The Senate
Motion to Call Upon the Government to Evaluate the Cost of Implementing its Five-year Action Plan on Sexually Transmitted and Blood-borne Infections Adopted
December 1, 2020
Pursuant to notice of November 5, 2020, moved:
That, given the year 2020 is the deadline to achieve the 90-90-90 treatment target of UNAIDS, the Senate of Canada call upon the Government of Canada to evaluate the cost of implementing the Government of Canada five-year action plan on sexually transmitted and blood-borne infections, to establish national targets in the fight against HIV/AIDS and to increase funding for the Federal Initiative to Address HIV/AIDS in Canada pursuant to the 20th recommendation of the 28th report of the Standing Committee on Health, tabled in the House of Commons during the First Session of the Forty-second Parliament.
He said: Dear colleagues, I rise today to move that the Senate call upon the Government of Canada to evaluate the cost of implementing its five-year action plan on sexually transmitted and blood-borne infections, to establish national targets in the fight against HIV/AIDS and to increase funding for the Federal Initiative to Address HIV/AIDS in Canada pursuant to the 20th recommendation of the 28th report of the Standing Committee on Health, tabled in the House of Commons during the First Session of the Forty-second Parliament.
Why make such a request in the middle of COVID-19, you might ask? Why address this chronic illness which, in the eyes of some, now affects a small portion of the population and, moreover, has practically been eradicated, since we now have treatments that let those living with the disease lead an almost normal life?
Colleagues, there are many answers to these questions. Here are some facts. Since the beginning of the epidemic in the early 1980s, about 75.7 million people have become infected with HIV, and 32.7 million people have died of AIDS-related illnesses. In 2019, 38 million people were still living with HIV.
Obviously, there are still too many people infected annually and globally, too many people are likely to die from contracting this virus.
In Canada, the latest data published in the Public Health Agency of Canada’s HIV in Canada Surveillance Report are very worrisome. In 2018 alone, 2,561 new positive diagnoses were reported across the country. That’s an increase of 8.2% compared with 2017.
By way of comparison, in 2015, there were 2,078 positive diagnoses, or about 500 fewer cases. Between 2014 and 2018, the number of new infections in Canada rose by 25.3%.
Most disturbingly, in 2016, the Public Health Agency of Canada estimated that 14% of people living with HIV/AIDS didn’t know they were infected. That means that 8,835 people could have unwittingly spread HIV/AIDS in Canada.
Did you know that the age groups with the highest rate of new HIV/AIDS cases in Canada are those between the ages of 30 and 39, followed by those 40 to 49 and those 20 to 29? It is disturbing to know that so many people, especially young adults at the peak of their working lives, are still contracting the virus, at a time when they can contribute the most to our society. These numbers are not just statistics, colleagues; behind every positive diagnosis, there is a human being, often a young person, whose life is turned upside down and whose future is compromised.
In Canada, key populations from all age groups include migrant populations, particularly those from countries with higher HIV prevalence; Indigenous people; drug users; sex workers and their partners; men who have sex with other men; and people who have experienced life in prison. Rates of HIV/AIDS are 15 times higher in federal prison than in the community.
These key populations all face challenges that are both unique and common to them: discrimination, stigmatization, access to appropriate care, treatment and follow-up. COVID-19 has only multiplied these obstacles.
The coronavirus has had a huge impact on prevention and on patients’ access to treatment and ongoing care. The current public health crisis is making it harder to manufacture and distribute drugs and is creating some serious challenges with respect to the supply of treatments here and around the world. This could lead to an increased number of deaths connected to HIV/AIDS.
According to recent modelling by the Joint United Nations Programme on HIV/AIDS, a six-month disruption of HIV/AIDS treatment as a result of COVID-19 could lead to more than 500,000 extra deaths next year in sub-Saharan Africa alone.
Canada is no exception. I recently spoke with Dr. Réjean Thomas, the founder of the renowned Clinique médicale l’Actuel in Montreal. He painted an alarming picture of the pandemic’s impact on services to people with HIV/AIDS in Canada.
Although this clinic has managed to remain open during the strict lockdowns of late, other clinics have had to temporarily close to comply with the well-warranted public health rules.
Some examples include supervised injection sites, medical clinics at which telephone appointments have become the norm, reduced access to certain types of psychological services, and the closure of a number of community organizations dedicated to promoting awareness of and supporting people with HIV/AIDS.
