Health Committee on April 30th, 2019

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

Thank you, Chair, and thank you to all the witnesses for being here today.

I have questions for all of you, but I'll start with Jody and see how far I get in my seven minutes.

Jody, you were talking about some statistics on how the health of LGBTQ people is worse, with 130 times the rate of AIDS, 20 times more anal cancer, and four times more suicide. You talked about mental health issues. You mentioned a specific program. Can you tell me a bit about that program and why it's effective? It's a mental health program.

[Jody Jollimore]

I was probably talking about a funding program with the Public Health Agency of Canada. They have a mental health fund. They recently did a call for LOIs—letters of intent—and they're currently deciding on who will get funded in that program. It's an excellent example of the federal government supporting agencies to do that work.

Sometimes I think the feds can skirt their responsibilities around health care by saying, “oh well, this is a provincial jurisdiction”, but there are numerous examples of where the federal government is providing funds to front-line organizations to do that work, and that mental health fund is one of them. Also, it's my understanding that under this there are subcategories. I think there's a mental health fund for black Canadians and for other populations.

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

Okay. There is a specific part that's LGBTQ focused.

[Jody Jollimore]

There is not a specific part.

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

No, there's not. Okay.

[Jody Jollimore]

Right now, the fund—

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

There should be.

[Jody Jollimore]

Certainly, like everybody else, we can apply to the fund, but there's no specific stream. That's my argument. There should be a specific stream, because of course then we would be more apt to have queer reviewers reading it, and we wouldn't have to go into the general stream.

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

Okay. Sounds good.

My next question is for you, Gabriel. In terms of talking about the way the government collects and uses data, if you could tell us anything, what would you say the federal government should be doing in terms of the way it collects and uses data?

[Gabriel Girard]

Thank you for your question.

As Mr. Jollimore very clearly stated, we need research programs that focus on the health issues of sexual and gender minorities. Unfortunately, these programs aren't being devised at this time. We need targeted programs that show a willingness to develop this field of research. This requires funding for research, but also the recruitment of researchers from the communities concerned to conduct, develop and publicize the research.

I think that the CBRC in British Columbia is a good example of what can be accomplished in terms of community-based research and of how the research can be institutionally recognized. There are also examples of community-based research in Quebec. I think that the research institutions and staff are ready, but research funding or research programs that focus on LGBT health should be established.

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

Very good. Thank you.

I'll go to Joël, and we'll talk about surgeries.

My sister-in-law is transgender and had to go to Quebec to have the surgery.

[Joël Xavier]

Me too.

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

Where else in Canada is that surgery available? Do we know anything about how much it costs? How many doctors in Canada actually would be skilled to do that?

[Joël Xavier]

In Canada right now, funding for surgeries is by provincial jurisdiction, so it varies from province to province.

In terms of who can perform surgeries, it depends which surgeries you're speaking of, because there are many different options available to us. In terms of genital surgery, of reconstructing the genital anatomy, right now there's Montreal.

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

That's it, in the whole country?

[Joël Xavier]

Yes.

Women's College Hospital in Toronto is looking into providing surgical options in Ontario.

B.C. has, in the past, and I think they might be thinking of doing it again—but correct me on that, Jody.

Depending on the province, not all provinces will pay for interprovincial, out-of-province surgeries. This greatly disadvantages trans women especially, who face a lot more risk of violence if they don't have genital surgery. For trans men, it's also problematic because there's only one surgeon in Canada who does genital surgery.

There is a diversity of techniques available, so it would be important to be able to fund out-of-country surgeries as well, or fund physicians, surgeons in all of Canada, to be able to access education to have access to different surgical techniques to make sure that the techniques available to citizens are the most up-to-date and the best for each person's individual circumstance.

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

Excellent.

Rachel, I'm interested in Pride Home. I come from an area that has a large rural part in the riding. Can you give some examples? How big is this group home? How many people would come and take advantage of it? Are there transportation barriers or other barriers that need to be addressed as well?

[Rachel Loewen Walker]

We have six beds in the home, and it's supported by a live-in mentor. There is a suite in the basement. It's a pretty big house, with six bedrooms, and every bedroom has its own bathroom. It has wonderful privacy. Then there are shared living spaces: kitchen, dining room, as well as heated garage in which they do all kinds of art projects, and then another gathering space in the basement. It's a wonderfully sized house.

We've had 14 youth in the home throughout the last two years, but it is long term. If someone moves in at the age of 16 and this is the best place for them until they are 21, that's fantastic. We've had a number of youth age up from Pride Home, and then we help them work with intentional landlords to find safe and secure housing following that.

