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ACT position statements

Below are ACT’s position statements. These tackle a single issue and articulates ACT’s viewpoint around it. Position papers exist around issues that impacts and/or is related to the agency’s programs, services, strategic goals, mandate and/or mission.

 

Feedback or comments on where ACT stands? Get in touch with ACT’s Communications Coordinator at communications@actoronto.org.

September 2021 - National Day for Truth and Reconciliation
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ACT stands in solidarity with Indigenous peoples across this continent who are grieving and are re-traumatized due to the uncovering of thousands of previously undocumented grave sites at Indian Residential Schools (IRS). These graves hold thousands of children and youth killed during their operation. The last IRS closed its last door as recent as 1996. ACT, like many others, demand immediate federal implementation of all recommendations of the 2015 report of the Truth and Reconciliation Commission.

September 30th has been declared National Day for Truth and Reconciliation by the federal government. Yet here in Ontario, the government has refused to mark this day as a statutory holiday.

The National Day for Truth and Reconciliation is meant to recognize and commemorate the intergenerational harm that residential schools have caused to Indigenous families and communities, and to honour those who have been affected by this injustice. 

As an HIV service organization, we understand the emotional, spiritual, mental, and social complexities that stigma, discrimination, and collective loss have on communities and individuals. ACT supports the recommendations and calls to action of the Truth and Reconciliation, and we recognize that we must actively engage in the work of decolonization. As Indigenous communities across Turtle Island are calling out, we stand by the claim that “All Children Matter”.

ACT condemns all contemporary forms of Indigenous child apprehension and abuse inflicted by governments and institutions, including the child welfare system, social services, healthcare, and policing. As an organization we are committed to learn, to hold each other to act on solidarity through education, training, and accountability to Indigenous communities. We wear orange on Sept 30th to show solidarity and highlight the lack of police accountability and commitment to investigating the overwhelming numbers of murdered and missing Indigenous women, children, two spirited and trans people.

ACT urges everyone to act in solidarity with residential school survivors for full implementation of the Truth and Reconciliation Report.

Participate in local gatherings such as the one being held on Thursday, September 30th at Yonge Dundas Square from 11:00am - 4:00pm. Write to political representatives at the city, Provincial and Federal levels.

 

Resources, supports, and how to get involved:

 

June 2021 - Denouncing Anti-LGBTQ2S+ Hate
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This past weekend (Saturday, June 5, 2021), a member of the LGBTQ2S+ community, and a former ACT volunteer was brutally attacked at Hanlan’s Point Beach as he was heading home.

We know David Gomez as someone with a compassionate heart, who has worked tirelessly to protect our queer community. It is heartbreaking to know that in 2021, our community still needs to protect ourselves from horrific violence.

As we celebrate Pride Month, let’s remember that attacks like this are still happening around the world and locally in our own city. It’s our duty to combat anti-LGBTQ hate, racism and discrimination of any kind and support our own community.

We hope that David is surrounded by chosen family, love and care, and we wish him a speedy recovery. If you are able, please donate to David’s Go Fund Me page. No amount is too small or too big.

To donate: www.gofundme.com/f/queerbashing-victim-toronto-healing-aid-fund

June 2021 - ACT Stands in Solidarity with the Muslim Community
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On Sunday, June 6, 2021, while out for their daily evening walk, a Muslim family in London, Ontario was targeted in a hate-motivated crime, committed by a 20-year-old white male, as he ran over the family of 5 with his pick-up truck, leaving a 9-year-old as the only survivor.

This attack was confirmed by the London police as a premeditated hate crime rooted in anti-Muslim hate and xenophobia.

We at ACT stand in solidarity with the Muslim community as we mourn those killed in this tragic act of violence. We denounce all forms of hate and discrimination based on religion (anti-Muslim hate), race, and xenophobia.

To access support:

Naseeha Mental Health Hotline for Muslims and non-Muslims, from 12 pm – 12 am, 7 days a week: www.naseeha.org or call 1-866-NASEEHA (647-3342)

How to help:

www.gofundme.com/f/salman-family-accident-relief

June 2021 - ACT Stands in Solidarity with Indigenous Communities as we Mourn the 215 Children
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No statement or words can convey enough of our sorrow, grief, rage and despair over the discovery and report in the news over the past weekend of the remains of 215 children in a mass grave at the site of the former Kamloops Indian Residential School in British Columbia. As many Indigenous people have pointed out, Canadian colonialism and genocide is not history - it is a present and ongoing reality.

For more than 100 years, thousands of Indigenous children were taken from their families and forced into residential schools, where their languages and identities were brutally stripped from them. Many never made it home. The last residential school in Canada closed in 1996.

ACT supports the 96+ recommendations of the Truth and Reconciliation and we recognize that we must actively engage in the work of decolonization. This news is a stark reminder that we still have so much decolonizing to do right here throughout Canada and on an international basis. As Indigenous communities across Turtle Island are calling out, we stand by the claim of “All Children Matter”.

What we can all do now:

Get Educated – Truth and Reconciliation begins with Truth
Learn about the past research done by the Truth and Reconciliation Commission and about missing children, unmarked burials, and children who never returned from Residential School in the final report (volume 4) of the Truth and Reconciliation Commission of Canada.

Read "An Overview of the Indian Residential School System" a booklet for general information about the purpose, establishment, and history of the Indian Residential School system in Canada, created by the Anishinabek Nation and based on research compiled by Karen Restoule.  

Reconciliation at Work
Learn more about embedding Reconciliation into your work and agency by viewing the Guidance for the HIV Sector in Ontario: Reconciliation in Action, A Community Process.

Find Support: Crisis Line
A National Indian Residential School Crisis Line has been set up to provide support for former students and those affected by calling the 24-hour national crisis line: 1-866-925-4419.

2-Spirited Peoples of the First Nations has counselling and Elder supports available upon request. Please email support@2spirits.org

Change.org Petition: Call for a National Day of Mourning for the Lost Children of Residential Schools

Check out Idle No Morefor more updates and allied solidarity.

March 2021 - In Solidarity with the Asian Community: Stop Asian Hate Here and Throughout the World
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ACT stands in solidarity with the Asian community in Toronto, in Canada, and throughout the world and we support the local work of these organizations:

The misogynistic and racist violence in the Atlanta area killed eight people – six of whom were Asian women. Remember the names of the people that are gone too soon: Daoyou Feng, Delaina Ashley Yaun, Hyun Grant, Paul Andre Michels, Soon Chung Park, Suncha Kim, Xiaojie Tan and Yong Ae Yue.

