Excerpt from DEBATES OF THE LEGISLATIVE ASSEMBLY (HANSARD) November 16, 2005

D. Cubberley: Thank you, minister. I appreciate the
responses. We're going to scroll through some things
now for a while before getting into seniors estimates,
when we'll have a more stable area of questioning.
A couple of questions in the area of prevention. The
first one has to do with the Ministry of Health's goal of
reducing the incidence of HIV infections by 50 percent
over a five-year period beginning in 2003. A subset of
that was the goal of increasing the proportion of HIV
positive individuals who are linked to appropriate
care, treatment and support service by 25 percent over
that same period of time. I'd like the minister to comment
on that in light of funding available to groups
who are working in the field to control the rate of HIV
infection.

Hon. G. Abbott: I appreciate the member asking
this very important question. To begin to just set out a
couple of the key facts around the challenge that is HIV
infection, the B.C. Centre for Disease Control, which is
a very important player in terms of helping us try to
manage this enormous health challenge, estimates that
as many as 13,000 British Columbians are currently
living with HIV. They also report that 457 people
tested newly positive for HIV in 2004. That gives you
some sense of the magnitude of the challenge.
In terms of moving to meet that goal, one of the
factors that comes into play in terms of us knowing the
number of people who may actually be affected by
HIV, on May 1, 2003, HIV was added to the list of reportable
conditions in schedule A of the Health Act
communicable disease regulation in accordance with
the recommendations contained in the provincial
health officer's report on HIV reportability that was
released in 2002. The consequence is that we are seeing
more HIV cases reported with that reportability requirement
coming into play.
We continue to work towards those ambitious
goals. I certainly confirm that those are ambitious
goals, but they're ones that we are going to work tirelessly
to try to meet. There are a number of things that
are being undertaken. Some very excellent work is being
undertaken by health care professionals and others
across the province to try to eliminate the spread of
HIV.
In particular, there are some harm reduction programs
underway which we believe will bear short-term
and long-term benefits and results for those who might
be threatened with HIV — among them, the needle
exchange programs, which are now a feature in most of
the large urban areas in our province. As well, the
member will know that in recent years there has been
the addition of a safe injection site in the downtown
east side of Vancouver, which is part of a larger federal
and provincial assessment of whether that will, in the
long term, constitute an important part of how we
might manage the spread of HIV in this province and
in this nation.
We also have been working with the health authorities,
with each authority developing its own plans in
relation to meeting the HIV challenge in their areas. A
good example of the kind of excellent work that is
flowing from the HIV planning done in conjunction
with the health authorities is a prenatal HIV screening
program which is not only underway across the province
but is working effectively. Our officials believe
that now very close to 100 percent of pregnant women
are being effectively screened in respect to this.
There is a lot of great work that is being undertaken.
Again, these are ambitious goals, but I think we
all believe that we owe it to society, and certainly, we
owe it to those who might be potentially threatened
with HIV to work rigorously and tirelessly to try to
meet those very ambitious goals.

D. Cubberley: I appreciate the continuing commitment
to the goal, which is a worthy goal and obviously
one that's important to us because the costs of
each additional person…. Quite apart from the human
suffering associated with it, the direct costs to society
for each new HIV infection are estimated at between
$188,000 and $225,000 per person.
The challenge we're facing is that the pathways for
infection are diversifying. I think the minister touched
on one of those in referring to IV drug use, and that has
obviously become one of the main sources that has
enabled the disease to begin to make its way more into
heterosexual populations from where it began and become
a disease that any part of society may face.
One of the other challenges is that the incidence of
HIV infections is actually rising, and that, of course, is
of grave concern. In light of the target of achieving a
reduction by 50 percent, we may well, at this point in
time, despite very good efforts in many directions, be
moving in the other direction.
A lot of the preventive work and a lot of the kind of
community-based prevention care, treatment and support
work for individuals who have contracted HIV is
supplied through organizations like AIDS Vancouver
Island or the Vancouver AIDS organizations. The funding
to those kinds of organizations has remained essentially
the same for probably a decade. So the question
really is whether the ministry is considering, through
health authorities, making a more sustained investment
in those kinds of organizations as part of a plan
to bring down the incidence of new HIV infection in
society.

