—who have come to me as well.
Evidence of meeting #34 for Health in the 45th Parliament, 1st session. (The original version is on Parliament’s site, as are the minutes.) The winning word was study.
A recording is available from Parliament.
Evidence of meeting #34 for Health in the 45th Parliament, 1st session. (The original version is on Parliament’s site, as are the minutes.) The winning word was study.
A recording is available from Parliament.
Conservative
Dan Mazier Conservative Riding Mountain, MB
Do we have unanimous consent that I can speak next after this motion?
Conservative
Matt Strauss Conservative Kitchener South—Hespeler, ON
Thank you, Chair.
I just want to ask, now that we're back—we've gavelled in—if either I or Mr. Mazier could have the.... I'm happy for this amendment to proceed with unanimous consent. I would like to make sure that we're able to get on the speaking list after that.
Do I have your assurance?
Liberal
The Chair Liberal Sukh Dhaliwal
I go one step at a time. I'm doing my job as chair. I cannot promise things long before it's time. I have to go one step at a time, Dr. Strauss.
Honestly, I act as fairly as I can. I'm a human being. I might make some mistakes, but my intent is to be 100% fair to all sides here.
If we do not have any more speakers on the list, we are going to take a vote on the amendment brought forward by Dr. Strauss.
Does everyone agree with that amendment? Is it unanimous?
Liberal
The Chair Liberal Sukh Dhaliwal
We already voted. We adopted it. It was 11 to zero.
We're now going back to the motion as amended.
Do you want me to read it one more time or not?
I know Dr. Strauss is on the speaker's list, but don't you worry.
Does anyone want me to read the motion into the record?
Mr. Blanchette-Joncas, you have the motion in both official languages. I'll read it to make sure you're happy with it.
We are going to be debating this motion:
That, pursuant to Standing Order 108(2), the Standing Committee on Health undertake an urgent study on the rising rates of HIV infections in Canada, with particular attention to the recent declaration of a public health emergency by the Province of Manitoba related to the spread of HIV and syphilis, including the disproportionate impacts on specific regions and populations, including 2SLGBTQI+ communities, Indigenous peoples, women, rural and northern communities, and individuals experiencing homelessness, mental health challenges and substance use disorders;
That the study examine federal programs, funding, prevention strategies, access to testing and treatment, harm reduction initiatives, public awareness efforts, and intergovernmental coordination related to HIV prevention, care and support services;
That the committee hold no fewer than two meetings on this subject;
That witnesses include officials from the Public Health Agency of Canada, the Minister of Health, representatives from Manitoba Health, Indigenous health organizations, frontline community organizations, medical and public health experts, and individuals with lived experience;
That, for the purpose of completing this study and ensuring that the report is tabled by July 22, 2026, the committee continue its work through the summer, if necessary, and the chair be authorized to schedule meetings related to this study after the House rises for the summer;
And that the committee report to the House requesting permission to table this report after the House rises for the summer, if necessary.
Does everyone have this in both official languages?
That's good. I don't see any objections.
I have the speaking list, and Dr. Strauss, you are on the speaking list.
Please, go ahead.
Conservative
Matt Strauss Conservative Kitchener South—Hespeler, ON
Thank you so much, Chair.
As instructed by you, you didn't want to deal with this while we were on the amendment. I very much want to know if we have some assurance from the Liberal members opposite that once we vote for this HIV study, we can proceed to an investigation on PrescribeIT.
If it is the case that they're willing to go on the record saying that they're willing to do that, I'm looking forward to voting for their motion. If they are not willing to go on the record saying that they're willing to do that, I'm looking forward to discussing this motion further.
Who's next on the speaking list? Dan, are you on it?
Liberal
Liberal
The Chair Liberal Sukh Dhaliwal
I'm giving you all the terms you need. I can't explain your question to you. I cannot say that, because you have to speak through me. I don't see anyone with their hand raised. I'm not in a position to answer your question.
Do you see what I mean?
Liberal
The Chair Liberal Sukh Dhaliwal
The only way that question can be answered is if the vote is called. It's by whichever way the vote goes. The members can change their minds at the last minute.
Do you understand that?
Liberal
The Chair Liberal Sukh Dhaliwal
It's not up to me. It's not up to one committee member. It is up to the committee as a whole. The majority have to decide how they want to vote on this. That's what it is. I cannot attach any conditions.
