Question Period Note: HIV and STBBI Funding in Canada

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The Government of Canada invests $33.4 million annually in grant and contribution funding to support community-based organization initiatives to address HIV and other sexually transmitted and blood-borne infections (STBBI) in Canada. In 2022, federal investments towards STBBI amounted to $106.4 million, including funding from Indigenous Services Canada (ISC) and the Canadian Institutes for Health Research (CIHR). However, community organizations and other domestic STBBI stakeholders have been vocal in their requests to increase annual funding.

Key Messages
• We remain committed to ensuring that Canadians have equitable access to prevention, testing and care for sexually transmitted and blood-borne infections (STBBI), whereby $106.4 million was invested by the Government of Canada in 2022 to address STBBI.
• We recognize the critical role that community-based organizations play in Canada’s ability to achieve the global targets, reduce barriers, and address systemic inequities affecting Canadians living with or affected by HIV.
• Annual investments of $33.4 million in community-based projects continue to be a pillar of the Government of Canada response through the HIV and Hepatitis C Community Action Fund and Harm Reduction Fund, and an additional investment of $8 million to increase access to HIV self-testing for 2022-2023.
• Community organizations will play a central role in distributing HIV self-test kits, particularly among populations most affected by HIV. The new $8 million investment will support broader distribution of self-test kits in an effort to reduce the number of undiagnosed in Canada.
• Canada proudly hosted the 24th International AIDS Conference (AIDS 2022) in Montreal from July 29th to August 2nd. The Government of Canada participated in multiple conference events and advanced several key initiatives including endorsing the global Undetectable = Untransmittable (U=U) declaration, announcing $17.9 million in funding on HIV self-testing, announcing consultations on the criminalization of HIV non-disclosure, and committing $15 million for renewed funding to UNAIDS.
If pressed on funding
• In 2022, the Government of Canada invested $106.4 million to address HIV and other sexually transmitted and blood-borne infections initiatives in Canada.
• The Public Health Agency of Canada invests $26.4 million annually through the HIV and Hepatitis C Community Action Fund to support community-based programs across Canada to address HIV, hepatitis C and other sexually transmitted.
• Through the Harm Reduction Fund, the Agency also invests $7 million annually to support projects that help reduce HIV and Hepatitis C among people who share inhalation and injection drug-use equipment

In 2003-04, funding levels for the Canadian Strategy on HIV/AIDS were $42.2 million per year. In 2005, the Government of Canada (GoC) launched the Federal Initiative (FI) to address HIV/AIDS in Canada, and committed to doubling funding to $84.4 million by 2008-09. Expenditure Review Committee Cabinet Cuts (2005), which took effect in 2007-08, and Budget 2012 reductions brought HIV funding levels down to $72.6 million, where funding remained stable until 2017/18. During this period, in 2007, the Canadian HIV Vaccine Initiative was launched as a time-limited partnership between the GoC and the Bill and Melinda Gates Foundation. As part of this partnership and over a 10-year period, the GoC dedicated $26 million from the FI and invested an additional $82 million to support HIV vaccine research, for a total of $108 million.

PHAC, in consultation with stakeholders, made a strategic shift to take an integrated approach to the prevention of all STBBI rather than siloed disease specific approaches, given the common routes of transmission and prevention behaviours, and the over-representation of common populations in rates of infection. Interventions and programs are designed to address the complexity and interrelated nature of risk factors and transmission routes for STBBI while recognizing that disease-specific approaches may be appropriate in some cases.

Community Funding
Part of PHAC’s funding is investing $33.4 million annually in grants and contributions to support community-led responses to HIV, Hepatitis C and related STBBI. The HIV and Hepatitis C Community Action Fund (CAF) receives $26.4 million annually to support community-led integrated approaches to disease prevention initiatives and responses to addressing common transmission routes, risk behaviours, affected populations, and stigma associated with STBBI. Of which, $4 million annually is dedicated to projects led by Indigenous organizations.

Through the Harm Reduction Fund (HRF), PHAC invests $7 million annually to support projects across Canada that help reduce HIV and hepatitis C among people who share injection and inhalation drug-use equipment. These funds complement existing investments under the CAF by focusing on a population that is particularly at-risk for STBBI. The funding helps community-based organizations implement or enhance harm reduction measures by providing: education resources for people who use drugs; support for peer-based outreach and navigation initiatives; and training for health providers. Investments in the HRF also support objectives within the Canadian Drug and Substance Strategy.

Time-Limited HIV Self-Testing Initiative
Despite the availability of testing services for HIV, there remains an estimated 6,590 people in Canada living with HIV who are not aware of their status. Laboratory testing can be inaccessible to certain populations due to the lack of access to a healthcare provider, travel and wait times, and concerns about confidentiality and stigma. An $8 million time-limited investment (2022-2023) will support community-based organizations in the purchase and distribution of HIV self-test kits, which will be useful for reaching the undiagnosed by offering greater accessibility, privacy and convenience and by reducing the stigma associated with accessing traditional HIV testing.

