Evidence of meeting #36 for Health in the 42nd Parliament, 1st session. (The original version is on Parliament’s site, as are the minutes.) The winning word was donors.
A recording is available from Parliament.
Liberal
The Chair Liberal Bill Casey
That completes our seven-minute round. We'll go to five-minute rounds now, with Dr. Carrie.
December 8th, 2016 / 9:45 a.m.
Conservative
Colin Carrie Conservative Oshawa, ON
Thank you very much, Mr. Chair.
Thank you to all the witnesses for being here today.
My first question is for the Canadian AIDS Society.
First, Gary, I want to say thank you for all your good work over the years. We've heard that Canada is a leader, and I think a lot of it is due in part to organizations such as yours and the on-the-ground organizations.
When we learned recently that the health minister cut and reduced by a substantial amount funding to HIV and AIDS organizations across the country, I was a little shocked and surprised, frankly, particularly at how it was done. We know that organizations such as yours are on the front lines. You promote education and awareness, and you provide information and resources on the ground, on the front lines.
As we've heard, testing and prevention are the key to this issue. I was wondering if you could give us your opinion. How do you see these cuts affecting the progress that has been made in regard to HIV and AIDS to date, particularly in terms of the educational part of it, the prevention and the outreach?
Executive Director, Canadian AIDS Society
Well, we were happy to hear that we are getting transitional funding for the next year from the federal minister and from the Public Health Agency, but it is a band-aid reaction to the cuts that are happening. There's a change, a shift, and the landscape is changing, but it should not be to the detriment of people living with HIV. That's our stance. That will be our stance in our advocacy, and I'll be moving forward to get full funding for 2018 and increasing the funding to the community action fund, which will be pro-rated, with maybe an injection of more funds to our countrywide efforts against HIV.
The front-line services, which do prevention, treatment, and support work on the front lines, are the most affected by this funding cycle. Also, because we're focusing only on prevention for people who are HIV negative, for everybody who is living with HIV, it's about making sure that they stay undetectable, because we know now, with science, that people who are on their medication become undetectable and cannot transmit new HIV cases down the road. It's imperative, in the 90-90-90 approaches with UNAIDS, that we have a holistic approach to how we do prevention of HIV. We believe strongly that this is missing in the Canadian effort with the new funding cycle for community organizations.
That's what we'll be lobbying and going towards. I think that if we maintain a holistic approach to fighting HIV on all levels, it will ultimately be better for all Canadians, because we will reach zero transmission by 2030 if the money is put towards getting to that.
Conservative
Colin Carrie Conservative Oshawa, ON
I hope you're successful with that. I'm certainly very supportive of it.
We were looking at your website. An estimated 75,500 people in Canada are living with HIV. This is more than ever before. The good news is that people are living, and they're living longer, but what surprised me is that one in five of them don't even know. This is what I find so important, and what is so important with the work that you guys do on the ground. We're talking today about MSM and gay men, who are the most affected by HIV and AIDS in Canada. As was stated earlier, they account for 56% of HIV/AIDS cases in Canada and 45% of new infections.
As we look at this issue, having more blood donors is obviously very positive, and it's something that I think we have to move towards, but the question again is whether the science behind a removal of the one-year ban sufficient enough to ensure the safe blood system in Canada? You mentioned something really important. You talked about the scientific and behavioural criteria, and you mentioned stigma. You mentioned an example in Nova Scotia. I know that Nova Scotia was hit quite hard with the cuts. What further research needs to be done, and what more can we do, for example, for the scientific and behavioural criteria? Do you have examples of that?
Executive Director, Canadian AIDS Society
Yes. There's been some behavioural and community-based research that has been done in the last couple of years, but very little. One of the trailblazers in behavioural research for HIV and related STBBIs is Joanne Otis from the University of Quebec in Montreal. She has based her whole life's work on behavioural science and behaviour to see why men will reduce their protection barriers in their sexual behaviour.
That, I think, is the key to understanding what the behaviour is in the MSM population and the whole population in general, because we must not lose sight of the fact that 32.6% of new HIV cases are heterosexual people. There's a big percentage that's heterosexually based.
When we look at MSM and the whole portfolio, at aboriginals, and at different populations, it's extremely important to understand what is the behaviour. Is it the users of opioids? Is it intravenous drug use? Is it because there are new immigrants coming into Canada who look for different alternatives or whatever? That has to be researched. If we're going to find the key, it will be based on behaviour, I find, but it's also scientifically based.
Liberal
Darshan Singh Kang Liberal Calgary Skyview, AB
Thank you, Mr. Chair.
I would like to thank all the panel members for coming here and shedding some light on this issue.
On June 16, 2016, Health Canada granted Canadian Blood Services and Héma-Québec the authorization to change the donor criteria for MSM from requiring a deferral period of five years to a period of one year. What kind of donor increase did you have you changed from the indefinite deferral to five years? Do you have any data proving that the number of donors went up when you reduced that to one year from five years?
