Mr. Chair and members of the standing committee, my name is Sarah Chown. I am a settler on the unceded ancestral lands of the Coast Salish peoples, and I use the pronouns she and her.
Since 2015, I have worked at YouthCO, a youth-led agency that addresses the impacts of HIV and hepatitis C stigma. We use peer education and peer support to connect with indigenous youth, youth living with HIV and hepatitis C, and queer and trans youth.
While our organization's mission is about HIV and hepatitis C, these viruses disproportionately affect many LBGTQ2 people. For us to address HIV and hepatitis C, we must consider the broader health and well-being of queer and trans youth. This is what brings me here today.
This afternoon, I will talk about the experiences of youth in our programs who are queer and trans, and who may also be indigenous and/or living with HIV.
Before I can do these things, I must share my first recommendation with you: This study must heed the calls to action of the Truth and Reconciliation Commission. Specifically, as per call to action 18, this committee must recognize the impact of colonization on the health of indigenous peoples today, and implement aboriginal people's health care rights. This committee should seek the continued participation of indigenous queer, trans and two-spirit people as it moves forward. At a minimum, this includes incorporating LBGTQ2 narrative and research from and by indigenous people.
Many indigenous people are queer and trans, and this has been true before these words even existed in English. In the LBGTQ2 acronym, the 2 stands for “two-spirit”, an English word introduced in 1990. Métis scholar Chelsea Vowel tells us the term was chosen by indigenous people to be a “"pan-Indian" concept [encompassing] sexual, gender and/or spiritual identity.” It does not replace terms and teachings from each unique indigenous nation, nor is it a word all indigenous people who are queer and trans use to describe themselves.
To speak about indigenous youth, we must name past and—as importantly—ongoing forms of colonization. In what is now called Canada, colonization has deprived generations of youth of the chance to learn in and from their own families and communities. Without these opportunities, some communities no longer have pre-colonial knowledge about the role of two-spirit people or the words in their language to describe these identities. Upon arrival, colonial powers imposed overt transphobia, homophobia and biphobia, the belief that it is wrong to have gender roles outside western norms of men and women, and the belief that people can only be straight and cisgender. Together, these concepts can be referred to as “cissexism and heterosexism”. Both refer to prejudice towards queer and trans people. Due to these beliefs, colonizers also actively persecuted two-spirit people.
As a result, today's indigenous youth may not know that in many communities, two-spirit people were an important part of indigenous life, and they may not have two-spirit role models. Limited access to two-spirit teachings and community can be an isolating experience and have direct impacts on mental health. Without community support and adequate counselling services, substance use and suicide can become realistic options for young people. Combined, these structural factors and health inequities shape a syndemic—intertwining, mutually reinforcing epidemics—that worsens the impact of any one of these factors and contributes to the disproportionate numbers of queer, trans and two-spirit youth who die preventably each year, whether by suicide, untreated HIV or as missing and murdered people.
In response, I recommend that the federal government fully resource indigenous communities to lead responses to the intersections of colonization, cissexism and heterosexism. As a non-indigenous person, I hope by sharing some of these needs, this committee will do further work to hear directly from more indigenous queer, trans and two-spirit people.
Whether or not we are indigenous, too many queer and trans youth are not getting relevant information about our health. Last year, my colleagues Ghada and Avery conducted a survey with over 600 high school students in more than 80 communities. We embarked on this work because we suspected many youth were not getting the knowledge they need to make informed decisions about HIV.
What we learned was disappointing. Forty-five per cent of students told us that their sex education did not recognize that their sexual and gender identities even exist. Practically, this meant many students were only learning about penis-in-vagina sex, which is not the only way queer and trans people have sex. Furthermore, it is not the type of sex that accounts for most new cases of HIV in British Columbia. Heterosexism and cissexism mean many educators are not equipped to talk about the sex that is relevant to all their students, and as a result many queer and trans youth are not getting safer sex information.
In our survey, 84% of students agreed that school is an important place to get sex ed. Students told us they wanted sex education that is standardized, relevant to their experiences and delivered by someone who is knowledgeable and able to create safer spaces. Therefore I recommend the federal government implement the 2019 Canadian guidelines for sexual health education and fund community-led sex education classes and campaigns to bypass the current patchwork of sex education in this country.
Heterosexism and cissexism also mean that health information does not address queer and trans people and that queer and trans people are not always counted in research and surveillance data. Without this information, organizations rely on queer and trans people in our programs and on our staff teams to provide this information from their own experience.
At YouthCO, this approach to getting information has meant we have left out facts and context that are specific to trans, non-binary and two-spirit youth when it comes to HIV and hep C. One way we are responding to our shortcomings in this area is to advocate for research to include these youth. Without this research, trans, non-binary and two-spirit youth are not represented in the data governments use to fund interventions and services. I recommend the federal government ensures existing public health surveillance systems count trans, non-binary and two-spirit people within the ethical framework Jack mentioned.
The federal government must also ensure queer and trans people are updated on all surveillance systems and CIHR-funded research projects across health domains. With this new data and existing data about queer and trans health inequities, I recommend the federal government continue to introduce funding dedicated to queer and trans health beyond just HIV.
Now I want to talk about the queer and trans youth in our programs who are living with HIV. The stories of these young people have many threads in common. First, youth are not being offered information about HIV, or the medication that treats and prevents it, as part of their regular health care.
Second, youth who sought mental health or addictions support were not always able to find it. Too often, support was only available through private programs or after a long wait-list. In many cases, support that was available did not have the capacity to address queer and trans-specific issues. For example, many addiction facilities are divided into men's and women's programs and in these scenarios some youth are left to choose between being misgendered in the program or not getting the addiction treatment they need.
Housing and employment insecurity disproportionately affect queer and trans youth who are less likely to have safe families they are able to ask for help. These factors can push us to have sex or use substances in ways where we are more likely to come into contact with HIV. Many emergency housing options are also gendered, leaving youth to choose whether they will be safer on the streets, in a gendered shelter or spending the night as a sex worker.
I recommend that federally funded institutions that house people, like corrections facilities, shelters and addiction treatment programs provide gender-neutral options and be staffed by people who have received queer and trans competency training. This recommendation would address this syndemic that drives health inequities among queer and trans people today.
Queer and trans youth living with HIV worry that they cannot afford HIV medications if they leave British Columbia. This is one reason I recommend the federal government introduce a national pharmacare program. This program must ensure access to HIV medications as well as gender-affirming medications such as hormone therapy.
Across our work at YouthCO we encounter people who still have more misinformation than facts about what it means to be queer and trans and what it means to be living with HIV. Some of this misinformation comes from the current policy of the federal government, like the deferral period for male blood donors and the criminalization of HIV non-disclosure. This misinformation fuels stigma and makes it harder for us to talk openly about our lives and get the health care we need. As long as this is the case, health inequities for queer and trans people will persist.
Thank you for your time. I look forward to your questions.