Q. How does Bill C-4 open the door to more active prevention of conversion therapy?

Bill C-4 is an amendment to the Criminal Code of Canada, making it an offense to cause someone to undergo conversion therapy, remove a minor from Canada to undergo conversion therapy elsewhere, promote or advertise conversion therapy, or financially benefit from conversion therapy. I am thankful to the survivors and activists who tirelessly fought for our government to take action on the issue of conversion therapy. This law creates an important legislative mechanism to support our work. However, we must not be complacent in assuming that the law will singlehandedly remove conversion therapy from the country. The limits and unintended consequences of Criminal Code enforcement, are well-documented in the context of other public health issues.

Perhaps the greatest benefit of Bill C-4 is the potential to activate broad public education about the issue of conversion therapy and related practices and ideologies. My colleague and conversion therapy survivor Michael Kwag has written, “as much as we need to rid our society of bad actors peddling harmful and fraudulent ideas, we also need to push for policies and initiatives that will create the affirming communities that we know queer and trans people need to thrive.” Michael’s comment opens the possibility of leveraging the core message of Bill C-4—that 2S/LGBTQ people and identities are valid and not in need of change—to double down on our efforts to make sure all Canadians receive this message repeatedly, and clearly.

Q. What can public health practitioners and administrators do to further the cause of 2S/LGBTQ health equity?

In my 2021 blog post, I introduced the notion of the “conversion therapy pyramid“—subsequently published by our research team in the Canadian Journal of Psychiatry. The pyramid reminds us that conversion therapy practices are held up by other pervasive practices that doubt self-determined 2S/LGBTQ identities or dissuade us from adopting or expressing these identities. These practices are often referred to as “sexual orientation and gender identity and expression change efforts,” or SOGIECE.

In the interest of promoting public health action in the wake of enactment of Bill C-4, I offer two practical examples of SOGIECE-related efforts that are sites of 2S/LGBTQ inequity and deserve our support, the interest of digging into the next ‘layer’ of the pyramid.

Gender-affirming healthcare: the importance of self-definition and autonomy

From interviews with conversion therapy survivors, our research team learned that the core premise of conversion therapy practices is someone in authority (e.g., a healthcare provider, counselor, religious leader) claiming to know the best course of action when it comes to the sexual or gender identities of others (e.g., patients, clients, adherents). My colleague Florence Ashley, a bioethicist and jurist, has explained how licensed healthcare providers become harmful anti-transgender gatekeepers when they insist upon medical transition models that do not center patients’ autonomy.

This month, Florence and I published a commentary for CMAJ, arguing that effectively ridding our medical system of conversion therapy will require regulatory enforcement that includes particular attention to denial of gender-affirming care. Of course, regulatory enforcement should be paired with “carrots” that incentivize the expansion of gender-affirming care access. Here in BC, we are fortunate to have TransCareBC leading these efforts. Other Canadian colleagues have demonstrated how practical, patient-centered gender-affirming care can be effectively taught through public health and other health professional education channels. These models must be scaled and fully funded to continue moving toward health equity for trans people.

2S/LGBTQ-inclusive comprehensive sex education

The delivery of sex education in Canada—and British Columbia—is inconsistent and patchwork, with little to no guarantee of inclusion of 2S/LGBTQ content. This is relevant to conversion therapy for two reasons. First, school-based sex education may be thought of as a ‘safety net‘—a place where 2S/LGBTQ youth who are otherwise stigmatized by families or communities may receive the unequivocal message that their sexual and gender identities are valid and healthy. Second, 2S/LGBTQ youth are disproportionately affected by sex education curricula, that fails to meet Canadian Standards. Without evidence-based, non-stigmatizing education, 2S/LGBTQ youth are left to make sexual decisions on their own, in the absence of clear, health-promoting guidance.

Q. How can you learn more about 2S/LGBTQ equity?

This is a good time to activate public health efforts to eradicate anti-2S/LGBTQ practices. Women and Gender Equality Canada is poised to launch a national LGBTQ2 Action Plan. Here at the BCCDC, the Two-Spirit Dry Lab—the first public health research group that focuses exclusively on Two-Spirit people—is preparing to conduct a three-year, CIHR-funded study to understand how Two-Spirit promotes health equity for Indigenous people. As my research team builds on what we’ve learned about conversion therapy, we will be launching a new survey that will explore all of the topics outlined here, working with Canadian youth and 2S/LGBTQ communities.

Consider checking out the following BC and Canadian organizations and efforts that are working hard for a bright future for 2S/LGBTQ people. They will appreciate your support:

• Path to Patient-Centred Care
• Action Canada for Sexual Health & Rights
• Community-Based Research Centre
• No Conversion Canada
• MindMapBC

If you want to do more to support survivors of conversion therapy, have a look at recommendations compiled by Reilla Archibald, a nurse and MPH student working with our team.

To keep updated about our team’s research, follow me on Twitter.

Acknowledgements:

Thank you to the BCCDC Foundation for Public Health, Andrew Beckerman, and CIHR for funding this work.

I am grateful to the courageous conversion therapy survivors who have tirelessly told and retold their stories so that the rest of us would finally take action to combat these traumatic practices.

Finally, the following students have contributed to this research: David Kinitz (University of Toronto), Trevor Goodyear (University of British Columbia), Elisabeth Dromer (Université de Montréal), Amrit Tiwana (Simon Fraser University, SFU), Reilla Archibald (SFU), Julia Schillaci-Ventura (SFU).

