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Health of those in the 2SLGBTQ+ community disproportionately affected by COVID-19 pandemic

Doctors say members of this population have worse health outcomes compared to their heterosexual and cisgendered counterparts since the start of the pandemic in March of 2020.
COVID-19, file, stock photo

The health care issues those in the 2SLGBTQ+ community face on a daily basis have been further exacerbated by the COVID-19 pandemic, a group of experts shared during an Ontario Medical Association (OMA) panel on Wednesday.

Doctors say members of this population have worse health outcomes compared to their heterosexual and cisgendered counterparts since the start of the pandemic in March of 2020.

Barriers to access to care has been a huge issue for the 2SLGBTQ+ population, but the pandemic created even further challenges.

“Factors include high rates of stress due to systemic harassment, social stigma and discrimination and a lack of 2SLGBTQ+ specific information,” said OMA president Dr. Zacharias.

In light of Pride Month, a group of experts were brought together to share what the medical community can do to provide better support.

Some of the main issues discussed were increased rates of sexually transmitted infections (STIs), the current wait time for gender-affirming surgeries and mental health.

Dr. Zacharias said there has been a concerning rise in the number of cases of syphilis recorded in Ontario, of which the Public Health Agency of Canada said the majority are among gay men or men who have sex men.

Yet, a national survey released in March showed testing for STIs, HIV and hepatitis C had dropped 45 per cent since the pandemic.

A surveillance report from January showed a 21 per cent decrease in HIV infections in 2020 compared to 2019 across Canada. However, the decrease could be drop in testing and not a decreased rate in infection.

“When thinking about caring for 2SLGBTQ+ patients, it’s really central to their care just requires compassion and judgment-free care,” said Dr. Ed Kucharski, the chief medical officer of Casey House, a hospital for living with or at risk of HIV.

Dr. Kucharski said he believes there’s a multitude of reasons why there could be a drop in testing.

“In the early days of the pandemic, many services shut down and we are mostly concentrated on COVID. So that to me makes a lot of sense of why screening or testing for STIs went down,” explained Dr. Kucharski. “I still think there is some perception in the public that services aren’t fully open and operational so people don’t have that permission to get out, get screened and tested.”

“There also may have been that stigma that people have faced when we were told to stay away from people, to stay home. And so when people were sexually active, I think that they did face some stigma going into their health-care provider and asking for testing,” added Dr. Kucharski.

Dr. Tim Guimond, a psychiatrist at the Centre for Addiction and Mental Health, is the mental health director at HQ, a new medical clinic for gay men and transgender people set to open this summer in Toronto. The goal is to provide a “convenient downtown destination for HIV, sexually transmitted infection and blood borne infection testing.”

“When we do this, it should be 15 or 20 minutes that it takes for a standard visit to our clinic. This is going to be kind of revolutionary in efficiency and convenience for people, which we hope will drive up people having routine testing much more frequently,” said Dr. Guimond.

As a psychiatrist, Dr. Guimond added often the rates HIV and other STIs often tend to be higher in those who are suffering from untreated mental health and substance abuse problems. He said the clinic will also be addressing this.

“If you come in and have requested mental health help, you’ll do some self-assessment, and we will string into a level of service that matches the severity of the problems you’re facing,” explained Dr. Guimond. “And support that with pure programming, recreational and social programs that appeal to people in the community to make this a centre that helps fight the isolation.”

The 2SLGBT+ community has historically faced mental health and substance abuse problem and wait times for counselling for this population are longer. Some waited between 9-12 months for help during the pandemic.

“I think that it will be helpful for government to increase investment in mental health care generally, but also be very aware of the way that race and sexuality and gender influences this, and there may be need for targeted dollars to help increase the supports in those areas,” shared Dr. Guimond when asked what more the province can do to support the 2SLGBTQ+ population.

Another key issue addressed during the panel was the backlog of gender-affirming surgeries in Ontario. The pandemic created a backlog of millions of surgeries during surges of the virus in which non-emergent procedures were paused.

The wait time now for medically necessary gender-affirming surgeries has skyrocketed. Depending on the type of surgery, the wait time is between 12 to 24 months for upper surgeries and up to 65 months for vaginoplasty in province.

“The cause of the wait times is multifactorial. In particular, there’s an absence of an integrated surgical care pathway in Ontario and a lack of local options, providers and funded surgical capacity. All of those issues are problematic,” said Jack Woodman from Women’s College Hospital. “There’s been little planning at a provincial level to address access and resource needs.”

Woodman spearheaded the effort to have gender reassignment surgeries at the hospital, the first public hospital in Canada to offer them.

“Many people still have to access care outside province or country. A third of patients are having surgery outside Ontario. Most OHIP surgeries occur in high volume private clinics outside province.”

“I’ll emphasize while not every person who identifies as trans will require surgery, we know that for those who do, it can save lives and profoundly impact the quality of life,” Woodman added.

Dr. Zacharias explained there isn’t just one solution to help all members of the 2SLGBTQ+ community.

“The 2SLGBTQ+ population is growing and we want to do better to support their health care. That doesn’t mean one approach for all. 2SLGBTQ+ people are not a monolith.”

“The 2SLGBTQ+ community’s health care needs are as diverse as they are. Our approach to caring for people and as population should recognize individual needs,” she added.

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