Today, you will hear the views and ideas of our pozcast guests. We're eager to showcase their expertise and provide a platform for their views, but they may not always reflect or align with the views of the Positive Effect, or the Map Center for Urban Health Solutions.
Welcome to pozcast. We are created by and for people living with HIV. On each episode, we explore what it means to be poz. We challenge the status quo, and we share stories that matter to us. I'm James Watson, and I'm HIV positive. If you're living with HIV, listen up.
I grew up at a time when people who were gay were discriminated against and there's tremendous amount of homophobia throughout the community. The church regarded us as sinners. The government regarded us as criminals, and the healthcare system regarded as sick. So if they're happy in a place like HQ, in my dreams, when I was first coming out in my late teens, I think my life would have been completely different.
We have a great show for you. This is pozcast.
Real innovation in a clinical setting doesn't come around all that often. So I am excited to have the opportunity to explore a brand new center of excellence in Toronto called the HQ Health Hub.
Now HQ provides integrated health services solely for guys into guys and all trans and non binary folk. And it's designed to function holistically, combining mental and sexual and social health, all under the same roof. And one of its really cool features is how fast everything's done. The speed and efficiency it offers at sexual health testing and treatment, as well as its mental health and support is tremendous. I've been there, it's great in every way. The people are great, the space is great, the service was great. Sure feels like innovation to me. So to make sense of all this innovation and good news, we're gonna chat with our very special guest, John McCullagh.
John is a longtime advocate and community leader living with HIV, who sat on the boards of the Ontario Aids Network, and Catie, and who has a history of championing innovative clinical programming and services. In 1981, he co founded the social service organization now known as David Kelly Services that provides counseling and support free to the to 2SLGBTQ+ community, and went on to found the Out and Proud program at the Children's Aid Society of Toronto. And now, although retired, and after several years as a policy analyst with the Ontario Public Service, he is the Co-Chair of HQ's board of directors.
Welcome to pozcast, John.
Thank you, James. It's good to be here.
Excellent. So before we get into talking about HQ, I just want to chat briefly about you. Because you've had an illustrious work and volunteer career in the HIV and queer community. So I'd like to hear more about your journey and what you've learned along the way. But just to be clear, you're retired now, right?
I am retired. I've been retired for 11 years. And my background is social work. I trained in England where I grew up, but you might and and went to university, and so you make at all that's what my accent hasn't changed. But since I've been in in Toronto, my activism has really been based on a professional poetry. It's made for my social work profession, as opposed to the kind of political activist although I've gone to my fair share of marches and wave flags in my time. But I would say that really, I have a passion for queer and trans health and for the health of people living with HIV. And that's what caused me and a couple of lesbian friends and my friend, David Kelly, who sadly passed away now, of AIDS.
We co founded what is now David Kelly Services, it was then called the Toronto Counseling Center for lesbians and gays really, as a result of the bathhouse raids in 1981, because there was a lot of trauma we were seeing from the community. So that really led me into really focusing on queer Men's Health primarily. So I then went to work for the Children's Aid Society and it was there that I, as you mentioned, I founded t Out and Proud program that make sure Child Welfare Services are open, inclusive and affirming.
And then I after I retired, I came back to the HIV world. I have actually at the counseling center throughout the 80s, I was a counselor there and that was a kind of very interesting but challenging experience because it coincided with the, the first years of the AIDS epidemic. So of course, although many of the issues we were talking with the same as they are now anxiety, depression, shame coming out, it really was very different when we were counseling, people dying of AIDS, because that was the reality of an HIV diagnosis in those days. And, you know, dealing with things like employment and family relationships and end of life care. It wasn't just us doing that, but there's AIDS community of Toronto, we're doing this, as well. But it was just the two organizations that basically we're doing this work. And I along the road, I have my own HIV diagnosis. Although being living with HIV, I think a long time but I don't I don't identify as a long term survivor because I was diagnosed after the introduction of combination antiretroviral therapy.
Is that the definition now?
I think it's effective treatment actually, is the definition now. Oh, but before a tease came along and really changed what it meant to live with HIV, who was diagnosed after that time. So that was why I don't identify as a long term survivor.
Right. So how did you? I mean, that's still a lot of trauma, I suppose. And all of that. I mean, how did you keep yourself from burning out along the way?
I think I think that's part of one's training as a social worker, that one has to be very professional and focused on the work one is doing when one is working. But then it's also also important to take care of oneself, and then give oneself me time, because if you don't take care of yourself, you can't take care of other people. But I was also was very fortunate, you know, I have I have a loving partner, who I've been with now for getting on for 50 years, actually. Same guy.
Well congratulations, that's amazing.
