June 15, 1998

 To:Board of Health

 From:Dr. Sheela V. Basrur, Medical Officer of Health

 Subject:Purchase of service agreements with AIDS Committee of Toronto and YOUTHLINK Inner City for the period July 1, 1998 to June 30, 1999

  Purpose:

 This report requests approval from the Board of Health for purchase of service contracts for the AIDS Committee of Toronto and YOUTHLINK Inner City.

 Funding Sources, Financial Implications and Impact Statement:

 The AIDS purchase of service budget was approved in the 1998 Operating Budget by City Council at its special meeting of April 28, 29 and 30, 1998. Of the approved $406,416 in the 1998 budget, 50 percent was spent out in January to fulfill commitments pertaining to the July 1997 - June 1998 purchase of service cycle; 50 percent is available for payments related to the funding approval sought in this report, for the period July 1998 - December 1998. Funds in the amount of $128,404 for the AIDS Committee of Toronto and $74,804 for YOUTHLINK Inner City are available in Public Health 1998 Operating Budget, Account No. 734-760-651. The remaining $203,208 will be included in the Public Health 1999 Operating Budget. ($128,404 for the AIDS Committee of Toronto and $74,804 for YOUTHLINK Inner City). This split-year funding is a pre-amalgamation carry-over. Historically, the AIDS purchase of service period has been July to June; thus, each year the former Toronto City Council allocated funds of $406,416, with 50 percent of the funds being drawn from the next fiscal year.

 Recommendations:

 (1)That a purchase of service agreement for the provision of HIV/AIDS prevention services by the AIDS Committee of Toronto be entered into for the period of July 1, 1998 to June 30, 1999, at a cost not to exceed $256,808, inclusive of GST;

 (2)That a purchase of service agreement for the provision of HIV/AIDS prevention services by YOUTHLINK Inner City be entered into for the period of July 1, 1998 to June 30, 1999, at a cost not to exceed $149,608, inclusive of GST; and

(3)That the appropriate City of Toronto officials be authorized to take the necessary action to give effect thereto.

 Council Reference/Background/History:

 AIDS purchase of service agreements are designed to provide HIV/AIDS prevention services to communities that are difficult to reach. They play a key role in assisting Public Health in accessing these communities for the effective delivery of public health services. In accordance with this principle, renewing the purchase of service agreements with the AIDS Committee of Toronto and YOUTHLINK Inner City will continue to assist Public Health in meeting the current needs for HIV/AIDS prevention services in the former City of Toronto. AIDS purchase of service agreements, in conjunction with AIDS prevention grants, are a policy-supported, integrated component of Public Health=s HIV/AIDS program.

 In the current year, AIDS purchase of service funding directly funded 52,000 of the AIDS Committee of Toronto=s direct service contacts and 5,000 of YOUTHLINK Inner City=s client contacts. These two agencies provide significant HIV/AIDS preventive services to reach high risk populations such as men who have sex with men, street-involved youth and individuals living with HIV/AIDS. HIV/AIDS continues to have a major impact upon gay men and men who have sex with men; the median age of HIV onset is shifting to the youth population, such that prevention among high risk youth is now critical.

 Comments and/or Discussion and/or Justification:

 With the support of the purchase of service agreement, the AIDS Committee of Toronto does targeted HIV prevention work with self-identified gay men, gay men who do not connect with gay groups, and men who do not self-identify as gay but have sex with men. HIV/AIDS is still highest among men who have sex with men. The AIDS Committee of Toronto works collaboratively with a number of HIV/AIDS agencies, community agencies and groups to develop and deliver a variety of community-based education activities.

 The purchase of service agreement also provides support for the AIDS Committee of Toronto referral services program that links people infected with and affected by HIV/AIDS with the information and services they need. The AIDS Committee of Toronto maintains a community referrals database that tracks services related to HIV/AIDS for service users and service providers, and makes this information available by person, telephone or via the AIDS Committee of Toronto=s web site, and through issue-focussed referral lists that are produced and regularly updated to meet a variety of needs. A world class library provides a comprehensive reference service to members of the public, including people infected and affected, teachers, medical/nursing/social work students and other smaller City-funded AIDS projects.