Here at ACT, we oppose xenophobia, misogyny, anti-sex work and anti-Asian violence. We recognize that anti-Asian racism is also a local issue. Violence towards Asian Canadians has increased by 700%, while anti-Asian misogyny has also increased since the pandemic began last year. The Chinese Canadian National Council, Toronto Chapter (CCNC Toronto) has released a report about anti-Asian racism during COVID-19 in Canada. 40% of the anti-Asian racist incidents over the past year were reported in Ontario. Asian survivors who identify as women represent close to 60% of all reported cases, while those who identify as men are twice as likely to report a physical assault, compared to women. The fight against systematic oppression, misogyny, and anti-Asian racism – and racism of any kind - is also our fight. As is our fight against homophobia, transphobia, heterosexism and HIV-related stigma and discrimination. 

In an effort to support community members from our priority populations affected by anti-Asian racism, ACT continues to offer the following:

  • Counselling (free and confidential) during our virtual drop-in hours starting Friday, March 26, Monday, March 29 and Wednesday, March 31. Please contact us at counselling@actoronto.org to schedule your appointment.

Here are some resources that are available for our Asian community members, and community members who need support during this difficult time:

March 2021 - Rising Above the Pandemic: Fighting for Justice For All - Toronto International Women’s Day 2021
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International Women’s Day (IWD) is recognized each year on March 8th, to celebrate the political, social, and activist achievements of women past, present, and future. The origin of IWD is marked by major events of the early 20th century, including on February 28th, 1908, when 15,000 women in New York marched on the platforms of better pay, shorter working days, safety standards, the right to unionize and voting rights.

For over 40 years, Toronto has held the largest event in North America recognizing IWD. Our annual rally and marches are organized by the IWD Organizing Committee. These events represent a tradition of protest and political action for women’s liberation. It is a celebration of women’s unparalleled contributions to society and the diverse voices and experiences of womanhood.

The theme of this year’s International Women’s Day is Rising Above the Pandemic: Fighting for Justice. This theme encompasses demands to examine and address the intersection of women’s struggles with anti-Black and anti-Indigenous racism, and act on the material ways that women experience multiple forms of oppression. Such demands include increased sick days, implementing living wages, universal childcare, reproductive rights and freedom, access to affordable housing and a stop to rent evictions, to name a few.

The COVID-19 pandemic has had a gendered and racialized impact, which is grounded in systemic inequalities that impact all of us. The pandemic measures and circumstances have exposed and exacerbated disparities in physical and mental health outcomes, quality of life, economic insecurity, self-determination and health service access. These impacts are disproportionately experienced among women from racialized communities, trans women and non-binary folks.

We know that:

  • 57% of all COVID-19 cases in Ontario are among women.
  • 44% of COVID-19 cases are among newcomers and refugees.
  • In Toronto, people of colour make up 83% of reported COVID-19 cases, while only making up half of Toronto's population.
  • Women from various racialized communities work disproportionately in industries characterized by precariousness, low wages, and have high exposure rates to COVID-19 due to a lack of workers rights, proper PPE, and unregulated working conditions. These industries include homecare, personal care, service industries, long-term care, and in some areas of nursing.
  • There is a greater demand on women to be primary caregivers within the home, while increasingly experiencing gender-based violence as the pandemic continues.
  • Women are experiencing more economic stress due to rent evictions, cost of living, and higher unemployment.

All these factors and more add to women’s inability to access necessary support services. This is why women and our allies at ACT advocate for a comprehensive strategy to the COVID-19 crisis that responds to the gendered and racialized impact of the pandemic.

ACT is committed to meeting the healthcare needs of our service user population. We provide services to over 200 women who come from multiple backgrounds that face discrimination related to race, gender, sexuality, class, HIV status, substance use, sex trade involvement and immigration status.

Decision-making that prioritizes profit over people’s lives and healthcare has caused unwarranted deaths. All of us have witnessed an unacceptable rise in gender and family-based violence, isolation, and the increase in community mental health crises without access to adequate resources. We at ACT call for a comprehensive strategy that responds to the social determinants of health to end this pandemic. Vaccinations alone will not do this.

As we pass the one-year mark of this pandemic, we ask all to participate in this year’s IWD to bring the calls of women, BIPOC, trans and non-binary people for a better future for all our communities and lives.

Watch Live at https://www.facebook.com/IWDToronto/

Community Resources:

  • Women’s Health in Women’s Hands (whiwh.com)
  • Assaulted Women’s Helpline: 1-866-863-0511
  • Toronto Rape Crises Centre/Multicultural Women Against Rape:1-416-597-8808
  • Worker’s Action Centre: 1-416-531-0778

 

February 2021 - The Future is Now: Celebrating and Supporting Blackness
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 The Future is Now: Celebrating and Supporting Blackness

 

This year’s theme for Black History Month is The Future is Now, an opportunity to celebrate and acknowledge the transformative contributions and work Black Canadians have made in our communities. Black History Month is an important reminder for all of us to pay tribute to the legacies of Black Resistance that has supported the progress made in HIV movements and built the foundations of our communities throughout Canada, in particular our queer and trans liberties.

Despite the incredible impact and progress in HIV prevention strategies, the current state of HIV cases within Black communities highlights a jarring reality that they are being left behind by the HIV movement (with Black communities making up 27% of reported HIV diagnoses in Toronto, and yet represent less than 9% of the Toronto population). Furthermore, in 2017, African, Caribbean, and Black women accounted for more than 50% of all new HIV diagnoses among women in Ontario, which emphasizes the reality of systemic inequality which creates division in health.

ACT is empowered by the notion that our work is to prioritize the longevity and sustainability of Black health and reduce the impact of HIV for Black communities. This should not be centred around one month, but rather, year-round. Dismantling systemic oppression takes a long time, and yet our work can be shaped today to address systemic anti-Black racism. In 2020, ACT made strides and sparked a greater sense of urgency and awakening within our own organization to mobilize our resources towards a future where Black life is affirmed, uplifted, and honoured as named by the Black Lives Matter movement. These are some examples of our work to better support Black communities as we endeavour to be accountable: 

  • In 2019 - 2020, 43% of service users assisted through Employment Action were Black.
  • 32% of service users attending Positive Youth Outreach programming were Black.
  • In 2020, we have engaged in conversations to address BIPOC service gaps within our organization.
  • Our organization underwent an Addressing Anti-Black Racism training to enhance our understanding of present implications of systemic racism on Black communities.
  • We hired a BIPOC Community Trainee to develop a BIPOC engagement strategy for the organization.
  • We created the BIPOC Engagement, Solidarity and Anti-Oppression Working group to implement anti-racist action organization-wide.

During this time of COVID-19, it is reported that Black people make up 9% of the city’s population and yet make up 26% of COVID-19 cases, highlighting again the systemic inequalities. We implore you to reflect on how you can support Black communities that have been disproportionately affected by the pandemic.