Another effect of the pandemic is that, like many people, a lot of HIV patients were affected by job losses, which meant a loss of income and the possible loss of the private insurance that covered some of their treatments.
Unfortunately, an inability to access services and a drop in income all too often result in an interruption in treatments that are essential to the patient’s survival. In some cases, those who had access to PrEP, a preventive treatment that can be up to 99% effective, interrupted their treatment because it was getting too hard to renew their prescription or get follow-up care.
It is also obvious that the pandemic greatly affects the mental health of many patients and individuals who suffer from addiction, notably sex or drug addictions. Colleagues, it is false to believe that because of the pandemic, these individuals have stopped having unprotected sex, using drugs or engaging in transactional sex. As a result, some clinics have observed an increase in the rates of sexually transmitted and blood-borne infections compared to last year, particularly syphilis and gonorrhea, which might be the result of multiple factors. Since HIV/AIDS is also an STBBI, it is possible we could observe an increase in prevalence across Canada once the data is available.
There is also another disconcerting reality to consider: If it was hard to get access to health care in rural regions before the pandemic, imagine the current situation under lockdown.
That is what Daniel Robichaud, who lives in a rural area of southwestern Nova Scotia, is going through. He has already spoken publicly about how his life was turned upside down when he found out that he was HIV positive a few years ago.
Although the treatments that he gets radically reduce the viral load in his blood, today, the effects of the disease are permanent and require constant care.
Although his viral load is under control, Daniel needs a lot of surgery and follow-up care because of his comorbidities. He says the pandemic has had a major impact on access to services. The number of medical appointments or support meetings he had access to before the pandemic dropped from two to practically none. He had to wait seven months before he started getting regular follow-ups again.
What’s more, the cost of certain life-saving medications increased substantially. For someone who lives on government assistance because of his health, you can imagine the stress and anxiety that this increase in the cost of his medication caused.
Honourable senators, this story alone shows the reason for such a motion and makes it clear that urgent action is needed.
December 1 marks World AIDS Day, and this year, it has a very special significance. Not only are we dealing with a pandemic, but December 2020 marks the deadline for achieving the UNAIDS 90-90-90 targets to which Canada has signed on.
What that commitment means is that, if we meet the targets by the end of the year, 90% of the people living with HIV will know their HIV status, meaning they have had access to a test.
Next, 90% of the people with diagnosed HIV infection will be receiving antiretroviral therapy. That means they have access to treatment. Last, 90% of the people on antiretroviral therapy will have a permanently suppressed viral load.
This last objective is crucial, since an undetectable viral load means that the virus is untransmittable. Although the person is not cured, her viral load in the blood is so low that it cannot be detected by testing and the virus can no longer be transmitted sexually.
Achieving these targets by 2020 should enable the global community to halt the AIDS epidemic by 2030, which will generate significant health and economic benefits for all of us.
Canada committed to achieving those targets, but, unfortunately, it will not do so in 2020, unlike a number of other countries that have achieved and even exceeded them, such as Australia, the Netherlands, Namibia, Switzerland, Zambia and Eswatini.
Data collection is one of our challenges. In Canada, the provinces and territories collect information about HIV/AIDS cases using their own criteria and then transmit that information to the federal government. As a result, there are disparities in the available data.
Saskatchewan, for example, distinguishes between Indigenous and non-Indigenous patients. Quebec provides no information about the ethnicity of diagnosed cases or the exposure category. British Columbia does not share information about the ethnicity of new cases.
In recent years, the Government of Canada has developed a pan-Canadian sexually transmitted and blood-borne infections, or STBBI, framework for action followed by a five-year action plan on STBBI.
Although welcomed by many, this action plan is neither costed nor has clear targets, yet specific investments in the HIV/AIDS response has long been called for by the many organizations consulted in the preparation of this motion.
According to the HIV Legal Network, when the federal government launched the Federal Initiative to Address HIV/AIDS in Canada in 2004, it committed to increasing funding specifically for this disease to $85 million. That promise was not kept, however, and Canada has yet to meet that funding target.
In June 2019, the Standing Committee on Health in the other place recommended that the government make a firm commitment to provide $100 million annually specifically for combatting HIV/SIDA in Canada. The committee did not get a response to its report. The government released its action plan the following month, but it did not contain a funding commitment.
