Mr. Chair, ladies and gentlemen, members of the committee, dear colleagues, I am very happy to be participating in this committee's work on LGBTQ+ health. I want to congratulate you on this work of collaboration and consultation.
Before I begin my remarks, allow me to introduce myself quickly.
First, on a personal level, I am a gay and cisgender man. On a professional level, as it is in that capacity I am participating in the committee's work, I am a sociologist, a member of the Centre de recherche de Montréal sur les inégalités sociales et les discriminations—CREMIS—where I coordinate the activities of a working group on gender and sexual diversity. I am also a planning and research officer at the Montreal regional public health directorate.
My professional and scientific expertise mainly focuses on gay and bisexual men, and other men who have sexual relations with men, be they cisgender or transgender. To shorten this, I will use the acronym gbMSM. I am interested in those men's conditions and situations mainly in the urban context. So I will speak today based on that expertise.
As an introduction to my presentation, I would like to specify the theoretical framework of my remarks—analysis relative to social inequalities in health. That analysis makes it possible to simultaneously look at systemic dimensions and community and individual realities of social health determinants. When we consider LGBTQ+ health, the analysis relative to social inequalities highlights the importance of a holistic health approach, in order to understand why sexually and gender diverse individuals are structurally in poorer health than the general population in terms of physical health, mental health, or in terms of the prevalence of blood borne and sexually transmitted infections, or STBBIs.
In the remainder of my presentation, I will identify the various health barriers faced by LGBTQ+ individuals as they appear both in scientific literature and in my professional practice.
In Quebec, LGBTQ+ health difficulties are documented inconsistently. For MSM, there are numerous studies, both quantitative and qualitative, mainly related to the HIV/AIDS epidemic. However, for lesbians, bisexuals, trans individuals and other sexually diverse people, the data is unfortunately more limited, often less specific, and mostly comes from what community organizations have been noting on the ground. However, there is sufficient retrospective to identify a few useful pieces of information on the various barriers LGBTQ+ individuals face in the recognition of their health problems.
My first point focuses on systemic or structural barriers.
In Canada, as in a number of developed countries, LGBTQ+ individuals have practically obtained equal consideration before the law. I say “practically”, as some rights are yet to be obtained, especially for trans individuals in Quebec. However, legal equality is not true equality. In other words, recognition of same sex couples and implementation of anti-homophobia policies are indisputable achievements, but they are often offside with the experience of many LGBTQ+ individuals.
In a society where heterosexuality remains the prevailing social norm, the experience and development of young LGBTQ+ people in particular remain strongly steeped in feelings of shame and, unfortunately, in name calling, bullying and violence. Those dimensions, which profoundly affect self-esteem, in large part explain the high rate of suicide attempts among LGBTQ+ individuals, but also more broadly the high prevalence of mental health issues, including anxiety, ill-being and poor body image. Saying this is not an acknowledgment of powerlessness. Our societies are evolving and can still evolve thanks to increased visibility of sexual diversity and gender and the proliferation of positive models, but also thanks to the work of allies and innovation in education.
My second point concerns barriers to LGBTQ+ health in the health system.
Over the past few years, a great deal of progress and innovation has been achieved, most often in response to the urgency of the AIDS epidemic. These advances are a very important source of education. However, they have two main limitations.
First, the existing services generally confine the health of sexual minorities to sexual health or the fight against STBBIs. Second, those services are first and foremost all adapted, with a few exceptions, to gay and bisexual individuals and other cisgender MSM.
However, the health problems of LGBTQ+ individuals largely stem from their difficulties to be recognized and welcomed in the health system as people with specific challenges and needs. That is a more obvious reality for LBTQ individuals than for gbMSM. The health care system, specifically in Quebec, is still all too often struggling to adapt to that reality for the following reasons.