It is time we acknowledge the realities of anti-Black racism. For far too long, the Black community has been cast on the fringes of society and we have played the neutral card. It is time we take collective action to change the system, address anti-Black racism, and keep each other accountable.

Here are useful resources to share and get involved:

June 2020 - In Solidarity with Black Lives Matter
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Tuesday, June 2, 2020

In Solidarity with Black Lives Matter

ACT stands in solidarity with Black Lives Matter and protesters demanding justice, including the prompt arrest and fair trial of law enforcement personnel. We also call for wide-ranging, progressive reform to policing as well as to the racist and broken criminal justice system and other systemic barriers that disproportionately affect Black communities.
 
As we head into this Pride month, ACT implores LGBTQ2S people worldwide to join the fight for racial and economic justice and against oppression in all its forms. For over 50 years, Pride has commemorated the Stonewall riots in New York, which were led by Black and Brown trans women protesting police brutality. They demanded fundamental rights and the freedom to live without fear and violence. Now, a half a century later, and in the face of the COVID-19 pandemic, we must continue that fight in the spirit of solidarity. Let us not forget that Pride began as a protest against police brutality and the injustices LGBTQ2S people faced. The fight against systematic oppression and anti-Black racism is also our fight. As is our fight against homophobia, transphobia, heterosexism and HIV-related stigma and discrimination. 

These systems and structures have been broken for generations, and it can feel impossible to address as an individual. Through collective action, these systems can begin to be addressed and dismantled. It is important for us to amplify Black voices and for allies to listen, support and advocate, and to unlearn problematic biases and behaviours and be critical of our actions. On an individual level, here are some ways that you can take action and make a difference:

https://blacklivesmatter.ca/donate/

https://www.gofundme.com/f/justice-for-regis

https://www.gofundme.com/f/georgefloyd

https://www.toronto.ca/city-government/council/my-local-government-its-for-me/have-your-say/

June 2019 - Queering Sexual Health Services in Toronto
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Queering Sexual Health Services in Toronto

Excerpt from Sex, Stigma, and Healthcare Systems: Community consultation series – Final report (2019)

Mike Smith I ACT

April 2019

From June 2018 to November 2018, 45 community consultation informants described barriers to healthcare impacting their ability to access services in Toronto. Some informants’ perceptions of healthcare services are positive, yet the majority of informants have had negative experiences and perceive elements of health services as problematic, especially sexual health services. With sexually transmitted and bloodborne infection (STBBI) transmission rates continuing to rise among cis and trans gay, bisexual, and queer (GBQ) guys[1], there is an urgency to adapt Toronto sexual health services to address population needs.

In our interviews, informants faced difficulty and distress when accessing sexual health services. Efforts to access adequate care often results in experiences of anxiety, shame, and discomfort. Informants expressed a perceived need for designated queer spaces and specialized services to address GBQ culture, experiences, and unique healthcare needs. As stated by Levesque, “health services should respond to the population’s characteristics to ensure the people’s capacity to use the services when facing need for care.”[2] This suggests that healthcare systems and services should be adapted to address specific healthcare barriers among diverse populations; and that services designed to serve members of the general population may be inherently less effective in serving the needs of cis and trans gay, bisexual, and queer guys.

The 6 Cs for improved healthcare access:

Informants offered many suggestions on how to improve access to services. These priorities can be summarized into the 6 Cs for improved healthcare access. This approach outlines informants’ perceived needs for improved experiences when interacting with healthcare services (see Figure 1):

Convenience – Make services easier to access

Increase service hours, schedule service hours during evenings and weekends, and open new spaces outside of the downtown core. Reduce wait times by introducing self-administered intake and risk assessment forms. Provide more drop-in services rather than exclusively appointment-based services. Allow service users to wait in spaces other than crowded waiting rooms if long wait times persist.

Comfort – Make services more enjoyable to access

Balance efficient operations with exceptional customer service to reduce service users’ feelings of anxiety, fear, and shame. Use patient-centred communication strategies that demonstrate compassion and empathy. Create a warm and inviting atmosphere with soothing imagery, open space, natural lighting, and calming sounds. Eliminate shame-inducing health education and counselling approaches.

Cultural connection – Make services more relevant

Design services to align with the values of diverse service users. Design services that respond to the distress preventing folks from accessing services. Ensure the imagery and staffing reflect this diversity. Invoke a sense of belonging and safety in clinical spaces for underserved populations such as racialized and gender-diverse folks. Demonstrate high levels of knowledge (or demonstrate an intention to learn) to increase perceptions of service suitability. Prepare staff to communicate using trans-inclusive language.  

Choice – Make services more empowering

Empower service users to have an increased element of self-determination when accessing services. Offer multiple types of tests, types of counselling and education methods, types of support services made available, types of treatment plans, and so on. Considering that some service users may not feel comfortable reporting certain behaviours during screening or risk assessments, increase flexibility when determining eligibility for services. 

Confidentiality – Make services more private

Make every effort to create discreet and private services. Provide anonymous services when possible and protect service users’ identities for non-anonymous services. Design clinical spaces to address service users’ privacy concerns; for example, consider having multiple wait rooms or private spaces for intake meetings.

Communication – Make services more well known

Produce promotional materials that engage specific sub-populations. Create multi-media health education campaigns for underserved populations, including folks who use substances, sex workers, and Two-Spirit folks. Measure the reach of these campaigns to indicate strengths and areas of improvement for communication strategies. Provide detailed information about testing and treatment protocols, clinical processes, how personal information will be stored, and so on.

For a thorough description of these findings, please refer to Sex, Stigma, and Healthcare Systems: Community consultation series – Final Report (2019), available soon at www.actoronto.org.

Toronto healthcare service agencies (and agencies throughout Canada) are encouraged to apply these findings and discover new opportunities to improve healthcare access for existing and prospective service users.

[1] Toronto Public Health (2017). Sexually Transmitted and Bloodborne Infections. Communicable Diseases in Toronto.

[2] Levesque, J., Harris, M., Russel G. (2013). Patient-centred access to health care: conceptualizing access at the interface
of health systems and populations. International Journal for Equity in Health, 12(18).

Nov 2018 - Trans Rights Are Human Rights - Response to Resolution R4
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Tuesday, November 20, 2018

Trans Rights Are Human Rights.

Today is Trans Day of Remembrance and we want to let our trans community know that their gender identity matters, and we have your back. While Premier Doug Ford has stated publicly that he has no intention of moving forward on the Ontario PC Party resolution, which was passed at the party convention this past weekend (which stated that gender identity was a “Liberal ideology” and that references to gender identity should be removed from the Ontario sexual health education), it’s disturbing to know that in 2018, such views are held by a major political party. We’ve already seen this government roll back the update to Ontario’s sexual health education curriculum. This will have damaging effects on students as they will no longer be supplied with the knowledge they need about consent, online sexual harassment, bullying and sexual health education inclusive of those in same gender relationships. To suggest that gender identity is “not real” is deeply rooted in transphobia.

