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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. AIDS 2010 Vienna, July 2010. The Canadian Health System The Public Health Agency of Canada

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AIDS 2010 Vienna, July 2010

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  1. 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 AIDS 2010 Vienna, July 2010

  2. The Canadian Health System The Public Health Agency of Canada The Federal Initiative to Address HIV/AIDS in Canada The Population-Specific HIV/AIDS Status Report Demographic Profile – People from HIV Endemic Countries HIV/AIDS Surveillance and Epidemiology Health Determinants and Vulnerability to HIV/AIDS Current HIV/AIDS Research Community Response to HIV/AIDS Conclusions Presentation Outline

  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. 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. 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. 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. 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

  8. HIV-Endemic Countries

  9. Focus on African and Caribbean HIV-Endemic Countries

  10. 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

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

  12. Geographic Distribution of HIV-Endemic AIDS Cases Number of reported AIDS cases by province and national proportional distribution for the HIV-endemic exposure subcategory, cumulative to December 31, 2006 (n=1248) Prairie Provinces 56/ 4.4% Quebec 690/ 55.3% British Columbia 37/: 3.1% Ontario 451/ 36.1% Atlantic Canada 14/: 1.2%

  13. Health Determinants and Vulnerability to HIV/AIDS

  14. 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

  15. 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

  16. 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

  17. 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)

  18. 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

  19. 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

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

  21. 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

  22. 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

  23. 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

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