Publications from our team on the topic of CT:

• Ridding Canadian medicine of conversion therapy
• “Conversion Therapy” Experiences in Their Social Contexts: A Qualitative Study of Sexual Orientation and Gender Identity Expression Change Efforts in Canada
• Experiences with sexual orientation and gender identity conversion therapy practices among sexual minority men in Canada, 2019-2020
• “They Want You to Kill Your Inner Queer but Somehow Leave the Human Alive”: Delineating the Impacts of Sexual Orientation and Gender Identity and Expression Change Efforts
• The scope and nature of sexual orientation and gender identity and expression change efforts: a systematic review protocol
• Prevalence of Exposure to Sexual Orientation Change Efforts and Associated Sociodemographic Characteristics and Psychosocial Health Outcomes among Canadian Sexual Minority Men

The post Beyond the Ban: A Public Health Strategy to Eradicate Anti-2S/LGBTQ Practices appeared first on Pacific Public Health Foundation.

What does conversion therapy have to do with public health? Public health is about preventing disease and injury, promoting health, ensuring that everyone has the same opportunities to achieve their optimal health (health equity), and the recognition that social factors do have an impact on our health outcomes over our lifespan (or, social determinants of health).

Members of LGBTQ2S+ communities already face health disparities ranging from disproportionate rates of HIV to higher rates of mental health and substance use challenges. Conversion therapy deliberately targets members of these communities, further exacerbating the health inequities they face as a population, and compounding their negative health outcomes. For example, a gay man who is HIV positive, who has also experienced conversion therapy will face a host of compounding inequities that will impact his health over his lifetime. To generalize, it will be harder for him to access appropriate health supports and improve his health than for a heterosexual man who hasn’t been through conversion therapy, or who doesn’t have HIV.

Or, consider a trans woman of colour who experiences poverty, perhaps because she was forced to leave her home at a young age when she came out to her family, and subsequently lived through conversion therapy. Here, her social determinants of health like her race, income, housing status, and gender identity are all factors that impact the healthcare she receives, and put her at risk of poorer health. One of the purposes of public health is to identify and address those disparities and inequities. Public health allows us to take those individual stories and experiences of trauma and address them at a systemic level, doing more good for more people. Instead of just improving health for one person, we can do it for populations.

So, there’s hope. There are people right here in BC and across North America fighting for change, fighting to protect future LGBTQ2S youth and adults from being subjected to these practices, working to ensure that future generations don’t face these same kind of systemic or institutional inequities. For those who have already lived through it, we want to best support them.

We need to know what support survivors need, where they need it, and how we can get it to them. This may sound obvious but a few ideas that were considered on Saturday were the need for peer supports, so survivors feel comfortable with their support worker and aren’t re-victimized by having to engage with a healthcare provider. And, considering the impacts of colonization and racism on Two-Spirit survivors, and examining the role that residential schools played in conversion therapy. What about new comers to Canada who may have experienced conversion therapy in their home countries? What services are they already accessing when they arrive here, how can help be offered to them in a place they already are and in a way that’s both culturally relevant and safe?

These questions haven’t been formally asked in relation to conversion therapy before. We don’t even know what questions to ask necessarily. At the event, I posed a question to my small working-group: “is there any formal training in school for psychologists, counselors, or physicians in how to help survivors of conversion therapy?” Silence. One of my group mates, an academic who is working in this area, eventually said “no, it’s mentioned that it’s happening but not how to meet the needs of patients who have experienced it”.

This is why the Foundation is running its campaign. These questions have to be answered. Survivors and all LGBTQ2S+ people deserve the opportunity to access and achieve their best health. I know that because of my privilege, I’m afforded more of those opportunities—why should anyone else be denied that? Please, join me in making that possible. Make a gift to support the health of survivors, and action to make sure future generations never have to experience it.

You can also help by sharing this post on social media and tagging us @bccdcfoundation, and by following us on Facebook, Twitter, and Instagram.

The post Reflections: Conversion Therapy Survivors Dialogue – Part 2 appeared first on Pacific Public Health Foundation.

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Not sure what conversion therapy is? In simple terms it’s the practice of trying to “repair”, change, or suppress a person’s sexual orientation/attraction to members of the same gender, or do the same to their gender identity or expression. It is neither effective at changing sexual orientation or gender identity, and can cause numerous psychological harms.

Here’s the point where you may be wondering “why is the BCCDC Foundation, which focuses on public health, talking about conversion therapy?” That’s fair. This is important to us and part of our current Emerging Areas priority because of the health implications that are caused and exacerbated by conversion therapy, and because it’s an issue of health equity.

We at the Foundation believe in and support work that promotes health and wellness in all its facets, and that our role is to foster health equity  across the board. Because of the trauma and psychological harms (self-hatred, depression, anxiety, and suicide) that conversion therapy can cause, along with challenges with substance use and threats to mental health, we see this as an important and aligned space to be involved in, and are areas of work at our partner organization, the BCCDC.

We’re working with Dr Travis Salway to support his new work and research into conversion therapy (also known as sexual orientation and gender identity change efforts, or SOGICE). Dr Salway has partnered with the Community Based Research Centre and Born Perfect on a dialogue event that brings together survivors, researchers, support workers, policy advisors, and legal experts. Their conversation will support survivors in telling their stories in a supportive, affirming, and collaborative environment. Those stories and the collective expertise will begin to form important research questions to answer with the aims of empowering survivors, identifying how to best support the health and wellness of LGBTQ2S youth and adult survivors, how to create institutional change, and what advocacy can be done to end SOGICE practices. The health of LGBTQ2S communities is an essential part of public health.

We really need your help to support this cause, improve LGBTQ2S health, and promote health equity by making a gift to the crowdfunding campaign today. You can also help us out by raising awareness and sharing this campaign and post with your friends.

The post Conversion Therapy in Canada and LGBTQ2S Health appeared first on Pacific Public Health Foundation.