Great. First off, I'd like to thank the Standing Committee on Health for the invitation to speak here today, and also for dedicating the resources of the committee to this study, which I think is pretty unprecedented in Canada. It's a real sign of progress in society, as well as in the federal government. It's a real honour to be here today.
I'd also like to acknowledge that I'm here today on the traditional, unceded and ancestral territories of the Algonquin peoples.
The focus of my remarks today will be on improving the sexual health of gender and sexual minority Canadians. I'm a gay man, a public health physician who's responsible for some sexual health services in B.C., and a public health researcher who has a focus on gay men's health, testing and digital initiatives around sexual health care. Those are the perspectives that I'll be bringing today. However, on the flip side, I just want to acknowledge that there are other perspectives related to issues of sexual health that I hope you'll get the chance to hear from during this study, including those of two spirit people and gender minorities.
I'll start by outlining some of the challenges that I see related to sexual health. As I'm sure it's no surprise to people in the room, there is a higher burden of sexually transmitted and blood-borne infections among gender and sexual minorities, and I'll call those STBBIs for short. This includes ongoing high or increasing rates of HIV and STIs, particularly syphilis, among gay, bisexual and other men who have sex with men.
Recent experience from Ontario tells us that there continues to be a lot of resistance in society to health education in schools that's relevant to today's youth. Even when that's available, it often is not as relevant for gender and sexual minority youth.
On the other side, we know that health care providers are often not trained or comfortable with providing appropriate sexual health care to gender and sexual minorities, so this lack of education and training really contributes to the many barriers that gender and sexual minority people face in accessing appropriate sexual health care. These include barriers that are common to many Canadians, such as factors like distance to a clinic, opening hours, or wait times for appointments. Also, everyone is affected by the stigma that still surrounds sex and infections in society, and that leads to people's being embarrassed to talk to people about their sexual health, or to providers' feeling uncomfortable asking questions.
Gender and sexual minority people face additional barriers, which are related to the need to talk about their identity or their orientation with their care provider. As you can imagine, many people fear negative reactions. They fear being judged or discriminated against when they do so. Unfortunately, all too often that's based on past negative experiences in health care.
While in some major urban centres—like Vancouver, where I'm from—people may be able to access quite friendly and culturally appropriate LGBT services around sexual health, all these barriers become more pronounced once you go into rural and remote communities.
Finally, there's a strong connection between sexual health and mental health for gender and sexual minority people. I know you've heard from a lot of witnesses already about mental health. As they've discussed, we know that stigma in society against gender and sexual minority people leads to negative experiences, which have an impact on mental health and could lead to a higher prevalence of mental illness.
These same negative experiences and mental health issues, such as substance use, can also lead to sexual risk-taking and a greater chance of infection. This is a concept that's known as syndemics, or synergistic epidemics of these types of factors, and it's been demonstrated from research for gay, bisexual and other men who have sex with men in Canada.
However, we still typically approach sexual health and mental health in silos. This leads to our not providing comprehensive care or tackling the factors that contribute to poor sexual health. For example, in B.C., research by Dr. Travis Salway, who spoke to this committee on Tuesday, has shown that it commonly is reported by members of sexual and gender minorities that they have unmet mental health needs when they're presenting for care in sexual health clinics. That suggests that these are services that are actually probably ideal forums for also thinking about mental health and are a way for engaging people in mental health.
I'll now move to focus on what I think are five opportunities for the federal government to address these challenges.
First, I think that current national sexual health guidelines and resources need to be re-examined to make sure that they're appropriate for all gender identities, such as the Canadian Guidelines on Sexually Transmitted Infections. As we've started to do in B.C., these need to use clinical approaches that are relevant after gender-affirming surgery; need to shift away from gender-binary approaches, talking about men and women or males and females; and need to adopt trauma-informed care as fundamental principles.
Second, there needs to be greater integration across sexual health and mental health. The Public Health Agency of Canada last year released the pan-Canadian STBBI framework for action. It's actually a good step in this direction because it integrates across different infections and also recognizes the impact of syndemics. Certainly, as federal actions follow from this framework, the needs of sexual and gender minorities should be a major focus.
However, I think we need to go further and pay attention to mental health within these sexual health services. Another way to support this nationally could be to incorporate mental health and substance use assessments, as well as brief mental health interventions, within federal guidelines related to STIs or sexual health where this is often not talked about in great detail, as well as within related resources for providers.
