CANADA

Advocates want national standards for including LGBTQ identities in medical records

The Canadian Press
Thu, July 6, 2023 



Correcting health-care providers who assume he's heterosexual gets tiring for Jeremy Long, who wants his queer identity to be acknowledged and counted in electronic health records.

"It's taxing on a person's mental health and their ability to be understood by the world and to have to constantly feel like it's a piece of the fight of coming out again and again, which can be retraumatizing," the 38-year-old said from Vancouver.

"People aren't always asking questions that lead to more understanding. They're just labelling and so to have to correct that, it feels exhausting."

Long, who came out at age 15, said LGBTQ patients too often face judgment and feel unsafe when they seek care.

Advocates are pushing for the inclusion of gender, sex and sexual orientation (GSSO) information in electronic health records through a co-ordinated and standardized approach across the country.

The Community-Based Research Centre, based in Vancouver, released a report Wednesday calling for all jurisdictions to add more fields on medical forms that would capture the full diversity of sexual orientation and gender identity.

Michael Kwag, the centre's executive director, said that information is either misrepresented or not properly collected in Canada's health-care system. Including it would make it easier to plan for services the LGBTQ community needs, improve access to appropriate care and lead to better health outcomes, says the centre's report.

"Lesbian, gay, bisexual or queer people do have unique health needs and at times also experience higher rates of physical and mental health issues," Kwag said of issues such as depression, anxiety and sexually transmitted diseases including syphilis.

Trans people may also not be screened for breast, cervical or prostate cancer if their electronic health records are not updated, he noted.

Kwag said clerical and administrative workers, as well as health-care professionals, should be trained to better understand sex and gender as distinct concepts. Sex refers to someone's physical characteristics, such as male, female and intersex, and gender is how people identify themselves.

He also cautioned health-care workers about the harms of "deadnaming" patients and using incorrect pronouns, which can happen if medical records are not updated to reflect gender identity.

The research centre's report recommends Health Canada work with provinces and territories to encourage adoption of evolving terminology to include LGBTQ identities in health records.

In an emailed response, Health Canada said collecting standardized data on gender, sex and sexual orientation is a critical step to understanding health-care inequities and discrimination.

Work led by Canada Health Infoway, the Canadian Institute for Health Information (CIHI) and Statistics Canada tries to encourage all jurisdictions to adopt common technical and data standards, including the recording of a patient's gender, sex and sexual orientation.

"These commitments are expected to improve the quality and safety of patient care and provide decision makers with a more complete picture of the health-care system."

Francis Lau, a retired researcher at the University of Victoria's school of health information science, said that four years ago, he created an ongoing working group on sex, gender and sexual orientation with Canada Health Infoway, a federally funded non-profit working to improve health-care delivery through use of digital records.

Lau, who co-chaired the group until recently, said it released a national plan two years ago for provinces and territories to consult with various community groups about collecting and using information related to gender, sex and sexual orientation. Some provinces, including Alberta and British Columbia, have published standards on those issues.

An Alberta Health Services spokesman said provincial standards were developed in 2019 to collect patient information on diverse genders and sexual orientation at all health-care settings and pharmacies as part of a system called Connect Care.

It is expected to be rolled out next year and will include pharmacies.

However, data on sex assigned at birth is requested only if it is clinically relevant and a patient can choose not to disclose any information, he said.

B.C.'s Health Ministry released a "GSSO Health Information and Guidance" document earlier this year about the collection of data to "support trauma-informed care that addresses barriers to access such as misnaming, misgendering, outing and missed opportunities for preventive screening.

It includes guidance on using yet-to-be-specified coding to record people's negative experiences in the health-care system, such as transphobia, "worries related to gender expression and "cisnormative bias," or the assumption that everyone's gender identity matches their biological sex.

Lau said the Canada Health Infoway working group is trying to come up with coding in medical records for various sexual orientations and for those who may be gender fluid or do not want to disclose that information.

"The action plan only talks about what needs to be done," Lau said. "It left the when, how, who to the jurisdictions and organizations, the governments, because you need time and resources to do it."