Colleagues, HIV/AIDS is costly for Canada. According to information from the Canadian AIDS Society, each new infection represents $1.3 million in direct and indirect costs.
For people of my generation, the Coronavirus brings us back to the tragedy of the early 1980s when this terrible, invisible enemy, HIV/AIDS, was claiming its first victims in Canada.
Personally, I had to mourn too many dear friends who died during this period; too many young people who suffered discrimination, isolation and stigma, some of whom had to die without the support of their family and community.
Colleagues, I am also speaking today in memory of my best friend, Bernard, a renowned set designer, author and actor, whose career was cut short far too soon. It is also in memory of my former colleague, Pierre LeBlanc, a talented producer at Radio-Canada Acadie who left us too soon.
I am also speaking for my fellow Acadian, Daniel, who is fighting tenaciously for his survival today. I am thinking of a single mother I knew who died too young, leaving her young children parentless.
Lastly, I am speaking for the health care workers and the many volunteers who have been caring for HIV/AIDS patients for more than four decades, and who need better support.
Honourable colleagues, there may be people around you today who carry the virus and still don’t know it. There may also be people around you who are HIV positive and know it but don’t dare talk about it, for fear of rejection.
Even today, in 2020, living with HIV/AIDS means living with the fear of rejection and discrimination. Despite treatment, living with HIV in 2020 also sometimes means living with a time bomb inside you. That’s how many people who are living with HIV/AIDS feel.
We have to acknowledge that Canada has made a lot of progress in the past 40 years. It’s true. The advent of treatment has extended the lives of many patients. We must admit that no vaccine has been found yet —
I’m sorry, Senator Cormier. Your time has expired. Are you asking for five more minutes?
Two minutes?
Is leave granted?
Senator Cormier, you may continue with your speech.
We have to acknowledge that Canada has made significant progress, as I was saying. We must admit that no vaccine has been found yet and that far too many young Canadians continue to be infected by this terrible virus.
This is partially due to the lack of prevention and education on the dangers of this virus. The shortcomings of sex education in our schools and the taboos that still exist about this disease delay the eradication of HIV/AIDS.
More than ever, colleagues, we realize that health is our most precious gift. Canada must continue its commitment to achieve the 90-90-90 targets and aim for the eradication of this disease by 2030. That is why I am asking for your support to adopt this motion today on World AIDS Day 2020, calling for concrete action by the Government of Canada.
Thank you, meegwetch.
I rise today, World AIDS Day, December 1, 2020, to support Senator Cormier’s Motion No. 44 calling on the Government of Canada to act and meet its 90-90-90 goals. The idea is that by 2020 — only 30 more days — 90% of people who are HIV infected will be diagnosed, 90% of infected people will be receiving antiretroviral treatments and, as a result of that treatment, 90% of those people will achieve viral suppression bringing the amount of virus in the blood to an undetectable level and thus preventing the further spread of the HIV virus.
I’m sorry to say that the fast-track targets will not be achieved in most countries.
Senator Cormier has spoken at length and in detail about the status of HIV/AIDS in Canada and the need for a strong and funded federal strategy to address HIV/AIDS in Canada. I couldn’t agree more with him, and I want to underline his points about protecting our most vulnerable populations who are disproportionately impacted by this long-lasting and catastrophic global pandemic. My intention is to speak briefly in support of this motion to encourage us to also look at our international commitments, and the impact the COVID-19 pandemic is having on the AIDS pandemic worldwide.
Colleagues, in the early, dark hours of the morning of April 8, 1982, by the light of a kerosene lantern, in the Kanye Adventist Hospital, in Kanye, Botswana, assisted by very skilled midwives, I gave birth to a beautiful healthy baby girl, my third daughter, Lindelwa Naledi. Naledi means star and Lindelwa means the one we were waiting for. At that same time, many other mothers across the sub-Saharan African nation and its surrounding countries were also giving birth to their precious daughters. Little did we or they know what was in store for them and for their health.
Our family moved back to Canada when our Lindi was just a babe in arms, and other than the common childhood and adult ailments, Lindi has enjoyed good health. Those other girls who were born that rare, rainy April night in the desert nation of Botswana unfortunately fall into one of the world’s worst AIDS statistics categories. In 2019, 26.3% of all women between the ages of 15 and 49 in Botswana were infected with HIV.
