September 28, 1998
To:Board of Health
From:Dr. Sheela V. Basrur, Medical Officer of Health
Subject:AIDS Prevention Program Update and Status of Provincial Funding
Purpose:
This report presents information about current City AIDS prevention activities and programs;
places City programs within the provincial context; and informs the Board that increased
provincial funding for AIDS prevention is unlikely.
Source of Funds:
Not applicable.
Recommendations:
(1)That the Board of Health advocate to the Minister of Health to establish funding for
condom distribution and education through AIDS service organizations, health units and other
organizations with significant HIV prevention programs throughout Ontario.
(2)That the Board of Health advocate to the Minister of Health to maintain on-going 100
percent funding at the current level for the AIDS Sexual Health InfoLine (AIDS Hotline).
(3)That the Board of Health advocate to the Minister of Health to establish on-going 100
percent funding at the current level for the Sex Information and Education Council of Canada
and Planned Parenthood Ontario.
(4)That the Board of Health request the Minister of Health to re-affirm the Province's
long-term commitment to funding for community-based HIV prevention programs and
services, including its newly established funding for the emerging issue of injection drug use
as an AIDS risk behaviour; and further to integrate needle-exchange into the new injection
drug use projects.
Background:
At its meeting on June 23, 1998, the Board of Health "requested the Medical Officer of Health
to report back to the Board for its September 15, 1998 meeting on the current activities and
programs aimed at AIDS prevention being provided by the City of Toronto, showing how
much the City of Toronto provides to the total province-wide AIDS prevention programs and
indicate the potential likelihood of increased provincial funding in this area."
Comments:
- AIDS AND HIV IN TORONTO
By the end of June 1997, there have been an estimated 3,724 cases of AIDS in Toronto.
Toronto makes up 22.6 percent of the population of Ontario but has 62.3 percent of all AIDS
cases reported. The number of new cases of AIDS in the City has been decreasing since 1993
-- likely due in part to early and aggressive treatment of people living with HIV, and also
because the number of new HIV infections has decreased. As of December, 1996, an
estimated 9,750 people in Toronto had been diagnosed with HIV, a prevalence rate of 5.5 per
1,000 adults. The number of people with undiagnosed HIV is unknown.
Because HIV is the virus that causes AIDS, examining risk factors contributes to
understanding how preventive measures today may impact on the incidence of AIDS in the
future. In terms of HIV risk factors, Toronto compares favourably with other jurisdictions.
Although HIV and AIDS incidence and prevalence data has been compiled for the new City
of Toronto, risk factor data is only available for the former municipalities. Risk data of the
former City of Toronto are used here; this data should be reflective of the new City as 80% of
HIV infections occurred in the former municipality of Toronto.
In Canada and other areas of Ontario, the number of HIV infections has been increasing, with
a majority of the increase occurring among injection drug users, young gay men and non-IDU
heterosexuals (especially women). While the median age of individuals with new infections in
Canada dropped from age 32 years in 1982-93 to 23 years in 1986-1990, the median age of
former City of Toronto residents with HIV has remained stable at about 34 years old
throughout the last decade. Injection drug use as a risk factor has remained stable at
approximately 8% (in contrast to Vancouver and Montreal which have rates of 20 - 23%). The
number of AIDS cases among women in the former Toronto, which almost doubled between
1994 and 1995, has not grown as rapidly as in Canada. Furthermore, the number of women
diagnosed with HIV has remained stable since the epidemic began.
While it would be impossible to accurately analyse all the factors influencing Toronto's
pattern of HIV and AIDS, it is highly likely that Toronto's lower growth in HIV/AIDS rates
are due in part to the excellent and well-linked public health, community-based and
hospital-based services in Toronto. Resources in Toronto are well balanced between
prevention and the support, care and treatment programs that in turn serve to prevent HIV and
AIDS. As well, significant local resources are well targeted to behaviourally at risk
individuals.
