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Is Canada Further Marginalizing Those With HIV?

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UNAIDS (Joint United Nations Program on HIV/AIDS) has set ambitious goals to be reached by 2015 -- zero new HIV infections, zero AIDS-related deaths and zero discrimination. Targets that will help achieve the first goal of zero new infections are, firstly, to reduce sexual transmission of HIV by 50 per cent -- including among young people, men who have sex with men and in the context of sex work -- and secondly, to prevent all new HIV infections amongst people who use drugs. To know if we have reached these goals we need to measure infection rates in these communities -- easier said than done.

Canada used to be a leader in supporting research to monitor HIV in key populations -- terrifically difficult because the activities that put them at risk are covert and illegal in many countries; surveillance can expose vulnerable populations to authorities and create risks for them.

Until 2012, Canada supported an innovative project in Pakistan that developed a system for surveillance among people who inject drugs and among male, female and transsexual sex workers.

Mapping methodologies were developed to identify where people who inject drugs and sex workers gather and then determined their numbers so that a scientific sample could be calculated.

Integrated biological and behavioural surveys conducted by people who they trust -- for example local NGOs -- measured rates of HIV infection and the risk factors associated with infection. Not only did this provide Pakistan with information to plan and monitor HIV prevention strategies and services, the HIV/AIDS Surveillance Project changed how surveillance is conducted among key populations, particularly in countries with concentrated epidemics.

The research done by the project has led to the development of rigorous methodologies for HIV surveillance among vulnerable and marginalized populations, methodologies that do not increase the risk to them. The project's methodologies have been taken up by UNAIDS and WHO.

But Canada bowed out of supporting the HIV/AIDS Surveillance Project this year, albeit having supported it since 2005. The expertise and innovation developed in this partnership between Canada and Pakistan risks stagnation.

This is just one more brick in a wall that is contributing to exclusion and marginalization of those most vulnerable to HIV infection. Reaching key populations needs dedicated, key-population focused efforts from civil society to deliver services and advocate, from government to set policy and support services and from researchers to let us know if we are making progress.

We need all of these actors. It's such a shame that our government has lost its vision of never leaving anyone behind.