Could you imagine if more than one quarter of our collective children were infected with HIV?
In the year 2000, a 15-year-old in Botswana had a more than 50% chance of dying from an AIDS-related illness. Between 1999 and 2005 Botswana lost close to 17% of its health care workforce due to AIDS.
In the UNAIDS report Prevailing Against Pandemics by Putting People at the Centre released last week, it was reported that 38 million people are currently living with HIV worldwide, with more than 12 million people waiting for life-saving treatment. In 2019, 1.7 million people were newly infected with HIV and 690,000 people died from AIDS-related illnesses worldwide.
In a recent conversation and subsequent correspondence I had with Stephen Lewis, Canada’s former ambassador to the UN, former UN Special Envoy on HIV/AIDS in Africa, founder of the Stephen Lewis Foundation and co-founder and co-director of AIDS-Free World, Stephen said the following:
The consequences of COVID-19 really have to be stressed. It’s not just an horrific number of additional deaths through disruption of services, it’s also the fact that the world was behind on the 90-90-90 targets even before the virus burst upon the scene. Now it’s way behind. Infectious diseases like HIV and TB have become collateral damage in the face of the COVID pandemic. The challenge, as always, will be funding. More and more international finance is going to COVID; the diversion of funds leaves HIV gasping. It’s especially hard on community-based services on the ground.
Investments in HIV and the lessons from how communities have responded to HIV have actually strengthened the fight against COVID. HIV activists and communities have mobilized to defend the gains in the AIDS response to protect people with HIV and other vulnerable groups and to push back against the coronavirus.
The recent UNAIDS report further suggests that to get the global HIV response back on track, we should adopt a new set of targets for 2025 and that, if those are achieved, we will make possible the Sustainable Development Goal 3.3 of ending the AIDS pandemic by 2030.
These targets are holistic and address the inequalities on which HIV, COVID-19 and other pandemics thrive and put people most at risk and marginalized at the centre: young women and girls, young women like those born the night our Lindi was born in Sub-Saharan Africa, adolescents, sex workers, transgender people, people who inject drugs and gay men and other men who have sex with men.
Colleagues, on November 25, people around the world marked the International Day for the Elimination of Violence Against Women, which launched the 16 days of activism against gender-based violence.
There is a significant but not often discussed link between gender-based violence — and sexual violence in particular — and HIV/AIDS.
During the 2008 elections in Zimbabwe, countless numbers of women who were associated with the opposition parties were raped by thugs enlisted by then-President Robert Mugabe as part of his show of power.
We know that sexual violence aids and abets the spread of HIV. During the 1994 Rwandan genocide, the Interahamwe, the Hutu militia group, brutally and intentionally targeted and subjected Tutsi women to sexual violence on a massive scale. A 2001 study revealed that 70% of the rape survivors from the genocide were HIV positive. I visited some of these women as they were trying to rebuild their lives and those of their children in Rwanda. These examples of the weaponization of rape and intentional HIV transmission are very concerning and require particular attention.
Now back to Botswana, for some hopeful developments after these very painful and horrific examples of HIV transmission.
Starting in 2002, Botswana was the first country in Africa to provide free antiretroviral treatment to people with HIV.
In Sub-Saharan Africa, both Botswana and eSwatini — the country formerly known as Swaziland — have achieved the 90-90-90 targets, with Botswana currently covering nearly two thirds of the related expenditures from its own domestic resources.
Zimbabwe, Cambodia, Thailand, Switzerland, the Netherlands, Australia, the U.K. and Denmark also are well on their way or have already met the 90-90-90 targets. Of course, many countries are falling behind.
As Senator Cormier mentioned, this shockingly includes Canada, where we saw a significant increase in new infections over the last four years for which we have statistics, and where an estimated 14% of individuals living with HIV are not even aware of their status. Indigenous people account for 9.6% of all people with HIV in Canada and people in our prisons also have a disproportionately high infection rate.
While I am completely in agreement with and wholeheartedly support Senator Cormier’s motion urging the Government of Canada to evaluate the cost of implementing its five-year action plan on sexually transmitted and blood-borne infections, to establish specific objectives for Canada to achieve in the fight against HIV/AIDS and to increase funding for the federal initiative to address HIV/AIDS in Canada, I am asking us to expand our horizons and also remember our commitments to our international neighbours.
