Health Committee on April 11th, 2019

[Don Davies, NDP, Vancouver Kingsway, BC]

Mr. Lacasse, with regard to the federal initiative on AIDS, can you tell us basically what the funding status of that is? Has it changed? What is the government currently putting into it, and what should they be putting into it in your view?

[Gary Lacasse]

We estimated that $100 million is lacking in the funding from unspent monies and the increase promised to the initiative in 2004 under the Liberal government. About $113 million is missing overall in the end.

At the moment the fund has been increased, but it's a temporary increase to include prevention and harm reduction for people who use injection drugs. The fund was increased, but specifically for the population of people who used drugs, so the fund stayed stable. In reality, it hasn't gone up. It's only gone up for five years, and that's it; then it was repealed back.

[The Chair, Liberal, Bill Casey]

Okay.

We have to move on to Mr. McKinnon now.

[Ron McKinnon, Liberal, Coquitlam—Port Coquitlam, BC]

I'd like to preface my questions by noting that budget 2019 does provide a $20-million fund over two years for community-level work for LGBTQ2 organizations across the country. It also increased funding for events such as pride festivals and so forth to increase awareness, to increase acceptance and, hopefully, to reduce the stigma.

Having said that, I'd like to continue with Mr. Davies' questioning about HIV criminalization or at least criminalization of non-disclosure. I'd like to note as part of this that the justice committee, which I am a member of, is currently engaged in a study instigated by Mr. Boissonnault on HIV non-disclosure, so I've heard some of this kind of testimony as well. I don't have the witness list in front of me right now, but I think the Centre for Excellence is on it. I would urge anyone who would like to submit a brief to that committee to do so if they're not already on the list.

I'd like to carry on from there and mention, as Mr. Davies pointed out, that one of the problems we're hearing is that the fear of criminalization is an impediment to people getting tested. If they don't know they're infected, they really can't be charged with non-disclosure. I think the identification rate is very low, and much lower than it should be, because of that.

I'm going to ask each of you who would like to comment on this what other impacts on the health of LBGTQ2 people might this criminalization contribute to.

Dr. Moore, would you like to comment?

[Dr. David Moore]

Sure. Thanks very much.

We do have some data from studies in Vancouver about HIV testing among gbMSM and their reasons for not going for testing. The most recent data we have was collected between 2012 and 2014. In there I think something like 90% of gbMSM living in Greater Vancouver had ever been tested, and 70% of those men had been tested in the last two years. When you ask guys who had not been tested recently why they didn't get tested, the main reason was that they intended to but hadn't got around to it, so it maybe relates to the question of convenience or access or having a gay-friendly doctor to do the testing. The other main reason was that they felt they were at low risk for acquiring HIV. In fact, in looking at that, we did actually find some validity to that, that the guys who didn't get tested who said they were at low risk, were in fact appropriately assessing their risk of acquiring HIV.

We didn't ask specifically about criminalization, but we asked about reportability or having your name reported to public health. That was discussed by some men as a reason for not getting tested, but it was quite a small proportion and quite a way down on the list of reasons for not getting tested.

[Ron McKinnon, Liberal, Coquitlam—Port Coquitlam, BC]

Thank you.

Dr. Gilbert.

[Dr. Mark Gilbert]

To your question, I think I would add that while criminalization of HIV non-disclosure obviously has profound implications for the individuals who are concerned, I think it has a much greater negative impact on society around perpetuation of HIV stigma. Every case gets reported in the news. It just contributes to people's perceptions that people with HIV are irresponsible and are morally bad and wrong. I think that's one of the biggest challenges with HIV non-disclosure and really, I think, something that is really critical to try to change. The federal government does do periodic surveys of anti-HIV stigma attitudes and there remains a substantial proportion of people who have very stigmatizing attitudes towards people with HIV, including attitudes around criminalization. While that's by no means now the largest part of society, it's still significant. I think this is why these kinds of structural policy changes can really help make a difference on societal factors like stigma.

[Ron McKinnon, Liberal, Coquitlam—Port Coquitlam, BC]

Thank you.

Mr. Lacasse, would you care to comment?

[Gary Lacasse]

I think everything has been said pretty much from a community perspective, but it's really the stigma that comes with it. We really have to ensure that we have language that does not stigmatize people when it comes to health care. If you talk about somebody who is autistic and you add to that HIV criminalization, right there the red flag is going to go up like crazy. I think we have to have a more holistic approach to health care in Canada. We're not doing our job. I'm sorry.

[Ron McKinnon, Liberal, Coquitlam—Port Coquitlam, BC]

Thank you.

Mr. Croteau.

[Gerry Croteau]

One of the things that is helping to lessen the stigma about getting tested is U=U. Undetectability, with the use of either an internal or external condom, where you don't have to disclose...to a possible partner, has helped to eliminate some of that stigma, although stigma is still there. But definitely in our area—and I speak for Simcoe and Muskoka—many men still do not consider HIV testing to be part of their health regime in the same way they see eyes, dental, prostate, heart, cholesterol, etc....

In many cases as well, confidentiality still plays a big part in rural communities, because in many health care centres in rural communities, you recognize the car, or your wife may work there or a relative may work there in a smaller community, so you hesitate to get tested for HIV because of the fear of having that information divulged to either your employer or someone within the community.

[Ron McKinnon, Liberal, Coquitlam—Port Coquitlam, BC]

One of the problems we've heard about already is that there is a lack of instant testing or kits on the market that you can go into a drugstore and get. Would you agree with that position?