I have read the motion in place, as amended. That's what we are debating right now. Once the list is exhausted, we'll go to the vote on this.
Conservative
Matt Strauss Conservative Kitchener South—Hespeler, ON
Of course. I understand, Chair. I just want to hold space—
Liberal
The Chair Liberal Sukh Dhaliwal
You can do those things off-line. You can talk to the members on the other side. I'm not going to have that debate here.
They're not willing to answer. I don't see any hands up. The only hand up is Mr. Mazier's.
Once you stop speaking, I will go to the speaking list.
Conservative
Matt Strauss Conservative Kitchener South—Hespeler, ON
Great. Well, yeah; I wanted, myself, to hold space for them to answer that query. As you say, Chair, nobody can definitively say 100% how they're going to vote until they do vote, but I think most of the members in this House, most of the members on this committee and most of the members on the opposite side are people of integrity. If they go on the record with the cameras on—thankfully, the cameras are on today—to say that they'll vote one way or another, I would generally trust that, and I would then be willing to move forward to a vote, but as you haven't seen any hands go up, I think we'd better discuss this motion further.
I do want to inform the committee that there are literally thousands of epidemiologic and other medical papers on HIV in Manitoba. I think, before we proceed with yet another study on HIV in Manitoba, we ought to consider some of the research that is out there. I'm delighted to be able to talk with you all today about a study I found on this topic. It's in the International Journal of Infectious Diseases Regions, a sub-journal of the International Journal of Infectious Diseases, which is one of the premier journals in the field. The International Journal of Infectious Diseases Regions deals specifically with communicable diseases in regions, and in this case Manitoba. Although I have not fully critically reviewed the study that I'm going to be talking about for the next while, it is in a high-quality, scholarly source. I hope we'll all take its findings really seriously.
The lead author on the paper is Megan Sorokopud-Jones. I understand her to be in the division of general internal medicine at the University of Manitoba, so she is very much on the ground. The objectives of the paper are as follows: “Describe the proportion of people newly living with HIV with sexually transmitted and blood-borne infections...before, at, and after HIV diagnosis in Manitoba, Canada.” I think that's really topical. As the motion as amended includes syphilis, I think this will touch on both this paper and our study. The paper was published in just December 2024, so it's quite topical. It was perhaps ahead of the wave in terms of what was about to happen with the increased number of cases we're seeing of HIV in Manitoba presently.
The paper says, “People living with human immunodeficiency virus (HIV) with additional sexually transmitted and blood-borne infections...have poorer health outcomes.” That's as opposed to people with just one, which I suppose is not terribly surprising.
It goes on to say the following about sexually transmitted and blood-borne infections:
STBBIs can cause an inflammatory response, leading to the release of cytokines and immune cells in the genital tract, which can increase the risk of HIV transmission and acquisition. Having a syphilis infection has been shown to nearly triple one’s risk of HIV acquisition and in men who have sex with men, previous rectal gonorrhea or chlamydia and having multiple repeated sexually transmitted infections were associated with increased risk of HIV acquisition. People diagnosed with HIV co-infected with syphilis progress more frequently to neurosyphilis than controls. People living with HIV and concurrent hepatitis C virus...have accelerated liver fibrosis, which may be caused by HIV viremia, HIV-associated immune dysfunction, or a side effect of antiretroviral therapy. Women living with HIV are more likely to have higher recurrence rates of genital herpes and genital ulcers from syphilis than women without HIV. In addition, women living with HIV who have pelvic inflammatory disease experience increased severity of symptoms and a greater probability of progressing to tubo-ovarian or fallopian tube abscess.
In Manitoba, Canada, the total number of people newly living with HIV has increased 52% over the past 5 years. The demographic composition of individuals newly diagnosed with HIV has changed dramatically in Manitoba—
I'll just bring the committee's attention to the fact that this was published in 2024, so it was probably written a bit before that. This is a slow-moving catastrophe that we're now terming an urgent crisis, but it was noticeable—the signal was there, I take it—as early as 2019.
The demographic composition of individuals newly diagnosed with HIV has changed dramatically in Manitoba, with a recent sharp increase in females, and injection drug use and heterosexual sex as primary risk factors for HIV acquisition. The increase in new HIV diagnoses has been partially linked to increased methamphetamine use in the province. Between 2013 and 2018, there was a seven-fold increase in the number of people documented as using methamphetamines in Manitoba and those using methamphetamines were found to be younger adults, live in lowest-income areas, and have comorbid mental health conditions.
