Good afternoon, Mr. Chair and members of the Standing Committee on Health. I am grateful for the opportunity to speak to you here on the traditional territory of the Algonquin first nations.
My name is Jody Jollimore and I'm the executive director of the Community-Based Research Centre or CBRC. My expertise comes from 15 years of HIV prevention, a master's in public policy, but most importantly as a gay man who has lived, worked and loved in Nova Scotia, Quebec and British Columbia.
I'm lucky to have been born in a time when it's good to be gay. I grew up with Will & Grace, Svend Robinson, and for the most part, gay marriage. By the time I had my sexual debut, life-saving medications meant that men like me were no longer being cut down in their prime by AIDS.
But despite the immense political and human rights gains, our health outcomes, the health outcomes of all queer people, continue to be some of the worst in the country.
My organization, CBRC, was started in 1999 as a response to HIV among gay men in B.C. While we were founded for and by gay men, we made strides to include other sexual minority men, including bisexual, queer—cis and trans—and 2-spirit people. Our nationwide Sex Now survey comprises the largest dataset of this population, which continues to be an important source of information for policy-makers and program planners.
You see, while governments were trying to either ignore or, worse yet, erase our population, we were in the background quietly collecting data, developing reports and talking about gay men's health to anyone who would listen. These days, we've increased our focus on public policy, recognizing that the kind of change needed is transformational and structural. For instance, we've partnered recently with Canadian Blood Services to inform their policy change on blood donations for men who have sex with men.
But before we talk policy, I want to tell you a story that I think contextualizes some of the struggles we face as a community.
One of my best friends in high school was gay. He was a great friend and mentor to me. We both left rural Nova Scotia to pursue our dreams. But my friend had always struggled with undiagnosed depression and this worsened when we moved to the city. Despite being surrounded by more of his peers than ever, he continued to feel lonely, depressed, anxious, all very common issues impacting queer people, even in big cities. He self-medicated with substances and eventual started using crystal meth. Meth made him feel good. It made him feel wanted and accepted and part of something. It's hard to tell whether he was using meth or not when he contracted HIV, but I was with him the day he got his results. And we cried together. But we knew it would be okay because there were treatment options to keep him alive, especially in British Columbia. Only my friend didn't opt for treatment. Instead, he further isolated himself. He lost jobs, apartments, lovers and friends because of his meth use.
Left untreated, HIV becomes AIDS. And though it's rare in Canada, it does still happen, and usually only to those who are most marginalized and disconnected from care. My friend died of AIDS in the late 2000s despite there being free medications that would have saved his life. And my friend was not one of the most marginalized. Instead. like me, he was quite privileged. I'm white, I'm able-bodied, I'm cisgender, and I'm HIV-negative. These all make me privileged, and yet, according to the Public Health Agency of Canada, the fact that I'm a gay man means that I'm 131 times more likely to get HIV, 20 times more likely to develop an HPV-related anal cancer, and 4 times more likely to commit suicide.
This is startling. Yet, this is what we consider a healthy, privileged gay man. So the bar is set pretty low.
I listened to my colleagues' testimony from your last three meetings, and I was able to sit in on your meeting when you were in Montreal at RÉZO. I think the speakers have done a great job of setting the foundations for this study. By now, you know that our health is not great. Across the board—physical, sexual, and in terms of mental health—on all fronts we fall short. And this is only what we know with the limited data we have. If we were truly leveraging the research and data tools within the federal government, we'd know so much more.
Let's talk about what the feds can do about this. First off, my buddy had some mental health issues that were not being discussed at home or at school. Recent investments in mental health had been made, but they're modest and they frequently do not address the unique situation faced by queer people. Our mental health impacts so many other aspects of our health, and it's far more costly to treat the problem than prevent it. Treatment is almost always more expensive than prevention.
The feds should increase their investment in mental health and earmark specific funds for sexual and gender minorities. The mental health fund at the Public Health Agency is a program that could be expanded to include, or be mandated to target the agency's funding calls towards, organizations doing queer work.
We also need to reduce stigma in this country. It's killing us. First, the stigma, fear and shame reinforce minority stress and trauma, but that same shame and stigma prevent us from accessing the services we need. The result is high rates of HIV and STIs, substance use, depression, anxiety and suicide.
The federal government has the ability to impact stigma in several ways. The first is equality under the law—and we're getting there, but there's still work to be done. Then there's the overuse of the Criminal Code on things like substance use, which we're seeing having devastating impacts on drug users in this country, and also the criminalization of HIV non-disclosure. Both contribute to stigma in our communities. Then there's the fed's role in education and awareness. The government sponsors social marketing around substance use, anti-racism and healthy eating. It could do more around sexuality and gender. That could be funded either using a health lens through Health Canada or an equity lens through Women and Gender Equality.
We also need dedicated funding. There are many examples of dedicated funding for various populations. There is the harm reduction fund for drug users, the mental health of black Canadians fund, which is fantastic, but we need similar funds for queer people. Whether it be through the Public Health Agency funding or CIHR and their health centres, we need more dedicated queer funding for programs and research.
I know that you've heard this many times over the past few weeks, but we have to do something about the way we collect and use data in this country. That would be a quick fix, but we also need to find innovative approaches to fill those gaps.
I know this committee has studied pharmacare and made recommendations on it, but I want to make an additional plug, namely that whether it be for HIV meds, HPV vaccinations or hormone therapy for trans people, a national pharmacare program would go a long way to improving access to prevention tools. Short of that, there are some creative ways the feds could fund treatments in provinces that don't cover them. For instance, federal funding has been used to help address gaps in provincial access to hepatitis C treatment. The federal government could expand this strategy to ensure that queer people are able to access the medications they need, regardless of where they live.
And for me that's the role of the federal government, to ensure equity and access for all Canadians, because queerness, or being a sexual minority, doesn't impact just one community. It crosses racial, ethnic, religious and political lines. Gays, lesbians, trans and queer people are living in and coming from every community in this country, regardless of which riding you represent. Why should queer people have to move to the city to get the appropriate health care they need?
Our data shows that the further outside an urban centre you go or live, the less likely you are to be out to your doctor. And we also know that if you aren't out to your doctor, you're 10 times less likely to be tested for HIV, much less receive the kind of health services you need.
I was doing interviews in B.C.'s interior and after a long day I stopped in the city of Castlegar to grab some coffee. That's where I met Todd. Todd was a lively fellow, clearly gay, clearly out and proud. I went into my community researcher mode and I started asking him questions. My city-slicker attitude was what are you doing here in Castlegar? His response was that he had been to the city, done Vancouver and Calgary and he always came back here. Castlegar is his home and he loves it here. I thought this is why I'm doing this work. That's why this study is important, so that folks like Todd don't have to move to the city to be safe, to find competent health services and to live free of discrimination.
I want to share a quote with you and then I'll wrap-up, Mr. Chair:
Over our history, laws and policies enacted by the government led to the legitimization of much more than inequality – they legitimized hatred and violence, and brought shame to those targeted.
This was part of the government's apology to LGBTQ2 Canadians in 2017.
Chair, and members, this is your chance to right some of those wrongs, to change laws and policies that continue to lead to poor health outcomes for queer, trans and two-spirit people. I challenge you to do so, and I offer my organization's support and expertise. I look forward to talking with you about how we can make communities safer and healthier for queer Canadians.
Thanks.