Yeah, thank you. So he was at my side all the time. And of course, I had a good network of friends in the community. And I think that kind of has protected me from much of the stigma that people with HIV experience. But I made the decision early on after my diagnosis to, to totally out about that, because I see the HIV closet just like the other closet...queer closet. And I'd rather breathe the fresh air of the outside rather than the stuff inside of the closet.
Well said. Yes. Agreed. So I mean, you've been on probably still are on lots of committees and research studies. And and I wonder, is it still the sexual health angle, like what draws you to some committees and boards rather than others?
It's the sexual health angle, I think. It's something that I kind of got into in 1981, with the founding of a counseling center, that is now David Kelly Services, and at the AIDS epidemic, that really kind of focused that's where I want to put my interest. That's why I felt I had skill sets. And, you know, along along the road, I kind of got good at committee work, and chairing committees. And so that led me into kind of all the board work I've done. I would say the other thing is, and my friends laugh at me about this, I find it very difficult to say no. So I think to some extent, I've got I've got because I never say no. So people think, oh ask John, he'll do it. Then John of course does it. And because the more I don't say no, the more people come and ask me to do more work.
I was just gonna ask you, like, if you purposely planned your volunteerism path, or if you were pulled in a million different directions, that's how it is formed?
Pulled in a million directions, but I enjoy what I'm doing, because I wouldn't do it directly. So I do, I do enjoy it.
That's good. So I mean, what advice would you give to other people living with HIV starting out who want to get involved in the like, in the sector in some way?
I think the best thing to do is to is to volunteer. The HIV sector, has amazing number of volunteer programs. And you can do something like being a front desk reception, you can distribute condoms, you can with with with extra training, you can facilitate support groups. You can sit on boards of directors or committees of boards. It's just a question of finding out what what interests you and maybe doing a bit of trial and error and seeing what, what works for you and what doesn't, but, but I will say just evail yourself of the numerous volunteer opportunities that are available in the sector.
Right. Well, that's good advice. I mean, it's good to find out what it is so many different opportunities to find out what does interest you?
So how did you ultimately get involved with HQ? I've read somewhere that might have been connected to your work on the Toronto to Zero Committee.
It is it was a it was a subcommittee of the Toronto to Zero initiative, which is Toronto's manifestation of a worldwide initiative called Fast Track cities, which is attempting to make sure that we meet the 90 90 90 goals. And I think they're now 95 95 95 goals in each local city. And in Toronto's case, it was a question of attempting to bring together all the various agencies that working in HIV with the objective of ending the or significantly reducing the incidence of HIV transmissions so that HIV infections become very rare and that those of us living with HIV, have access to treatment and can obtain a an undetectable viral load. So one of the one of the components of the Toronto to Zero initiative was the development of a Gay Men's Health Hub, which was something that we many of us have been thinking we needed for a long, long time. And I can tell you why we felt we needed it by maybe sharing with you an anecdotal experience that I had in the mid 80s.
At a time, when the HIV test had just become available, I was experiencing some some fatigue, and I had some swollen lymph nodes. So I went to see my doctor, who was a gay, gay doctor. And he just right there then said, Well, I obviously you have HIV. Wow. And we hadn't yet tested. I knew I came for a test and he offered me the test. Ultimately, the test came back negative three weeks later, that was the longest three weeks of my life, because that was a time when a diagnosis was almost always fatal. Then when I returned three weeks later, for my test results, the guy at the the reception desk said You're looking very nervous, what's the problem? I said, I'm going to get my HIV test results. And he said, Well, you don't need to worry, they're just fine. And I got this from the reception person. So that's just one personal anecdote that I had. I hope that's not replicated, of other people. But I think many of us have had very many negative experience in accessing health care. I mean, things like fear of judgment, providers who don't understand our needs. And so distrust. Many of us have life experiences around childhood trauma of experiencing homophobia and transphobia. We have community high rates of suicide, substance abuse, substance use challenges, high rates of STIs, and HIV, and all these things, we don't get good care. We don't get quality care. We don't get care that respects us. Or we fear we might not, then that creates a barrier for us to get the health care we need.
Right. My doctor told me to go look up AIDS in the phonebook after I tested positive. So...
yes, yeah, it's troubling. Those experiences are far too common. Yeah,
yeah. So did it take a long time for that? How did this initiative take shape?
Well, it took shape. It started by there was a two day workshop convened by the Ontario HIV treatment network that brought together here in Toronto about 50 frontline service providers working in HIV, and in Gay Men's Health, primarily, where we brainstormed what we need what needed to change in the city to ensure that gay men, because we were thinking of gay men at the time, can receive culturally competent care, can receive it in a safe, warm, welcoming way, without judgment without a lecture, and without a referral to somewhere else. And we came up with the model of HQ, which actually is based on a number of other agencies across the world, most notably 5016 Street in London, England, the Health Initiative for men in Vancouver and Fenway Health in Boston. So we came up with this concept of a one stop shop, where guys can come and get holistic, integrated care, as you said in your introduction, where we can treat not just our sexual health, but also our mental health that we have substance use challenges as well. And our social wellness, social well being because so many of us experience loneliness and isolation. And that's what we're attempting to do it at HQ. We just opened this summer after long COVID related delays. So we will Two years late.
