Thank you for inviting me.
The Gilbert Centre is the largest 2SLGBT centre north of Toronto and south of Ungava Bay.
“The homophobia we experience as children spreads throughout our lives like ripples on a pond. I remember everything, and so will your children,” and my children.
The impact of being a teenager in the 1960s, at a time when support services for LGBTQ youth were unavailable was that to be gay was to be at risk of criminal prosecution. Disclosure was never an option. Support for many of us within the family structure centred on being normal, for a boy. For many of us, that was hockey, cars and woodworking, and never showing an interest in the arts, theatre or fashion. For girls, it meant home economics, being cheerleaders and never showing interest in activities perceived as male.
Health issues, if any, centred on cuts, concussions and broken bones. By the time the hormones kicked in, there was no sex education. Safer sex practices were not taught, and girls got pregnant if you held their hand—that's a Quebec thing.
Now fast-forward to 2019. The landscape has changed dramatically, in some instances for the better, but in others, it seems to have reverted to the 1990s, as it pertains to the 2SLGBTQ community.
Here I will cite the following. One, Ontario had a lesbian premier, Kathleen Wynne, from 2013 to 2018. Two, on November 2016, Randy Boissonnault was appointed special adviser on LGBTQ issues to Prime Minister Trudeau. Three, in May 2017, Ottawa apologized for past wrongs to the LGBTQ community. Four, in November 2018, Ottawa announced a $450,000 fund to improve the safety of LGBTQ Canadians. Moreover, in 2019 Ontario dropped references in all sex-ed curriculum, to sexual orientation, gender identity and same-sex relationships.
The first bullet point in my brief discusses health issues within urban and rural communities that centre on the 2SLGBTQ community. When it comes to health concerns, many seek out a “gay” doctor, in the hope of being able to be transparent and in a safe place. Discussing health issues such as condom use, STI and HIV testing, mental health and concerns such as the use of PrEP are not easily communicated by health care professionals who are unwilling and unaware or uncomfortable discussing these concerns with their 2SLGBTQ patients.
Stigma remains problematic for gay men, men who have sex with men and HIV-positive folks. In 2016, Health Canada approved Canadian Blood Services and Héma-Québec's application to reduce the men who have sex with men ineligibility period from five years to one year. It remains stigmatizing to cite gay men as somehow being carriers of the HIV virus, or any number of other STIs.
Note that HIV is not only found among gay men, who represent 47% of HIV-positive folks. There remain 53% of others—injection-drug users, women and children. This stigma feeds into the inability of gay men to access health care in a timely manner. Many gay men do not visit their health care professionals, due to stigma, and therefore are not always receiving the proper health care they require.
U=U—undetectable equals untransmittable—the prevention access campaign, is a worldwide message that HIV folks who are undetectable cannot transmit HIV. The medical discovery has been endorsed by over 850 organizations from nearly 100 countries. Some health care professionals remain doubtful of the U=U message, thereby preventing their HIV-positive patients from fully embracing the tremendous freedom that U=U brings.
U=U brings with it the need to adhere to meds, proper diet and exercise. Health care for HIV-positive folks is critical in this country. It's not just good physical health, but also mental health and emotional well-being.
The cost of HIV meds can well exceed $1,000 per month, which is affordable for those who have private insurance, or in Ontario's case, the Trillium drug program. What if you can't afford the meds? We need to make HIV meds available at no cost, as they are in B.C., as mentioned earlier, freeing up the stress of securing meds, and allowing HIV-positive folks to live a healthy life.
HIV specialists are often located in major urban centres, which makes accessibility difficult for rural populations that may have transportation challenges. For some from rural communities, access to a 20-minute appointment could involve a day's commitment, due to buses that run only twice a day, and often require a bus transfer. Bus and train schedules are not always convenient or available in rural Ontario.
With regard to transgender health, within the trans community, many encounter issues, for example, with the use of their preferred name. Government-issued IDs use the name assigned at birth. Using the name assigned at birth and not the preferred name can be triggering.
In many instances, hospital, medical and government forms fail to address transgender folks correctly. The incorrect use of pronouns, sex and health issues that are unique to transgender folks can be very problematic when accessing health care. For example, for a trans woman who hasn't had confirming surgery but is on hormone replacement therapy, it may be awkward, or a trans man may need to have a mammogram if they haven't had top surgery, or a pap smear for cervical cancer. These are areas of concern when accessing health care.
Regarding indigenous communities, in Simcoe County and Muskoka, we have Beausoleil First Nation, Wahta Mohawk First Nation and the Chippewas of Rama First Nation. The problems are many for Canada's indigenous people, including aboriginal, first nation, Métis and Inuit people. They range from higher incidence of mental health problems and lower access to appropriate care—despite greater willingness in the general population to seek mental health care—to systemic public health care issues. Health care is viewed as white man medicine by many in the indigenous communities.
Social media sites that connect men who have sex with men, such as Grindr, Squirt and Facebook have enabled men to access quick and often anonymous sex without much concern about transmission of STIs, such as HIV or HCV. I bring this to your attention, because in rural communities, isolation is a factor and social media tends to bring the 2SLGBTQ community closer together. Accessing sexual encounters is therefore easier—it's GPS-based—and therefore the possibility of transmission of STIs is higher. This increases not only health risks but also health care treatments in a timely manner.
I recommend—and it's a dream, right?—providing training to health care professionals to be more inclusive and diverse in their respective medical practices, from receptionists to the doctors; ensuring that health care professionals are current in their use of terminologies and pronouns; encouraging awareness on the part of health care teams of the need to be willing to assist the 2SLGBTQ clients with their health care concerns, even when it is not within their scope of practice; and ensuring that their medical forms are inclusive of the 2SLGBTQ community.
Government should be mindful when allocating program dollars for short-term funding agreements that this limits the ability to provide ongoing clinical and practical support. In addition, the ability to hire individuals with the needed skill sets is hindered when employers are only able to provide short-term contracts of six months to a year. Short-term contracts are not viable to social workers, as an example.
HIV and ARV medications, including PrEP and PEP, should be free to all Canadians, and trans health care should allow for affordable confirming surgeries to be possible in all provinces—and that includes feminization surgery and language therapy.
To wrap up with some historical context, remember that in Canada, even though our health system is not always up to par for the 2SLGBT community, our LGBT rights are some of the most advanced in the world. Same-sex sexual activity has been lawful in Canada since June 27, 1969. Historically, Canada has frequently been referred to as one of the most gay-friendly countries, with its larger cities featuring their own gay communities, such as Toronto's Church and Wellesley, Montreal's gay village, Vancouver's Davie village and Ottawa's Bank Street gay village.
Global surveys from March 2013 show that 80% of Canada's general population—87% of folks aged 18 to 29—favour social acceptance of the LGBT community. A large majority of Canadians support same-sex marriage, which has been legal since 2005. Polls show that 70% of Canadians agree that same-sex couples have the same rights as heterosexual couples to adopt children. Finally, polls show that 76% of Canadians agree that same-sex couples are just as likely as other parents to raise their children successfully.
In closing, Canada is very gay friendly. Our health care system ought to be as well.