Alongside the increasing incidence of HIV, Manitoba also reported higher incidence of other STBBIs than national reports. The provincial test positivity for syphilis has doubled between 2018 and 2021 and Manitoba continues to have the highest rate of infectious syphilis of all Canadian provinces. Furthermore, in 2019, there were 370.8 chlamydia and 94.3 gonorrhea diagnoses per 100,000 people nationally in Canada, but Manitoba reported 601.0 chlamydia and 272.7 gonorrhea diagnoses per 100,000 people. Manitoba also reported the highest rate of HCV of any province in 2019 with 54.2 diagnoses per 100,000 people.
Substance use, houselessness severity, and female sex are associated with a greater prevalence of STBBIs. Previous research has shown that unstable housing was associated with HIV acquisition and affects the HIV continuum of care, reduced treatment effectiveness, and not receive appropriate HIV care. In a metanalysis of studies of STBBIs prevalence among American houseless adults, young women were found to have the highest prevalence of chlamydia and gonorrhea infections. Women living with HIV in Canada are increasingly additionally burdened by houselessness, food insecurities, and use of illicit substances. In three Canadian provinces, 79% of women living with HIV experienced food and/or housing insecurity. Our study group recently found that females newly diagnosed with HIV are additionally burdened by houselessness, injection drug use, mostly methamphetamine, and mental health conditions.
As part of a larger investigation of HIV syndemics in Manitoba, our primary objective was to describe the proportion of people diagnosed with syphilis, HCV, hepatitis B...gonorrhea, and chlamydia before, at, and after HIV diagnosis among people newly diagnosed with HIV in Manitoba between 2018 and 2021 by sex, housing status, injection drug use, and methamphetamine use. Our secondary objective was to identify the factors associated with syphilis, HCV, gonorrhea, or chlamydia acquisition and any of the four STBBIs after HIV diagnosis.
That's just the introduction of the study. I'm interested in going through the rest. I don't see any Liberal hands going up.
When I look at the motion before us.... We had a brief discussion about Ms. Sidhu's amendment to add, I believe, “LGBT”, only one Q, “I”, no A and then a plus. Oh, I'm sorry. I missed “2SL” at the beginning. At the time, there was some confusion about which letters she included and which she didn't, and whether she included the Q for “queer” or the Q for “questioning”.
Now, as I read the scholarly literature already out there, it sounds like this crisis in particular is not affecting that community. I almost wonder if this committee erred in thinking it was. I wonder if that, in itself, speaks to stigma and bias against the community—assuming that because there is an HIV epidemic in Manitoba, it pertains to that community. In the scholarly literature before us, at least, I don't see any evidence that it is.
I will let the chair interrupt me at any point if he sees Liberal hands coming up. I invite him to do that. I'm not seeing any. I suspect he's not seeing any either, so I think we should continue to go through this study.
Methods
Study design
All people referred to the Manitoba HIV Program in Manitoba, Canada, and confirmed to be newly diagnosed with HIV by the Manitoba Health Epidemiology and Surveillance Unit between January 1, 2018, and December 31, 2021 were considered in this retrospective cohort study. This centralized program provides care to all people living with HIV in the entire province of Manitoba and has three HIV care sites in Manitoba: Health Sciences Centre and Nine Circles Community Health Centre in Winnipeg and 7th Street Health Access Centre in Brandon.
That's really interesting to me, and I think it pertains to our motion. There is already a centralized program that provides care to all people with HIV in Manitoba. Perhaps it would make sense to add Dr. Sorokopud-Jones to the witness list as part of this study motion. I'm already grateful to her for informing me of this before we continue.
Chair, I understand there are Liberal hands up now. I'll cede my time. We can perhaps return to this at a later point.
Conservative
The Vice-Chair Conservative Dan Mazier
Yes, there is a switch. The other chair is indisposed.
Mr. Bailey is actually next. Then it's Ms. Konanz and then me.
Conservative
Burton Bailey Conservative Red Deer, AB
Thank you, Chair.
I'd like to ask the analyst if she could provide an estimate on when the report could be reviewed, translated and tabled in the House.
Conservative
The Vice-Chair Conservative Dan Mazier
Who would you ask?
I'm sorry. I was not paying attention, because I was looking at the list.
It's for the analyst.