- EXISTING CITY PROGRAMS AND SERVICES
In the mid 1980s, the Ministry of Health initiated 100 percent funding for HIV/AIDS
prevention programs. Public Health's HIV/AIDS prevention program is multi-faceted and
provided by staff from a variety of disciplines. Programs include:
(a)group education in schools and community settings;
(b)one-to-one assessments including counselling, testing, support, treatment and referral;
(c)partner notification;
(d)outreach and promotional programs;
(e)support and funding to community-based partners;
(f)training to health, social service, education and human resources workers;
(g)data collection analysis and research;
(h)consultation, collaboration and networking; and
(i)advocacy and policy development.
The program includes both population-level interventions and targeted interventions.
Examples of population-level interventions are mass media health promotion and supports to
enhance education of school-aged children. Examples of targeted interventions are needle
exchange, outreach to men having sex with men, and outreach to street-involved youth and
sex trade workers.
Programs vary by district. For instance, Toronto, Etobicoke and York have differing needle
exchange programs. In the former Toronto district, high-profile social marketing campaigns
across the GTA were implemented while other districts worked with local media.
Scarborough, East York and North York's needle exchange programs are in the development
stages.
See Appendix A for greater detail.
- CITY PROGRAMS WITHIN A PROVINCIAL CONTEXT
(i)1997 Spending
One way of looking at how much the City provides to the total province-wide AIDS
prevention programs is to look comparatively at spending at the provincial and local level.
Two proxy measures have been used to estimate prevention budgets: health unit spending and
community grants.
The last year of 100 percent provincial funding for AIDS and Sexual Health was 1997. In
1997, the Ministry of Health provided the following for health unit HIV/AIDS prevention
programs.
|
Public Health Branch
budgets to health units |
To Ontario
(including
Toronto) |
To the Six
Toronto health
units |
Percentage
allocated to
Toronto |
| Staff/operating base
budgets |
$8,221,054 |
$2,065,139 |
25% |
| Condoms |
$1,197,945 |
$529,000 |
44% |
| Needle Exchange |
$1,206,128 |
$340,000 |
28% |
| AIDS/Sexual Health
InfoLine |
|
$567,146 |
N/A |
|
|
|
|
| Grants to community agencies in Toronto came from several government sources. In
1997, spending was as follows: |
|
Public Health Branch
budgets to health units |
To Ontario
(including
Toronto) |
To the Six
Toronto health
units |
Percentage
allocated to
Toronto |
| Ontario (AIDS Bureau) |
$10.9 million |
$3.5 million |
35% |
| Federal (ACAP) |
$1,862,030 |
$823,270 |
44% |
| Former City of Toronto |
--- |
$1,052,808 |
N/A |
| Former Metro Toronto |
--- |
$132,326 |
N/A |
An additional $1 million has just been allocated by the AIDS Bureau to prevent HIV among
injection drug users. Forty percent ($399,600) of the new fund will come to Toronto,
providing six new full-time workers at agencies or Public Health.
Toronto benefits greatly from this 3-tiered government commitment. For instance, Toronto
has been able to emphasize AIDS project funding only because the Province pays for core
administration. Nationally-oriented AIDS service organizations (funded federally and
provincially) contribute numerous local services. Grants staff from all three levels of
government cooperate, improving monitoring and evaluation of local Toronto projects (see
Appendix B for additional details with respect to funding).
(ii)City Contributions to Ontario Programming
An alternative way of looking at how much the City provides to the total province-wide AIDS
prevention programs, is to ask what kinds of contributions Toronto makes beyond its
boundaries. Toronto has historically been active in regional and provincial networks, along
with other health units. As the key urban health unit, Toronto has also often been called upon
by other health units to offer advice and share resources. Some examples of recent support to
provincial health units include the following:
(a)Training programs are often open to attenders from beyond Toronto.
(b)Templates of print resources developed in house are shared with Ontario health units
which are encouraged to print to meet their local needs.