In terms of transportation, we were actually donated a car, which is wonderful. For the youth living in the home, the wrap-around supports include mostly getting them to take the bus, but barring that, definitely driving them to appointments.

Accompanying, navigating and witnessing those appointments is one of the things that our full-time staff member, who also supports the home, does most. She goes with them to appointments so that people are using the correct pronouns and names and they know how to navigate those pieces.

We have had youth move into the home who are not from Saskatoon. I think we've had four from outside of Saskatoon, one from a first nation that was about four hours away. Now there's a group home taking shape in Regina as well. I know Prince Albert is looking to develop a similar model. It's starting to really grow across the province and we're seeing a lot of positive outcomes as a result.

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

That's my time.

[The Chair, Liberal, Bill Casey]

Mr. Davies, you have two minutes.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you, Mr. Chair, and thank you to the witnesses for being here.

I have so many questions to ask and so little time.

Jody, I'll begin with you. I have a few questions for you.

I know since January 1, 2018, British Columbians at high risk of HIV infection have been able to receive pre-exposure prophylaxis, or PrEP, daily oral antiretroviral medication that prevents new HIV infection, at no cost. However, according to doctors and patients, this hasn't completely removed the barriers to accessing the drug.

In a 2018 article in The Globe and Mail, you're quoted as saying:

Now that cost is not a factor, it's actually getting people on the medication that's going to be the next big thing. Sometimes people think, “Oh, there's a program, so the work is done.” What we're saying is, it's really not. For us the work is just beginning.

Could you outline for us the remaining barriers to accessing PrEP and what you suggest we'd do?

[Jody Jollimore]

I appreciate that background research.

There are a couple of things. One of the barriers is being out to your health care provider. As I said, we have research outside of Vancouver that shows us that in smaller communities up north, upwards of 60% of people are not out to their health care provider. If you're not out, you're not getting the kind of services you need, much less prevention tools for HIV, because you wouldn't be considered high-risk for HIV.

That's one thing. I think that, through cultural competency, having health care providers ask the right questions, making them seem open, is certainly one way to deal with that.

Then there's the pervasive stigma. A health care provider can be as open and competent as possible, but if the individual feels that their sexuality or their sex life is somehow inappropriate because of something they experienced as a child or as youth, bullying or all of this trauma that we know happens at a very young age in queer people's lives, it impacts their ability to come out and to live freely later in life. Certainly those upstream barriers are really important.

I know it's not a federal jurisdiction, but we have a real problem with sex education in schools in this country where queer students are not learning about their sexuality. They're learning from porn, and that's not the place where we want young people learning about sexuality.

With regard to other upstream factors around violence or childhood trauma, we need to invest in the types of programs that would ensure that, by the time people are at their sexual debut and ready to make those decisions, they're able to either come out or at least acknowledge that their sexuality is at risk.

[Don Davies, NDP, Vancouver Kingsway, BC]

That segues nicely into my next question, which has to do with self-testing.

My research shows that it's estimated that more than 9,000 Canadians are living with undiagnosed HIV. This is where most new infections originate. We also know that Canada is committed to the UN goal of having 90% of all people living with HIV knowing their HIV status by 2020, so I would think we would want to remove all barriers to testing, including stigma, as you said, and lack of access to clinics.

We understand that self-testing is both feasible and accurate and is being used in other countries, which has led to an uptake in testing. I'm thinking particularly about marginalized groups that may find it difficult or uncomfortable to reveal they are having.... Perhaps they are men who are having sex with men or people in rural communities where their aunt might be in the clinic.

It's difficult. I understand that in the U.K., three HIV self-testing kits can be delivered directly to your mailbox, but I understand that's not available in Canada. Do you know why it's not available in Canada? Would you recommend that we urge Health Canada to approve self-testing kits?

[Jody Jollimore]

Certainly there is a push to get more testing options approved in Canada. I think you heard some of that testimony by Dr. Mark Gilbert a couple of weeks ago, and I know there is a brief coming forward that will also talk about the various testing options.

Self-testing or home testing is certainly one. There is peer testing and then there are the types of technologies, let alone how they're administered.... There is dried blood spot testing where it's a simple finger prick, and you put in a few drops of blood, and then you can send that off to a lab to be tested. There are oral kits. For instance, if you cross the border and go into America, there are a number. You can either just spit into a tube and they can use saliva, or you can take a self-sample and—

[Don Davies, NDP, Vancouver Kingsway, BC]

Can you get those here?