Question Period Note: Support for 2SLGBTQI+ : Health portfolio

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• 2SLGBTQI+ and other marginalized populations experience worse health outcomes across a range of issues. These health inequities are the result of persistent, inequitable social and economic conditions for these groups. These impacts are amplified for Indigenous and racialized 2SLGBTQI+ populations affected by the intersecting impacts of colonialism and racism.
• The Government of Canada is committed to addressing stigma and discrimination against 2SLGBTQI+ populations and reducing the social and health inequities that they face.
• Our focus is on creating inclusive environments where everyone feels seen, safe, respected and welcomed.
• This work is important because we know that intersecting systems of discrimination create barriers to employment, housing, social support, health, and social services, and threaten the personal safety and overall well-being of 2SLGBTQI+ individuals.
• To address the unique needs of these populations, we are investing in research, health promotion and disease prevention programs, as well as initiatives to improve health care. This includes programs to address mental health, gender-based violence and sexual and reproductive health.

Historical and ongoing injustices endured by 2SLGBTQI+, Indigenous, racialized, immigrant, and disabled populations, and women, have created persistent, inequitable social and economic conditions for these groups. Consequently, 2SLGBTQI+ and other marginalized populations experience stigma, discrimination and worse health outcomes across a range of issues. These health inequities are amplified for Indigenous and racialized 2SLGBTQI+ populations affected by the intersecting impacts of colonialism and racism.

Gay, lesbian and bisexual Canadians experience substantial inequities in self-rated health and mental health, household food insecurity, smoking, heavy drinking, asthma, arthritis, and HIV infection. Canadian studies have also revealed significant socioeconomic inequities facing 2SLGBTQI+ populations, including in income, employment and workplace stress, as well as experiences of violence, hate crimes, and discrimination. Suicidal thoughts, plans and attempts are disproportionately prevalent among 2SLGBTQI+ youth compared to non-2SLGBTQI+ peers.

Recent Developments to Support 2SLGBTQI+
Blood Donor Deferral Period for Men who have sex with Men
There are two blood system operators in Canada – Canadian Blood Services (serving all provinces and territories except Québec) and Héma-Québec (serving the province of Québec). Both are regulated by Health Canada.
On September 11, 2022, Canadian Blood Services eliminated the three month blanket donor deferral period for all sexually active men who have sex with men, and instead began screening all donors, regardless of gender or sexuality, for high risk sexual behaviour. Health Canada authorized this change towards more inclusive screening on April 28, 2022. The Government of Canada provided $5.4M, starting in 2016, to support the necessary research to effect this change.
In March 2022, Health Canada approved a submission from Héma-Québec to move to sexual-behaviour based screening for all source plasma donors. On October 2, 2022, Héma-Québec replaced their plasma donation questionnaire with a gender-neutral questionnaire, using the same questions as those authorized for Canadian Blood Services for use in the rest of Canada.
On September 6, 2022, Health Canada authorized Héma-Québec’s submission to eliminate the three month blanket donor deferral period for all sexually active men who have sex with men, and others impacted by this process, and to begin screening all blood, platelet, and plasma donors, regardless of gender or sexuality for high risk sexual behaviour. Gender neutral, behaviour-based screening for blood and platelets will take effect on December 4, 2022.
Moreover, non-binary and transgender donors must presently be evaluated by Héma-Québec medical staff for donation eligibility prior to attending blood drives. As of December 4, 2022, anyone wishing to donate blood products through Héma-Québec will answer the same questions regardless of sex or gender identity, and an evaluation by a Héma-Québec medical staff member will no longer be required.
Monkeypox
Community-based organizations have been an important source of expertise regarding health promotion, disease prevention, and culturally responsive communications for the Government’s response to monkeypox. The virus continues to be an ongoing concern, and more work remains to be done. As of August 12, 2022, Public Health Agency of Canada has invested $900,000 in new investments through the HIV and Hepatitis C Community Action Fund to the Community Based Research Centre (CBRC), H.I.M. Health Initiative for Men Society in Vancouver, the Queer and Trans Health Collective in Edmonton, The AIDS Committee of Toronto, RÉZO Montreal, and the Ottawa Gay Men’s Wellness Initiative (MAX Ottawa) to increase the capacity of communities in the regions most impacted by the monkeypox outbreak.
AIDS 2022
On August 1, 2022 at the AIDS 2022 conference hosted by Canada, the Government of Canada announced a time-limited (September 2022 – March 2023) investment of $8 million to acquire HIV self-test kits and support community-based organizations.
Health Portfolio Initiatives
The Health Portfolio currently supports the health of 2SLGBTQI+ populations through a range of both targeted and inclusive initiatives, and will seek opportunities to strengthen these efforts as the 2SLGBTQI+ Action Plan evolves over its 5-year timeline. Some of these initiatives include:
Public Health Agency of Canada (PHAC):
1) Data and surveillance initiatives, such as the Pan-Canadian Health Inequalities Reporting Initiative and enhanced surveillance through funding support for the Sex Now Survey;
2) Education and training initiatives, such as the Agency’s involvement in updating the “Pride Guide” resource for 2SLGBTQI+ youth in Canada;
3) Funding programs that have supported 2SLGBTQI+ projects, including the Mental Health Promotion Innovation Fund (2 targeted projects), the HIV and Hepatitis C Community Action Fund (23 targeted projects), the Preventing Gender-Based Violence initiative (5 targeted projects), the Mental Health of Black Canadians Fund (3 targeted projects), the Dementia Community Investment (1 targeted project), and the Harm Reduction Fund (3 targeted projects);
4) Research and knowledge translation initiatives, such as the Canadian Research and Knowledge Translation Agenda on Suicide and its Prevention, which includes a focus on 2SLGBTQI+ populations; and
5) Emergency preparedness and response, such as the $900,000 investment from the HIV and Hepatitis C Community Action Fund to increase capacity of 2SLGBTQI+ community organizations in the regions most impacted by the monkeypox outbreak.
Health Canada:
1) Funding programs that have supported, or are anticipated to support projects focused on 2SLGBTQI+ populations. The Sexual and Reproductive Health Fund ($45 million over 3 years, starting in 2021/22) has a strong emphasis on initiatives focusing on 2SLGBTQI+ populations; of the first 9 projects that were funded, 5 focus on 2SLGBTQI+ populations, for a total dollar value of $8.8 million. Additional funding programs supporting 2SLGBTQI+ populations include the Substance Use and Addictions Program ($100 million over 3 years, starting in 2022/23); and the Addressing Racism and Discrimination in Canada’s Health Systems Program ($14.9 million over three years, beginning in 2021/22); and
2) Broader initiatives to improve access to care, which do not focus on 2SLGBTQI+ populations, but include the populations through an SGBA Plus lens, such as the Action Plan on Palliative Care, National Standards for Mental Health Services, National Standards for Long Term Care, the Task Team on Equitable Access to Virtual Care, and Wellness Together Canada.
Canadian Institutes of Health Research (CIHR):
1) CIHR supports research and knowledge mobilization related to 2SLGBTQI+ health, including through the following time-limited priority-driven research initiatives:
• Catalyst and support grants for Community-Led Research on LGBTQIA/2S Wellness;
• The Health Research Training Platform on Stigma Reduction and Life Course Mental Wellness for LGBTQ/2S Populations (co-funded with PHAC and Egale);
• The CIHR Sex and Gender Science Chair - LGBTQI2S Wellness and Resilience;
• The Transitions in Care initiative, which includes research that will inform how healthcare teams can collaboratively work with intersex individuals across Canada in an effort to improve lifelong wellbeing within this population across several transitions in care;
• The Indigenous Gender and Wellness Initiative, which includes research to improve wellness of Indigenous Two-Spirit and LGBTQI+ individuals and communities;
• Catalyst Grants for Healthy Youth, which includes dedicated funding for 2SLGBTQI+ youth (Note: this competition is currently underway with results expected in March 2023);
• Transforming Health with Integrated Care Implementation Science Team Grants, including projects related to gender-affirming health (Note: this competition is currently underway with results expected in April 2023);
• CIHR recently launched the National Women’s Health Research Initiative in partnership with the Department of Women and Gender Equality (WAGE). This will invest $20 million over five years to advance a coordinated research program that addresses under-researched and high-priority areas of women's health. The initiative promotes an intersectional lens to research and care to tackle persistent gaps for all women, including members of 2SLGBTQI+ communities.
2) CIHR also continues to advance measures to promote equity, diversity and inclusion within the research ecosystem, including for/with 2SLGBTQI+ researchers and trainees, for example through commitments to further gender equity in CIHR’s strategic plan and the Tri-Agency Equity, Diversity and Inclusion Action Plan.

