We speak out for changes that could improve the lives of people with HIV and HCV in BC.
The Pacific AIDS Network (PAN) is the collective voice representing members on issues that impact the health of people our member organizations serve. These issues can include scope and delivery of services, policy developments and directions, funding levels and availability, and social inequities affected by government decision-making.
This is some of our communication with government ministries, funders, health authorities and related allies and stakeholders. Contact our Executive Director, J. Evin Jones, for more information.
Updated BC Crown Counsel Prosecution Guidelines and Sex 2 policy
The spring of 2018 saw the publication of the updated BC Crown Counsel Prosecution Guidelines including the Sex 2 policy, which indicates how people living with HIV may be charged in cases of non-disclosure of HIV. On May 31st, we posted a blog by PAN’s Executive Director, J. Evin Jones, BC’s New Prosecutorial Guidelines on HIV Non-Disclosure Murky and Troublesome. In it she described collective “concerns that the policy is too vague and that it does not provide enough guidance – particularly given (the) lack of Risk of sexual transmission of HIV from a person living with HIV who has an undetectable viral load consensus statement mention.”
PAN sent a letter to BC’s Attorney General, David Eby on June 25, 2018. It reads, in part,
The failure of the BC Prosecution Service to adopt an evidence-based approach is of great concern. We therefore call upon you in your role as Attorney General, to work to ensure that BC prosecutors do not prosecute people in those circumstances that Justice Canada has concluded do not warrant prosecution.
PAN received a letter of response July 13, 2018. It reads, in part,
I would like to take this opportunity to clarify that it is not my role to become involved in the day-to-day operations of the BCPS [BC Prosecution Service]. The BCPS manages the prosecution function on behalf of the Attorney General. British Columbia is very different from most other jurisdictions in Canada. In British Columbia it is Crown Counsel, not the police, who decide whether criminal charges should be approved.
The Prosecution Service readily acknowledges the understandable concerns expressed about stigmatization associated with an HIV-specific offence. BCPS policies are reviewed on a regular and ongoing basis to ensure they accurately reflect developments in Canadian criminal law, respond appropriately to emerging trends or community needs—including scientific developments—and reasonably balance individual rights with societal interests..
PAN remains deeply troubled about how the Sex 2 policy may be applied, and will continue to work with provincial and national partners on this advocacy issue.
The Sex 2 Policy was updated in April 2019. As PAN Executive Director J. Evin Jones writes, “While some significant ground has been gained, these new prosecutorial guidelines fall well short of the key recommendations made by the Canadian HIV/AIDS Legal Network in its January 2019 submission to the BC Attorney General. This also feels like an opportunity lost, where once again prosecutorial guidelines are being adopted without adequate consultation with legal and scientific experts and community leaders, including people living with HIV.”
PAN Outreach to Ministry of Mental Health and Addictions
In January 2018, PAN sent a letter to Doug Hughes, the Deputy Minister, Ministry of Mental Health and Addictions to request an in-person meeting to discuss how PAN might support the Ministry of Mental Health and Addictions in addressing the overdose emergency. The letter included an introduction to PAN’s work, leadership in the opioid response, and provided background for the potential discussion. Its points include:
- Our membership includes many harm reduction agencies on the frontlines of the opioid crisis which is an ongoing priority for PAN.
- PAN as a provincial network, is committed to doing all that we can to provide support, capacity building and education for frontline workers and PWLE – the vast majority of which unfortunately do not have access to the same supports and resources as first-responders and public health/primary care workers. As documented in our widely circulated Rapid Assessment Report, responses from those working directly with the crisis, were clustered around similar needs related to supporting staff, clients, peers at the frontlines, as well as increased training opportunities, enhanced knowledge sharing, and increased funding.
- Since May of 2017, we have been meeting on an ongoing monthly basis with Ministry of Health and Ministry of Mental Health and Addictions staff to discuss areas of collaboration and for the purposes of information sharing. In late December we were pleased to invite staff from the new provincial Overdose Emergency Response Centre (OERC) to join these standing meetings.
- PAN and our members have been proud to work alongside the province, the health authorities and the BC-CfE vis-à-vis STOP. For the OD crisis, we fully support the development of a Cascade of care (like STOP) and wrap-around services (like the HIV response).
We are awaiting a response from Deputy Minister Hughes.
PAN Supports the Call for PrEP to be covered by Pharmacare
The BC government released a statement on December 28 saying “British Columbians at high risk of HIV infection will be able to receive pre-exposure prophylaxis (PrEP), a daily oral antiretroviral medication that prevents new HIV infection, at no cost.”
