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Lesbian, Gay, Bisexual and Trans (LGBT) Ontarians and Primary Health Care Anna Travers, MSW Director, Rainbow Health Ontario

Agenda  Introduction to Rainbow Health Ontario  Lesbian, Gay, Bisexual and Trans Ontarians as Primary Health Care Clients  Building Capacity to Serve LGBT Ontarians  Progress and Leadership  Challenges  Questions and Discussion

About Rainbow Health Ontario  RHO is a Knowledge Transfer and Exchange Program funded by the Ontario Ministry of Health and Long-term Care.  RHO is a program of Sherbourne Health Centre, Toronto, which provides a broad range of primary health programs and services to several thousand LGBT clients, as well as homeless and newcomer populations.

About Rainbow Health Ontario  RHO’s goal is to improve access to services and promote the health of Ontario’s LGBT communities.  We work with health and social service providers, researchers, policy makers and LGBT community members in three main areas:  Information and Outreach  Education and Training  Research and Policy

LGBT Ontarians as Primary Health Care Clients

Adult health promotion Cathy, a new client is 52 years old. During her initial appointment with the nurse practitioner, she says “By the way, I’m a lesbian so you won’t need to worry about a pap test”. How should the NP respond?


Peter and Ken have been a couple for over 30 years. They have been leaders in the local gay community. Recently Ken had a stroke and has lost much of his mobility and ability to care for himself. The health centre has a Seniors’ Program that offers exercise, social activities and a nutritious lunch. Will it be a welcoming place for Ken? How will staff deal with homophobic remarks by other clients?

Youth, Newcomer Kumar, aged 15 and his family have lived in Canada for 3 years. His mother has brought him in because of severe headaches. He is also spending a lot of time in his room and says he is being teased at school. Alone, Kumar tells you that “the kids always call me fag�. How would you explore what is going on with this boy?

Transgender Margaret is a trans woman. After years of unemployment and lack of contact with her adult children, things are finally improving. She has moved here to take a new job and reconnect with her son. Margaret requires ongoing hormone treatment, and appropriate screenings and health education. Will the providers be able to meet Margaret’s health needs? Will staff use appropriate pronouns?

Bisexual, Refugee Paul, a refugee claimant from Mexico, has been referred by his lawyer. He was beaten and set on fire for being bisexual. Paul needs medical documentation of his injuries for his hearing. He also needs counselling for trauma and referrals to places where he can find support as a bisexual man. How comfortable is the team in dealing with these issues?

Two Spirited

Kim,17 identifies as Two Spirited and has left home due to conflict with her family. She is living on the streets, using crack cocaine and doing sex work. Kim is now pregnant and wants to “get clean and get settled”. She has many needs including a wish to know others who identify as two spirited. How will the team approach Kim’s complex needs?

Colleagues Grace, one of the medical secretaries, is pregnant. She has never talked about her private life, but the staff are aware that she has a same-sex partner. There is much conversation behind the scenes. Some staff want to hold a baby shower for Grace as they do for other colleagues. Others find the idea inappropriate. How should this be handled?

Building Capacity to Serve LGBT Ontarians

Foster research, disseminate evidence and best practices  Better population based statistics and inclusion in population level surveys, e.g. Canadian Health Survey.  In Canada, more robust research on health status and specific concerns of LGBT people in many areas, not only HIV/AIDS.  Professional schools need to include education on health disparities of LGBT people, how to work respectfully with clients.

Promote understanding of historical and social factors  Understand how historical institutional and personal discrimination have affected LGBT communities.  Be aware of ongoing effects of homophobia and transphobia on health and wellness of LGBT people.  Learn differences between sexual orientation and gender identity and use appropriate language and vocabulary.

Organizational Change  Health service planners:  Community engagement, need assessments  Use of evidence, inclusion in strategies and funding decisions.