Hon. G. Abbott: I want to be very cautious in the
way that I express this, because the member raises a
very legitimate concern around the incidence of HIV,
and we share the profound concern with that increase
that's been expressed. Not to diminish the challenge,
but it was certainly the strong advice of the provincial
health officer when, on May 1, 2003, reportability was
attached to HIV, that we would see some bump in the
number of known cases of HIV. So part of it will be the
reportability, but some unknown portion of it may be
an increase in the incidence of HIV as well. Obviously,
we need to be concerned about this, and we are.
We also believe, as the member obviously does,
that HIV/AIDS organizations play an important role in
helping us to deal with this challenge, and we have
added an additional $60 million to our budget for the
public health area over the next three years for health
authorities to work with AIDS organizations to assist
us in trying to meet the very ambitious goals that have
been set out. I do hope that we achieve it, but we may
not. If we don't, then it will be disappointing. The $60
million is for public health, not just for AIDS, but AIDS
is an important part of it.
In terms of additional funding, I should also note
that there has been very strong growth of antiretroviral
drug coverage in this province. It has moved
from $12.9 million in '96-97 to $22.5 million in '97-98 to
$26.6 million the following year; $30.2 million, $31.3
million, $35 million in '01-02; $36.8 million in '02-03;
$37.9 million in '03-04; $47.2 million in '04-05; and $61.3
million in '05-06. So, as you can see, there have been
very substantial incremental investments year over
year in the anti-retroviral drugs as well, which are an
important part of trying to manage this very important
health challenge.

D. Cubberley: I appreciate the comments, and I
also appreciate the reiteration of commitment. I recognize
that a 50-percent reduction is an ambitious goal,
but I think it is a good goal to set, and I think it's one
that we should make every effort to reach.
I want to press the minister a little bit on the matter
of funding. I'm very appreciative of the money that's
going into the drug side of it for people who have the
disease, and with all of the elements of the health system
working on their parts of it, I think that's a good
thing.
I want to come back to the community-level organizations
and ask the minister very directly, in a soft
way, if he and the ministry are willing to consider increasing
the funding to the community-level organizations
that are a direct point of contact both with people
who are contracting the disease and with many populations
who are at risk — and whose services, through
the distribution of clean needles and the like, help to
protect people from acquiring the disease. There has
been no significant increase to funding in a decade.
That's not the entire responsibility of the government
today, but in light of the importance of it, I would ask
the minister to consider increasing funding to those
organizations.

Hon. G. Abbott: Just to clarify a few points and to
address the member's important question, the antiretrovirals
are not simply a matter of maintenance or
managing the disease but are also an important part of
prevention. In fact, I understand from staff that the
drugs in question will be an important part of reducing
the incidence of infection of others and are, thereby, an
important part of prevention as well.
The $60 million over three years that I mentioned is
incremental to the funding that is already in place. I'm
not going to make statements in the House about how
the health authorities should make their allocative decisions.
Indeed, they will receive their share of that $60
million, and they will be making important allocative
decisions about exactly where they believe the greatest
public health benefit can be derived.
With the health authorities holding contracts on
this with community organizations like AIDS Vancouver
and so on, we know that they can make those allocative
decisions in light of their meetings and submissions
from those organizations. The health authorities
recognize that organizations like AIDS Vancouver and
so on are an integral part of meeting the challenge and,
hopefully, of stemming the tide of HIV infection. We
encourage the health authorities to work with the
community organizations and vice versa, because that's
a little closer to the ground, and thereby, hopefully, the
wisest and most productive use of those incremental
public health dollars will have its effect.