(c)Condom tender results are shared with all health units and venders are required to maintain
volume price to all Ontario health units.
Increasing AIDS prevention activities throughout Ontario benefits Toronto because a
significant portion of our population is drawn from other parts of the province as well as
outside Ontario.
- POTENTIAL OF INCREASED PROVINCIAL FUNDING FOR HIV/AIDS
PREVENTION.
(i)Additional Provincial Funding
Public Health staff has consulted with senior staff at the Ministry of Health, both within the
Public Health Branch and the AIDS Bureau. Provincial staff have indicated that there will not
be additional funds for AIDS prevention in the near future (with the exception of the new
injection drug use prevention program mentioned in Section C, i). This is in keeping with the
Government's commitment to maintain downloading of Public Health to the municipalities.
The lack of opportunity to influence the Province in this regard is evidenced in activities of
the Sexual Health Network of Ontario. In 1997 the Network coordinated a vigorous lobby to
preserve 100 percent Provincial sexual health and AIDS funding. Currently the Network has
reduced its lobby for funding and instead is focussed on ensuring appropriate service delivery
by municipalities and monitoring by the Ministry of Health.
Providing condoms may be an area where a small amount of funding might be attainable
following a high investment of resources and extensive coordination across Ontario.
Provincial funding for condoms had never been integrated into Public Health Branch's base
AIDS budget. However approximately $1 million to support condom education and
distribution had been provided to health units annually throughout most of the 1990s. Such
funding was created in response to municipal and public pressure. It is possible -- although
not likely -- that collaborative pressure from municipalities and AIDS service organizations
could result in stable condom funding being established. To be acceptable to the Province,
such a funding mechanism could not contravene downloading of public health. This should be
possible if a condom education and distribution program were administered through the AIDS
Bureau on behalf of AIDS prevention programs and services, with health units included
among a variety of providers. Alternatively, the Provincial Pharmacy's program and budgets
could be adjusted to create a condom program parallel to on-going vaccine provision
programs.
(ii)Maintaining Existing Provincial Funding Commitments
It is very important that the Province maintain existing funding commitments to Toronto
Public Health in the areas of AIDS prevention and sexual health. Such funding is three-fold:
(a)AIDS and Sexual Health InfoLine (the AIDS Hotline);
(b)contracts to the Sex Information and Education Council of Canada (SIECCAN) and
Planned Parenthood Ontario's Facts of Life Line;
(c)the new funding for prevention activities with injection drug users.
Provincial funding for the AIDS and Sexual Health InfoLine, a provincial program
implemented by Toronto on contract to the Ministry, appears stable. The new injection drug
use programming is anticipated to be funded for at least several years. However, addressing
needs of injection drug users is politically-sensitive at a provincial level. Thus, urging
continued commitment is appropriate. The Province should also be encouraged to integrate
needle-exchange into the new injection drug use prevention programs.
SIECCAN and Planned Parenthood Ontario provide programs serving Toronto and other
jurisdictions throughout Ontario. These programs have been funded by 100 percent provincial
funding which flowed through East York. In the downloading settlement, the Province
committed 100 percent provincial funding for these programs only for 1998. Because these
programs are provincial in scope, the Ministry is the appropriate on-going funder and should
be urged to stabilize their budgets.
Provincial funding to community agencies and institutions that partner with Public Health is
vital to the prevention of HIV/AIDS and to the care and treatment of those living with HIV
and AIDS in Toronto. As such, the report includes a recommendation that the Board
encourage the Province to re-affirm its commitment to HIV/AIDS, specifically by ensuring
stability for the AIDS Bureau.
Conclusion:
The Province is unlikely to increase its contribution to HIV prevention funding in Ontario.
The Department's development of a needs-based budget and service planning will be
addressed, e.g. needle exchange, grants, and uneven allocation of resources resulting from
pre-amalgamation variation in programs to ensure that public health continues to have quality
HIV prevention programs.