Trans people continue to face violence, and not recognizing their gender identity is a form of violence. The passing of this resolution is a fundamental attack on the rights of queer and trans people and their rights. Because trans rights are human rights.

We at ACT want to let our trans family know that we see you. Your gender identity matters and we will continue to fight with you for your right to self-identify.

We kindly ask our community to continue speaking up and standing up against transphobia, homophobia and other oppressive behaviours.

 

Oct 2018 - Police Involvement in Pride Toronto 2019 Parade
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There is no pride in policing.

The police should not be allowed at the Pride parade. At least not yet.

Pride started as a protest against the police and their raids on Toronto bathhouses in the early 1980s. ACT was formed 35 years ago by a group of activists and allies from the LGBTQ community to fight for our lives and the lives of people living with HIV and AIDS. Pride became a platform where we expressed our resistance and our collective rage towards institutions that continued to discriminate against us, as men in our community were dying. 

We remember our history and our roots. We haven’t forgotten about the violence queer people – especially queer, trans, disabled, Black, Indigenous and other people of colour - have experienced and continue to experience today, including from the police. This is why ACT needs to express our disappointment with Pride Toronto. We believe that the decision to allow uniformed members of the Toronto Police Services to apply to march in the 2019 Pride Parade has been made prematurely and without meaningful consultation with the community.

What improvements have the Toronto Police Services made over the past two years to establish a better relationship with the LGBTQ community? Let us not forget the bathhouse raids in 1981, the Pussy Palace raid in 2000 and Project Marie in 2016, when the police focused resources to arrest men in a Toronto park at the same time they were “expressing regret” for the bathhouse raids and dedicating a mural in the Church Street Village. Remember the missing and murdered members of our community including Sumaya Dalmar and Alloura Wells, Tess Richey, Selim Esen, Abdulbasir Faiza, Majeed Kayhan, Kirushna Kanagaratnam, Andrew Kinsman, Dean Lisowick, Soroush Mahmud and Skandaraj Navaratnam, whereby the police failed to respond to the community’s concerns.

Let’s also remember the HIV-phobic comment that was made by the police in 2017 when they tasered a man who was already restrained, while telling bystanders that “he’s going to spit in your face and you’re going to get AIDS.”

The fight against systematic oppression and anti-black racism is also our fight. As is our fight against homophobia, transphobia, heterosexism and HIV-related stigma and discrimination. 

Our work in preventing new HIV infections and supporting those living with HIV involves working with diverse, marginalized communities including diverse groups of women, non-binary folks, and cis and trans gay, bisexual, and queer guys.  

We call for both meaningful engagement with our diverse communities, and concrete actions to build trust between the community and the Toronto Police Services before allowing uniformed members of the service to march in the Pride parade.

Aug 2017 - Harm Reduction Services for People Who Inject Drugs in Toronto
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Introduction to issue:
People who inject drugs are more vulnerable to acquiring hepatitis C and HIV. In Toronto, people who inject drugs have also been dying from overdoses at an increasing rate. Harm reduction distribution and establishing integrated supervised injection services are effective public health tools for reducing the spread of HIV and hepatitis C, and preventing unnecessary deaths from overdoses. For these reasons, ACT fully supports Toronto establishing comprehensive harm reduction services that protect people who inject drugs and affirms their right to healthcare services.



Background + context:

In 1989, and in the face of ardent opposition from the police, Toronto Public Health began offering unused injection drug gear as part of a new needle distribution program called the Works. The program was initially set up in direct response to high rates of HIV and AIDS among people who inject drugs.

Toronto Public Health’s Harm Reduction Distribution Program has since expanded to cover many areas of the city and has been highly effective at preventing HIV from spreading. It has been found that the prevalence of HIV among people who inject drugs is approximately 3%, one of the lowest among major North American cities. However, upwards of 70% of people who inject drugs in Toronto were living with hepatitis C.1 

In 2012, St. Michael’s Hospital and the University of Toronto published the results of a feasibility study into supervised consumption sites in Toronto. The authors recommended that Toronto “would benefit from implementation of supervised injection facilities” and that “the optimal model” for such sites was a “fixed facility that is integrated within an existing organization.”2  In 2017, the City of Toronto Public Health Department approved three supervised injection sites to be located at Public Health (The Works), Queen West-Central Toronto Community Health Centre, and South Riverdale Community Health Centre. These agencies are three of the busiest needle distribution programs in Toronto and together they distribute almost 75% of sterile needles in Toronto. 3

Between 2004 and 2015 (the most recent figures available), deaths resulting from overdoses increased by 73%, from 146 to 253. When looking specifically at deaths from accidental overdose, the numbers have jumped by more than 149%, going from 82 in 2004 to 204 fatalities in 2015. The reason for such a rise is understood to be an increase in the prevalence of narcotics such as fentanyl and heroin. 4

Toronto’s Overdose Action Plan (2017) outlines 10 recommendations, two of which are related to the work of ACT; Recommendation #2: Overdose Protocols and Naloxone, and Recommendation #9: Social Factors. ACT is committed to meeting these recommendations through its policies and procedures, resources, and by training its staff.

Conclusion:
ACT supports equitable access to life-saving health services for all people living with and affected by HIV and AIDS, including people who inject drugs. We acknowledge that some people who inject substances may not be ready, willing, or able to begin treatment to reduce their use. For this, we encourage all proposed and future supervised injection sites to offer a range of supports to help care for people who use drugs who struggle with addiction, HIV and AIDS, hepatitis C, mental health challenges, and other physical sickness.

ACT believes in the benefit of comprehensive harm reduction strategies for all groups living at increased risk for HIV and hepatitis C, including safer sex tools, harm reduction distribution, safe injection sites and procedures for responding to an overdose.



1. http://www.stmichaelshospital.com/pdf/research/SMH-TOSCA-report.pdf page 11.

2. http://www.stmichaelshospital.com/pdf/research/SMH-TOSCA-report.pdf page 14.

3. https://www1.toronto.ca/wps/portal/contentonly?vgnextoid=f998163207663510VgnVCM10000071d60f89RCRD

4. Toronto Public Health, Toronto Overdose Action Plan: Prevention and Response (March 2017) page 4.

Oct 2016 - People Who Achieve and Maintain An Undetectable Viral Load Cannot Sexually Transmit HIV To Their Partners
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A growing body of evidence demonstrates that people living with HIV who are able to attain and maintain an undetectable viral load will not pass the virus on during sex, regardless of whether condoms were used. Given this breakthrough, ACT is confident in the use of effective HIV treatment as a reliable form of HIV prevention.