Chief Medical and Scientific Officer, Head Office, Canadian Blood Services
I'll try to answer that. It's not a straightforward question to answer because we don't actually ask a question any longer. We don't really know what our denominator is, but we do know that in the days when we were having permanent deferrals, we would put a code on donors' files if they had reported MSM behaviour. We know that when we went to the five-year deferral, we gained back about 100 donors. As we've gone to the one-year deferral, we know that we've taken this code off about 400 donor files.
We do believe that the number of people who are now eligible to donate and who couldn't donate previously is larger than that, but because we're not actively asking for that information any longer, we're not completely sure. I would say that it's a few hundred. It would be less than 1,000.
Liberal
Darshan Singh Kang Liberal Calgary Skyview, AB
My next question is about the estimate of blood that will be accessible by eliminating the deferral time. What amount of blood will be accessible?
Chief Medical and Scientific Officer, Head Office, Canadian Blood Services
We haven't tried to quantify in that way. There are satellite effects of changing this donation, which also includes the fact that as we are working to improve the eligibility of donors, others who have not been donating because they're angry about deferral practices that Canadian Blood Services has had, are starting to say that this is becoming more reasonable. They come back to donate or they start to donate a first time. Again, we don't have exact numbers for that.
Liberal
Darshan Singh Kang Liberal Calgary Skyview, AB
Thank you.
My question is for the AIDS Society about funding cuts. I think the funding remains at $26.4 million annually and there is no funding cut?
Executive Director, Canadian AIDS Society
The funding has been maintained at $26.4 million, yes. That stayed, but there was a shift in the funding landscape, and that had the repercussion that 33% of organizations across Canada, including at the Canadian AIDS Society, were defunded because we were not meeting the objectives of the new criteria, but the criteria were lacking a lot of transparency and were shifting continuously without any community engagement to see what the new funding should look like. We were blindsided by the new funding, but we also saw that, since 2008, $13.8 million out of the fund was not spent by previous governments.
What we're requesting is that the money that was not spent be re-addressed to address the shortfalls in the funding which we see now. When we look at the new transitional funding for the one year, a lot of the gaps are going to be addressed that were not addressed in the funding. Public Health said there were enormous gaps that they didn't address in the funding cycle this year, and that they didn't expect that there would be so many gaps. They're addressing it, so hopefully we'll have a better impact.
Liberal
Darshan Singh Kang Liberal Calgary Skyview, AB
So it's not the present government, but the previous government somehow. What was the reason not to spend that money?
Executive Director, Canadian AIDS Society
We saw that under the different portfolios of the federal initiative it was not spent. It could have been under research. It could have been under community action. It was different. It was throughout all the portfolios of the budget.
Liberal
Darshan Singh Kang Liberal Calgary Skyview, AB
But the reason.... I'm asking for the reason why the funding—
Executive Director, Canadian AIDS Society
We were never able to get the reasons why it was not spent.
Conservative
Rachael Thomas Conservative Lethbridge, AB
My first question is for Health Canada.
I understand that $3 million of funding has been given to do behavioural research. Can you explain a bit about how that funding is being used and about what you're hoping to accomplish through that funding?
Director General, Biologics and Genetic Therapies Directorate, Health Products and Food Branch, Department of Health
Certainly.
The funding is $3 million for CBS and Héma-Québec, actually, and the use of that funding is to support research into alternatives to the MSM deferral. It would basically be supporting projects focused on examining alternative screening approaches, and also, perhaps, with respect to funding projects related to other types of technology, such as pathogen reduction, which is a type of potential treatment of blood.
The international conference in January, which Dr. Sher referenced in his remarks, is going to be used to set the research agenda, the priorities, and what the bulk of the funds would be used to support.
Conservative
Rachael Thomas Conservative Lethbridge, AB
Okay.
Who's invited to that conference? Who are the stakeholders at the table who are helping to make that decision?
Chief Medical and Scientific Officer, Head Office, Canadian Blood Services
Maybe I'll take that, since I'm organizing the conference. The stakeholders at the table are in two different categories, really.
The intention of this meeting is to set a research agenda, and we have invited a collection of researchers from the Canadian university setting, for the most part, and also some international folks who do research in this area internationally in countries that have looked at making changes or have made them. This group is being asked to come together to help us understand what are the research questions, what are the studies need to be conducted to answer those questions, and what are the barriers preventing us from doing that research in Canada.
We have also invited representatives of patient advocacy groups and representatives of LGBTQ stakeholder organizations to attend that meeting, and there will be some representatives there from ministries of health from other countries that are looking at changing their MSM deferral.
That's sort of the general group.
Conservative
Rachael Thomas Conservative Lethbridge, AB
Okay. I'm sorry. Maybe I missed this on the list, but will there be patient advocacy groups there at all?
Chief Medical and Scientific Officer, Head Office, Canadian Blood Services
Yes.
Conservative
Rachael Thomas Conservative Lethbridge, AB
Ms. Parker, you talked a bit about the deferral window and about the fact that Spain and Italy do not actually have one. I understood from your statement that Spain has seen an increase in HIV-positive blood. Did I understand that correctly? Or was that not you?