   The AIDS Committee of Toronto is a credible organization within the community and is well positioned to reach men who have sex with men and to serve as a centre for information collection and dissemination. It has appropriate infrastructure and expertise in developing and delivering effectively targeted education programs. The vast majority of clients live in the new City. The AIDS Committee of Toronto is currently planning to licence partnerships and programs in additional areas of the new City. The programs supported through the AIDS Committee of Toronto=s purchase of service agreement involve a substantial number of volunteers who deliver the majority of the activities.

 With the support of the purchase of service agreement, YOUTHLINK Inner City undertakes targeted HIV prevention work with street-involved youth. As the HIV epidemic evolves, more infections are occurring in young people. Among young people, street youth are especially at risk for becoming infected with HIV due to a variety of risk behaviours. Addiction Research Foundation surveys show high rates of drug use among Toronto street-involved youth, including sharing of needles. As a group, street-involved youth tend to have frequent and multiple sexual partners, often engaging in prostitution. Street youth have high rates of sexually transmitted diseases.

 YOUTHLINK was incorporated in 1912 (as Big Sisters Association). Inner City, a division of YOUTHLINK, was established in 1980 after the murder of Emmanuel Jacques, in response to a request from the then Metro government and the Province to provide Aan outreach service to street youth in the downtown core of Toronto.@ During the past 18 years of service provision, Inner City has grown into a well-respected and extensively utilized program, reaching approximately 13,000 at risk youth. YOUTHLINK Inner City will continue to provide HIV/AIDS prevention education and on-going counselling/support to street youth populations in the former City of Toronto through a variety of outreach and on-site strategies. Emphasis is downtown, with some service in other high-risk areas of Toronto.

 Appendix A details the services and terms of agreement for the purchase of service agreements for the AIDS Committee of Toronto and YOUTHLINK Inner City. The services, terms of agreement and budget for the AIDS Committee of Toronto were developed in consultation with Joan Anderson, Director of Education and Advocacy; those for YOUTHLINK Inner City were developed in consultation with Karen Positano, Supervisor, YOUTHLINK Inner City.

 Conclusions:

 This report details new community-based AIDS purchase of service agreements to begin in July 1998, as part of Public Health HIV/AIDS prevention program.

 Contact Name:

 Liz Janzen, Regional Director, Toronto Office

Toronto Public Health

Tel: 392-7458

Fax: 392-1483

email: ljanzen@city.toronto.on.ca

  Dr. Sheela V. Basrur

Medical Officer of Health

  Appendix A

  A.AIDS Committee of Toronto

 SERVICES:

 The parties agree that, for the period July 1, 1998 to June 30, 1999, the AIDS Committee of Toronto will:

 1.facilitate access to HIV/AIDS-related information, client assessment, referral services and a range of other programs offered by AIDS Committee of Toronto and external agencies for people infected and affected by HIV/AIDS through Referral Services, in person and by telephone; and by the development of specific referral lists for the public and service providers (e.g., anonymous testing sites);

 2.provide community-based education on HIV prevention and health promotion to self-identified gay men, gay men who do not connect with gay groups, and men who do not self-identify as gay but have sex with men, through the following strategies:

 a)develop and deliver specific messages and diverse campaigns that promote the adoption and maintenance of behaviour change including campaigns focussed on youth, and safer sex maintenance for HIV positive and HIV negative men, including community workshops/discussion groups;

 b)develop partnership strategies with community groups serving men who have sex with men from other language and cultural groups including participation in the Toronto Gay Men's Education Network;

 c)undertake peer education and outreach to venues such as bars, bathhouses, parks, youth-oriented social sites and community events such as Lesbian and Gay Pride Day activities; such education and outreach to be prioritized to fill gaps not being reached by other HIV prevention projects; explore feasibility of using washroom advertising in venues frequented by gay men/youth;