First, the population in question is often perceived as a very small minority by the decision makers. That may be true in certain contexts, but it does not preclude the implementation of inclusive approaches and policies. Second, the health care needs expressed by LGBTQ+ communities unfortunately do not appear to always be a priority in the context of fiscal restraints. Finally, health authorities do not always have an adequate perception of health needs. In the absence of studies and available data, as I was saying in my introduction, certain segments of the population are unfortunately still being ignored. However, experience shows, specifically in Montreal, that service adaptation can be the focus of close cooperation between the affected communities, the organizations that represent them and health services.
The third level of barriers to LGBT health I wanted to talk about today stems directly from the precedent, as it concerns professional practices.
All too often, LGBTQ+ people ask for health services, but they are struggling with difficulties or going through negative or arbitrary experiences. Those difficulties can manifest in a number of ways.
First, there are discriminatory or stigmatizing practices, which unfortunately still exist. Second, health stakeholders or professionals, feeling insufficiently trained, refer patients to other colleagues, and that sometimes leads to unjustified wait times. Finally, more generally, it is difficult to reach a health care professional who is open and welcoming, either for reasons of geographic remoteness or financial barriers, or because those professionals are already overbooked.
The last barrier level I want to talk about has to do with the individuals themselves. Taking care of ourselves and our health is an eminently social and cultural practice. Gender and sexual orientation, but also skin colour, education level, income level and community integration play key roles in all those processes. Why? Because becoming aware that we have particular and legitimate health needs as LGBTQ+ individuals requires a certain level of personal comfort, a knowledge of our body, an ability to reason and a desire to take care of ourselves that also develop through interactions with other members of our community and with the health care system. The transition from a perceived health care need to the effective use of health care is part of the relationship map in the same way as care maintenance, pursuit of our treatment or medical follow-up.
Having provided a brief overview of these different barriers, I would like to conclude my presentation by identifying a number of potential solutions that stem mainly from my professional experience. From the outset, I want to specify that the success of these solutions is based on three winning conditions: intersectoral collaboration, recognition of the expertise of the affected communities, and the taking into account of diversity of health care needs of LGBTQ+ individuals.
The first potential improvement has to do with the health journey.
The first challenge related to the health journey is related to navigation. In Montreal, research with gbMSM has shown that, beyond specialized or adapted services, the key is also in the affected men's ability to navigate the health care system. Access to regular STBBI screening is a good thing, but that gateway should also make it possible to be referred, if necessary, to mental health services and addiction services, or community resources to break down isolation. The silo approach still conditions the use of care too often. Putting in place navigation tools, such as online service mapping, would make life easier for affected individuals and facilitate the work of health care professionals.
The second challenge related to the health journey is that health care needs of LGBTQ+ community members vary depending on identities and life stages. For example, LGBTQ+ seniors need services as seniors, but also as LGBTQ+ individuals. An integrated approach would help take that into account accordingly.
Finally, a third very simple idea to facilitate the health journey would be to implement visual tools such as posters or pamphlets in services or organizations indicating that LGBTQ+ individuals are welcome. Those signs of consideration, often discrete, are a favourable signal for the affected people to feel comfortable opening up to their health care professional.
The second potential improvement has to do more directly with health care professionals. It clearly concerns knowledge—so initial and ongoing training—as numerous tools now exist to develop the skills of professionals who deal with LGBTQ+ patients. It also has to do with know-how, as, contrary to a preconceived notion, it is not necessary to be an LGBTQ+ health care specialist to take on patients from those communities.
In most situations, availability and attention to the individuals can be enough to identify difficulties and consider health options or a direction to take. A patient disclosing their sexual orientation or their gender identity must be seen as a very significant step by health care professionals.
Good afternoon, Mr. Chair and members of the Standing Committee on Health. I am grateful for the opportunity to speak to you here on the traditional territory of the Algonquin first nations.
My name is Jody Jollimore and I'm the executive director of the Community-Based Research Centre or CBRC. My expertise comes from 15 years of HIV prevention, a master's in public policy, but most importantly as a gay man who has lived, worked and loved in Nova Scotia, Quebec and British Columbia.
