Health Committee on May 9th, 2019

[Jeff Chalifoux]

Thank you.

[Len Webber, Conservative, Calgary Confederation, AB]

I want to address my first question to Professor Daley and Bill Ryan, two people from universities.

I received a briefing document from Health Canada, the Canadian Institutes of Health Research. It talks about government funding and funding in different areas. It has an annual budget of approximately $1 billion. Through its institute of gender and health, the Canadian Institutes of Health Research fosters research that explores how sex and gender influence health. Its strategic plan identifies research on the health and wellness of individuals who identify as LGBTQI2S as one of its key priorities.

I read about some of the research investments that it is doing. It has $11.7 million going into generating new knowledge and evidence that leads to better health outcomes and improved quality of care for LGBTQI2S Canadians. It has $500,000 for a team of researchers developing interventions for the prevention of human HIV infections among MSM and $750,000 in research for improved screening and treatment of serious cancers caused by HPV.

There is another $21 million for HIV/AIDS research, an annual amount of money to support research and trainees; $3 million for research to address the persistent health gaps faced by LGBT adolescents in Canada; $1.3 million for research on health outcomes of transgender youth undergoing clinical care; and $2.3 million for women's reproductive health in HIV. It just goes on.

Professor Daley, you mentioned that one of your recommendations, of course, is sufficient funding. I am just curious. Can you elaborate on that? Sufficient funding in what areas, and what do you think it should be?

[Prof. Andrea Daley]

In terms of my recommendation, it was about how to bring the information and knowledge we have into the curriculum. How do we develop a curriculum in a way that isn't just about imparting knowledge but also transforming people's beliefs, attitudes and ideas?

While there may be research being done, I'm not sure that all HIV/AIDS research is focused on queer and trans communities, HPV, women's reproduction and HIV.

The institute of gender and health takes a gender-based lens to the research process, so it's not always LGBTQ-related, even though people might make the assumption around HIV that it's related to LGBTQ communities. That's not always the case.

My main point is this: How do we take what we do know and move it into developing a curriculum that is robust, that is integrated, that is consistent and comprehensive, so that people aren't getting one-offs? Is today the day we lecture on LGBTQ people in social work, nursing, medicine, psychiatry or whatever that is?

What people are getting access to in professional health programs is very limited. It may actually be inadvertently reproducing stereotypes. When we talk about LGBTQ people in social work, we may talk about HIV or depression.

When we do see some of these pieces being brought into the curriculum, it's often, what I call, in a problem framework. It's always reproducing LGBTQ lives as problematic and pathological in some kind of way. We need to take the knowledge that's related to LGBTQ health, that's related to LGBTQ health services and LGBTQ lives, and create a robust curriculum across health professions, so there is a comprehensive, integrated approach to it.

Can I make one quick point as well?

[Len Webber, Conservative, Calgary Confederation, AB]

Absolutely, yes.

[Prof. Andrea Daley]

We can't leave the humanities and social sciences out of this. Equity studies, women and gender studies are the places where nurses, social workers and physicians will get access to much more theoretically rich and engaged discussions around sexuality and gender.

[Len Webber, Conservative, Calgary Confederation, AB]

On that note too, Mr. Ryan, you indicate you teach courses at McGill. Which faculty?

[Prof. Bill Ryan]

I teach in three programs: the social work program, the couple and family therapy program and in an MBA program in international medical health. In all of those I teach around gender and sexual diversity.

I agree absolutely with everything that's just been said. One of the things I want to mention is that if we didn't have the gender institute at CIHR, we would have nothing. I'm one of those who remembers before, where we could not get funding for any research on sexual and gender minorities except the disease model around HIV, which was important and necessary but it was very limited. The gender institute has opened doors. We're catching up with a lot of research.

There was a time when we could put all the researchers in Canada doing research on this issue around that table. The gender institute has allowed us to expand. We have to get to the point where all studies that look at anything related to human life conditions include sexual and gender minorities. We don't necessarily have to always have specific studies, but those specific studies are filling in pieces that we missed historically for generations.

[The Vice-Chair, Conservative, Marilyn Gladu]

That's your time.

Now we'll go to Mr. Davies for seven minutes.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you, Madam Chair.

Thank you to all the witnesses for powerful and very helpful testimony.