ACT’s position rests upon evidence from two scientifically and statistically sound, large-scale research studies. Together, they have demonstrated the effectiveness of HIV treatment and undetectable viral loads at preventing HIV transmission.

The HPTN 052 study first reported interim results in 2011 and final results in 2015.1HPTN 052 compared the rates of HIV transmission between serodiscordant (mixed HIV status) couples. In one group, the HIV-positive partner waited to start HIV treatment after being diagnosed. In the other group, the HIV-positive partner began HIV treatment upon learning of their diagnosis.

Takeaways from HPTN 052:

  • beginning HIV treatment upon learning of a diagnosis reduced the risk of onwards transmission by 96% compared to people who were HIV-positive but not on treatment
  • the study was interested in the effects of antiretroviral treatment more broadly on HIV transmission risk, not just people who attained an undetectable viral load
  • the study looked only at heterosexual transmission risk; it did not investigate HIV transmission risk through anal sex among serodiscordant (mixed HIV status) MSM couples (men who have sex with men)


The PARTNER study reported interim results in 2014 and published final results in 2016.2 PARTNER looked at the risk of HIV transmission when a person’s viral load had been rendered undetectable. The criteria used to qualify as undetectable was a viral load below 200 copies/ml of blood.3 Participants included serodiscordant heterosexual and MSM couples having condomless anal and vaginal sex. With a combined but approximate 58,000 sex acts reported, there was no linked HIV transmission between couples.

Takeaways from PARTNER:

  • effective HIV treatment lowers the viral load in many people living with HIV to undetectable levels, and an undetectable viral load renders the risk of transmitting HIV to effectively zero
  • some participants were removed from the study because their viral load ceased to be undetectable and did not return to being undetectable
  • some participants’ viral load briefly rose but then returned to undetectable levels. They were kept in the study and did not transmit HIV despite a temporary rise in their viral load4
  • the presence of an STI did not impact the risk of transmission for a person living with HIV when accompanied by an undetectable viral load5

What These Results Mean:

The results of these studies attest to the truth and power of treatment as prevention. A Canadian-born strategy, it improves the health of people living with HIV, reduces the stigma surrounding HIV, and dramatically reduces the risk of HIV transmission.6 This new research should be embraced and celebrated. It should also serve as further motivation to ensure all people living with HIV in Canada and around the world have access to HIV treatment and the supports to remain adherent.

The results of these studies are definitive but that does not mean there are not considerations. The authors of the PARTNER study report a 95% confidence limit to its data and explain that “with eligible couple-years accrued so far, appreciable levels of risk cannot be excluded, particularly for anal sex and when considered from the perspective of a cumulative risk over several years.”7 If concerned about STIs or pregnancy, an undetectable viral load is not applicable and other safer sex methods should be used.

ACT also recognizes that for some people living with HIV, attaining and maintaining an undetectable viral load may not be possible. Reasons for this are complex and relate to both treatment access, treatment effectiveness and personal health challenges. As a result, we understand the benefits of an undetectable viral load to be absolute but further work is required to extend the benefits to as many people living with HIV as possible. While HIV treatment will not always yield an undetectable viral load, it can consistently lower viral loads and generate a host of benefits to the overall health and well-being of people living with HIV.

ACT is dedicated to strengthening the health and well-being of the communities it works with, and recognizes its role in communicating the benefits and limitations of emerging HIV treatment and prevention technologies. We will continue our tradition of challenging HIV-related stigma and commit to achieving our vision of a Toronto with zero AIDS-related deaths and zero new HIV infections. Treatment as prevention and undetectable viral loads are crucial to securing this optimistic future.



1. Cohen MS; Chen YQ; McCauley M; et al. (August 2011). "Prevention of HIV-1 infection with early antiretroviral therapy". N. Engl. J. Med. 365 (6): 493–505.
2. Rodger AJ, Cambiano V, Bruun T, et al. Sexual Activity Without Condoms and Risk of HIV Transmission in Serodifferent Couples When the HIV-Positive Partner Is Using Suppressive Antiretroviral Therapy. JAMA. 2016;316(2):171-181.
3. This is a significantly higher threshold than in Canada, which defined undetectable as a viral load below 50 copies/ml of blood.
4. Rodger, Cambiano, Bruun et al, “Sexual Activity Without Condoms,” 177.
5. Rodger, Cambiano, Bruun et al, “Sexual Activity Without Condoms,” 179.
6. Montaner JS, Hogg R, Wood E, Kerr T, Tyndall M, Levy AR, Harrigan PR. The case for expanding access to highly active antiretroviral therapy to curb the growth of the HIV epidemic. Lancet. 2006 Aug 5; 368(9534):531-6.
7. Rodger, Cambiano, Bruun et al, “Sexual Activity Without Condoms,” 179.

Oct 2014 - Pre-Exposure Prophylaxis (PrEP) as a form of HIV prevention
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This paper was originally published in October, 2012. To ensure its accuracy, updates have been made as new data surrounding the efficacy of and access to PrEP emerge.

The AIDS Committee of Toronto (ACT) supports the introduction of innovative strategies that help to reduce the transmission of HIV, including Pre-Exposure Prophylaxis (PrEP).

ACT believes that PrEP should be a part of a comprehensive approach to HIV prevention that includes access to condoms and lubricants, risk reduction counselling, information provision, the scale-up of social and behavioural interventions, access to regular and voluntary HIV and STI testing, community development activities, as well as the development of other biomedical interventions such as mircobicides.

While PrEP is not licensed for use in Canada as an HIV prevention method, it is being prescribed "off label" for these purposes. ACT encourages the implementation of PrEP in Canada and welcomes further research to inform individuals, communities and health care providers regarding its use as an HIV prevention technique. ACT is concerned about the costs associated with accessing PrEP off-label in Canada and encourages its coverage under both private and public drug plans.


Background:

In July 2012, the US Food and Drug Administration (FDA) approved the licensing of the anti-HIV medication Truvada for PrEP, and have developed guidelines for PrEP eligibility and implementation1. Truvada’s safety and efficacy for PrEP were demonstrated in two large, randomized, double-blind, placebo-controlled clinical trials: The iPrEx trial evaluated Truvada in 2,499 HIV-negative gay men or transgender women who have sex with men with evidence of high risk behaviour for HIV infection, such as inconsistent or no condom use during sex with a partner of positive or unknown HIV status, a high number of sex partners, and exchange of sex for commodities. Results showed Truvada was effective in reducing the risk of HIV infection by 44 percent compared with placebo in this population. Efficacy was strongly correlated with drug adherence in this trial: in a sub-study that measured Truvada drug levels in participants, comparing those with drug measured in their blood (i.e. those that were adherent with their medications) to those with no drug measured in their blood (i.e. those that were non-adherent), the effectiveness of reducing the risk of HIV infection rose to 92 percent.