This move has long been advocated for by the Community Based Research Centre for Gay Men’s Health, YouthCO, and Health Initiative for Men. Their advocacy work has been supported by PAN and identified as an urgent advocacy item at PAN’s Fall Conference.
In early October of 2017, PAN submitted a letter to Premier John Horgan, Minister of Health Adrian Dix, and MLA Spencer Chandra-Herbert. PAN wrote in support of the request for PrEP to be immediately funded by the government of BC, a move advocated for by the Community Based Research Centre (CBRC), YouthCO, Health Initiative for Men (HIM), and others.
In its letter, PAN noted the pride those in BC can take in regards to advances in HIV treatment and prevention, as well strong community work:
British Columbia has led the world in providing access to HIV treatment and there is so much to be proud of in terms of the work that has been done in this province by government, health authorities, and the BC-CfE and community partners – across the continuum – to combat HIV transmission. CRBC is a recognized leader regarding gay men’s health provincially and nationally and we applaud them for taking on this important advocacy initiative.
BC must continue with its dedication to best practices:
Deeply concerning is the reality that presently more than half of new infections occur in the gay, bisexual and other men who have sex with men (gbMSM) population. Diagnoses within young gbMSM aged 20-24 doubled from 2012 to 2014, and within ethnic minority gbMSM now representing over a third of all cases.
In British Columbia, Pharmacare still does not cover TDF-FTC for HIV prevention. Without public access, the most vulnerable individuals will not have access to this effective prevention tool. Given this government’s commitment to harm reduction, we are asking you to direct BC Pharmacare to immediately offer full coverage for TDF-FTC for HIV prevention.
PAN received a response to our letter later in the month. In essence, it says:
At this time, Truvada for PrEP is still under review by the Ministry of Health (the Ministry), and the BC Centre for Excellence in HIV/AIDS (the Centre) currently does not provide routine coverage for PrEP of HIV. The Ministry is working with the [BC Centre for Excellence in HIV/AIDS] on this review as well as determining the best available generic drug pricing. Our aim is to complete the review and make a decision before the end of this year.
We encouraged groups and individuals to advocate for this funding sooner rather than later to avoid the likelihood that more people become infected.
On December 22, 2017, PAN sent another letter to Minister of Health Adrian Dix.
We were pleased to see the government announcement about publicly funded PrEP on December 28,.
Welcome to Incoming Minister, Mental Health and Addictions and Minister of Health (2017)
PAN sent a letter to Judy Darcy, Minister, Mental Health and Addictions and Adrian Dix, Minister of Health, in July 2017. We expressed our congratulations and hope that we may work together in addressing the ongoing opioid crisis.
(Excerpt:) On behalf of the member organizations of the Pacific AIDS Network (PAN), we would like to extend our sincere congratulations to both of you upon your appointment as Minister, Mental Health and Addictions and Minister of Health, respectively. We also wish you and your colleagues every success as our new provincial government. It is an exciting and dynamic time for British Columbia!
Clearly, there are many challenges that lie ahead – not the least of which is the ongoing public health crisis of overdose and overdose deaths. We are heartened by Premier Horgan’s obvious passion and determination to address this situation, as is evidenced by his many public statements as well as by the creation of a new Ministry of Mental Health and Addictions.
PAN and our member organizations share this determination. PAN is a proactive provincial network of almost 50 community-based and allied organizations working to address HIV, HCV and related conditions. We facilitate communication and the sharing of best practices, and provide professional/workforce development and leadership trainings to our members and people living with HIV (PLHIV) from throughout BC. Our members include many harm reduction agencies on the frontlines of the fentanyl and opioid crisis in communities throughout BC.
Since Dr. Kendall declared a public health emergency in April 2016, we have seen some important policy changes and shifts by both the federal government and the province. The creation and resourcing of overdose prevention sites (OPS) in communities across BC; the repeal of the so-called Respect for Communities Act and subsequent federal approval of five new supervised consumption sites in BC (in the DTES, Kelowna, Kamloops and two in Surrey including an exemption to supervise consumption of oral and intra-nasal substances at Safepoint) are welcome developments in harm reduction. The everbroadening distribution of no-charge naloxone kits through the Take Home Naloxone Program; and the increasing numbers of people starting on, and physicians prescribing, opioid substitution/agonist therapy (OAT) are also good progress.