K. Conroy: Keeping with the blood-borne viruses, I
wanted to ask some questions about hepatitis C. I was
interested in the numbers, Mr. Minister, that you
brought forward about HIV, but for hepatitis C, it's
estimated that 65,000 British Columbians already live
with the disease and that 1,500 to 2,400 new infections
are going to be occurring annually. In fact, B.C. accounts
for 30 percent of Canada's infections.
Along that line, I know in the framework that the
ministry put forward for the provincial chronic disease
prevention initiative, when that was tabled, there was
very little mention of hepatitis C. So there's a huge opportunity
for the ministry to be looking at prevention
and implementation strategies. I'd like to ask the minister:
specifically, what is the response to the hepatitis C
epidemic and the actual dollars that are earmarked
specifically for hepatitis C?

Hon. G. Abbott: I'll try to at least begin to answer
the member's very important question. In British Columbia
our response to hepatitis C is done primarily
through B.C. Hepatitis Services, which is a division of
the B.C. Centre for Disease Control. It's through them
and through the Ministry of Health and assorted agencies
that our response to this is developed and managed.
In terms of the magnitude of the challenge, we're
advised that approximately 55,250 British Columbians
have been confirmed as infected with hep C, based on
antibody testing. About 25 percent of those infected
with hep C are known to spontaneously clear their
infection. Therefore, at the present time about 41,000 of
the 55,250 are antibody-positive individuals likely to
have chronic infection with hepatitis C. An estimated
20,000 British Columbians are currently infected with
hep C but have not yet been diagnosed as having
chronic infection. Therefore, the total number of people
currently living with hep C in British Columbia is, as
the member noted, approximately 60,000, or approximately
one in every 70 people in British Columbia.
In terms of senior government support for this, the
multi-year federal government–funded hep C initiative
ended on March 31, 2004, but there have been subsequent
extension announcements which will take us
through to March 31, 2006.
The member can maybe ask me, if she's interested
in this. According to the B.C. Centre for Disease Control,
3,062 people were newly tested as positive for hep
C in the year 2004. We do have a regional breakdown
of those 3,062 persons, but I will leave that detail and
be glad to provide it if the member wishes. But otherwise,
I won't go through it now, in the interests of time.
In terms of the provincial response to this, we
spend in excess of $100 million a year on hepatitis C.
That estimate has been developed by the B.C. Hepatitis
Services at the B.C. Centre for Disease Control — over
$100 million a year on hep C. That would cover important
programs like the cost of antiviral drugs, immunization,
education activities, hepatitis testing and a
range of other services for persons who have been afflicted
with hepatitis C.
I hope the member finds that useful. I'll invite her
supplemental questions.

K. Conroy: I would appreciate the regional breakdown
in writing. If we could get that at some point,
that would be great.
It's also my understanding that the federal dollars
are specifically for pilot projects. I would wonder what
the ministry is going to be doing with those pilot projects
in March 2006 when the federal dollars end, if the
ministry will actually be supporting those projects.
Because it's also my understanding that those projects
are quite critical out in the province and have been
doing a lot of preventative work. I guess my other
question to the minister would be the actual preventative
work that the $100 million is being spent on.

Hon. G. Abbott: The member is correct. There are
pilot projects underway which are community-based
and aimed at prevention of the spread of hep C.
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There are five pilot projects in different corners of
the province that are being undertaken as Centre for
Disease Control projects in concert with health authorities
and then community-based in partnership with,
I'm sure, local hep C support groups and organizations
of that character.
The member's question was: what will happen
when the federal funding is discontinued in a year or
two? It is our hope, after some considerable discussions
with the federal government around this, that federal
funding will in fact continue for the foreseeable future.
I would stand somewhere between cautiously optimistic
and boldly confident that we will get a continuation
of that funding from the federal government, and we
look forward to continuing our dialogue with them.