2SLGBTQI+ Action Plan
On August 28, 2022, the Government of Canada launched the first-ever federal 2SLGBTQI+ Action Plan, which seeks to improve the social, economic and health outcomes of 2SLGBTQI+ populations in Canada through a whole-of-government approach. WAGE is the federal lead on the Action Plan.

The historic $100 million Budget 2022 investment in the Action Plan, allocated entirely to WAGE, will support activities such as community capacity, anti-stigma, awareness and research – all of which will advance meaningful action on the social determinants of health and have a positive impact on the health of 2SLGBTQI+ populations.

The Health Portfolio’s current initiatives to support 2SLGBTQI+ populations also contribute to the Action Plan’s objectives, but more work remains to be done. The Health Portfolio will continue to work with federal partners such as WAGE to advance the priorities of the Action Plan and related Government of Canada equity initiatives, such as Canada’s Anti-Racism Strategy 2.0, Canada’s Action Plan on Combatting Hate, and the Missing and Murdered Indigenous Women and Girls 2SLGBTQIA+ National Action Plan.

• Mental health: Worse outcomes for 2SLGBTQI+ people have been reported across a range of indicators, including (but not limited to) mental health. For example, the prevalence of low self-rated mental health among bisexual adults is 3 times that of heterosexual adults; among gay/lesbian adults it is 1.7 times that of heterosexual adults.
• Suicide: 2SLGBTQI+ people in Canada are more likely to contemplate suicide in their lifetime (approximately 40% of LGB Canadians vs 15% of heterosexual Canadians).
• Substance use: 24% of gay, lesbian, bisexual, and other non-heterosexual respondents to the 2018 Survey of Safety in Public and Private Spaces reported having used drugs or alcohol to cope with experiences of emotional abuse and physical violence, versus 10% of heterosexual respondents.
• Chronic disease: Higher prevalence of cardiovascular diseases, some types of cancer and respiratory diseases among 2SLGBTQI+ communities, with the onset of chronic diseases also happening earlier in life.
• Barriers accessing healthcare: Experiences of discrimination within the healthcare system sometimes cause 2SLGBTQI+ people to avoid seeking healthcare in the first place. For example, 12% of respondents to the Trans PULSE survey had avoided the emergency room in the previous year, despite needing care, and 45% reported having unmet healthcare needs within the same period.