June 30, 2014

Dear Members of the Board of Health: Councillors Joe Mihevc (Chair), Raymond Cho, Sarah Doucette, John Fillion, and Kristyn Wong-Tam and Abdul Fattah, Pamela Gough, Monte Harris, Suman Roy, Jennifer Sarjeant and Rumina Velshi cc Dr. David McKeown, Medical Officer of Health, Jann Houston, Director, Healthy Communities and Herbert Co, Supervisor, Urban Health Fund (TUHF), Jason Altenberg, Chair, TUHF Review Panel, Councillor , Susan Shepherd, Manager, Toronto Drug Strategy Secretariat.

As the Board of Health considers the funding allocations for the first year of the Toronto Urban Health Fund (TUHF), the Toronto HIV/AIDS Network (THN) must express to the Board that there are serious concerns about the transition to TUHF and the resulting impact of loss of services provided by community agencies to affected communities.

A significant portion of the Recommendations not to fund projects are in the HIV Prevention Stream which will have a negative impact on the local response to HIV. The historic importance and current value of community agency programming that incorporates volunteer infrastructures, peer programming and community capacity, with targeted and collaborative programs serving specific communities appears to be in question. In general, funding to HIV Prevention services has been going down over the previous years according to Toronto Public Health information. Although Harm Reduction had seen increases over the previous years, loss of harm reduction services has occurred in the transition and there are serious questions about the future direction of TUHF for the HIV Prevention and Harm Reduction Streams.

We acknowledge that AIDS Service Organizations (ASOs), other HIV-related services and Harm Reduction services, and therefore the affected communities they serve, are being supported by the Recommendations, and we are appreciative of this. However, it is important for the Board to understand that there are community services being lost, while there are significant concerns about the application and review process, the transition to TUHF and the future of the program. The vision for the program remains unclear. The future funding allocation model needs to be transparent and engage stakeholders before decisions are made. Very importantly, growing a program cannot happen without growing the resources.

First year process and impact: THN has not, and will not, be speaking to specific applications but we can share our observations about process and negative impact. THN has been raising concerns from last summer about potential loss of services and the need to avoid unintended consequences. We understood that the new program aimed to have greater accountability and a higher quality of applications, and to reach out to include more agencies. We identified that projects from smaller agencies would be at greater risk. Agencies had heard changes were coming but to take the changes in and

1 adapt quickly would be difficult especially when TPH was itself in the process of deciding upon making those changes. Initially we heard from TPH a commitment to capacity- building and support to agencies in making the transition but these efforts were inadequate. We acknowledge the staffing challenges that TPH faced. There was some effort to provide support through other structures such as community health promotion staff. However, THN member agencies advised that this came late, and staff themselves were learning about the application process. The understaffing severely limited the support available and some of the agency applications were affected as a result. This was the first year in a grants program to address HIV and substance use where the decision-making process was based entirely upon the application except for the limited appeals opportunity. Knowledge of the work by groups on the ground was avoided in favour of ‘objectivity’ which made support for the application process all the more critical.

Projects for and with people living with HIV/AIDS (PHAs) – peer projects. There is a significant loss of engaging PHAs as peers in HIV prevention projects that impacts frontline work with gay men, MSM and newcomers, despite PHAs being identified by TUHF as a priority population. We do recognize that the criteria for Poz Prevention became more restrictive according to the paper on Poz Prevention distributed December 9, 2013 in advance of the February 5, 2014 application date. However, we are disappointed and object to the fact that TPH made its decision, which is final, without appropriate consultation. Again, time and support was limited for agencies to be able to understand and adapt to such a significant narrowing of criteria. The lack of process and result sends a troubling signal about a lack support for PHA peer projects under HIV Prevention. This also contradicts TPH’s stated recognition of the Greater and Meaningful Involvement of People living with HIV (GIPA/MIPA).

Review Panel:The Review Panel took on many more hours of work and had increased responsibilities this year. With new members and a consolidated panel, we hoped for a robust orientation but it focused upon the technical aspects of application scoring. We believe that the orientation needs to reflect the added level of responsibility. The Review Panel also needs the context for its work, some understanding of the community response to HIV/AIDS and its partnership with TPH, starting with the mobilization of the gay community and the ethno-racial communities to develop ASOs, and the collaborations and advocacy to bring in needle exchanges and harm reduction. There has been a proud partnership between TPH and community and that context is important for the review panel.

Growing a program - Without the necessary increase in resources there will be more losses in services to priority populations. We were pleased to hear recently from TPH management, some understanding of this and a stated desire to only grow TUHF further as new funding might become available. Transparency and consultation on future directions are essential and we hope this position on program growth might become a firm commitment from TPH. The selection of an allocation model could have a huge impact on services and we are very concerned about the vulnerability of the HIV Prevention and the Harm Reduction Streams under TUHF. The stated intent to grow the program is a good one which THN supports. However. we have seen how working to expand the program has meant loss of valuable services in the first year.

Child and Youth Resiliency Stream- As a new funding category this Stream remains unclear in terms of its rationale and direction, despite a short background paper

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(November 2013) and a consultation report (March 2013) provided by TUHF. THN clearly supports programming for youth but there are considerable questions on the purpose of this Stream, the rationale, who it is serving and future directions – will there be a clear focus and connection to preventing HIV and substance use problems? While the intent of this stream was to target young people in order to avoid problematic substance use or reduce HIV risk, the stated priority populations for the Stream did not include gay youth which sent a negative signal, although it was communicated that they were not specifically excluded. It took an appeal for one project targeted specifically for LGBTQ youth to be funded for only one year.

The problems from the first year need to be openly acknowledged and addressed for the future of TUHF. The changes to the application and review process were very significant, very hard for some agencies to adapt to while TPH itself was in a decision- making process, at the same time as implementing the first round, and understaffed, all within months.

We appreciate being able to have open discussions with TPH management and have facilitated community input as well as shared a number of concerns from our network perspective. The responsiveness and incorporation of some key community input has been an important and acknowledged reflection of the long and positive relationship between TPH and community agencies. We will provide a more detailed submission to management. THN will also bring a submission and request a deputation when the Board of Health considers the evaluation of the TUHF application and review process and considers the future directions.

THN is appreciative of opportunities for dialogue and we hope this dialogue can be strengthened going forward and expanded to directly include more stakeholders in the coming months given both the magnitude of the positive and negative impact your decisions will make.

We will help in any way we can. It is critical that issues be openly discussed and problems resolved as much as possible for the communities affected by HIV and substance use.

With thanks,

Keith Hambly, Executive Director, Fife House and Murray Jose-Boerbridge, Executive Director, Toronto People With AIDS Foundation, Co-Chairs, Toronto HIV/AIDS Network (THN)

THN contact: Joan Anderson, Project Manager [email protected] 416-873-6099

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