Contact Name:
Connie Clement
Director, Planning and Policy
tel: 392-7463
fax: 392-0713
email: cclement@city.toronto.on.ca
Dr. Sheela V. Basrur
Medical Officer of Health
Appendix A
AIDS PROGRAM OVERVIEW
The City's AIDS program began in 1987 with an emphasis on increasing general knowledge
levels regarding HIV transmission, HIV prevention and harm reduction. Over time, increasing
emphasis has been placed on shaping behaviour and influencing behaviour change to prevent
the spread of HIV. The Department's HIV/AIDS program is managed in conjunction with the
sexual health and sexually transmitted disease programs, and is mandated by Provincial
Mandatory Program Standards. All Public Health districts in Toronto have HIV/AIDS
prevention programs, although not all services are available in all districts.
The HIV/AIDS program is managed within the context of the larger sexual health and
sexually transmitted disease (STD) programs. For example, case management issues are
assessed along with other communicable diseases, such as tuberculosis and hepatitis. STD
clinic services are often delivered as part of sexual health/STD clinics. AIDS Prevention
education support to schools and community locations is delivered as part of sexual health
education. Harm reduction activities are linked to determinants of health and other
blood-borne disease and substance use issues.
HIV/AIDS program staffs include public health nurses, educators, counsellors, coordinators,
health education consultants, a community projects officer and management.
In addition to Public Health staff, resources are allocated to community-based agencies to
deliver targeted AIDS prevention programs and services. The Board of Health allocates just
over one million dollars in annual grants to approximately 40 Toronto community-based
projects. (The grant's program was unique to the former Toronto.) In addition, HIV/AIDS
program activities are delivered through partnership agreements with eight community
agencies in Toronto District that provide needle exchange, and funded service contracts in
three districts (the AIDS Committee of Toronto; Youthlink-Inner City; Hassle Free Clinic;
Birth Control and VD Information; Immigrant Women's Health Centre; the Sex Information
and Education Council of Canada; Planned Parenthood of Ontario).
Public Health also has numerous informal partnerships to enhance service provision. The
following are a few examples.
(a)York's team work with Black Coalition for AIDS Prevention to undertake AIDS education
with barber shops and salons.
(b)North York's collaboration with Sunnybrook Hospital to provide training.
(c)Scarborough's partnership with the Warden Woods Community Centre in the development
of the Scarborough Community HIV/AIDS Network.
Less HIV/AIDS prevention programming is geared to the general public than was the case in
the 1980s when most people knew little about AIDS. Today, the majority of programming is
geared to groups within which a significant portion of individuals may be at behavioural risk
of acquiring HIV, other STDs or becoming unintentionally pregnant. HIV/AIDS risk may be
through unprotected sex or through sharing needles to inject drugs. Key examples include
men who have sex with men, youth, injection drug users, people from endemic countries,
street involved individuals, residents in correctional facilities, heterosexual women (especially
those entering new relationships or in violent relationships).
The AIDS prevention program can be broken down into the following components.
1. Group health education support and/or programs in schools and community settings
Focus is on prevention of HIV/AIDS including safer sex, fear reduction, counteracting
homophobia through classroom teaching, displays at university/college orientation,
workshops at community agencies, etc. Participants include school-aged children (especially
grades seven and eight), young adults, adults, parents. In most districts, school-oriented
programming emphasizes support to teachers. Three districts formal arrangements exist to
provide support to teachers; in a fourth district, resources were recently transferred to the
Board of Education. Some districts lack resources to provide significant educational
programming and instead refer requesters with community agencies, (often in Toronto District
and funded by City grants) to provide the service.
2. One-to-one assessment, education, counselling, testing, support, treatment and referral
Service provided in clinics, other community settings, schools; via telephone lines at district
offices and the AIDS & Sexual Health InfoLine (a provincially-funded province-wide
telephone service); through special program outreach (e.g., street outreach, mobile van);
through community funding. Clientele includes those identified with HIV and other STDs;
individuals identified as contacts of STD/HIV infected clients; individuals exposed to HIV
who are considering post-exposure prophylasix; persons testing for HIV who are waiting for
results; individuals at behavioural risk of acquiring HIV and other STDs. The extent of
programming varies by district.