However, the ongoing death toll and related damage clearly indicate that more is needed. We need an increased level of investment – particularly at the community-based/frontline level – to support treatment, prevention and above all harm reduction. We urge you to consider scaling up evidence-based practices such as OPS and OAT; and to further resource harm reduction agencies and programs that are effectively providing low-barrier services that help to link people to care and to keep them on treatment. Further, combatting this crisis will also require a willingness to try new and novel approaches.
PAN and our member organizations offer themselves as enthusiastic partners to you and your colleagues to combat this crisis. We also recognize that the relationship between your ministries, the health authorities and community-based organizations will be critical ones. Given our decades of experience addressing the HIV epidemic, and with grassroots mobilizing and innovating, PAN and our members are uniquely positioned to: test new and novel approaches along the continuum of care; to scale up effective, low barrier harm reduction services; to engage people where they are at; and to help facilitate consultation and meaningful engagement with people with lived experience.
PAN as a provincial network, is committed to doing all that we can to provide support, capacity building and education for frontline workers and PWLE – the vast majority of which unfortunately do not have access to the same supports and resources as first-responders and public health / primary care workers. We are also committed to advocating for a stronger, more coordinated response to the crisis and to greater levels of accountability at all levels – government, health authority, police and law enforcement and from our own network. We know that these are commitments that each of you, and Premier Horgan share. We would greatly welcome the opportunity to meet with you, to further discuss how PAN and our member organizations might serve to support you in your roles, and in addressing the overdose crisis.
Federal Funding (2016)
At PAN’s 2016 Executive Directors Summit, one of the two key topics that participants identified as pressing for the session was the concerns regarding the process, outcomes and next steps of the Public Health Agency of Canada’s (PHAC) HIV and Hepatitis C Community Action Fund (CAF). Earlier in the fall, PHAC announced the decisions of the funding competition’s Letter of Intent (LOI) process, and those decisions had significant implications for HIV and HCV service delivery in BC. During the Summit, PAN member ED’s and other leadership discussed key messages (initially developed by the PAN Board of Directors at their face-to-face board meeting the day before) for a letter from PAN to the Minister of Health Dr. Philpott.
Following the ED Summit, a letter containing these key messages was sent to Dr. Philpott on November 2nd, and PAN received a response letter from the Minister on December 13th. The Health Minister’s response invited a meeting between PAN and the President of PHAC, Dr. Mithani; as well as the Chief Public Health Officer.
A face-to-face meeting between PAN senior staff, Dr. Mithani and two key PHAC regional representatives was subsequently arranged and took place in Vancouver on January 17th, 2017. During this meeting, the concerns held by PAN and its members about the CAF funding process, decisions, and implications on service delivery were discussed. Dr. Mithani acknowledged those concerns. The President also sought feedback on PAN’s recommendations as to how to potentially improve: funding competitions and communications regarding PHAC funding priorities in the future. A key topic of conversation was how to effectively evaluate PHAC funded community-based programs and thereby ensure “maximum impact”. Together, PAN and PHAC committed to working together to maximize the collective impact of community support and services addressing HIV, HCV and other STBBIs.
Moving forward, PAN will continue to follow up with PHAC staff at regional and national levels, as required, to best support various member organizations through the transitional and “top up” funding processes. Along with our member organizations, and allied stakeholders and partners throughout BC and Canada, PAN will also continue to call more funding for the sector (including advocating for dedicated funds for HCV and other STBBIs). If you have any questions regarding PHAC’s HIV/HCV CAF or PAN’s work on this critical issue, please contact PAN’s Executive Director, J. Evin Jones via email [email protected].
HPV Vaccine Advocacy
On January 14, 2015 PAN wrote a letter to the Honourable Terry Lake, Minister of Health,, to request that the Minister consider broadening the current HPV vaccine program in BC to include all genders, and in particular, those living with or at-risk of HIV and HCV. A letter of response was received from Warren O’Briain, Executive Director, Population and Public Health Division.
Subsequently PAN launched an advocacy initiative in March 2015, which involved writing to all of the Executive Directors of PAN member organizations to encourage them to write their own letter to the Minister of Health advocating for “accessible, free HPV vaccination program for all genders and especially for people living with or at-risk for HIV and HCV” as well as calling for a universal, school-based vaccination program for boys as well as girls.
In part because of this work, in July 2015 the Ministry of Health announced an expansion of the current BC publicly-funded HPV vaccination to boys and young men — who are gay, bisexual or MSM or who are otherwise at risk, up to the age of 26. Starting September 1st 2015, this expanded eligibility of BC’s publicly funded HPV vaccine program, for boys and young men at a higher risk of contracting HPV, included HIV-positive males, 9 to 26 years of age (inclusive of those who may not yet be sexually active and are questioning their sexual orientation).