National Microbiology Laboratory Testing (northern, remote, and isolated communities)
Through the National Microbiology Laboratory (NML), PHAC will invest an additional $8.7 million in 2022-2023 to expand community-based and community-led testing initiatives in northern, remote, and isolated (NRI) communities. The NML will also support training, verification and ongoing quality oversight for these community-based testing programs. For people living in NRI communities, access to culturally appropriate, community-owned and led testing options for infectious diseases can be key to improving their overall health. With these funds, organizations and communities will be able to purchase diagnostic tests for screening, confirmatory testing and ongoing monitoring in the community. This way specimens can be tested on location and not have to be sent elsewhere, leading to faster diagnostics. The NML also receives $5 million over five years under the new Innovative Diagnostics Program for developing novel approaches to support community-based testing for reaching the undiagnosed.

The British Columbia Centre for Disease Control (BC-CDC) and First Nations Health Authority along with agency and community partners will receive $1.2 million in 2022-2023 to implement a range of community-based testing innovations that will provide a broader range of testing services for a series of rural, remote and isolated communities. These efforts will help inform a series of shared priorities and next steps for the scaling up of community-based STBBI testing approaches in the province of British Columbia based on the evidence generated through this project.

Funding to Support Researchers
Canada also recognizes the importance of funding research that creates new knowledge and resources that improve the health of Canadians that are affected by HIV and STBBI. Understanding how the social determinants of health affect those impacted by HIV and other STBBI will allow Canada to create more equitable approaches that help us reach our global targets. From 2016-17 to 2020-21, CIHR funded over $228 million on HIV/AIDS research and more than $63 million on Hepatitis C research. Examples of 2019-2020 investments include:
• $6 million over five years to support research to investigate the introduction of new HIV/AIDS and STBBI testing technologies in Canada, including the HIV self-test kit approved for use in Canada in 2020.
• $12.5 million over five years to three Centres for HIV/AIDS, hepatitis C and other STBBI Population Health and Health Services Research. The Centres aim to improve health and access to effective programs and services for people living with and at risk of HIV/AIDS and STBBI, particularly for populations most affected. Two of these Centres focus exclusively on Indigenous populations and are grounded in Indigenous knowledge and methodologies.
• $19.9 million over five years in six Biomedical and Clinical HIV/AIDS Research Team Grants to develop effective prevention, treatment and care strategies to improve the health of Canadians affected by STBBI. Projects will explore issues such as gaps in testing, using anti-retroviral medications, and finding new approaches to eliminate persistent HIV infection.
• $22.85 million over five years for the Canadian HIV Trials Network, which aims to accelerate the translation and uptake of new knowledge into clinical applications, interventions and guidelines for HIV/AIDS care.

• The Government of Canada Five-Year STBBI Action Plan (2019) outlines an integrated approach to the prevention of all STBBI. Stakeholders accept the integrated, community-focused approach and appreciate its increased efficiency; however:
o HIV stakeholders are critical about the use of HIV-specific funds to support an expanded number of infectious diseases; and
o Hepatitis C stakeholders are concerned that the uniqueness of the public health response required will be lost among the broader HIV response.
• In 2022, the Government of Canada invested $106.4 million to address STBBI across Canada, including: $72.6 million for the Federal Initiative (FI) ($41.5 million for PHAC, $4.2 million for Correctional Service Canada, $22.4 million for CIHR, and $4.5 million for ISC); $8.9 million for Public Health responses to addressing Hepatitis C; $7 million for the Canadian Drugs and Substances Strategy Harm Reduction Fund; and $17.9 million to improve access to HIV self-testing and diagnostic services in northern, remote, and isolated communities.
• On August 1, 2022, at the 24th International AIDS Conference, the Government of Canada announced $17.9 million in time-limited funding (2022-2023) to improve access to HIV self-testing. This includes $8 million to community-based organizations to support their capacity to distribute and promote HIV self-tests and link people to care, $8.7 million to the National Microbiology Laboratory to expand community-based and led testing in northern, remote, and isolated communities, and $1.2 million to the BC-Communicable Disease Center (CDC) and BC’s First Nations Health Authority to build on previous initiatives by identifying testing potential for other infectious diseases, including STBBI.
• Community partnerships help the Government of Canada advance the work of our Action Plan and achieve global STBBI targets by providing innovative, tailored approaches to address STBBI that are free of stigma and discrimination.
• PHAC invests $26.4 million annually to the HIV and Hepatitis C Community Action Fund (CAF), which supports community-based responses to STBBI in order to prevent new infections, reduce stigma and discrimination and increase access to testing and treatment. From this investment, $4 million annually is dedicated to projects led by Indigenous organizations.
• PHAC also invests $7 million annually to the Harm Reduction Fund (HRF) to support community-based projects across Canada that will help reduce HIV and Hepatitis C among people who share drug-use equipment such as needles and pipes. These funds complement existing investments under the CAF by focusing on a population that is particularly at-risk of STBBI.
• In addition to the funding they receive from the FI, CIHR also funds HIV and hepatitis C research. From 2016-17 to 2020-21, CIHR funded over $228 million on HIV/AIDS research and more than $63 million on hepatitis C research.
• In addition to the FI, from 2017-2022 ISC allocated $37.5 million with an $11 million ongoing commitment for prevention, testing, treatment, and care for STBBI, including HIV, for First Nations and Inuit communities.
• The global 90-90-90 HIV targets stated that by 2020, 90% of all people living with HIV know their status, 90% of those diagnosed receive antiretroviral treatment, and 90% of those on treatment achieve viral suppression. Canada's 90-90-90 estimates for 2020 lie within the range reported by other comparable countries such as the United States of America, France, Germany, Australia, the Netherlands, and Finland.