Health Committee on May 9th, 2019

[The Vice-Chair, Conservative, Marilyn Gladu]

Very good.

That's the end of our first round. We're going to go into our second round for five minutes.

Mr. Lobb.

[Ben Lobb, Conservative, Huron—Bruce, ON]

Thanks, Ms. Gladu.

I'm sure our analysts here have all this information, but I'll ask any of you folks here. If you are HIV positive, which provinces will pay for your medication? Do they all pay for it? Do none of them pay for it? To be honest, I'm unsure, and I don't know if anybody else on the committee actually knows this.

[Brook Biggin]

I don't have an exact list of provinces, but I can tell you that it does differ. Right now, if you're living with HIV in Canada, if you live in a province like Alberta, you're covered through the provincial public program. If you live in other provinces, like Manitoba or even Ontario, it's not done in that same way. It does definitely place a disproportionate burden on people living with HIV.

That's why one of the recommendations that has come through different people—either through pharmacare or looking at a different mechanism, which I believe the federal government has done around hep C cure drugs—is some sort of mechanism where Health Canada or the Public Health Agency reimburses certain provinces for that. Definitely HIV medication is something that should be looked at—especially for treatment but also for prevention.

[Ben Lobb, Conservative, Huron—Bruce, ON]

Right.

Obviously, this study is talking about health, and we've had a whole bunch of different things and it can all funnel in. The government's looking right now at a pharmacare program. At the end of the day, do you think that should be covered in a pharmacare program, at minimum?

[Brook Biggin]

Yes.

Not only because people living with HIV are people who should be cared for, but also it's a good public health strategy. We know that when people living with HIV are undetectable, they do not pass the virus on to others, so wouldn't we want people living with HIV to have access to medication? Do we want to impose financial barriers on them? I don't believe we do. Remember, we say we can effectively end the HIV epidemic in this country by the year 2030 if we take on some of these good public health strategies. We should definitely not be putting barriers in people's way.

[Ben Lobb, Conservative, Huron—Bruce, ON]

To be honest, I can't remember if it's been brought up at other committees or not, but seeing as this is our last meeting, it probably should be put on the record. I can't remember if any of the other people or groups have commented or have been consulted by Dr. Hoskins on that, but we'll probably put that in our committee.

The other thing I want to ask you about is PrEP. I don't know anything about it, but I understand it suppresses and prevents all this. Is it covered? Should it be covered? It sounds like it should be covered. What does the panel think?

[Darren Ho]

PrEP is an HIV-prevention drug that's based on ARVs—antiretroviral treatment or HIV medication. We know it's an effective drug and it is covered in most Canadian provinces, such as B.C., Alberta, Ontario, Quebec and some others, I think. I can't think of them off the top of my head.

In all of these provinces, there was huge advocacy that had to happen for PrEP to get covered provincially for each province, and it's still something that has to happen in some provinces and the territories. We know that PrEP is an effective tool, so yes, it should be covered.

[Brook Biggin]

You really need a multipronged strategy. There's no magic bullet when it comes to HIV, but if we do PrEP, get people diagnosed and linked to care, make sure they can afford and access their drugs and get their HIV undetectable—if this committee made sure those things in combination were covered—we would end the HIV epidemic.

[Ben Lobb, Conservative, Huron—Bruce, ON]

I have a number of different notes here. Is hormone therapy covered now? I want to make sure that we have a good, broad range of opinion here for the report. I didn't know if anybody had a comment on hormone therapy. Should it or shouldn't it be covered? I don't know.

[Prof. Bill Ryan]

It depends on the province. As you know, in Quebec we do have pharmacare, so in Quebec it's covered. My understanding is that there are several provinces where it's not covered, or at least the requirements are stricter than in other places in order for it to be covered.

That's certainly something that I think, in terms of health, should be looked at very seriously as something to recommend.

[Ben Lobb, Conservative, Huron—Bruce, ON]

I have one other question, probably on a broader range, on the HPV vaccination. I know two individuals who have ended up getting throat cancer from that. Is that something that your general practitioner should be suggesting or should public health be suggesting it? What should we be doing for HPV?

[Darren Ho]

I think that's something I would put on a list of competency training things for health care practitioners. If you're talking to a patient who is a young gay man who has sex with men, you should talk to him about HPV vaccines.

[The Vice-Chair, Conservative, Marilyn Gladu]

That's your time.

Off we go then to Mr. Ayoub for five minutes.

[Ramez Ayoub, Liberal, Thérèse-De Blainville, QC]

Thank you, Madam Chair.

I will continue by speaking about training, particularly of professionals.

Mr. Ryan, you were in the Lanaudière region of Quebec recently, if I understand correctly.

You mentioned that you had heard about electroshock therapy as a treatment method. I don't want to make a bad pun, but I was a little shocked to hear about electroshock therapy being used as a medical treatment in 2019. In fact, if you, Mr. Ryan, or Ms. Daley, have any information on that, I would like to have it.

Could you give a brief overview of the situation regarding the training professionals already working, who are already in the field and whose training dates back a few years? We know, of course, that they take refresher courses throughout their careers, but what is your assessment of the training situation with regard to the LGBTQ community?

I'd like to hear your opinion, Mr. Ryan, particularly on the issue of the training of professionals already working in Quebec, if you are in a position to do so.

[Prof. Bill Ryan]

We have a program that is accredited through the Université de Montreal. It's run by the province. It's called “Sexes, genres et orientations sexuelles : comprendre la diversité”.