Health service providers:    

Policies to ensure safety of clients, staff, volunteers Training in cultural and clinical competence Recruitment of LGBT people to board, staff, volunteers Environment which reflects community, is respectful and affirming.

Networking, mentorship and ongoing learning  To retain and build knowledge, confidence and skills, health service organizations and individual practitioners need:  Networks in which they can share information, make referrals, and build local integrated systems.  Ongoing sources of learning and mentorship – webinars, fact-sheets, mentorship, newsletters, conferences.  Evaluation and measurement of progress of organization and individuals.

Progress and Leadership in Ontario

General LGBT Training (2009 – 2013)  Some CHC’s have been actively providing services to LGB clients for years, e.g. Centretown.  Over the past 5 years, many CHC’s, mental health agencies, shelters, and others have accessed RHO and other trainings.  RHO’s LGBT general training ranges from 2 hours to a full day. 32 centres have received some training.

Examples of general training workshops       

LGBT cultural competence, history, language, etc. Mental and emotional health issues Health disparities and clinical concerns Working with racialized and newcomer LGBT people Seniors health, long-term care, palliative, etc. Issues for LGBT youth, Serving LGBT families, family planning and support.

References and Resources  Brotman S, Ryan B, Meyer E. (2006). The Health and Social Service needs of gay and lesbian seniors and their families in Canada. McGill School of Social Work. Montreal.  Part III - Barriers and Specific Population Groups. Access to Care: Exploring the Health and Well-Being of Gay, Lesbian, Bisexual and Two-Spirit People in Canada. McGill Centre for Applied Family Studies, Health Canada.(2000)  The Health of LGBT People. (2011) Institute of Medicine. National Academies Press. Washington,  Fredriksen-Goldsen, K. et al (2013) Physical and Mental Health of Transgender Older Adults: An At-Risk and Underserved Population. The Gerontologist, doi:13.1093/geront/gnt021  RHO website resources –

Trans Health Connection  Special RHO project started in 2011 to provide intensive training to primary health and social service providers.  Four full days of training on providing comprehensive primary care to trans clients:    

introductory session – history, trans identities, language hormone assessment and management preparation for surgery and aftercare of clients providing social and psychological support, group work

Thunder Bay Ottawa

Trans Health Connection Training and Education across Ontario, 2011 - 13

Peterborough Ajax / Oshawa Cambridge Toronto St. Catharines Windsor

Trans Health Connection trainees by profession MODULE


Primary Care













Social Work





Mental Health










Youth Workers










Community Health

























Examples of Leadership in LGBT care in Ontario  Primary Care      

Centretown, Ottawa, Norwest, Thunder Bay Quest, St Catharines Windsor FHT E. Mississauga (LAMP) Lang’s Farm, Cambridge

Sherbourne, Planned Parenthood, Access Alliance, Parkdale, WHWH (all in Toronto)

Other Organizations Children’s Aid Society, Toronto Children’s Services, Thunder Bay Family Services Ottawa CMHA Peterborough Many AIDS service organizations Many university student organizations

Hospitals and Long-Term Care Mount Sinai Hospital Children’s Hospital of Eastern Ontario Fudger House and True Davidson Acres Sick Children’s Hospital North Ontario School of Medicine

Challenges in providing LGBT Care

Challenges  LGBT people are still invisible to many organizations although estimated to be 1 – 1.25 million in Ontario.  Often not seen as part of all our diverse communities  Not always regarded as population group with diverse and legitimate needs.  Organizations have many competing priorities and are required to balance many needs.  Majority of health care providers still have no formal education or training in LGBT health.  Gaps in research and policy make it harder to develop comprehensive strategies.

Questions and Discussion  Do you have questions or information to add?

 Do you have suggestions on how the primary health care sector should move forward?  Is there a role for the AOHC and the Board?

RHO Educational Session with AOHC Board on LGBT People Living in Ontario and Primary Health Care  
RHO Educational Session with AOHC Board on LGBT People Living in Ontario and Primary Health Care