I'm lucky to have been born in a time when it's good to be gay. I grew up with Will & Grace, Svend Robinson, and for the most part, gay marriage. By the time I had my sexual debut, life-saving medications meant that men like me were no longer being cut down in their prime by AIDS.
But despite the immense political and human rights gains, our health outcomes, the health outcomes of all queer people, continue to be some of the worst in the country.
My organization, CBRC, was started in 1999 as a response to HIV among gay men in B.C. While we were founded for and by gay men, we made strides to include other sexual minority men, including bisexual, queer—cis and trans—and 2-spirit people. Our nationwide Sex Now survey comprises the largest dataset of this population, which continues to be an important source of information for policy-makers and program planners.
You see, while governments were trying to either ignore or, worse yet, erase our population, we were in the background quietly collecting data, developing reports and talking about gay men's health to anyone who would listen. These days, we've increased our focus on public policy, recognizing that the kind of change needed is transformational and structural. For instance, we've partnered recently with Canadian Blood Services to inform their policy change on blood donations for men who have sex with men.
But before we talk policy, I want to tell you a story that I think contextualizes some of the struggles we face as a community.
One of my best friends in high school was gay. He was a great friend and mentor to me. We both left rural Nova Scotia to pursue our dreams. But my friend had always struggled with undiagnosed depression and this worsened when we moved to the city. Despite being surrounded by more of his peers than ever, he continued to feel lonely, depressed, anxious, all very common issues impacting queer people, even in big cities. He self-medicated with substances and eventual started using crystal meth. Meth made him feel good. It made him feel wanted and accepted and part of something. It's hard to tell whether he was using meth or not when he contracted HIV, but I was with him the day he got his results. And we cried together. But we knew it would be okay because there were treatment options to keep him alive, especially in British Columbia. Only my friend didn't opt for treatment. Instead, he further isolated himself. He lost jobs, apartments, lovers and friends because of his meth use.
Left untreated, HIV becomes AIDS. And though it's rare in Canada, it does still happen, and usually only to those who are most marginalized and disconnected from care. My friend died of AIDS in the late 2000s despite there being free medications that would have saved his life. And my friend was not one of the most marginalized. Instead. like me, he was quite privileged. I'm white, I'm able-bodied, I'm cisgender, and I'm HIV-negative. These all make me privileged, and yet, according to the Public Health Agency of Canada, the fact that I'm a gay man means that I'm 131 times more likely to get HIV, 20 times more likely to develop an HPV-related anal cancer, and 4 times more likely to commit suicide.
This is startling. Yet, this is what we consider a healthy, privileged gay man. So the bar is set pretty low.
I listened to my colleagues' testimony from your last three meetings, and I was able to sit in on your meeting when you were in Montreal at RÉZO. I think the speakers have done a great job of setting the foundations for this study. By now, you know that our health is not great. Across the board—physical, sexual, and in terms of mental health—on all fronts we fall short. And this is only what we know with the limited data we have. If we were truly leveraging the research and data tools within the federal government, we'd know so much more.
Let's talk about what the feds can do about this. First off, my buddy had some mental health issues that were not being discussed at home or at school. Recent investments in mental health had been made, but they're modest and they frequently do not address the unique situation faced by queer people. Our mental health impacts so many other aspects of our health, and it's far more costly to treat the problem than prevent it. Treatment is almost always more expensive than prevention.
The feds should increase their investment in mental health and earmark specific funds for sexual and gender minorities. The mental health fund at the Public Health Agency is a program that could be expanded to include, or be mandated to target the agency's funding calls towards, organizations doing queer work.
We also need to reduce stigma in this country. It's killing us. First, the stigma, fear and shame reinforce minority stress and trauma, but that same shame and stigma prevent us from accessing the services we need. The result is high rates of HIV and STIs, substance use, depression, anxiety and suicide.