3. Case management/partner notification
Services to ensure appropriate treatment of individuals identified with a STD, including HIV,
and to identify and contact exposed individuals, provide partner notification, counselling and
referral. Toronto district has much greater volume of such work.
4.Promotion and education about safer needle use and provision of access to clean needles
Education (both group and one-to-one) is delivered by needle exchange counsellors and other
Public Health staff. Comprehensive needle exchange services are provided through a fixed
Public Health site, mobile vans, street outreach and partnered needle exchange sites. The
Toronto District program recently expanded to include a pilot methadone clinic component.
5.Promotion and education about condom use and provision of condoms
Condoms, dams and water-based lubricant are distributed as part of educational programs to
initiate condom-use habits, and also to support ongoing safer sex condom use by those with
high-risk behaviours. Such programs occur within HIV/STD clinics, as part of needle
exchange/harm reduction programs, gay bathhouses, park outreach, through 'condom boxes'
provided in community agencies and physicians, etc. Toronto District has a great number of
agency sites distributing condoms; all districts utilize condoms.
6.AIDS prevention promotion to general public
Programs include mass media campaigns, e.g., 'Sex Talk' campaign geared to teens to
encourage talking about sex and condom use; consultation to media and provision of news
articles to community newspapers; participation in local events for AIDS Awareness Week,
World AIDS Day, AIDS Walk Toronto. All districts promote through local media Toronto
District has greater experience with national media and campaigns.
7. Organizational support, funding and community development
Direct funding includes annual AIDS prevention project grants to Toronto District agencies
(39 projects in 1997/98); contracts specifically about HIV/AIDS (ACT, Youthlink-Inner
City), contracts to clinics (Hassle Free, Birth Control and VD Information). Public Health has
service agreements with needle exchange partners in the Toronto District (financially
bolstered by the AIDS Prevention grants).
Public Health also provides some secretariat support to special projects (e.g., ethnocultural
AIDS research project) and is an active member on several committees and networks (e.g.,
Needle Exchange Coordinating Committee, Gay Men's Education Network, Women's
Outreach Network, HIV/AIDS Cultural Network, Scarborough Community HIV/AIDS
Network).
Community development strategies are an integral part of most districts AIDS programs. This
involves working with client-initiated groups, agency-based projects and networks, both to
strengthen community initiatives and to collaborate in program delivery. A good example are
Scarborough initiatives that have lead to a strong partnership with Warden Wood Community
Centre and the creation of the Scarborough Community HIV/AIDS Network, including a
Harm Reduction Sub-Committee which will be the location of one of the new Ministry
position to reduce HIV spread among injection drug users.
8.Training to social service and health workers
Focus is on improving service by other providers; supporting a high quality of life for people
living with HIV AIDS and those who are HIV+; policy development; ensuring universal
precautions/infection control. In addition to training offered every few months for new service
workers, targeted training has recently been provided to daycare staff, Ministry of
Corrections, Immigration and Refugee Board staff and human resources professionals.
Consultation, support with organizational planning, etc. are available to Toronto agencies,
institutions and practitioners. Education, support and sometimes resource provision (e.g.,
pamphlets) to physicians, for instance, regarding improved HIV/STD treatment is common to
all districts. Placements are provided to health and social services students.
9. Evaluation, data collection and analysis and research
Program components include evaluation, literature reviews, issue papers, policy reviews; data
collection and analysis (including Public Health program data and data from HIV anonymous
test sites). As well, Public Health identifies data collection problems and intervenes as needed
(e.g., negotiation with Province), and shares information with other health units and
jurisdictions (e.g., Ministry of Health).