Brook, I know you've commented publicly about the benefits of PrEP. I think Alberta did a great job in making that available. I was going to ask if that should be covered for all Canadians, but I think I know the answer. We do.

In our last meeting, we found out that HIV self-test kits are available in certain countries in the world, like in the U.K. where you can mail them in. It's delivered to your mailbox. This would be particularly helpful for people who want to test in confidence in rural small towns or places where they don't feel comfortable going to a professional who might know them.

Do you have any thoughts to give this committee on whether Canada should be pursuing those kits?

[Brook Biggin]

Yes, for sure. A written brief submitted by the Community-Based Research Centre provides very specific recommendations around that.

I'm not sure if you're familiar with the concept of 90-90-90, but essentially back in 2014, UNAIDS recognized that when people had a suppressed viral load they couldn't transmit the virus to others. Essentially it said that one way we could end the epidemic by 2030 is to get 90% of people who are living with HIV diagnosed, 90% of those diagnosed on treatment and 90% of those on treatment to have a suppressed or undetectable viral load. The last data I was able to see from the Public Health Agency of Canada was up to the end of 2016. They found that 86% of those who were living with HIV were diagnosed, 81% of those diagnosed were on treatment and 91% on treatment had an undetectable viral load.

We see that people living with HIV are doing their job, when they can get diagnosed and on treatment and hit their target four years early, before 2030 when we're supposed to hit 90-90-90. However, we're seeing that in the health system, the two 90s that it's most responsible for, is where we're falling short. Of course, one of them is related to diagnostics. You've heard from multiple witnesses, both through written briefs and oral presentations, about the need to catch up with testing. It's true. I believe Jody Jollimore mentioned that one of these tests is manufactured in B.C., and we can't get it.

[Don Davies, NDP, Vancouver Kingsway, BC]

It's in Richmond.

[Brook Biggin]

There's been a lot of energy on the ground both in CBRC's and the EMHC's research. The community is ready for it. When you look through the types of testing they would prefer, you have to get down to the third or fourth preference before something is available.

The community is hungry. We know it works in other high-income countries. I think that people on the ground and throughout different provinces are wondering why it's taking us so long to catch up. Definitely home-based testing, different types of point of care testing, we are all for it. We should do it. It works. Why not?

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

Darren, I'm from Vancouver. In the Lower Mainland of B.C. we enjoy living in, I think, one of the most multicultural communities in the country. I'm aware of the different cultural and developmental sensitivities in sexual minority and gender diverse communities.

In your view, what types of tools or services or supports would be helpful to promote discussion of these issues within ethnic and racial and linguistic minority families or communities?

[Darren Ho]

A lot of these discussions have to happen, as you say, within ethno-racial and racialized communities. One thing that's missing, however, is support from our allies on how to get these conversations going, like space and time and staff and all of these things. There is often a misconception that these conversations have to happen more in racialized communities, because maybe racialized communities are more homophobic or transphobic or against queer rights.

It's also important to recognize that homophobia and transphobia exist across all identities and races and cultures, but maybe in some parts of Canada we see more homophobia and transphobia in certain groups due to the media or due to giving people more platforms. I would say to continue the work of having these conversations in all communities and eventually it will trickle down to people of coloured communities.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

Jeff, first of all, thanks for sharing your powerful story with us. I have to admit my ignorance. When I first started the study, I thought “two-spirited” was an indigenous word for being gay. Through this study I have learned that it's actually a much more complex concept that varies among different nations across the country. I am curious to know what your definition of “two-spirit” would be.

[Jeff Chalifoux]

The term “two-spirit” was created in 1990 in Winnipeg at a two-spirit gathering as an umbrella term used by first nations across Turtle Island, many of whom had different gender terms and up to seven gender titles. When it comes to 2S, the concept at that time was that 2S held both the male and female spirit within them, and that correlated with those along the LGBTQI spectrum in those identifying factors.

For me, two-spirits are those who transcend the boundary set by the binary, and the role of two-spirits is to sort of.... It's really difficult because at that gathering in Winnipeg they came up with that term and it's been discussed a lot among indigenous nations and among two-spirit organizations and individuals. Oftentimes there are those who don't feel as if they hold the male and female spirit, or the masculine and feminine spirit, and that just speaks to the different nations and languages and traditions that have been happening among the tribes.