The Partners PrEP trial was conducted in 4,758 heterosexual couples where one partner was living with HIV and the other was not (serodiscordant couples). The trial evaluated the efficacy and safety of Truvada and Tenofovir versus placebo in preventing HIV infection in the uninfected male or female partner. Results showed Truvada reduced the risk of becoming infected by 75 percent compared with placebo.

As these large-scale trials continue to develop, the efficacy of PrEP, when taken daily, is being shown to reduce the transmission of HIV by over 90% and as high as 99%.

PrEP was also endorsed by the World Health Organization (WHO) for use among men who have sex with men that may be at higher risk for HIV infection in July 2014 2.

According to the FDA, “Truvada for PrEP is meant to be used as part of a comprehensive HIV prevention plan that includes the following:

  •  HIV risk reduction counselling
  • consistent and correct use of condoms
  • regular HIV testing (at least every three months)
  • screening and treatment for sexually transmitted infections (STIs)."


Truvada will not prevent the transmission of other STIs including syphilis, gonorrhea and chlamydia. Some STIs increase the likelihood of HIV infection. Regular STI testing and treatment is therefore integral to the use of PrEP.

When used as PrEP, Truvada should be taken every day in people who are confirmed to be HIV negative. The FDA warns that when used as PrEP, Truvada must not be prescribed to patients whose HIV status is ‘unknown’ (ie. they have not been tested for HIV) or who are HIV-positive (as this could lead to the development of drug resistance as Truvada is always prescribed in combination with other anti-HIV medications for those who are HIV-positive). The FDA encourages physicians to test their patients who use PrEP for HIV at least every three months.

Truvada is not approved in Canada or other countries for use as PrEP; it is however, approved for HIV treatment and is therefore available with a prescription. Truvada manufacturer Gilead Sciences has yet to seek approval for Truvada as PrEP in Canada, Western Europe and Australia. In Canada, a month’s supply of Truvada (for HIV treatment) costs between $800 - $1,100 per month.

Concerns exists as to whether public and private drug plans in the US will cover the costs associated with Truvada as PrEP, thus reducing access to PrEP for those who might benefit the most from it.

ACT is dedicated to strengthening the health and well-being of the communities it serves and recognizes its role in communicating the benefits and limitations of emerging HIV prevention technologies. ACT is optimistic about the implementation of PrEP in Canada, but is concerned about the costs associated with accessing PrEP off-label in Canada. To that end, we encourage its coverage under both private and public drug plans, and support efforts to achieve such access.



1 Interim Guidance: Preexposure Prophylaxis for the Prevention of HIV Infection in Men Who Have Sex with Men:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6003a1.htm?s_cid=mm60

2. WHO: People most at risk of HIV are not getting the health services they need
http://www.who.int/mediacentre/news/releases/2014/key-populations-to-hiv/en/

Jan 2014 - Need For Equal Access to Post-Exposure Prophylaxis (PEP) in Ontario
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Post-exposure prophylaxis (PEP) is a four-week daily dose of anti-HIV medications in pill form that can possibly stop HIV infection if taken within 72 hours of potential exposure. (ii, iii, iv, v, vi)

In Ontario, access to PEP is subject to a healthcare provider’s discretion. It can be argued that people who are exposed in the workplace to body fluids that may contain HIV (e.g. a healthcare worker who accidentally suffers a needle-stick injury) or in emergency circumstances, such as a sexual assault, elicits one response, while those people whose exposure to HIV is through unprotected sex, a condom break during sex or shared needles elicits another. ACT believes that PEP be prescribed to individuals regardless of method of exposure.

Barriers to accessing PEP include incorrect assessments, the cost of PEP medication and a lack of information regarding prioritization or awareness of PEP among health care providers. These barriers can reduce the timeliness in which people receive treatment or the prescription of anti-HIV medications with difficult side effects.

It is estimated that 646 people were infected with HIV in Toronto in 2012. Each HIV infection prevented in Canada is estimated to save our health care system between $242,686 and $376,785.(vii)

While PEP is offered free of charge in a sexual assault situation and in many occupational exposure situations, the cost of a month’s supply of PEP for an individual in Ontario can cost between $900 - $1300 depending on the medications prescribed and requires private health insurance to cover it.(viii)

ACT believes money should not be a barrier for an individual’s access to PEP and that a provincial standard of care for non-occupational PEP is long overdue.

This disparity between Ontario and other provinces and jurisdictions’ standards leaves Ontarians at a greater risk of a potentially preventable disease.

It is imperative that the government of Ontario extend treatment coverage of PEP to all Ontarians and establish provincial standards of care for all types of HIV exposures; and to ensure that all health care providers are informed and equipped to provide service to people who have been potentially exposed to HIV in a timely and respectful manner.

Background
After potential exposure to HIV in the workplace and in sexual assault circumstances the cost of PEP is covered through Ontario’s health care system. ACT believes that other circumstances of exposure such as consensual sex or drug use also merits the same, consistent coverage.

Affordability, stigma and a lack of access should not be a detriment to an individual accessing medication. ACT believes that prevention is a more sustainable and considerate allocation of resources than a lifetime of treatment.

ACT believes that all Ontarians deserve access to PEP if they have been exposed to HIV, regardless of method of exposure. People who are at risk in community settings (i.e. human bites, accidental contact through discarded needles, or those that result from consensual sex or sharing of injection equipment) should be eligible for coverage. The current two-tier approach adopted by the Ministry of Health and Long-Term Care discriminates against those who have had sexual exposure. Moral judgements about people who engage in sex have no place dictating public health policy.

There is currently no standard of care for non-occupational exposure in Ontario. The decision to provide PEP lies with the healthcare provider and is made on a case-by-case basis. Many healthcare providers in Ontario are unaware of non-occupational PEP, are not trained to provide PEP, or may be unwilling to prescribe it. This means that people may be assessed differently, kept waiting longer, or prescribed older anti-HIV drugs with more severe side effects that impact people’s ability to adhere to the treatment.

PEP for non-occupational exposures is an accepted clinical practice in many jurisdictions. In Canada, Alberta, Quebec, Manitoba, Saskatchewan, Prince Edward Island and British Columbia have standard of care protocols in place. Internationally, the US, UK, Australia, Netherlands, France, Switzerland, Spain and Denmark, among others have protocols.

The present funding position of the Ministry of Health and Long-Term Care represents a contradiction. The science and efficacy of PEP treatment is not in question. We know that it works and the government recognizes this by providing access and coverage for occupational and sexual assault exposure. ACT believes coverage of PEP should be provided as part of a comprehensive HIV prevention strategy.

