Queering sexual health services in Toronto

By Mike Smith - Gay Men's Health Systems Navigator, ACT

From June 2018 to November 2018, 45 community consultation informants described barriers to healthcare impacting their ability to access services in Toronto. Some informants’ perceptions of healthcare services are positive, yet the majority of informants have had negative experiences and perceive elements of health services as problematic, especially sexual health services. With sexually-transmitted and bloodborne infection (STBBI) transmission rates continuing to rise among cis and trans gay, bisexual, and queer (GBQ) guys[1], there is an urgency to adapt Toronto sexual health services to address population needs. 

In our interviews, informants faced difficulty and distress when accessing sexual health services. Efforts to access adequate care often results in experiences of anxiety, shame, and discomfort. Informants expressed a perceived need for designated queer spaces and specialized services to address GBQ culture, experiences, and unique healthcare needs. As stated by Levesque, “health services should respond to the population’s characteristics to ensure the people’s capacity to use the services when facing need for care.”[2]This suggests that healthcare systems and services should be adapted to address specific healthcare barriers among diverse populations; and that services designed to serve members of the general population may be inherently less effective in serving the needs of cis and trans gay, bisexual, and queer guys. 

The 6 Cs for improved healthcare access  

Informants offered many suggestions on how to improve access to services. These priorities can be summarized into the 6 Cs for improved healthcare access. This approach outlines informants’ perceived needs for improved experiences when interacting with healthcare services (see Figure 1): 

Convenience – Make services easier to access 

Increase service hours, schedule service hours during evenings and weekends, and open new spaces outside of the downtown core. Reduce wait times by introducing self-administered intake and risk assessment forms. Provide more drop-in services rather than exclusively appointment-based services. Allow service users to wait in spaces other than crowded waiting rooms if long wait times persist. 

Comfort – Make services more enjoyable to access

Balance efficient operations with exceptional customer service to reduce service users’ feelings of anxiety, fear, and shame. Use patient-centred communication strategies that demonstrate compassion and empathy. Create a warm and inviting atmosphere with soothing imagery, open space, natural lighting, and calming sounds. Eliminate shame-inducing health education and counselling approaches. 

Cultural connection – Make services more relevant

Design services to align with the values of diverse service users. Design services that respond to the distress preventing folks from accessing services. Ensure the imagery and staffing reflect this diversity. Invoke a sense of belonging and safety in clinical spaces for underserved populations such as racialized and gender-diverse folks. Demonstrate high levels of knowledge (or demonstrate an intention to learn) to increase perceptions of service suitability. Prepare staff to communicate using trans-inclusive language.  

Choice – Make services more empowering

Empower service users to have an increased element of self-determination when accessing services. Offer multiple types of tests, types of counselling and education methods, types of support services made available, types of treatment plans, and so on. Considering that some service users may not feel comfortable reporting certain behaviours during screening or risk assessments, increase flexibility when determining eligibility for services. 

Confidentiality – Make services more private 

Make every effort to create discreet and private services. Provide anonymous services when possible and protect service users’ identities for non-anonymous services. Design clinical spaces to address service users’ privacy concerns; for example, consider having multiple wait rooms or private spaces for intake meetings. 

Communication – Make services more well known 

Produce promotional materials that engage specific sub-populations. Create multi-media health education campaigns for underserved populations, including folks who use substances, sex workers, and Two-Spirit folks. Measure the reach of these campaigns to indicate strengths and areas of improvement for communication strategies. Provide detailed information about testing and treatment protocols, clinical processes, how personal information will be stored, and so on. 

For a thorough description of these findings, please refer to Sex, Stigma, and Healthcare Systems: Community consultation series – Final Report (2019), available soon at www.actoronto.org. 

Toronto healthcare service agencies (and agencies throughout Canada) are encouraged to apply these findings and discover new opportunities to improve healthcare access for existing and prospective service users. 

[1]Toronto Public Health (2017). Sexually Transmitted and Bloodborne Infections. Communicable Diseases in Toronto.

[2]Levesque, J., Harris, M., Russel G. (2013). Patient-centred access to health care: conceptualizing access at the interface 
of health systems and populations. International Journal for Equity in Health, 12(18).