- Policy development and related advocacy
Policy development is both site-specific (e.g., consultation/training to a workplace) and
systemic (e.g., supporting renewal of the national AIDS strategy). Recent advocacy has
included issues related to methadone maintenance programming, in-prison education and
supports, quality of life issues for people living with HIV/AIDS, better access to health care
services (e.g., for injection drug users, ethno-cultural and language minority groups).
Appendix B
City-Provincial AIDS Prevention Budget Information
- Toronto Public Health Budget
The total Public Health budget for HIV/AIDS prevention in the new City is estimated at
$3,524,363.
Levelling up:
The key AIDS-related programs have been considered by Public Health for levelling up thus
far: needle exchange and the AIDS Prevention Funding Program. (See Investing in Public
Health, report presented to the Board of Health at its March 24, 1998 meeting.) Initial
estimates to adequately level up these programs are: needle exchange ($549,000) and grants
($1,092,725). Both of these programs will be further addressed in reports related to the 1999
budget.
Service harmonization and review:
A service review of sexual health clinics and a harmonization project regarding sexually
transmitted disease case management are underway. Both of these projects will have
implications for HIV prevention.
As amalgamation continues, existing resources will be re-allocated throughout the new City
based on assessments of neighbouhood/population needs. For instance, Toronto District has
greater staff resources assigned to both education and case management and other districts. It
is expected that some of Toronto's staff will be reassigned to address currently unmet needs in
other districts. (Some differential in staff assignments is expected to continue because Toronto
District has a disproportionate number of AIDS and HIV cases and at-risk populations
disproportionately reside in Toronto.) Such reallocation of staff and budgets by district will
occur through the remaining organizational design and forthcoming needs-based program
planning.
Non-Public Health budgets:
The City's only HIV prevention costs outside of Public Health include grants to five AIDS
service organizations funded by the Community Services grants program; in 1998, these
sub-totalled $132,326. The City-wide process to develop and implement a new municipal
grants policy will include assessment of whether any transfer of funds should occur and how
these grants should be managed. Following more detailed review, it may be that AIDS
funding be allocated solely through Public Health's AIDS Prevention Fund.
Remaining 100 percent Provincial funding to Toronto Public Health
The City continues to deliver one HIV prevention service with 100 percent provincial
funding. The AIDS and Sexual Health InfoLine, a telephone counselling and education
service accessible province-wide by 800-phone number. The City receives $567,146 to deliver
this service. Of 60,609 client calls served in 1997, 54.5 percent were to local callers. It is
anticipated that this provincial revenue will remain the same for 1998/99.
The Sex Information and Education Council of Canada (SIECCAN) and Planned Parenthood
Ontario provide programs serving Toronto and other jurisdictions throughout Ontario. These
programs have been funded by 100 percent provincial funding which flowed through East
York. In the downloading settlement, the Province committed 100 percent provincial funding
at $50,000 each program only for 1998. Because these programs are provincial in scope, the
Ministry if the appropriate on-going funder and should be urged to either stabilize on-going
funding through Toronto Public Health or find another mechanism to continue on-going
provincial funding for these useful services.
- Public Health Branch:
Until December 1998, nearly all HIV/AIDS prevention programming in health units was 100
percent provincially-funded. A breakdown of the Ministry of Health's Public Health Branch
base budget allocation to health units for AIDS prevention in 1997 (the most recent year for
which figures are available) gives a reasonable proxy overview of public health dollars spent
on AIDS provincially in that year. The Provincial Public Health budget for AIDS was
$8,221,054 to the 42 Ontario health units; $2,065,139 (25 percent) of this came to the six
Toronto health units.
In addition to 100 percent funding included in health units' base budgets, Toronto
traditionally obtained a significant amount of one-time funding and funding that was
informally renewed from year to year. The condom and needle exchange budgets comprised
the vast majority of such dollars. In 1997, the Province's $1,197,945 sent to the health units
for condoms, $529,000 (44 percent) came to Toronto's six amalgamating health units
combined. Of the $1,206,128 spent by the Province for syringe exchange programs, $340,000
(28 percent) came to Toronto, Etobicoke, and York combined.