[Gary Lacasse]

We do the national HIV testing day on June 27 each year now. We get free kits from bioLytical, the company that makes the instant testing kits. We are trying to bring them out to communities that don't use instant testing, but only use blood draw. Point-of-care testing is extremely important with other technologies, like dry blood spots. The more diverse offerings you have for testing, the more people will get tested. It's the Hygrade method; the more you produce, the more people will eat them, whatever.

I think that's the best route to go about it, but our market value is not there for these companies in Canada. We have to have a more express route with the other countries for approving these new methods that are based on science, rather than just our own, because the cost is supposedly prohibitive.

We did point-of-care testing in the Maritimes. We were told by PHAC that we were bringing point-of-care testing kits to the Maritimes, almost as a guerrilla thing. I told them that was not the case. We were doing it with private clinics in New Brunswick that would be testing point of care. We did 37 point-of-care testings in Cape Breton, which had never done it, but since then, Nova Scotia has adopted point-of-care testing, so we're doing something right. Let's continue down that path.

[The Chair, Liberal, Bill Casey]

Thanks very much.

Now we have to go to our five-minute round, starting with Ms. Gladu.

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

My first question is for Dr. Moore.

I know that the Canadian AIDS Society talked about the HIV rate going up by 17% in 2017, but I got the impression that in B.C. it was going down.

Could you quantify that, and could you say what's happening with hepatitis C rates and syphilis rates in B.C.?

[Dr. David Moore]

With respect to HIV, we had the lowest number of new HIV diagnoses in B.C. since the mid 1990s in 2017 and 2018. The rate in 2017 seemed anomalously low. In 2018, it is still a decrease, but not as great as it was in 2017. We think we're generally on the right track, although the deceases are not as dramatic as we would like to see. Now that we've been running an HIV PrEP program for a year, in 2019 we hope to see really dramatic drops in new diagnoses amongst gbMSM, because we've seen this really dramatic scale-up of PrEP.

As far as hepatitis C goes, I happened to look at the HCV surveillance report for the country a couple days ago. It generally shows that overall, diagnoses have been on a slow, steady decline since 2012.

Mark Gilbert might know better about HCV rates specific to B.C.

Certainly, men who have sex with men are overrepresented in the HCV epidemic as well, but certainly not to as great an extent as people who use injection drugs. There is still a risk there. Of course, there is a lot of optimism around HCV now with effective and more affordable HCV treatment that is now getting publicly funded. I think that's another place where we're optimistic.

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

When people take PrEP, do they stay on it after they come to the level where they're not transmitting HIV anymore?

[Dr. David Moore]

It's a different process. You're giving it to people who don't have HIV, so there is nothing to actually measure to see if they're taking it. It was originally licensed and studied as a daily pill that you take every day, to prevent you from getting HIV before you potentially get exposed to it.

Since licencing, and since some of the original studies, there have been other studies that have shown that you can actually use it in a so-called on-demand way. If you're planning on being sexually active, you can take two tablets that day, and then take a tablet a day for up to two days after you last had sex. That actually seems to work just as well as taking it every day.

One of the things we're struggling with as a program is how to measure continued use of PrEP when we know that people are using it in different ways. For the people who are saying they're using it regularly every day, that's fairly easy to monitor. For people who are using it intermittently, it's a bit more challenging.

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

Thank you.

This question can be for anyone.

We heard a lot of testimony about the need for LGBTQ-specific mental health aids. I am honestly not aware of any that existing in the country.

Does anybody know if any exists anywhere that we should be duplicating?

[Gerry Croteau]

Could you repeat that question, please?

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

I've heard again and again that there is a need for LGBTQ-specific mental health aids, meaning people who understand what LGBTQ people have experienced and can help them with that. But I am not aware of any of those services and I wonder if anyone here is.

[Dr. Mark Gilbert]

I certainly know of some community organizations or groups that are offering mental health services for sexual and gender minority people, so in that respect there are sort of tailored programs that are really acknowledging that cultural safety context or trauma people might have, and really informing it in that way.

I am not aware of any other of this type of intervention or tool that's specific to LGBTQ people.

I do think the challenge is really more about taking existing tools and helping them to be adapted or tailored for the population.

[Gerry Croteau]

At the Gilbert Centre....

First of all, I want to say one thing about the Gilbert Centre. We do get PHAC funding over five years for an HCV positive self-management program, which is being funded by the Canadian government. We are working in partnership with the University of San Diego and Stanford University and the University of Victoria to bring about a self-management program for people who have HCV, but can't overcome the virus.

I'd welcome sending it to the committee. It's still in draft form. Just don't tell PHAC I'm sending it out ahead of time. But I would like to send it to you if you want, if it would help the committee. It's going to be published and distributed across Canada.

The Gilbert Centre does have a trans and gender diverse program funded through the County of Simcoe. We do have a social worker and we work in partnership with the Canadian Mental Health Association. We have two social workers on staff who deal predominantly with trans folks, but we also deal with gay men through the Gay Men's Sexual Health Alliance, funded by the AIDS bureau of the Ministry of Health and Long-term Care.

[The Chair, Liberal, Bill Casey]

Thanks very much.

Now we're going to Ms. Sidhu. I understand that you're going to split your time with Ms. Lambropoulos.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you all for being here.

My question is for Mr. Croteau.

You said that health care professionals should be more inclusive. You also mentioned “needed skill sets”. What kinds of skills are you looking for?