It's offered free of charge to any health care professionals, community organizations or educational establishments that want to ask for training. It's voluntary, which means that someone is not obliged to take it, and it's voluntary mostly in terms of registration, so the people who come are generally people who want to follow it. One of the problems we have in promoting it is that it's often seen as being soft. Some health care professionals will take training on pharmacology, for example, but they won't agree to take training on sexuality or gender diversity because they see it as being much less important to their practice.

It's a two-day training. Depending on how long ago they were trained, they often come with worries about the notions that they have, knowing or thinking that these notions are incorrect, but they don't know what to replace them with so they just stay silent. They'll often say to people who say they're gay or lesbian or trans, “I don't deal with that. I can't work with that. I don't know anything about it.”

What we try to do is to reassure them that it doesn't take an awful lot of training to become more comfortable with these issues. It's a question of motivation. What we hear back from the community is that people educate their health care professionals. It's hard to educate your professional when you're in a vulnerable situation and when you don't necessarily have all the answers yourself.

It would be really important to make sure that at the college and university level this content is integrated across the board in health and social services, and education.

[Ramez Ayoub, Liberal, Thérèse-De Blainville, QC]

Go ahead, if you want to add something. I maybe want to respond to that.

[Prof. Andrea Daley]

I want to think about intersectional education and training as well.

In the social work context, we're taking up the calls to action from the Truth and Reconciliation Commission, and part of this is thinking about how we decolonize education.

I have a million thoughts right now, because I think one of the things that happens around sexuality is that our lives get reduced to sex. The whole issue of how we talk to our children about sexuality is loaded because people think only about sex. Our lives are so much more than that. I think when we think about how we train and how we educate health care providers, we have to think through multiple lenses: a decolonial lens and—

[Ramez Ayoub, Liberal, Thérèse-De Blainville, QC]

I'll need to interrupt because I want to ask another question to Mr. Ryan.

Would it be fair to say that you would recommend that the courses be obligatory?

[Prof. Bill Ryan]

Yes. I would recommend that it be obligatory for an accreditation in health, social services and education.

[The Vice-Chair, Conservative, Marilyn Gladu]

Great.

Now we're going to go to Mr. Webber, for five minutes.

[Len Webber, Conservative, Calgary Confederation, AB]

I want to get back to funding.

Brook, you had mentioned in your presentation that the current investment in queer health is insufficient. We have another briefing here that we got from Health Canada and the Public Health Agency of Canada. They've indicated here that there are a number of community-based grants and contribution programs specifically designed to address the needs of the LGBTQ populations, and they've come up with a number of different programs.

Again, there's $112 million and an additional $92 million of non-government funding in areas that “aim to increase the reach and impact of evidence-based approaches that support healthy choices and behaviours” in the LGBTQ community. There's $30 million to support community-based harm reduction projects across Canada to enhance street outreach, build capacity among service providers to expand mobile outreach, and reduce rates of HIV and hepatitis C. There's $5 million for a new centre of innovation in infectious diseases. There's $37.5 million over five years for STBBI programs and services for first nations and Inuit. There's $26.4 million to support communities across Canada to implement innovative and evidence-based STBBI prevention interventions. It just goes on.

There's $7 million for an increased access for gay, bisexual, two-spirited, transgender populations to the equitable and efficient health services that they need. There's $550,000 to reduce stigmatization attitudes towards people living with HIV. It continues to go on here. There are a number of programs through Health Canada.

For you to say that their current investment is lacking, I just want to maybe get some more clarification on that. Are you accessing those grant applications?

This is a question for all of the community-based individuals here. How is your funding?

[Brook Biggin]

To that point, I read through the brief and a lot of the funds that they mention don't necessarily deal specifically with queer populations but other issues. Of course they consider LGBTQ populations, but if you actually went down to how the money was divvied up, very little of some of these funds went toward studying sexual and gender minority communities.

I think there's a scale and application when we talk about funding. Yes, of course, having more money to work with is never a bad thing, but there's also looking at it's application, which is why our recommendation was specifically around establishing queer funding streams. It was not so much about giving more money to all of these different things, but ensuring that—similar to other populations who are disproportionately impacted, like with the mental health fund for black men and often within HIV there are specific funding streams for indigenous communities—queer communities have some kind of money that is definitely set aside. Otherwise, once your review committee changes or the government changes, or this or that, you're competing with everybody else and sometimes we see, even though there's lots of money, very little of it is going to this population in so much need.

[Len Webber, Conservative, Calgary Confederation, AB]

I see.

Are there any other comments?

[Jeff Chalifoux]

In terms of the Edmonton 2 Spirit Society, I know that we've made several applications—and not just E2S. E2S is short for Edmonton 2 Spirit Society. There's the 2 Spirits in Motion Foundation, which has made several grant applications to Canadian Heritage, as well as to Women and Gender Equality Canada. At this point, I think that all have been denied because of certain—I'm just looking at this....

Apparently they didn't fit the criteria. It's trying to address the health of two-spirits, but it's a heritage grant looking at cultural aspects or vice-versa. It's hard for us, at E2S specifically, to incorporate our cultural practices within the western paradigm of how to structure these kinds of things because when you apply for these grants, you have to spend the money and do it in a certain way. Sometimes that doesn't recognize the culture, the way the storytelling happens or how we come together in ceremony.

We don't have a lot of two-spirit elders and knowledge keepers left. We know that there is a lot of funding that does go to indigenous organizations. I know that in Edmonton alone there are Bent Arrow and other organizations, but they don't have two-spirits on staff. They don't have that knowledge of the language there, and some of them are not bringing in two-spirit elders and knowledge keepers to actually share that with the youth and others.

[The Vice-Chair, Conservative, Marilyn Gladu]

Now we're going to go to Monsieur Ouellette for five minutes.