Health Committee on April 11th, 2019

[Gerry Croteau]

Across the country, no. In Simcoe County, the largest county in Ontario, in Barry, which is one of the larger cities in the county, we have one gay doctor. And I say “gay doctor” because there are men who are married to women and have sex with men, so they do not go to a gay doctor necessarily. They usually share the same doctor with their wife, so they're very hesitant to talk about sex outside of that relationship. So any concerns they may have about HIV or STBBIs tend not to be discussed with their doctor. They don't get into things like PrEP, or they don't get into things like HIV testing. Mind you, a lot of health care practitioners in our area are now testing in their clinics for HIV, no matter if you are straight or gay. It doesn't matter. Everybody gets tested, young and old.

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

Thank you.

[The Chair, Liberal, Bill Casey]

Mr. Davies, you have seven minutes.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you to all of you for being here and sharing your experience and wisdom with us.

Mr. Lacasse, I want to start with you. You've already mentioned some statistics about increases in HIV infections. I think you have written in a letter that there was a 14.4% increase in HIV incidence between 2015 and 2017, the largest increase since 2009. I'm just wondering if you know, Mr. Lacasse, that the Government of Canada has endorsed the global targets established by the joint United Nations program on HIV/AIDS and the WHO, and that includes the 90-90-90 target by 2020. Do you know if Canada is on target to meet 90-90-90 by 2020?

[Gary Lacasse]

I've been told that we're not going to meet them, but there's no official source.

We have some statistics, but our surveillance data is wrong. We can't even have assured surveillance data in Canada when we only know 60% of where our HIV cases are coming from on our surveillance data. It doesn't make sense. Two years ago, 10,000 people living with HIV disappeared. The estimates went from 75,000 people living with HIV to 63,000 in one year because we rejigged the estimates. I see people shaking their heads, but that's the truth.

When we look at our surveillance data and then we have estimate data, which one is true?

[Don Davies, NDP, Vancouver Kingsway, BC]

Is it that we're not meeting our targets or that we have no way of knowing if we're meeting our targets?

[Gary Lacasse]

In reality, I think it's both.

[Don Davies, NDP, Vancouver Kingsway, BC]

Mr. Lacasse, we know that access to antiretroviral meds is critical to achieving undetectable viral loads, and that's part of the goal. Do you know, roughly, what percentage of gay men in Canada who have HIV have access to antiretroviral meds?

[Gary Lacasse]

Everybody has access to get them. It's just that you have to be aware of your status. You have to also have access to those meds and able to afford the copay and so on and so forth.

I can't give you a statistic. I could tell you the broader statistic of how many people living with HIV are on medication by an estimate, but that's not—

[Don Davies, NDP, Vancouver Kingsway, BC]

What would that number be?

[Gary Lacasse]

Because 90-90-90 is a cascade, so 90—

[Dr. Mark Gilbert]

I can't remember.

[Gary Lacasse]

I can't either. I think about 70% are on their meds.

[Don Davies, NDP, Vancouver Kingsway, BC]

If you get that number, can you send it to the committee?

[Gary Lacasse]

Yes, I will.

[Don Davies, NDP, Vancouver Kingsway, BC]

Dr. Gilbert, when we talk about GLBTQ2S health, all we keep hearing over and over again is about stigmatization and discrimination. I want to ask a question about the blood donor ban on men who have sex with men. We know that there was a promise by this government to eliminate the five-year period of abstinence. That's been reduced to one year I understand. I've heard anecdotal testimony from gay men about the impact that has on their self-worth.

I'm going to ask you directly. Is there any valid scientific evidence that justifies enforcing a one-year period of abstinence on men who have sex with men from donating blood?

[Dr. Mark Gilbert]

No, there isn't, to my knowledge. My understanding of the decision to go to one year was not so much that it was.... It was based on science in general, in the sense that the five years was too long, but there was a parameter set that it shouldn't be less than a year. I do think there is evidence showing that it could be less than a year. Certainly for some people it could be much less. I know that trying to uncover some of that is an active area of research right now. I have colleagues in B.C. doing research on that.

[Don Davies, NDP, Vancouver Kingsway, BC]

The other thing we touched on was the criminalization of HIV. With regard to the provisions in the Criminal Code—if I have it right—requiring people who have HIV to disclose that to their sexual partner, one of the concerns I've heard people express is that it may actually work to actively discourage sexually active adults from getting tested.

Do you have any comment on that? Does it discourage testing? Do you have any concerns about that provision being in the Criminal Code of Canada?

[Dr. Mark Gilbert]

I don't have any evidence to back that up. I've heard anecdotal evidence or people saying that's a concern, but in terms of actual data, I don't know that.

I think what's important when it comes to testing is to make sure that we have options where people can get anonymous testing—which is something we only recently introduced in B.C. a few years ago—and options where people can actually get tested, so that they can find out their status without being worried about legal repercussions.

[Don Davies, NDP, Vancouver Kingsway, BC]

Is that the standard across Canada? Is anonymous testing available?

[Dr. Mark Gilbert]

Anonymous testing is available in most places in Canada, as far as I know. I can't say for certain it's in every province, but historically it's been one of the first forms of testing that was introduced with HIV testing.

[Don Davies, NDP, Vancouver Kingsway, BC]

What about the fact that this is in the Criminal Code at all? It seems to single out a particular virus and impose a particular obligation on a particular group of people. Is that good public policy in your opinion?

[Dr. Mark Gilbert]

I certainly don't support the criminalization of the non-disclosure of HIV. I think that largely has to do with stigma and is really unwarranted.

Personally, I think there are mechanisms under public health law to deal with cases when someone is potentially transmitting HIV, either unknowingly or knowingly. That's the route we've taken in B.C. We really try to steer away from criminalization. Recent prosecutorial guidelines have been issued on trying to discourage people from being charged. I do really think that public health law is the much better route to go than criminal law.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you, Mr. Croteau.

I was quite stunned to think of the fact that a gay man would not want to disclose to his own physician something as important to his identity and health as the fact that he's gay.

I know it's anecdotal, but how common is it that gay men feel that it's not safe enough for them to disclose their sexual identity to their own physician?

[Gerry Croteau]

I can send you a survey that we did in Simcoe County, which was funded for five years by the Public Health Agency of Canada, of men who had sex with men and who had female partners. For example, you mentioned the blood supply of gay men in 2016, but what about the men who are bi who are married to women who don't identify as gay and who are having sex with men? They are not queried on this at all. Gay men feel even more isolated, because a lot of gay men have sex with married men who are married to women.

When I came out gay, my wife and I had the same doctor. I would not tell my doctor that I was having sex with men, and I would not get tested with him for any kind of sexually transmitted infection that I may or may not have had. I would go into Toronto only because the confidentiality between my doctor, my wife and me seemed to be transparent. Whatever I disclosed to him, he would disclose to my wife and vice versa. I mean, I found out my wife had yeast infections before she told me in some cases.