The federal government has the ability to impact stigma in several ways. The first is equality under the law—and we're getting there, but there's still work to be done. Then there's the overuse of the Criminal Code on things like substance use, which we're seeing having devastating impacts on drug users in this country, and also the criminalization of HIV non-disclosure. Both contribute to stigma in our communities. Then there's the fed's role in education and awareness. The government sponsors social marketing around substance use, anti-racism and healthy eating. It could do more around sexuality and gender. That could be funded either using a health lens through Health Canada or an equity lens through Women and Gender Equality.
We also need dedicated funding. There are many examples of dedicated funding for various populations. There is the harm reduction fund for drug users, the mental health of black Canadians fund, which is fantastic, but we need similar funds for queer people. Whether it be through the Public Health Agency funding or CIHR and their health centres, we need more dedicated queer funding for programs and research.
I know that you've heard this many times over the past few weeks, but we have to do something about the way we collect and use data in this country. That would be a quick fix, but we also need to find innovative approaches to fill those gaps.
I know this committee has studied pharmacare and made recommendations on it, but I want to make an additional plug, namely that whether it be for HIV meds, HPV vaccinations or hormone therapy for trans people, a national pharmacare program would go a long way to improving access to prevention tools. Short of that, there are some creative ways the feds could fund treatments in provinces that don't cover them. For instance, federal funding has been used to help address gaps in provincial access to hepatitis C treatment. The federal government could expand this strategy to ensure that queer people are able to access the medications they need, regardless of where they live.
And for me that's the role of the federal government, to ensure equity and access for all Canadians, because queerness, or being a sexual minority, doesn't impact just one community. It crosses racial, ethnic, religious and political lines. Gays, lesbians, trans and queer people are living in and coming from every community in this country, regardless of which riding you represent. Why should queer people have to move to the city to get the appropriate health care they need?
Our data shows that the further outside an urban centre you go or live, the less likely you are to be out to your doctor. And we also know that if you aren't out to your doctor, you're 10 times less likely to be tested for HIV, much less receive the kind of health services you need.
I was doing interviews in B.C.'s interior and after a long day I stopped in the city of Castlegar to grab some coffee. That's where I met Todd. Todd was a lively fellow, clearly gay, clearly out and proud. I went into my community researcher mode and I started asking him questions. My city-slicker attitude was what are you doing here in Castlegar? His response was that he had been to the city, done Vancouver and Calgary and he always came back here. Castlegar is his home and he loves it here. I thought this is why I'm doing this work. That's why this study is important, so that folks like Todd don't have to move to the city to be safe, to find competent health services and to live free of discrimination.
I want to share a quote with you and then I'll wrap-up, Mr. Chair:
Over our history, laws and policies enacted by the government led to the legitimization of much more than inequality – they legitimized hatred and violence, and brought shame to those targeted.
This was part of the government's apology to LGBTQ2 Canadians in 2017.
Chair, and members, this is your chance to right some of those wrongs, to change laws and policies that continue to lead to poor health outcomes for queer, trans and two-spirit people. I challenge you to do so, and I offer my organization's support and expertise. I look forward to talking with you about how we can make communities safer and healthier for queer Canadians.
Good afternoon, everyone.
I want to begin by thanking all the committee members. I am very happy to be here. The fact that we have an opportunity to discuss these issues together and to ask ourselves questions is really important for democracy. Thank you very much for giving us this opportunity. I also want to thank the support staff here today, as well as the interpreters and other language professionals who make it possible for me to express myself in my language. Thank you very much.
My name is Joël Xavier. I am Franco-Ontarian by birth, but a Quebecker by adoption. I am a gay man and a trans individual. Yes, we can in fact represent two letters of the acronym. It is possible. In life, I have had an opportunity to be both trans and gay. Some may say that I am doubly stigmatized, but I think I am doubly lucky. As a Canadian citizen, I am personally, professionally and educationally affected by these issues. Currently, I sit on the board of directors of the Quebec LGBT council. It is in that capacity—as an administrator, a board of directors member—that I will make my presentation today.
You can ask questions afterwards in English or French. It's fine.
