1. 1 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

2. 2 Presentation Outline 1.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

3. 3 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

4. 4 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

5. 5 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

6. 6 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

7. 7

8. 8 8 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

9. 9 HIV-Endemic Countries

10. 10 Focus on African and Caribbean HIV-Endemic Countries

11. 11 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

12. 12 Estimated Proportion of Risk Exposure Categories Among new HIV Infections, by Time Period, Canada Source: PHAC Epi Updates, July 2010.

13. 13 Geographic Distribution of HIV-Endemic AIDS Cases Ontario 451/ 36.1% Quebec 690/ 55.3% Atlantic Canada 14/: 1.2% British Columbia 37/: 3.1% Prairie Provinces 56/ 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)

14. 14 Health Determinants and Vulnerability to HIV/AIDS

15. 15 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

16. 16 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

17. 17 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

18. 18 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)

19. 19 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

20. 20 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

21. 21 Community Response to HIV/AIDS Among Black Canadians 57 projects led by 43 organizations Project breakdown according to organization categories (n=57)

22. 22 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

23. 23 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

24. 24 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