 


 

i. CDC. 2005. Antiretroviral Post-Exposure Prophylaxis After Sexual, Injection-Drug Use, or Other Non-occupational Exposure to HIV in the United States: Recommendations from the U.S. Department of Health and Human Services. MMWR. 54(RR-2): 1-20

ii. Tsai CC, Emau P, Follis KE, Beck TW, Benveniste RE, Bischofeberger N, Lifson JD, Morton WR. 1998. Effectiveness of postinoculation (R)-9-(2-phosphonylmethoxypropyl) adenine treatment for prevention of persistent simian immunodeficiency virus SIVmne infection depends critically on timing of initiation and duration of treatment. Journal of Virology. 72: 4265–73.

iii. Otten RA, Smith DK, Adams DR, Pullium JK, Jackson E, Kim CN, Jaffe H, Janssen R, Butera S, Folks TM. 2000. Efficacy of postexposure prophylaxis after intravaginal exposure of pig-tailed macaques to a human-derived retrovirus (human immunodeficiency virus type 2). Journal of Virology. 74: 9771–5.

iv. Cardo DM, Culver DH, Ciesielski CA, Srivastava PU, Marcus R, Abiteboul D, Heptonstall J, Ippolito G, Lot F, McKibben PS, Bell DM. 1997. A casecontrol study of HIV seroconversion in health care workers after percutaneous exposure. New England Journal of Medicine. 337(21): 1485-90.

v. Tsai CC, Emau P, Follis KE, Beck TW, Benveniste RE, Bischofeberger N, Lifson JD, Morton WR. 1998. Effectiveness of postinoculation (R)-9-(2-phosphonylmethoxypropyl) adenine treatment for prevention of persistent simian immunodeficiency virus SIVmne infection depends critically on timing of initiation and duration of treatment. Journal of Virology. 72: 4265–73.

vi. Otten RA, Smith DK, Adams DR, Pullium JK, Jackson E, Kim CN, Jaffe H, Janssen R, Butera S, Folks TM. 2000. Efficacy of post-exposure prophylaxis after intravaginal exposure of pig-tailed macaques to a human-derived retrovirus (human immunodeficiency virus type 2). Journal of Virology. 74: 9771–5.

vii. Toronto Public Health. 2012. Sexually Transmitted and Bloodborne Infections: Communicable Diseases in Toronto 2012.

viii. Shoppers Drug Mart via Toronto Public Health, September 16, 2013.

Oct 2013 - Social Assistance Review: Proposed and Recent Changes to Social Assistance in Ontario
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On October 24, 2012, the Commission for the Review of Social Assistance in Ontario released its final report and recommendations.

In the past year since the release of the report, several of its recommendations made have been implemented, including:

  • Creating a $200 monthly earning exemption for people who receive benefits from Ontario Works (OW) and Ontario Disability Support Program (ODSP).
  • Improving financial independence for OW clients by increasing the amount of assets they are able to keep before they can get help, such as a car they may need for employment.
  • Encouraging businesses to improve job opportunities for people with disabilities by establishing a Partnership Council on Employment Opportunities for People with Disabilities.1


ACT supports and commends the Government of Ontario for these positive changes to social assistance and welcomes the implementation of any recommendations that will improve the lives of people on social assistance and improve models of service delivery.

How will proposed and recent changes to social assistance affect people living with HIV/AIDS?

Many of ACT’s service users rely on ODSP or other forms of social assistance to meet their basic needs including housing, food, transportation and health care. A number of the reviews recommendations directly impact people Living with HIV/AIDS. ACT also receives funding for its employment services program (Employment ACTion) from the Ministry of Community and Social Services through ODSP, and any changes to the funding model will affect program and service delivery.

Of the 108 proposals made regarding social assistance in the review, ACT is taking a position on the following recommendations from the implementation priorities laid out in year one of the proposed provincial strategy.2 These are recommendations that may have a direct or indirect impact on ACT programs and services, and the well-being of ACT service users and members of the community.

Early Priorities identified in Brighter Prospects: Transforming Social Assistance in Ontario:

  • Moving forward on employment for people with disabilities

We strongly encourage the Ministry to modify the eligibility requirements for ODSP Employment Supports, so that once an individual is deemed eligible for ODSP Income Support they become automatically eligible for employment supports. This will eliminate the need for employment service agencies to get additional approvals prior to assisting these individuals to find employment.

ACT also supports the Ontario Disability Education Network (ODEN) position to streamline the approval process for people who have a disability who are not in receipt of ODSP Income Supports. At the same time, people with disabilities who are not able to work should not be forced to look for work.

In addition, the government should eliminate the punitive approach to people who make mistakes in income reporting and/or other documents required by ODSP.

  • Transfer ODSP delivery to municipalities

ACT does not support the downloading of social assistance, including affiliated employment service delivery, to the municipal level. There is a concern that if services are downloaded, individual municipalities may not prioritize ODSP recipients in the same way and may not dedicate the appropriate level of resources to service delivery, thereby increasing the vulnerability of this already vulnerable population. The current provincial delivery of ODSP Income and Employment Supports ensures a level playing field for delivery of services because those services are managed and delivered through one provincial body as opposed to many different municipal bodies. As the Government of Ontario is a champion of the Accessibility for Ontarians with Disabilities Act (AODA), by maintaining ODSP supports at the provincial level, the government can demonstrate its commitment to action as well as legislation.

People with disabilities (including people living with HIV/AIDS) must be viewed as a distinct group for employment services and such services must take into account the specific disability. The stigma of HIV/AIDS remains pervasive in the workplace. People living with HIV/AIDS need to have continued access to specialized employment services and supports which they need to help achieve successful employment outcomes. This requires contracting out the delivery of direct services to third party delivery agents who are specialized in providing employment services for specific disabilities.

  • Implement new performance-based funding arrangements with third-party service deliverers

The current ODSP funding model for third-party service deliverers needs to include funding for service providers for intake/assessment, skills upgrading, preparing for job readiness, job placement and retention supports follow-up while recognizing the unique needs for people living with disabilities. We understand this model is currently in place for Employment Ontario and under review with ODSP.

ACT’s Employment ACTion program experiences many clients who need a second, third or more replacement jobs due to a labour market that increasingly relies on contract work or part-time work. Helping service users to find work after their initial contracts expire requires additional employment supports which are not covered under current ODSP funding model.

  • Earnings exemption of $200/month

We applaud the government for taking this first step in increasing the earnings exemption, but feel it does not go far enough. We advocate for an exemption of up to $500 a month in earnings and/or to reduce the claw back on earnings from the current 50% to 25%.

