HIV/AIDS issues
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For Information…
http://www.phac-aspc.gc.ca/aids-sida/
publication/ps-pd/fs-info-eng.php
http://www.phac-aspc.gc.ca/aids-sida/
publication/ps-pd/fs-info-fra.php