As Winnie Byanyima, Executive Director of UNAIDS, said in a recent report:
No country can defeat the colliding pandemics of HIV and COVID-19 on its own. Such global challenges can only be defeated through global solidarity and shared responsibility.
When the United Nations General Assembly holds its high-level meeting in June 2021, there will be a golden opportunity for Canada and other member nations to recommit and remobilize toward ending the AIDS pandemic.
A final quote from my recent communications with Stephen Lewis regarding motion No. 44:
Yes, the focus of your debate will be on AIDS in Canada. That is understood. But Canada could emerge as an international humanitarian champion if it could take the lead in targeted support for low-income countries struggling with HIV.
Honourable colleagues, let’s show our solidarity with those living with HIV/AIDS in Canada and elsewhere, let’s demonstrate our commitment to those most at risk of contracting HIV/AIDS everywhere and let’s honour the memory of the 26,000 Canadians who have died of HIV/AIDS, more than half the number of Canadian lives lost in the Second World War. Also, let’s honour the memory of the 32 million people worldwide who have lost their lives to this viral scourge by passing this motion and committing to do so much more and so much better on this World AIDS Day 2020. Thank you, wela’lioq.
Honourable senators, I rise today in support of Senator Cormier’s motion with regard to federal funding of its five-year action plan on sexually transmitted and blood-borne infections.
Senator Cormier has laid out the facts and figures surrounding the present status of HIV/AIDS in Canada. Senator Coyle has shared with us the heartbreaking facts of what was going on in Africa.
With the current pandemic, this is an opportune time to ask for answers from the government. While deaths in Canada from HIV/AIDS and in the developed world have dropped over the past 40 years, we should not ignore that this disease is still a deadly illness with no known cure.
Forty years ago, I became the Vancouver coroner. I vividly remember the panic in the Coroners Service, the medical profession and among first responders — young, seemingly healthy men wasting away, suffering from complications of an unknown disease, dying in large numbers, in some cases horribly disfigured. Panic, fear, harassment of gay men, and discrimination were all common. Some funeral homes would not come and pick up the bodies from my morgue. We, as investigators, would historically wear gloves and nothing else. We had no idea — none — of what we were dealing with, and society reacted in a way that we should be ashamed of. Continually going into rooming houses and finding single men laying there alone with no one was a daily occurrence; and some days, many times.
While we now have retroviral treatment that has lowered the death rate, the disease remains incurable. Forty years ago — such a short time — we had no idea; none. And the gay community in Vancouver stepped up. They stepped up and started finding out what was going on, where this was coming from and how it was spreading. They stepped up so that people would not be alone. They were there when people died.
At one point, the newspaper phoned me and said that they had information that a person involved in the AIDS community was assisting deaths. I went down and saw that person. I walked out and I said to him, “No matter what you tell me, you did not do this.” This is the situation that we were in. It was that drastic.
We can take comfort in the fact that the death rate has dropped, but we must remain vigilant in research and treatment. Canada led the world in retrovirus, but we are far behind other G7 countries in eliminating new infections. As Senator Coyle said, other countries in Africa, without the resources that we have, have taken it upon themselves to address this scourge on their citizens and the citizens of the world.
While the medication has allowed many of the sick to lead relatively normal lives, it’s not without risk and complications. The idea that HIV/AIDS is not a deadly disease anymore because of the retrovirus is simply false. Nothing has changed except that we’ve been able to find a medication that will keep people alive. But the disease did not go away and the complications do not go away.
Now is not the time to back off. I realize that we are in the middle of another deadly pandemic, but I believe we are close to a vaccine for COVID. Forty years after the fact, we still have no cure for this and no vaccine.
Honourable senators, this is not an “and/or” situation. We are better than that. We have to step forward and demand — not ask anymore — that our government implement the five-year action plan. If we don’t do this, COVID will be gone but we’ll still be dealing with HIV/AIDS.
I urge all senators to support this motion. Thank you.
Is it your pleasure, honourable senators, to adopt the motion?
Some Hon. Senators: Agreed.
An Hon. Senator: On division.
(Motion agreed to, on division.)
