Thank you for inviting CAS to appear before your committee to discuss LGBTQ2 health in Canada.
The Canadian AIDS Society is a national coalition of community-based organizations dedicated to strengthening Canada’s response to HIV and AIDS, which includes ongoing collaboration with community partners and Canadian stakeholders that ensure positive health outcomes for our LBGTQ2 populations, among others.
I would like to thank the committee for touring the different organizations across Canada. I see that you have thoroughly discussed chemsex, which includes crystal meth and other drugs that are devastating our communities of gay, bisexual and other men who have sex with men across the country, among other priorities and issues.
I would like to take my time today to focus on LBGTQ2 people living with HIV.
In the early years of the AIDS epidemic in Canada, 84% of the cases were gbMSM, most of whom died in the early years. Then, as drugs became available, they had to quit their jobs and go on social assistance to have access to these life-saving drugs. This created huge barriers for these individuals, their families and their communities, which created social and financial injustices through complacency from all levels of government.
Many of those who survived the epidemic are now facing their senior years with much trepidation. Imagine the double stigma of being gay and having HIV. We still have so much to do, but without an alignment from the federal government all the way down to local government, we will not be able to provide a place of peace and tranquillity for people living with HIV in their senior years.
Nationally today, depending on who does the statistics, 55.4% of new infections are gbMSM. Our work is having some impact, but we still have much to do, as gbMSM are overrepresented in HIV. We do have some good news, as rates in gay neighbourhoods seem to be on a downward trend, and targeted investments there seem to be working. Now we must also coordinate our efforts to reach them outside these neighbourhoods, as many of us who live outside these urban or rural areas are not exposed to prevention methods.
Complacency is truly at the root of the matter. As the Public Health Agency of Canada continues to centralize its efforts to reach gbMSM in gay neighbourhoods across Canada, and thus not effectively reaching all communities, better-aligned awareness campaigns must be developed and adapted accordingly.
Stigma remains one of the biggest issues for people living with HIV today. It is the one central issue that affects most of the social and health outcomes of people living with HIV. On top of all this, overall about 40% of people living with HIV have mental health issues.
Decriminalization of HIV remains one of the priorities for people living with HIV today. We had expected better from this government in addressing the criminalization of HIV. Although the justice minister announced a new directive to help limit unjust prosecutions on December 1 of last year, more should be done. The cases of HIV criminalization in Canada represent one of the highest rates in the world, and have significantly added to the stigma that people living with HIV already face on a day-to-day basis.
I would be remiss if I did not address the HIV funding landscape in Canada. We question the steps that Canada has taken to address HIV, hepatitis C and other sexually transmitted and blood-borne infections—or STBBIs—in recent years through the community action fund and the pan-Canadian STBBI framework for action.
Since the implementation of the CAF, both people living with or affected by HIV and other STBBIs and community-based organizations that serve them have felt its negative effects, as HIV and STBBI rates continue to rise in Canada. Those living with these infections are left behind, with decreased access to support and care. To progress toward the UNAIDS 90-90-90 targets that Canada aims to reach, we suggest the following three steps: reassess the priorities of federal funding; review the population-centred approach; and increase the funding for both testing and secondary prevention through care and support of those affected by, and most of all, at risk or vulnerable to HIV.
There must be a consistent and collaborative dialogue between community-based HIV movements and the federal government, which does not necessarily exist. It is only through long-term and committed engagement that we will reach these targets and reduce the overrepresentation of gbMSM in new infections.
I must also underline the fact that our own surveillance data is significantly flawed in Canada. To be a G7 country without a unified surveillance data reporting system in 2019 is shameful—and imagine, we have data on only 60% of the reported cases of HIV in Canada.
Unfortunately, concerns were raised in our letter to the minister of health in 2016 regarding the likely outcomes of the funding cycle of that year. The implementation of the CAF has left many community-based organizations without the necessary funds to address the priority populations, which represent the highest levels of vulnerability in their own areas. After seeing HIV rates increase by 17% in 2017, a second consecutive annual increase and the highest rate since 2009, it is clear that the new funding model under the CAF has not effectively achieved its goals set out by PHAC, and this is shameful.
Ironically, while the STBBI framework for action highlights the importance of positive prevention, it does not holistically address it. While positive prevention is identified as one of the seven funding priorities of CAF, there is a recognizable lack of emphasis on treatment and care in the descriptions of both CAF priorities and the programs or initiatives funded. We do recognize that treatment is a provincial jurisdiction, but the provinces take their lead from the federal government. If and when there is no leadership at the federal level, the provinces are more likely to let this slide.
With that specifically in mind, CAS launched a national HIV testing day last year, built on the success of the Saskatchewan HIV testing day. It is inconceivable that PHAC would not want, at the very least, to sponsor this effort that we're doing at CAS and coordinate this work at the federal level minimally. This project brings much-needed awareness of HIV and new HIV testing technologies to thousands of Canadians. The government’s refusal to support this initiative is indicative of the value it places on community-based organizations, many of whom provide vital services that people living with HIV could not receive anywhere else.
Community-based organizations do most of the same work as the health care sector at 20% of the cost and save more than $1.3 million over the lifespan of somebody infected with HIV. With more mission funding as opposed to only project-specific funding, organizations would be more able to ensure quality, long-term programming rather than constantly scrambling for new sources of funding. This would ensure a full spectrum of prevention, care and support for people living with HIV, specifically LGBTQ2 populations across Canada.
Mission funding would also alleviate the divides in community, as PHAC and Health Canada could ensure collaboration and support amongst community organizations instead of continually pitting them against each other.
We do have the tools to prevent infections: U equals U, that is, the undetectable equals the untransmittable, and PrEP, among others.
We are resolute in our mission of eradicating HIV and supporting those affected. At this precise moment in time, someone out there who is living with HIV or another STBBI and who is not aware of their status is transmitting it to someone else. Why is this? It is because our own health care system outside of our urban settings does not have the tools to prevent HIV and other STBBIs. The system is underfunded and is struggling to survive instead of thriving. How is it that a gay man in Gatineau, across the river, cannot walk into a clinic and be tested for HIV and other STBBIs without feeling stigmatized? Why is it that a gay man in New Brunswick cannot feel comfortable getting tested in New Brunswick? It is because the sexual health clinics are called “women's sexual health clinics”. That's why.
Our biggest roadblock to positive health outcomes for anyone in Canada is our own health care system. It is nearly impossible for the most vulnerable and marginalized to access it, and these are the people who are most at risk of HIV. The health care system is broken, and until we recognize that, we will not be able to move forward in a meaningful way that will positively influence the health outcomes of all Canadians, let alone those of the LGBTQ community.
I thank you for the opportunity. I would accept more dialogue around this, as we move forward.
Thank you.