The Quebec LGBT council, as a group, represents 35 organizations that defend LGBT+ rights and interests in Quebec in a context of social transformation. We have a consultative approach, which means that we consult our members and report on their projects, interests and priorities. We advocate, on a provincial level, for rights and the defence of interests. We cover all of Quebec and a population consisting of francophones, anglophones and allophones. Our perspective is intersectional. As my colleague said earlier, that means we take into account the way social and health determinants can be crossed and have an impact. That is important because we are not only LGBT. We are also individuals with a life, a certain age, cultural heritage, and so on.
Our consultations and research enable us to see, like you surely do, that the relationship between LGBT+ individuals and the health care system is not doing well. It is difficult for us to access health care. There are a number of structural and interpersonal causes, as well as causes such as regional remoteness. Like my colleagues have said, most services are available only in major urban centres. But we feel that people shouldn't have to move to Montreal or to Quebec City to receive care as LGBTQ individuals. Our community encompasses all layers of society. We should not be considered as exceptions, individuals who are very particular and difficult to understand. We are Canadians like everyone else.
This loss of trust is not new. Although many advances have been made in terms of rights, and people are becoming increasingly informed, there is a lack of research concerning namely the expertise of people who belong to the LGBTQ community themselves and stakeholders on the ground. It is difficult to obtain information to defend our rights. We feel that more money should be dedicated to research. I am also thinking of the men, women and non-binary individuals I know who are in their sixties and carry with them all sorts of traumatic experiences. Difficulty trusting the health care system is an experience we are going through. If we are told that we are strange, that we have something bad in us and our identity is considered pathological—which is still done in Canada—it is certain that we will not trust the health care system. A lot of time and efforts are needed to overcome those difficulties. For trans people, especially, access to health care is still very difficult.
If you read the briefs and testimony concerning bills 35 and 103, in Quebec, you will see that a lot of work remains to be done. Since 2009 in Quebec, certain gender affirming surgeries, for trans individuals, have been paid for by the government through the province's health insurance plan, RAMQ. However, to have access to those surgeries, trans individuals must still provide a psychiatric assessment and pay for it themselves. It can cost up to $1,000 or even more to obtain a psychiatric assessment before having access to gender affirming surgery. That is not the case for someone with cancer who undergoes a mastectomy. That person will not be asked to provide a psychiatric assessment. So inequalities exist in that respect. There also factors that render the system ineffective.
Simply in terms of the general health of trans individuals, we see in an Ontario study—but the same thing is seen in Quebec—that about 30% of trans individuals still do not go to emergency services for a medical emergency because they fear discrimination. As a result, our health problems build up because we are afraid of health care providers. Without access to that care, our health deteriorates. We end up going to the hospital when we are really forced to. That leads to costs for the system. As my colleagues were saying, the lack of prevention leads to long-term costs for the system.
We have a few recommendations to make. How much time do I have left?
With regard to trans people, it would be important to inform the health care community and make it aware of the specific issues faced by LGBTQ+ people. The health care community must empower LGBTQ+ people, like me, who have had trouble realizing that they aren't alone and that they have the right to demand good health care, like all Canadians.
It would be important to develop transferable guidelines for health care facilities for LGBTQ+ people, but especially for trans people, and to consult trans people in the development of these guidelines. It would also be important to create an advisory committee with people who have expertise in the field in order to develop guidelines, and to be in constant communication with government authorities.
Last but not least, I wanted to talk about the situation of intersex people in Canada. In Canada, intersex people still undergo surgeries without their consent. The term “intersex” means that at least one aspect of the biological sex isn't in line with the medical system's expectations for what the female or male sex should be.
From birth, surgical procedures are often performed that aren't necessary for the proper functioning of the child's urogenital system. These procedures are still being performed in Canada without the consent of the children, who are under the age of consent. The procedures have quite serious consequences later in life, especially in terms of pleasure. We all have the right to pleasure and sexual pleasure. In addition, there are sometimes medical complications or complications related to people's reproductive capacity and fertility.
