Evidence of meeting #139 for Health in the 42nd Parliament, 1st session. (The original version is on Parliament’s site, as are the minutes.) The winning word was testing.
A recording is available from Parliament.
Executive Director, Gilbert Centre for Social and Support Services
There's still a cost involved, of course.
Conservative
Len Webber Conservative Calgary Confederation, AB
However, it is free in B.C. You don't pay.
Is that a fact?
Conservative
Len Webber Conservative Calgary Confederation, AB
Well, we should all move to B.C. for access to free meds.
Conservative
Len Webber Conservative Calgary Confederation, AB
Mr. Croteau, I want to talk more about government ID and the fact that there should be more inclusive forms and that the ID should reflect someone's preferred name rather than their name at birth. Why is it so difficult to do that? Are they just strictly refusing to give you a name that you want to be called by? I don't understand.
Executive Director, Gilbert Centre for Social and Support Services
There's a cost associated with the change. Sometimes it's prohibitive for some who are, for example, on ODSP, the Ontario disability support program. At this time in Barrie, it's $1,200 a month. A one-bedroom apartment is $1,000 a month, so it's a question of where you want to put your money in terms of that.
Our agency does help with the change, but remembering that it's all part of the mental health process of someone. They just don't decide at age 30 or 50 that they're a trans man or trans woman. It has been a lifelong process.
Preferred name is not a nickname. Some practitioners still refer to it as a nickname. It's not a nickname, it's a preferred name.
Conservative
Len Webber Conservative Calgary Confederation, AB
They can go out and legally change their name, but obviously there is a cost there that makes it prohibitive to do that.
Executive Director, Gilbert Centre for Social and Support Services
Another thing is that forms are very important. When it's just male or female, it's stigmatized.
Liberal
Liberal
Doug Eyolfson Liberal Charleswood—St. James—Assiniboia—Headingley, MB
Thank you, Mr. Chair; and thank you all for coming.
I've said this at another meeting, but it bears repeating with the medical profession. I graduated from medical school in 1993, and the sum total of our education about LGBT health was that you should be nice to gay people, which is a correct but hardly sufficient.
Because there's a stigma with HIV, one of the challenges we had was that when we wanted to do an HIV test in the hospital environment, there were administrative procedures unique to HIV testing that you didn't see with any other test. I was an emergency physician before doing this, so all of my practice was in the hospital environment.
If a patient came in with jaundice, I would order liver function tests. I would order hepatitis B serology. I would do all of those things. I would just write it on an order sheet, somebody would come and draw the blood, and you would do it.
If it were an HIV test, you needed to fill out a number of forms. You had to document that you had consent to do it, and again, no other laboratory test had that requirement. When a 14-year-old girl came in with abdominal pain and I ordered a pregnancy test, I did not need consent to order that. However, for HIV, you needed consent, and the blood had to be put in special coded tubes that you would put a sticker on so that no one could see it. I understand that it was to preserve confidentiality and that there was stigma that was involved that wasn't involved with any other diagnosis.
At the same time, have there been any other reports that this tends to gum up the works and make practitioners less likely to order this test when it's so much more troublesome to do this? Has that changed in the intervening years?
Medical Director, Clinical Prevention Services, BC Centre for Disease Control
David, either you or I can address this.
Research Scientist, Epidemiology and Population Health Program, British Columbia Centre for Excellence in HIV/AIDS
Yes.
Medical Director, Clinical Prevention Services, BC Centre for Disease Control
Go ahead.
Research Scientist, Epidemiology and Population Health Program, British Columbia Centre for Excellence in HIV/AIDS
Maybe I'll start. What you're describing is a barrier to people getting tested—yes, absolutely. If you create administrative hurdles for people to get tested, not just for the patient but also for the provider, they're not going to do it.
In B.C. we developed provincial guidelines for HIV testing, which included a lot of specific recommendations, but one overall recommendation was that the consent you need for HIV testing should be the same as it is for any other diagnostic test. The Ministry of Health has been funding regional health authorities to promote HIV testing, quite successfully, in B.C. One thing we discovered in doing that was that, yes, a lot of these older procedures where you needed a specific form to do an HIV test in a hospital were still around as recently as 2014-15—we think in B.C. at least. Most people are onboard with a routine offer of HIV testing. Ideally, people should know that they're being tested for HIV and should agree to it, but you don't need to have a long drawn-out conversation about what's going to happen if they test positive.
I'm not sure how widespread that is across the country. Certainly the Public Health Agency of Canada, a few years ago, came out with HIV testing guidelines that again recommended routine offers of HIV testing not necessarily based on reported risk behaviour. I'm not sure specifically what it recommended around consent. You still hear the term “HIV counselling and testing”, which suggests that this is a more involved procedure than doing any other test, and it really shouldn't be.
Medical Director, Clinical Prevention Services, BC Centre for Disease Control
I would just add that we can't lose sight of the fact that an HIV-positive result is different from a liver function test result, in terms of its implications. I think what you need to do is to try to find out how you strike that balance between really trying to make it as simple as possible for the testing to occur, while still recognizing that there are some reasons to treat HIV differently. For example, within some of the testing guidelines, part of that was also making sure that people had.... We were saying that you could give people, in paper form at least, key information on HIV that they might need to know—for example, that their positive result is reported to public health.
It's not completely about removing everything that was done before. It's about seeing how that could be made more efficient within a testing process.
Executive Director, Gilbert Centre for Social and Support Services
I would add that the accessibility and making HIV testing normalized is the goal. In our centre we have a clinic called “George”, which is a clinic for guys who are into guys. HIV testing is much easier to access because it's in a safer space. The men who come in already know they're in a clinic that is very gay-friendly, and so they're much more comfortable talking not only about getting HIV testing but HCV testing and other STI testing as well.
Liberal
Liberal
NDP
Don Davies NDP Vancouver Kingsway, BC
Mr. Lacasse, you commented several times on the unacceptable state of data collection in Canada. In your view, why is the Public Health Agency of Canada's surveillance data so inadequate? Do you have any recommendations how we might address that?
Executive Director, Canadian AIDS Society
Well, take a look at northern Canada. We were at a conference looking at the framework and the medical officer from Nunavut said, “We take down how many HIV cases we have on the end of a paper at the end of our desk.” If you look at the Quebec model, you will see that they don't transmit all of the information. In the B.C. model, they have asked for all of the information on provenance to be stricken, I believe, though I'm not sure about it.
There's a different model in each province, and so there's no uniform access to collate the data. That's the problem. If it would come, with more jurisdiction around it.... Look, when we had a mental health initiative by this government in 2015, it was tied to transfer payments. Why can't we do that with everything else, to a certain extent, to get things moving and out the door? Sexual health is an important barrier to overall health and mental health, and everything else that comes with that. We have to have a way or mechanism to do it better.
NDP
Don Davies NDP Vancouver Kingsway, BC
Dr. Gilbert, I only have about a minute or two left, but I want to ask you and then Dr. Moore what steps the federal government should take to achieve zero new HIV infections in Canada? What advice would you give us on that?