It's hard to really give a definition. For each individual, it's quite different. For me, growing up, I always believed that how I wanted to live is the life that I have now, being able to be a father, to engage in romantic relationships with whomever I chose, and to have the kind of union and family unit I have now in the community surrounding my son. It wasn't something that I had growing up.

[The Vice-Chair, Conservative, Marilyn Gladu]

All right, we're going now to Ms. Sidhu.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you, Madam Chair.

Thank you to all the panellists for being here. It really helps us to create a good report.

When I was listening to all the panellists, one big thing comes up—intersectional education. We need that. For this type of education, there are four categories: health care providers, teachers, parents and youth. For health care providers, can each of you tell me how we can educate heath care providers, teachers and parents? I'm a parent of three teens.

Thank you, Jeff, for sharing your story.

How can parents know that? I have a son and we don't discuss sexual relationships. How can one parent know what his son or daughter is going through?

[Darren Ho]

That's a great question. I definitely think that if we allow this, or if we give space for our parents to ask these questions of their children, and for their children to explain their understanding of themselves to their parents, those would be much more fruitful conversations than any instructional or educational thing I could come up with right now.

[Sonia Sidhu, Liberal, Brampton South, ON]

Are there any educational webinars, or anything else we can learn from? Mostly, in ethnic communities—I'm not talking about me—they don't talk about that relationship. What other tools can they use?

Anyone can answer.

[Prof. Bill Ryan]

What comes to mind quickly is that we have opportunities where health care professionals and educators meet with parents, either in a health context or in something like prenatal courses. To me, prenatal courses are really rich places, where some subjects can be brought up that might be new to some parents. I would like to think that some day, in prenatal courses, someone asks, “What would happen if in 12 or 13 years, or maybe five or six years, your child came home and said, 'Mom, dad, I have something I need to talk to you about'?” I think if we ask that question before it happens, we're already starting to decide what our response might be.

I think all of us would agree, generally speaking, that most parents love their children and want what's best for their children. Most parents are just not always well equipped to respond, because they don't have the information. In instances like that, we can do it through campaigns. Quebec had a TV campaign against homophobia and transphobia that went into every living room in the province during popular television shows. Those kinds of things start us asking questions we might answer before a certain percentage of parents have a child who comes home and says, “Mom, dad, I have something I have to tell you.”

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you.

Ms. Daley, you are working on the LGBTQ2 home-care access project. In your view, is there a need for separate LGBTQ long-term care facilities?

[Prof. Andrea Daley]

I think other people on the panel may have some views on this, as well.

I have one point of clarification. The home-care project focused on in-home care. Residential facilities would be considered in-home, although we didn't include them in our study, because we felt they were different, in terms of the institutional context.

I believe in a multipronged approach and that existing long-term care facilities need to think about access and equity, and access and equity frameworks that explicitly address LGBTQ2 people moving into those spaces. I also feel there is perhaps a need for separate places for people to live, at this point. Many of the facilities aren't looking at LGBTQ policies and practices.

Tamara Sussman, from the McGill University school of social work, did what I would consider to be a bit of a scoping review. I was part of that work, more marginally. They called a number of different long-term care facilities—and you'll have to excuse me, I can't remember right now whether it was in Quebec or beyond—to ask about the policies they have related to older LGBTQ people moving into those spaces. I don't think there was one institution that had a policy, so in the absence of existing institutions expanding their ideas around access and equity, I think separate spaces are probably very much needed.

Other people probably have some ideas around that, as well.

[Prof. Bill Ryan]

I've been involved in elder care research for awhile, and there are two models. The American model is a private system, and you pay for yourselves. All kinds of communities have developed their own services, but to be honest with you, when I get to need elder care, I'm going to say, “I paid taxes all my life for public services, and I want public services to be adapted to my needs.” I shouldn't have to pay $10,000 more a month for a service that respects me and is adapted to me, after I've paid, like my neighbours have, my entire life for these services to be provided to me. I think there's a debate within the community about that.

I come from Montreal, which has elder care facilities where the language is Italian, the TV is in Italian and the cuisine is Italian. Some people might prefer that, but other people don't want to be put in those kinds of closets again. They want to be out there as they live their lives, with the general community. I think we'll see both. Primarily, I think Canadians generally feel that public services should be adapted to us and should be respectful of us. If not, there are human rights commissions that will redress that.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you.