TORONTO, June 8, 2022—The pandemic has widened some of the existing disparities and inequities in health-care access and outcomes for the LGBTQ community, according to a panel of physicians assembled by the Ontario Medical Association.The OMA continued the discussion on Twitter Spaces with Dr Rose Zacharias, Dr. Kevin Woodward, Sean Rourke, Jack Woodman, and Dr. Edward Kucharski.
Medical services have been missed, including testing, treatment and prevention campaigns for sexually transmitted and blood-borne diseases. Wait times have grown for gender-affirming surgeries. And mental health and substance abuse issues have worsened.
“The LGBTQ population is growing, and we want to do better to support their health care,” OMA President Dr. Rose Zacharias said at a media briefing marking Pride Month. “That doesn’t mean one approach for all. The LGBTQ community’s health-care needs are as diverse as they are. Our approach to caring for people in this population should recognize individual needs.”
Dr. Zacharias cited Public Health Agency of Canada data showing testing for HIV, hepatitis C and sexually transmitted infections dropped by 45 per cent since the pandemic began.
While that makes it difficult to get accurate data on the spread of these diseases, the REACH Nexus national research team says syphilis is surging in Western Canada. Public Health Ontario recorded 2,678 cases of syphilis last year, the highest number in at least a decade.
Dr. Ed Kucharski, a family doctor and chief medical officer of Casey House, a specialist hospital in Toronto for people living with or at risk of HIV, said the decline in testing could be due to many things including the focus on COVID-19, the perception that medical offices might still be closed and the possibility people were less sexually active during the pandemic. He said stigma could also play a role for those who were having sex.
“During the pandemic, we were told to stay away from people and to stay home,” he said. “When people were sexually active, I think that they did face some stigma going into their health-care provider and asking for testing. When thinking about caring for LGBTQ people, it’s about really being compassionate and judgment-free.”
Dr. Kucharski said Casey House more than doubled the number of harm reduction kits it gave out to patients or clients who use drugs during COVID. In the six months before the pandemic, they gave out 4,000 kits. In the first six months of the pandemic, they gave out 9,000 kits as other services shut down. He said the hospital used the opportunity to expand testing, prevention and screening services to those people.
Dr. Tim Guimond, a psychiatrist at the Centre for Addictions and Mental Health in Toronto, is also the mental health director of HQ, a medical clinic for gay men and transgender people opening in Toronto on July 22.
They plan to offer convenient self-service kiosks where people can get tested for sexually transmitted and blood-borne infections and have their results processed at an onsite laboratory and texted to them within four hours. Physicians, nurses and other clinicians will be available to counsel and start treating anyone whose test results come back positive on the same day.
Dr. Guimond said similar clinics in other countries have reduced HIV rates because people are able to get treated quickly after being diagnosed.
“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,” he said.
Dr. Guimond said mental health and substance abuse problems, which were already higher in the LGBTQ community, worsened during COVID. One Canadian study found about 25 per cent of LGBTQ people reported increased alcohol consumption during the pandemic and 19 per cent increased cannabis use.
Jack Woodman, vice president for strategy, quality, risk and privacy at Women’s College Hospital in Toronto, said another recent study showed that 45 per cent of individuals who identify as transgender or non-binary didn't have their health care needs met because of their gender.
The demand for gender-affirming related surgeries has also increased “exponentially” over the past decade and the pandemic has lengthened wait times, Woodman said. While not every person who identifies as transgender requires surgery, for those who do, it can save lives and profoundly impact the quality of life.
“We can see wait of 12 to 24 months for upper surgeries and unfortunately up to 65 months for vaginoplasty,” Woodman said.
Women’s College is the first public hospital in Canada and the only one in Ontario to offer a gender-affirming surgery program. About one-third of people who need this medically necessary surgery must go outside of Ontario, often to private clinics, Woodman said.
“Wait times for gender affirming surgery are too long and really they would not be accepted across pretty much any other types of surgical care,” they said.
Dr. Amy Bourns, a family physician at Sherbourne Health in Toronto and program director for the Enhanced Skills Residency Program in 2SLGBTQ Health at the University of Toronto’s Faculty of Medicine, noted that some costs related to gender-affirming surgeries are not covered by insurance. She said she had a patient who was approved for the surgery but could not afford the electrolysis that was required in advance.
Dr. Bourns said the pandemic created additional challenges for all marginalized populations.
“A lot of my patients had to make the difficult choice to actually move out of the urban centre, out of Toronto, because of financial, occupational or family reasons, to areas where access to their inclusive health-care teams and support services is impaired,” she said. It made them feel isolated and impacted their mental health and wellness.
Dr. Bourns said the pandemic has been especially difficult for young people in the LGBTQ community. A CMAJ study published June 6 found that transgender and non-binary youth have a five-fold higher risk of suicidal thoughts and a 7.6-fold higher risk of suicide attempts than their cisgender peers.
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