We also know that community-based agencies that are working with gender and sexual minority populations are already using integrated or holistic approaches across sexual health, mental health and other domains of health. These agencies are the front line of our society's response to these issues.
Federal community action funds are an important funding source for this work. In the past few years, the community action funds have been expanded from HIV to include hepatitis C. This is good, but it wasn't accompanied by an increase in funding. I think the scope of these funds should be expanded to more fully and embrace sexual health and mental health broadly, but this should be accompanied by an increase in funding.
Third, I would like to build on recommendations of the pan-Canadian framework for action related to testing. I believe we do need a greater range of testing approaches in Canada that make the best use of new and effective test technologies and that empower gender and sexual minority people to get tested. The federal government is already supporting this through the National Microbiology Laboratory's dried blood spot testing service for HIV and hepatitis C, as well as hepatitis B and syphilis. This is being used outside our traditional health care settings—sometimes by non-health care providers—and it has been very well received.
This program should be further expanded in Canada. It would also be important for the National Microbiology Laboratory to think about how similar approaches for other STIs like chlamydia and gonorrhea could also be implemented in this way. For example, this could include a greater focus on self-collected specimens for STBBIs, such as swabs and blood specimens, which a person collects themselves and sends to a lab for testing, and updating Canada Post regulations to allow for sending such specimens by regular mail. Similar programs do exist in many other countries.
One additional area to focus on federally is the licensing of new types of tests for STBBI, as Canada does lag behind other countries. For example, there are rapid tests performed by providers right at the point of care and that give results within minutes. We have one licensed rapid HIV test in Canada compared with seven in the States, and we have Canadian rapid tests for STBBIs that are being used internationally, but not here in Canada. Similarly, there are no home-testing or self-testing kits for HIV that are licensed in Canada. This is an approach that has been shown in other countries to be quite successful, very acceptable and to increase testing.
I imagine that the market size of Canada compared with other countries is one of the factors affecting why industries may not be pushing forward and getting test products licensed here, but I do recommend that Health Canada's therapeutic products directorate, which licenses these tests, consider how more of these products can be brought to the Canadian market. This could be done, for example, by somehow expediting the approval of tests that have already been approved in the U.S., by funding Canadian studies that are needed to validate existing test technologies or by providing special access to permits.
Fourth, there are opportunities related to federal initiatives on e-health or digital health, which is a rapidly growing area in Canada. Studies, including work we've done in B.C., have consistently shown that gender and sexual minority people are highly accepting of online or technology-based approaches that help to overcome the specific barriers I mentioned earlier in terms of accessing sexual health care. This has been shown for HIV prevention interventions.
We've seen this in B.C., where many gay, bisexual and other men who have sex with men have used our program GetCheckedOnline, which is a successful Internet-based testing program for STBBIs. In our research around this intervention, men have reported that they really value this service because it gives them control over testing and is a way to get testing without needing to talk to a provider about their sex lives.
Digital health initiatives also cross provincial borders, and with the ever-increasing access to the Internet does provide opportunities for the federal government to improve health directly. For example, the federal government could directly fund national digital health initiatives for campaigns for gender and sexual minorities, such as sexual health educational resources that can reach youth across Canada. However, there are few national digital health initiatives or research opportunities that are focused on digital health care for gender and sexual minority people, or even more broadly, for sexual health.
One way to improve this gap would be within Canada Health Infoway, which focuses on investments in e-health and digital health in Canada and is funded by the federal government. To date, the work of Infoway has largely focused on electronic medical records, chronic disease prevention and mental health. I recommend that digital health initiatives for sexual health and for gender and sexual minority people be made strategic priorities within Infoway's work.
Finally, the role of the federal government in funding new research related to sexual health for gender and sexual minority people is critical. I recognize there are many research efforts currently funded in this area, but there are other opportunities that should be considered. For example, moving forward with e-health or digital health as one of CIHR's strategic priorities could include funding dedicated to sexual and gender minority populations.
In closing, I am grateful to the committee for seeking to understand the health issues facing LGBTQ2 people in Canada, of which sexual health is just one component. I would encourage the federal government to continue with the excellent precedent that's being established with your study by making sure that sexual and gender minority peoples are meaningfully engaged at all stages in any federal initiatives arising from this study.