It's important to stop performing surgeries on intersex people without their consent. There are many intersex people. We often think that intersex people are an extreme minority. However, we're told that there are as many intersex people as there are people with red hair. So, there are many intersex people. I think that my time is almost up.
I want to thank you for your time and attention. I hope that this marks the beginning of a wonderful conversation. I'm very happy to be here, to be able to speak in my language and to represent Quebec. Thank you, everyone.
Thank you for inviting us to be here today.
To expand on Rachel's description of OUTSaskatoon, I'm proud to share that with a staff of 12, our services include a daytime and evening drop-in centre, free counselling, more than 10 evening and daytime support groups, two educators who provide diversity training to schools and businesses across the province, and more than 35 community events per year.
As well, we operate a weekly sexual health testing clinic and a monthly PrEP clinic in partnership with an organization called Saskatoon Sexual Health. In 2017, we opened Pride Home, a long-term group home for LGBTQ2 youth aged 16 to 21.
Before Rachel continues, I want to share one story about the value of community centres in improving the health and well-being of LGBTQ2 people.
When my gay daughter JQ first came out, she was only 12 years old. As she was struggling—and I mean struggling—to become herself and looking for a sense of community, we discovered this wonderful organization called OUTSaskatoon. In particular, my daughter loved attending Rainbow Coffee every week, a queer youth support group that provides leadership workshops, sexual health education, and arts and cultural activities for teens aged 15 to 19. As JQ explains now, seven years later, her experience at OUTSaskatoon helped make her the confident, healthy, socially engaged person that she is today. Not only that, but now JQ is part of our mentorship program for Pride Home and is passing along the support she received to a new generation of youth.
In preparing for today, we read through the transcripts of the meetings that came before, and listening today, we are impressed with the breadth and rigour of all who have appeared before this committee. In light of this, we won't repeat evidence that's already been given. Instead, we're going to focus primarily on the fundamental value of queer, trans and two-spirit community centres or service agencies as access points to both a supportive and safe community, and a larger continuum of health care.
We have four recommendations, as indicated in our submitted brief.
First is the creation of a dedicated federal funding portfolio for LGBTQ2 community centres and networks. Like other provinces, Saskatchewan has been experiencing great legal and political victories in recent years thanks to engaged community organizations and individuals. That said, the experiences of queer people in Saskatchewan and throughout the Prairies are unique, but are often under-represented in national research and programs. Not only that, but the political climate in Saskatchewan creates roadblocks to our community, including minimal provincial supports and no provincial strategy, whether in education, health care or social services.
The lion's share of the support for LGBTQ2 people in all of these areas comes from the few—actually only four—community-based centres spread out across the three prairie provinces. Surprisingly, OUTSaskatoon is one of the largest LGBTQ2 community centres in the country, a fact that is directly the result of our efforts to serve a geographically and culturally vast community through an outwardly facing, one-stop shop. That is something that I know other witnesses have expressed a need for in this study.
Community centres provide the social connections for people who are isolated. They provide education for those who hold on to divisive beliefs. They provide the counselling and health care needed to improve mental health outcomes, which means reducing anxiety, depression and loneliness. We see these benefits taking place every day.
As an example, last year we watched an individual move from coming in for counselling for depression to applying to be a volunteer and now volunteering in our drop-in centre, providing peer support to others going through the same thing.
We've also seen huge steps forward in the last year to increase partnerships between queer centres, including two national gatherings of centre leaders, one taking placing in Saskatoon and one in Ottawa just a few months ago.
Through these gatherings we've created a network called Enchanté Canada, whose mandate is to build and maintain a thriving network of two-spirit, gender, and sexually diverse community groups, and that hopes to support the development of many more centres than exist today—and especially, I want to stress, in more rural and remote areas where such services are all but absent. As well, the 2Spirits in Motion Foundation has formed to create a safe and supportive environment for two-spirit peoples across the country.