This report by The Canadian Press was first published July 6, 2023.

Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.

Camille Bains, The Canadian Press

Pleas for help as Montreal's LGBTQ Village falls victim to addiction, homelessness

The Canadian Press
Fri, July 7, 2023



MONTREAL — The Village, Montreal's historical LGBTQ neighbourhood, has become the scene of homelessness, addiction and crime, with locals suggesting that its social problems are being imported because of the district's history of being an inclusive space for marginalized people.

Richard Fitzgerald, who has lived in the Village for 46 years, says he has witnessed a slow decline.

"Twenty years ago it was a really lively place and it was known around the world." Now, he said, "you come here at night and it's scary. There's violence. There's a whole problem of people who have drug problems, mental health problems."

In response, the city has boosted police presence in the neighbourhood just east of downtown and assigned a two-person psychosocial intervention team to direct vulnerable people to resources. In June, it released a plan to revitalize the neighbourhood and deal with homelessness and mental health.

But residents and business owners say the measures are insufficient, and they lament that the municipal government helped create the problem by concentrating services for vulnerable people into one area without the necessary investments to properly care for them.

"They don't have anywhere to go," Fitzgerald said, sympathizing with people struggling with drug and mental health problems, whom he called "victims of a system."

"This is where they come, and the city encourages it because they try to say this is an inclusive area. I think the mentality is that the gay community is more open to marginality than the rest of the city."

Christian Généreux co-organized a march Tuesday through the Village streets in an effort to get the municipal, provincial and federal governments to address the district's social ills. Généreux said his neighbourhood's problems have been partly "imposed" on it.

He pointed to the city's decision during the COVID-19 pandemic to temporarily convert a large hotel in the area into a homeless shelter. “It imported to the Village problems that are not specific to the Village,” Généreux said.

“All this combination of factors makes it so all of this is grouped in one neighbourhood, and it creates pressure, a lack of security, and as the governments don’t provide the resources needed, these people find themselves in the streets with the problems they have.”

The Village has long been a hub for community organizations and services for marginalized people, said Bruno Laprade, a spokesperson for an LGBTQ organization and local historian who has been giving tours of the neighbourhood for 17 years. Commercial vacancies following the deindustrialization of the area in the 20th century meant non-profits and other groups could take advantage of lower rents, he explained.

He says the Village's problems have been compounded by a drop in tourism due to competition from LGBTQ destinations in other cities and even from other commercial areas of Montreal.

In the late 1990s and early 2000s, another scheme to revitalize the area that focused on attracting tourists eventually led the city to create a summer car-free zone on the strip of Ste-Catherine Street that runs through the Village, one of the first such programs in the city, Laprade said. Now, popular annual car-free zones in other parts of the city are drawing crowds, too.

Montreal's latest plan to bring people back to the Village includes an effort to redefine the neighbourhood's identity, with public art and memorials dedicated to the LGBTQ community, more extensive summer and winter programming, and the refurbishment of Ste-Catherine Street.

But change can't come soon enough for some.

Alain Guenette, manager of Bar Rocky, said he briefly closed his patio this year because his customers didn't feel safe sitting outside. "It's really dangerous there for us," he said. "It was scaring the customers." Bar Rocky has reopened its outdoor seating area, but Guenette said he's still not satisfied with the city's progress: "They really need to do more because this is really unpleasant."

Danny Jobin, owner of three bars on Ste-Catherine Street, said he has noted a decline in business as the number of unhoused people on the streets grows, and he wants the city to take action. "We need a lot of help from the government and the city," he said.

Généreux said there have been plenty of forums and reports over the years about how to help the Village. Now it's time to take action and to allow the area to recapture its place as a worldwide destination where people can celebrate diversity.

“We know what we have to do,” he said. “What it takes now is a sense of urgency to act on the part of all the governments concerned … it takes a global action plan, it takes resources on the ground.”

This report by The Canadian Press was first published July 7, 2023.

— With files from Sidhartha Banerjee

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This story was produced with the financial assistance of the Meta and Canadian Press News Fellowship.

Thomas MacDonald, The Canadian Press