Updated with response received May 6, 2024.
We remain very disappointed at the decision by PHAC to not refund the HIV Self-Testing Initiative.
April 12, 2024
The Honorable Mark Holland,
Minister of Health
House of Commons
Ottawa, ON
K1A 0A6
Email: [email protected]
Dear Minister Holland,
On behalf of PAN and our members, I write to voice profound disappointment at the discontinuation of federal funding for the National HIV Self-Testing Program. This decision comes at a particularly concerning time, given the alarming 25% rise in HIV transmissions across Canada in 2022, the highest increase seen in a decade. Similarly, here in British Columbia, the BC Centre for Disease Control surveillance reports suggest an increasing trend of new HIV diagnoses.
PAN is a network of over forty community-based organizations (CBOs) and peer-run organizations providing STIBBI and harm reduction services across BC, including in many rural and remote and Indigenous communities. Our members work on the frontlines to support people that often face barriers in accessing traditional HIV prevention, testing, and linkage to care services. Our members excel at relational care, in meeting people where they are at, and in providing services across the care continuum.
The HIV Self-Testing Program, supported by the Public Health Agency of Canada, has been a welcome strategy in reaching key populations here in BC and across Canada, offering low-barrier testing options for people who are hard-to-reach. Utilizing the HIV Self-Testing kits, our member organizations have been able to link people with treatment, care, and ongoing support. We know that having access to these kits has also empowered individuals by providing an anonymous and confidential option to manage their health.
The significance of HIV self-testing kits extends beyond their clinical value; they represent a critical tool for overcoming barriers to healthcare access, such as stigma, fear of judgment, and the challenges faced by individuals experiencing homelessness, substance use, and mental health issues. The distribution data has clearly indicated that the program particularly benefited those who might not otherwise have access to HIV testing, including those living in rural and remote communities, Black Canadians, Indigenous peoples, youth-at-risk, and members of the 2SLGBTQ+ community.
The program’s success is evident in its reach to first-time testers, nearly half of its participants, indicating its critical role in diagnosing individuals unaware of their HIV status. BC’s diverse population, geography, and limited availability of stigma-free and culturally safe spaces to access STIBBI testing presents unique challenges in HIV prevention and care, making the availability of self-testing kits essential.
The decision by the federal government to not continue funding this Program represents is a significant a step backward in Canada’s commitment to the global goal of ending HIV as a public health concern by 2030; and meeting the 95-95-95 targets by 2025 (that 95% of all people living with HIV know their status, 95% of those diagnosed receive antiretroviral treatment and 95% of those on treatment achieve viral suppression). It also contradicts the objectives of the recently released Government of Canada’s STBBI Action Plan 2024-2030. Canada’s collective response to HIV is at a juncture where the need for support and resources is more pronounced than ever. The discontinuation of federal funding for this critical program both undermines the progress made through the National HIV Self-Testing program, and risks leaving countless individuals without the means to know their status, connect to care, and prevent further transmission. It is disheartening to witness a departure from what should be a forward-moving strategy to address HIV epidemiology.
In the wake of rising transmissions and the demonstrated efficacy of the Program, we urgently call for a reconsideration of this funding decision. Let us not regress; the stakes are too high to halt a program that has proven its worth in facilitating early detection of HIV and ongoing relational care. Let us not cause further harms to hard-to-reach, underserved communities, and Indigenous peoples, among us.
PAN and our members stand ready to engage in dialogue and collaborate on ensuring the continuation and expansion of the HIV Self-testing Program. We hope for your support and leadership in recommitting to this evidence-based public health initiative.
Minister, thank you for your attention. We look forward to your prompt and positive response.
Yours Sincerely,
J. Evin Jones, Executive Director
May 6, 2024
Dear J. Evin Jones,
On behalf of the Honourable Mark Holland, Minister of Health, I wish to thank you for your correspondence of April 12, 2024, concerning funding for HIV self-testing (HIVST) in Canada.
In August 2022, the HIVST Initiative was announced as a time-limited investment of $8 million for the 2022-23 fiscal year to provide proof of concept that low barrier access to HIV self testing could reach key populations who had not previously tested for HIV. In order to complete the objectives of this initiative, an additional $8.6 million in funding was secured for the project in 2023-24. This funding has supported community based organizations in their efforts to reach the undiagnosed and provide individuals with the necessary linkages to education and care.
Community-based organizations like PAN play an important role in improving the health of people, especially those most disproportionately affected by sexually transmitted infections. Thank you for sharing your successes as a participating organization in the HIVST initiative; your efforts have contributed to thousands of people across Canada becoming aware of their HIV status, and gaining access to care.
Low barrier access to HIV self-testing has now been demonstrated to be an effective means of reaching the undiagnosed. As provinces, territories and other federal departments play a key role in HIV testing programs and operations, we will be working to extend awareness of these results. We are also encouraging organizations to initiate discussions with their public health authorities about the impacts their programs have had locally and opportunities to integrate self-testing into care pathways.
It is important to note that an inventory of HIV self-test kits will continue to be available beyond March 31, 2024, so that your member organizations can continue to distribute kits while supply remains.
With the release of the Government of Canada’s Sexually Transmitted and Blood-Borne Infection (STBBI) Action Plan for 2024-2030, the Government of Canada has reaffirmed its commitment to reducing the impact of STBBI, improving public health outcomes, and advancing overall health and well-being. This commitment extends to supporting the priorities, leadership, and self-determination of First Nations, Inuit, and Métis communities. Through the priorities and actions outlined in the plan, the federal government aims to drive positive change, reduce disparities, complement provincial and territorial efforts, and contribute to a healthier and more inclusive society.
As mentioned above, the effectiveness of low-barrier access to HIV self-testing has been firmly established. In accordance with this evidence, we are dedicated to sharing this proof of concept with our provincial and territorial counterparts, who hold jurisdictional responsibility for ongoing testing, treatment, and care.
Thank you again for writing.
Sincerely,
Donald Sheppard, MD, FRCPC
Vice President
Infectious Diseases and Vaccination Programs Branch