Humans love to generalize (see what we did there?)
In the media, generalizations about health issues tend to concentrate on fatalities, to the point where our perception of any given group is coloured by what’s most likely to kill the people in it – lung cancer, for example, or heart attacks – to the exclusion of other pathologies that might be less immediately deadly.
Media reports on health issues affecting the LGBTQI2S community focus our attention on sexually transmitted diseases – specifically HIV/AIDS – or the psychological impact of bullying. But as a recent CBA submission to the House of Commons Standing Committee on Health shows, that’s not even the half of it.
The Sexual Orientation and Gender Identity Community Section and Health Law Section has written to the committee, which is studying LGBTQ12S health, to enumerate several areas of concern including conversion therapy, drug treatment and intersex surgery, blood donations and trans health.
Conversion therapy is seen as a provincial or territorial issue and is thus dealt with via a patchwork of legislative responses, despite the federal government’s recent position that such therapies are “immoral, painful and do not reflect the values of our government or those of Canadians.”
The Sections point out that existing bans on conversion therapy apply only to minors, and not to incapacitated or otherwise vulnerable adults. They recommend extending the ban to include vulnerable adults and also to cover travel abroad for this purpose.
“The existing Criminal Code offences of kidnapping, forcible confinement and assault are insufficient to address conversion therapy,” the Sections say. “A criminal sanction targeted directly at conversion therapy is necessary to convey a clear denunciation, appropriately attribute moral blameworthiness and act as a strong deterrence.”
The Sections also recommend the government deny tax benefits to any organization providing the therapy.
Drug therapies – specifically pre-exposure prophylaxis, or PrEP treatments – have been linked to a decline in the number of new HIV infections, but the drugs are expensive and not covered consistently by health plans across the country. The Sections, noting the federal government’s plans for a national pharmacare program, recommend PrEP treatments be studied by the national drug agency for inclusion in the formulary.
Most Canadians would be surprised to learn that as many as 1.7 per cent of the population is born with differences of sex development – ambiguous genitalia also known as intersex variations. What usually happens in these cases is that the children are assigned a sex and surgically altered to conform to that assigned sex, what is called “normalizing” surgery.
The Sections argue that a growing number of health professionals, medical associations and countries are coming out against medically unnecessary normalizing surgeries on intersex infants and children.
“We are not suggesting a complete ban on surgical procedures,” the Sections say. “We recommend amending the Criminal Code to postpone genital normalizing surgeries on children until the child can meaningfully participate in the decision – except where there is immediate risk to the child’s health and medical treatment cannot be delayed.”
In terms of transgender Canadians, the Sections note that this group is at higher risk for stress, depression, suicide and infections due to sexually transmitted diseases, but more than half report negative experiences at emergency departments, and a third report negative interactions with their doctors. Waitlists for surgical procedures are also a problem, due to a lack of doctors trained in gender-confirming surgery.
The Sections recommend the federal government, in partnership with the provinces and territories, increase sensitivity and competency training in trans health issues, and fund training for GCS surgeries.