PAN also worked to collate and gather research relating to the HPV vaccine, HIV and gay men and other MSM in the blog post titled: Possibilities for Protection: HPV, HIV and MSM.
On June 28th, 2016, PAN again wrote to the Honourable Terry Lake, Minister of Health to respectfully reiterate our request that BC’s HPV Vaccination program be expanded, to create a gender neutral vaccine program that is truly universal in nature, AND to take measures to ensure free access to this vaccine for all people living with HIV/AIDS, regardless of age, sexual orientation or gender. As the letter states, the Pacific AIDS Network believes that providing the vaccination at no cost to people living with HIV/AIDS, should be an essential part of our public health care system. From a prevention perspective, the HPV vaccine should also be provided on a gender-neutral basis, as a means of both averting HPV and associated cancers, as well as reducing the incidence of HIV transmission.
In a letter dated July 26th, 2016, Minister Lake responded to our letter. In his response, the Honourable Minister notes that decisions with regards to the province’s vaccine program(s) are made on an annual basis by the Communicable Disease Policy Advisory Committee, chaired by the Provincial Health Officer. When making decisions, the Committee takes into account a number of factors, including efficacy, burden of illness, cost-effectiveness, feasibility of delivery and public acceptability. The letter further states, “Recent analyses have shown that a universal male HPV vaccine program is not cost-effective at current vaccine prices, particularly in jurisdictions where female uptake of the vaccine is higher than 50 percent, as it has been in BC since the program began in 2008. In this context, the Committee has recommended HPV immunization for school-aged males be considered only if the vaccine becomes available at a price substantially less than its current cost.” The Minister also states: “I am acquainted with the risks associated with HPV-related disease among people co-infected with HIV; to date, the Committee has not recommended a universal HPV vaccination program for individuals living with HIV.”
Emergency Intervention Disclosure Act
On May 9, 2012 PAN met with the Honourable Margaret MacDiarmid, Minister of Labour to express our concerns about Bill 39, the Emergency Intervention Disclosure Act, into law. The stated goal of the legislation is to enhance the safety of first responders. PAN expressed concerns that this legislation is not evidence-based and violates a persons’ rights to privacy and security.
On June 15/12 PAN wrote to the Provincial Health Officer, Dr. Perry Kendall, to formally lodge a standing request with the Provincial Health Office that we be notified when the provisions are invoked in the province and under what circumstances.
Read the full letter to Dr. Perry Kendall.
Read Dr. Perry Kendall’s letter of response.
Federal Funding (2011)
On June 6, 2011, HIV/AIDS Networks from across Canada sent a joint letter addressed Federal Minister of Health Leona Aglukkaq regarding the future of the AIDS Community Action Plan program through the Public Health Agency of Canada. Among other things, the letter requests that no further funding cuts be given to the ACAP regional budget as current levels are already creating hardship among ASOs. Further, the letter requests copies of the final consultation report on ACAP, conducted by the firm of Raymond Chabot Grant Thornton, be given to those organizations that participated in the process.
Read the full letter to Federal Minister of Health Leona Aglukkaq.
Federal Funding (2011)
In the fall of 2010, multiple organizations throughout BC received confirmation of HCV funding from the Public Health Agency of Canada. Due to the federal elections, contribution agreements for these projects were not signed and community organizations have been waiting to hear on the status of these agreements.
Read the joint letter from PAN and the Pacific Hepatitis C Network to Federal Minister of Health Leona Aglukkaq sent June 2, 2011.
Provincial Commitment to Community-Based Response Role in Seek and Treat for Optimal Prevention (STOP)
As a result of communication in 2009 (see below) with the Ministry of Healthy Living and Sport, PAN was invited to meet with the Honourable Ida Chong on February 24, 2010. Read a copy of the briefing note presented at that meeting.
Read a copy of the thank you letter that was sent to Minister Chong following the face-to-face meeting on February 24, 2010.
Community-Based Response in the Seek and Treat for Optimal Prevention (STOP) Rollout
In the Spring 2009 meeting, the member organizations of PAN set a number of priorities for the Network over the coming year. One of the requests made was that PAN prepare a communications brief for the Minister of Health and Minister of Health Living and Sport, describing the state of the HIV/AIDS epidemic presently in BC as well as outlining the importance of community-based AIDS organizations and their role in addressing the epidemic.