These networks both demonstrate the pivotal role that community centres have in the spectrum of health. Their value in decreasing reliance on primary health care cannot be overstressed.
The $20 million included within the new federal budget for capacity building and the community-level work of Canadian LGBTQ2 service agencies will support the life-saving work that is already taking place. We recommend that these funds be distributed by the Department of Women and Gender Equality in order to better integrate social, mental and physical health while prioritizing gender, sexual and cultural diversity within future initiatives across the country.
Alongside the alarming statistics about our communities, as have been widely studied and canvassed in this study, queer, trans and two-spirit people also represent rich and diverse cultural groups. We are innovative in our methods of care. We are progressive in our labour practices, programming and policy development. There is much for other sectors to learn from the queer community, particularly in relation to meaningful engagement with principles of intersectionality, decolonization, anti-racism, feminism and disability rights as many LGBTQ2 organizations work hard to incorporate these into their daily work.
At OUTSaskatoon, we have spent years building reciprocal relationships with indigenous communities, and this has made our work and our centre better.
To this end, our second recommendation is for a commitment to meaningful reconciliation and decolonization, including the central positioning of two-spirit people in organizations within this work.
Our third recommendation is for the inclusion of LGBTQ2 needs and voices within federal and provincial housing strategies, particularly for youths and older adults. Pride Home holds a special place in my heart, and so moving to the topic of housing, I only want to amplify what has been said by other witnesses.
At OUTSaskatoon, we've conducted community-based research into housing for seniors and for youths, and both areas need attention. Our findings in Saskatoon show that 40% of queer youth have experienced homelessness or face barriers to housing, and this is greatest for two-spirit and indigenous queer youth. We created Pride Home because we found that some youths had nowhere to go after Rainbow Coffee, due to being rejected by their families and due to the homophobia and transphobia in other shelters.
One of Pride Home's greatest strengths is that it does not adhere to a gender binary, and as well, we're able to provide wraparound supports throughout Saskatoon's existing community programming. The problem is that despite this model aligning directly with Housing First recommendations for youth homelessness, we've struggled to access sustainable funding for Pride Home, as both federal and provincial dollars earmarked for housing and homelessness are for capital projects and not staffing or operations. We can apply to get $1 million to build a brand new home, but we cannot apply for the $100,000 a year that it takes to support those youths living in the home.
We don't need more research into youth homelessness nor the barriers that LGBTQ2 seniors face. The evidence is vast, as Egale and Dr. Abramovich have already testified. We need investments and we need action.
For the queer community, housing strategies must include non-gendered and inclusive housing at the same time that they include education for existing housing agencies, shelters and residential care facilities, so that our communities can safely access all services.
We recommend that designated funds within Canada's homelessness strategy “Reaching Home”, and any future housing strategies, address these gaps in service.
I appreciate that background research.
There are a couple of things. One of the barriers is being out to your health care provider. As I said, we have research outside of Vancouver that shows us that in smaller communities up north, upwards of 60% of people are not out to their health care provider. If you're not out, you're not getting the kind of services you need, much less prevention tools for HIV, because you wouldn't be considered high-risk for HIV.
That's one thing. I think that, through cultural competency, having health care providers ask the right questions, making them seem open, is certainly one way to deal with that.
Then there's the pervasive stigma. A health care provider can be as open and competent as possible, but if the individual feels that their sexuality or their sex life is somehow inappropriate because of something they experienced as a child or as youth, bullying or all of this trauma that we know happens at a very young age in queer people's lives, it impacts their ability to come out and to live freely later in life. Certainly those upstream barriers are really important.
I know it's not a federal jurisdiction, but we have a real problem with sex education in schools in this country where queer students are not learning about their sexuality. They're learning from porn, and that's not the place where we want young people learning about sexuality.
With regard to other upstream factors around violence or childhood trauma, we need to invest in the types of programs that would ensure that, by the time people are at their sexual debut and ready to make those decisions, they're able to either come out or at least acknowledge that their sexuality is at risk.