Each municipality is now responsible for funding programs to meet the new Provincial
Mandatory Program Standards. It is difficult at this time to estimate whether municipal
funding required to meet the provincial standards will exceed or fall short of the previous
provincial funding level.
- AIDS Bureau:
In addition to the Public Health Branch funding, the Ministry of Health's AIDS Bureau
provides provincial resources and directly funds community-based agencies. A portion of
such funding is for HIV/AIDS prevention, while a significant portion is for support and care
programs for individuals living with HIV/AIDS. Of the 1998 Provincial AIDS grants budget
of $10.9 million (approximately 80 percent allocated to core funding), approximately $3.5
million (35 percent) is funding to groups in Toronto. Because many -- if not most --
provincially-oriented AIDS service organizations in Ontario are based in Toronto, this
includes a portion of money to help agencies fulfill their provincial, rather than local, service
mandates. (The same is true of the Federal funding noted below.) Included within the grants
budget is funding for many of the 34 anonymous test sites in Ontario, of which one (Hassle
Free Clinic) is located in Toronto.
The AIDS Bureau also provides secretariat for the Ontario Advisory Committee on
HIV/AIDS, which recommends policy and practice affecting Toronto as well as other
jurisdictions. The Bureau, jointly with the Ontario Region of Health Canada, supports the
Ontario AIDS Network (OAN), comprised of nearly all of the key AIDS service organizations
in Ontario. The OAN provides member agencies with training and consultation. The AIDS
Bureau also funds prevention through support for the HIV Social, Behavioural and
Epidemiological Studies Unit at the University of Toronto, with which Toronto Public health
has an effective working relationship. The Bureau provides annual training conferences for
anonymous test sites and other test providers, and training for AIDS service organizations,
health units, etc.
A new fund of $10 million to the Ontario HIV Treatment Network includes $2 million to be
administered directly by the AIDS Bureau. Of this, $1 million will go towards emerging
issues; for the immediate future, the emerging issues budget will be spent to prevent HIV
spread through injection drug use. The planning for these harm reduction projects was
undertaken by local, inter-agency committees, in which Public Health participated. The
Bureau is currently negotiating with the recommended host agencies, as Ministerial sign off
proceeds. Six of the 15 full-time positions will be within Toronto (one in Scarborough; 1 in
North York; 4 downtown). The budget for these positions will be $399,600 (or 40 percent of
the monies flowed out for new projects).
- Federal support of HIV/AIDS prevention programs and services in Toronto.
The Federal government supports AIDS prevention through a variety of budgets including
support of the Canadian Public Health Association's national AIDS Program (notably the
National AIDS Clearinghouse), the Canadian AIDS Society, AIDS funding through various
national research bodies. Federal financial support for AIDS prevention in Ontario is most
evident through the AIDS Community Action Program (ACAP) which provides grants to
community-based agencies. Of the $1,862,030 spent by the Ontario Region, Health Canada
for ACAP, $823,270 (44 percent) is to 17 Toronto-based organizations.
City funding as estimated contribution to total Ontario HIV/AIDS prevention funding.
It is not possible to detail an accurate estimate of HIV/AIDS prevention budgets for programs
throughout Ontario. The Provincial government contributions to HIV prevention in 1997, as
measured by portions of the Ministry of Health's Public Health Branch and AIDS Bureau
budgets, may be in the range of $13-13 million. If, in 1998, municipalities in Ontario spend at
a level similar to the 1997 AIDS budget for health units, other municipalities may spend in the
range of $8-10 million across the Province.
Toronto Public Health's 1998 AIDS budget is $3,524,363. This is without adding a financial
estimate of the contributions from related programs (e.g., case management of other sexually
transmitted and communicable diseases; sexual health education, counselling and clinic
programs; public health nursing education and counselling).