 3.provide a professionally managed library with a comprehensive reference collection on HIV/AIDS available to clients, the general public, students, health care workers, volunteers and staff of community and government services within the City of Toronto, through the following strategies:

 a)acquire, organize and provide access to a wide range of current periodicals, books, videotapes, etc. on HIV/AIDS and related issues, through the use of appropriate collection development and acquisition policies, bibliographic processing according to accepted standards, and the production of appropriate and relevant access tools (e.g., catalogues, guides, bibliographies);

b)enhance access to the collection through computer-based strategies including online access to information and current statistics, and electronic resource sharing;

 c)provide reference and first contact service to AIDS Committee of Toronto clients, in person and by telephone, through personal assistance in forming and answering queries, and through the production of convenient and easy-to-read information packages on important subjects, including drug and complementary therapies, opportunistic infections, etc.;

 d)provide reference service to other AIDS service organizations and community groups.

  TERMS OF AGREEMENT:

 1.The parties agree that AIDS Committee of Toronto will be funded by the Corporation of the City of Toronto for the period July 1, 1998 to June 30, 1999.

 2.AIDS Committee of Toronto agrees to allow its financial accounts relating to the operation of the program to be audited.

 3.AIDS Committee of Toronto agrees to provide for progress and financial reports on Public Health specified forms, satisfactory to the Medical Officer of Health.

 4.The parties agree that funds will be payable to AIDS Committee of Toronto as follows:

 $128,404.00Upon execution of the Agreement by both parties (July, 1998)

 $ 64,202.00Upon receipt of report #2 and invoice (January, 1999)

 $ 64,202.00Upon receipt of report #4 and invoice (July, 1999)

__________

$256,808.00

 B.YOUTHLINK Inner City

 SERVICES:

 The parties agree that, for the period July 1, 1998 to June 30, 1999, YOUTHLINK Inner City will:

 1.a)Provide daily morning and evening outreach to youth on the street, in order to communicate HIV/AIDS prevention education, distribute free condoms and latex dams, exchange needles/syringes, and offer counselling and assistance to help street-involved youth to overcome barriers and effect behaviour change based on harm reduction strategies (approximately 4000 youth per year);

 b)Conduct weekly HIV/AIDS film/discussion groups and daily informal HIV/AIDS discussions at the YOUTHLINK Inner City office where approximately 5000 youth per year receive help in stabilizing their lives which builds self-esteem and consequently promotes healthy changes in their lives by interrupting dependency on the street lifestyle;

 c)Conduct and promote specific HIV/AIDS education targeted at immigrant youth who frequent the walk-in office who are not seen on the street by the outreach workers. (These youth frequent the hostel system and 40% of in-office clients);

 2.Conduct HIV/AIDS prevention and education workshops 6-8 times per month for at-risk youth in group homes, community centres, etc.;

 3.Develop and implement health promotion strategies which ensure the cultural appropriateness and relevancy of various HIV/AIDS prevention activities (e.g., materials relevant to the street culture, and posters and novelties which reflect a broad range of ethno-cultural/racial backgrounds);

 4.Develop leadership initiatives around issues pertinent to street-involved youth by targeting other pilot neighbourhoods that are under-serviced for youth; undertake a pilot project in the Queen Street West area during summer 1998 to assess services needed by homeless youth in the west end of Toronto.

  TERMS OF AGREEMENT:

 1.The parties agree that YOUTHLINK Inner City will be funded by the Corporation of the City of Toronto for the period July 1, 1998 to June 30, 1999.

 2.YOUTHLINK Inner City agrees to allow its financial accounts relating to the operation of the program to be audited.

3.YOUTHLINK Inner City agrees to provide four progress and financial reports on Public Health specified forms, satisfactory to the Medical Officer of Health.

 4.The parties agree that funds will be payable to YOUTHLINK Inner City as follows:

 $ 74,804.00Upon execution of the Agreement by both parties (July, 1998)

 $ 37,402.00Upon receipt of report #2 and invoice. (January, 1999)

 $ 37,402.00Upon receipt of report #4 and invoice. (July, 1999)

__________

$149,608.00