People with disabilities should be provided with an incentive to find and keep work. As well, housing-geared-to-income should be taken into account when considering earning exemptions, as the majority of people on disability are also in subsidized housing.

  • Examine the impact of benefit withdrawal rates on the financial incentive to work to provide a better basis on which to establish the rate of withdrawal of social assistance benefits.

In today’s labour market which relies on contract or part-time work, often without benefits, people living with HIV/AIDS engaged in employment often need continuance of these benefits if they are not provided for by the employer.

  • Accelerate the implementation of the adult phase of the comprehensive mental health and addictions strategy with a focus on employment as a key outcome.

In addition to health status, some people living with HIV/AIDS often experience mental health and substance use challenges as barriers to employment and personal well being. This population needs increased supports to access high-quality services including early identification and intervention.

  • Partner with corporate leaders to champion the hiring of people with disabilities

We encourage the government to support and encourage the corporate sector to hire more people with disabilities. There are many small and large businesses who have been proactive and successful in hiring and integrating people with disabilities into the workforce. These models should be explored using a business-to-business educational approach and emphasizing the AODA. Service providers, particularly service providers with an expertise in episodic disabilities, should also be consulted and included in this process.

--

1. News Release: “Ontario Government Helping People Find Jobs, Improve Their Financial Security”, Ministry of Community and Social Services May 22, 2013

2. Lankin, Frances and Munir Sheik, Commissioners. Brighter Prospects: Transforming Social Assistance in Ontario. A Report to the Minister of Community and Social Services, 2012. Toronto, Ontario. P124-125.

Jun 2012 - Criminal Law and HIV Non-Disclosure
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ACT believes that criminal law is an ineffective and inappropriate tool with which to address HIV non-disclosure. HIV/AIDS is an individual and public health issue first and foremost, and should be addressed as such. 

 

Jul 2011 - HPV Vaccine Coverage
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ACT supports expanding access to the HPV vaccine, regardless of sex or gender, to reduce transmission of the cancer-causing virus and to save long-term health care costs. Allowing males to access the vaccine for free would allow men and women to take equal responsibility for preventing HPV, and also provide protection for gay men.

This could be implemented through a combination of the following strategies:

  • Expanding Ontario’s school-based HPV vaccination program to allow all students to participate, regardless of sex or gender.
  • Providing the HPV vaccine for free to males, females and trans people up to the age of 26, via public health units, sexual health clinics, HIV clinics and primary care physicians.


Background:

In July 2006, Health Canada approved a new vaccine to provide protection against four types of human papillomavirus (HPV), which can cause cancer and genital warts. Due to the limited research studies available at the time, Health Canada only licensed the vaccine for use in females aged 9 to 26 years. In 2007, the Government of Ontario rolled out a free province-wide school-based vaccination program for female students.

After studies demonstrated the effectiveness of the vaccine in preventing pre-cancerous anal lesions and genital warts in men, Health Canada approved its use on males aged 9 to 26 years in February 2010. However, Ontario’s school-based HPV vaccination program has not yet been extended to male students.

HPV is of particular concern to gay, bisexual, and other men who have sex with men, who are 17 times more likely to develop anal cancer than heterosexual men. Among HIV-positive gay men, the likelihood is even higher. The HPV vaccine prevents 77.5% of pre-cursor lesions to anal cancer in gay and bisexual men. Yet gay men do not benefit from the current vaccination program, and they must pay for the vaccine out of pocket, costing each individual hundreds of dollars.

Limiting the HPV vaccine to females also limits the effectiveness of the program in a heterosexual context, by reducing the number of eligible participants. Providing the vaccine for free to all eligible males would allow everyone – regardless of their sex or gender – to share responsibility for preventing HPV.

HPV vaccination not only benefits the health of the individual and our communities, but also reduces long-term costs in the health care system by preventing illnesses. In one modeling study by the Harvard School of Public Health (The Lancet Infectious Diseases. 10(12):845-52, 2010 Dec.), vaccination of gay, bisexual and other men who have sex with men would provide a cost effectiveness ratio of up to $15,290. The study found that vaccination was cost effective for this population even up to the age of 26, pointing to the benefit of expanding free access beyond school-based programs.

The health and economic benefits of HPV vaccination demonstrate the need to eliminate barriers by expanding coverage beyond the existing school-based vaccination program.

Dec 2009 - Treatment and HIV prevention
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The AIDS Committee of Toronto (ACT) believes that HIV testing and treatment should be offered to all people living with HIV, but no one should be forced to undergo either. No response to HIV can work without the engagement and voluntary participation of people living with and at increased risk of HIV.

ACT supports universal access to anti-retroviral (anti-HIV) drug therapy and other treatments for HIV/AIDS, in Canada and around the world. ACT believes that access to HIV treatment is a right of all people living with HIV/AIDS.

Recently, discussion has emerged regarding the potential of anti-retroviral treatment to be used as an HIV prevention tool. Some researchers have projected that universal application of anti-retroviral treatment could stop the global HIV epidemic in its tracks, by reducing viral load and infectiousness among those living with HIV.1

ACT supports a comprehensive approach to HIV prevention and treatment. Universal access to HIV treatment is a part of the HIV prevention response. However, any response must respect the health and human rights of people living with and at risk of HIV, and be delivered in combination with other HIV prevention methods, including:

  • access to condoms (male and female/receptive) and other barriers;
  • the development of microbicides (for both vaginal and anal use);
  • pre- and post-exposure prophylaxis;
  • voluntary, confidential and anonymous testing for HIV and other sexually transmitted infections; and,
  • needle exchanges and other harm reduction initiatives.

While ACT supports the laudable goal of increasing access to HIV treatment, and the concurrent role it can play in HIV prevention, we remain concerned about:

  • Treatment in settings without adequate viral load testing to identify cases of treatment failure, which could result in undetected viral rebound;2
  • Treatment in settings without access to second-line (ie newere) anti-HIV drug regimens which could result in increased transmission of drug-resistant HIV;2
  • The application of drug treatments that lower infectiousness, but are not medically necessary, which may have negative health impacts on those living with HIV/AIDS;3 and,
  • Universal application of treatment which violates the human rights of people with HIV/AIDS by removing the choice of when to begin anti-retroviral therapy.

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1. Montaner JSG et al. The case for expanding access to highly active antiretroviral therapy to curb the growth of the HIV epidemic. The Lancet 368: 531-536, 2006.

2. Alcorn, Keith. Treatment as prevention tool: enough evidence to say it works, says IAS president.<http://www.aidsmap.com/en/news/30D49BD7-41FC-4E0D-AEBD-A210794D0533.asp>

3. O’Neal, Reilly. Is HIV treatment HIV prevention? <http://www.thebody.com/content/art54536.html>