The Developing World Epidemic in the Developed World

1
The Developing World Epidemic in the Developed
World

• The AIDS Epidemic Among African and Caribbean
  Communities and other Black Canadians
• Presenter Esther Tharao
• Womens Health in Womens Hand CHC/
• African and Caribbean Council HIV/AIDS in
  Ontario
• August 16th, 2006

2
Introduction

• African and Caribbean people of African decent
  have become an important component of the
  Canadian epidemic
• In Ontario they constitute the fastest growing
  category of groups affected by HIV/AIDS (13.8 of
  all people living with HIV/AIDS)
• African and Caribbean women constitute
  approximately
• 33 of all HIV infections among women in Ontario
• 66 of all women living with HIV/AIDS in Toronto
• Rates of infection have increased by 87 between
  1999 and 2004 with annual increase of 13.3
  (Remis 2006).

3
Introduction (contd)

• In 2004, 18.5 of all new diagnoses in Ontario
  were among African and Caribbean people
• Substantial HIV transmission is occurring in
  Canada
• It is estimated that 22-59 of HIV infections in
  Ontario occur after migrating to Canada (Remis
  2006)
• 12.2 of prevalent infections in Canada are among
  black people

4
An Emerging Epidemic

• Community mobilization among black populations
  started in Ontario
• What were the signs of a growing epidemic?
• Rising numbers of those seeking support and care
  in the mid 90s
• Emerging data in 1997/98
• 70 of children born with HIV involved mothers
  from Africa and the Caribbean (1994-96)
• 10 of all people diagnosed with AIDS in 1996
  were African and Caribbean people
• African women constituted 32 of AIDS related
  deaths in Ontario in 1996
• Researchers produced numbers without context
  ((CAHR 1997)
• Lack of data on extent of epidemic and driving
  factors

5
Engaging African and Caribbean communities

• 1997
• 1st HIV/AIDS forum organized by the two African
  AIDS Service Organizations (ASOs)
• Aim of forum highlight status of epidemic and
  facilitate community discussion and mobilization
• 1998
• 2nd HIV/AIDS forum organized by an expanding
  circle of providers and also included government
• Aim - To share information and strategize with
  other providers on how to deal with HIV/AIDS
  issues in African and Caribbean communities
• 2000
• Working conference on Creating Strategic
  Partnerships to Address HIV/AIDS in African and
  Caribbean Communities
• Aim
• strengthening existing partnerships, identify new
  partnership opportunities in African and
  Caribbean communities
• Develop strategies for prevention and support
  services in context of the determinants of health

6
Emergence of a Strategic Plan and coordinated
Actions

• An HIV Endemic Working Group (HEWG) with expanded
  membership was formed in 1998 (ASOs, CHCs,
  government)
• Commissioning of an epidemiologic report to
  quantify the epidemic in Ontario completed in
  1999
• Working group expanded to become the HIV Endemic
  Task Force
• Role of Task Force - spearhead development of a
  strategic plan

7
Emergence of a Strategic Plan and coordinated
Actions (contd)

• Strategy to Address Issues Related to HIV Faced
  by People from Countries where HIV is Endemic
  completed in Dec. 2003
• Jan. 2004 - the HETF became the African and
  Caribbean Council on HIV/AIDS in Ontario (ACCHO).
  
• March/April 2005 ACCHO, the Strategy and
  Strategy for Life Campaign launched

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Role of ACCHO

• ACCHO has three major roles
• Coordination and support of Strategy
  implementation, revision/renewal, monitoring and
  evaluation.
• Advising and advocating on HIV/AIDS issues
  affecting African and Caribbean communities.
• Promote the greater involvement of African and
  Caribbean people living with HIV/AIDS in the
  response to HIV/AIDS.
• Goal of African and Caribbean HIV/AIDS Strategy
• To reduce the spread of HIV among African and
  Caribbean people in Ontario and improve the
  quality of life for people infected and affected
  by HIV

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Strategy Guiding Principles

• Service delivery must be based on an antiracism,
  gendered and anti-oppression framework
• Must be grounded in community based,
  participatory action and leadership
• Must foster self determination for African and
  Caribbean people
• Services must meet the needs of a range of people
  and groups (e.g., youth, women, gay men and other
  MSM, lesbians, trans people and IDUs).

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Strategy Objectives and strategic directions

• Coordination
• Service delivery within different settings
• Accountability of mainstream organizations to
  African and Caribbean Communities
• Advocacy
• Community Development
• Empowerment and capacity building
• Increasing awareness and being a voice
• Supporting local action
• Community engagement
• Research
• Setting research priorities and policies
• Promoting self determination through research
• Promoting research that is respective respectful
  and recognizes autonomy

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Activities to move strategy forward

• Setting a research agenda
• Research conference (ACCHO/OHTN) April 28-29th,
  2006 bring together researchers and community
  members to discuss and develop priorities
• Working with Public Health Agency of Canada to
  improve Epi and Surveillance reporting and Epi
  Update report production
• Undertaking research
• stigma and discrimination project partnership
  between ACCHO and the HIV Unit, University of
  Toronto
• Black MSM project
• Optimizing HIV prevention
• Expansion of prevention activities across the
  province
• HIV prevention campaign

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Activities to move strategy forward (contd)

• Capacity Building
• Prevention guidelines for service providers and
  organizations that work with African and
  Caribbean communities
• Training manual and training activities to be
  done in Toronto, Ottawa and Montreal March 2006

13
Creating a National Platform

• Have undertaken preliminary work to lay the
  groundwork for a National Strategy for Black,
  African and Caribbean communities in Canada
• Done through the National Spring-boarding project

14
Creating a National Platform (contd)

• Funded by the Public Health Agency of Canada
  through the Interagency Coalition on AIDS and
  Development (ICAD) and overseen by a national
  steering committee.
• Project Objective to conduct preliminary
  research that will contribute to the development
  of a national HIV/AIDS strategy for Black
  Canadian, African and Caribbean communities.
• Project developed in response to
• the disproportionate number of Black people
  testing HIV positive
• the need identified, Canada-wide, by AIDS service
  organizations on how to best respond to the
  increasing number of Black people testing
  positive/seeking HIV/AIDS services.

15
Creating a National Platform (contd)

• Work completed to date
• Environmental scan
• National consultation to build strategy
  framework.
• Next Phase consultation with all stakeholders
  across the country

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Lessons learned from ACCHOs Experiences

• Need to move from Epidemiologic terminology to
  the reality of who is affected AND needed to be
  included in the Strategy
• Move from populations from HIV Endemic countries
  to African and Caribbean communities
• Shift away from being the HIV Endemic Task Force
  to ACCHO
• New shift to include all black people living in
  Canada Springboard Project
• Creating room to facilitate voices within the
  African diaspora living in Canada
• Need to engage Intersectionality based on
  gender, race, sexual orientation, colourism,
  classism etc. within an anti-racist,
  anti-oppression framework