But you are here now. So that's important. So can you talk to me about the patient experience? So like I've been there, and I, so maybe you can walk me through the sort of kiosk approach?
Yeah, yeah. So HQ is very innovative and different, because it's largely self serve at least the initial, at least, perceptual health testing is largely self served. So when you come in, you gotta have an iPad, because the iPads available there. And you basically answers a number of questionnaires. If you have difficulty, there's staff there who can help you fill out this questionnaire, but it's basically attempting to get some demographic data. And also to look at your sexual behaviors and other issues you may have, it allows us to kind of tailor what you needed. So when you fill that out, you swipe your OHIP card, I should say, at this point that people who don't have OHIP coverage, such as newcomers, or refugees, we don't charge them for our services, but we give them an HQ card that's similar to an OHIP card, so you just swipe that card, and then the computer will then choose out a number of labels that you you then take with you into a self swab kiosk, there are like half a dozen of them, or seven, I think, where there are a number of swabs and urine sample bottles, and you, it's like a toilet, basically. But above the sink, there's a TV screen. And it gives you instructions in different languages, as to how to do a throat swab, a rectal swab, or to take a urine sample. You take all those, and then if you need a blood draw for something like syphilis, or HIV, right next door to these kiosks is the phlebotomist who is the person who takes gives you a very, very puncture, they take your blood, and then all of those samples, you take with you down the hall, to a slot in front of the lab, where you leave that and you go. And that whole process, you could be in and out within 15 to 20 minutes, there's no appointments, you walk in at your convenience, you get your results by text or email within 24 hours. And the great thing is that we're all used to our doctors telling us no news is good news. Otherwise, if you don't hear from us, you can assume everything is fine. We're not doing that. Everybody will get a text message or phone call to give them their results. Now I will say you get the result, if it's negative, if your test is reactive or positive, you were asked to come back to talk to somebody obviously, and and you will be offered treatment, be it for STIs or, or HIV.
You know, I'm just trying to imagine getting a text that I'm HIV positive. Is the protocol then to call back immediately or go back immediately is or is it just up to the patient?
The message won't say you're HIV positive. Like if your test is negative, it will say you're negative. If it's positive, the test will say, Would you please come back to me, we need to talk to you. Right. And that gives them as the opportunity to do the usual counseling, support, and also to make the offer of treatment. You know, it's one of the things we're trying to do is to give treatment to people as soon as possible after diagnosis, because we know that that is better for one's life, long term health outcomes. But the decision to take people to is a you know, an important one to consider. So we make the offer.
So I mean, I was amazed really, they gave me a tour of the clinic. I mean, it was it was a patient, it was wonderful. And I met the doctor and they sort of told me how to use the kiosk. And I was I was just really amazed that I can basically order up my own battery of tests. Yeah, you know, it's it's incredible.
The other thing I would say around an HIV test is that the expressed testing we offered at HQ is different from the kind of rapid point of care HIV tests you might get at another clinic or in your doctor's office or, well, no, you wouldn't get in your doctor's office, but a community clinic or the home tests that are now available, because we do the standard diagnostic blood tests right away from the get go. Because we have a state of the art lab, which means that we can give service users a definitive result right away
That's fantastic. So at the kiosk they asked you a bunch of screening questions, which included questions about substance use and mental health risk factors and then self harm and suicidal thoughts kind of thing. So what is set in motion if I am having substance use or mental health issues?
Well, what happens immediately is that this is flagged on the on the system. And so you will be immediately invited, before you leave that day to talk with a clinician and social worker, or psychiatrists that we have on staff to talk about those issues and explore with you, whether this is something that you'd like some support around, so that the online screening tools kind of really alert us to that so that we can provide the services that people need.
And why is it so important to combine mental and sexual and social health services all into one place?
Because we're all we're, we're not silent we are human beings, and we essential animals, and we, we have brains, and we have communities that surround us. And so often, sexual health goes alongside physical health, it goes alongside mental health. And so what we want to do is to provide those services in an integrated, holistic way. So basically, it's a one stop shop, so we don't have to send you somewhere else. This is something we can't deal with. If you need a residential care for example.
And what do you hope that the ultimate impact of HQ will be?
I think it will it be transformative for the health of guys into guys, and trans and non binary folk. You know, already, we are experiencing some really positive feedback from people who who love the space who love the treatment they receive in terms of the respect that they receive, it feels comfortable, it feels like home. And it feels like a place that you want to be.
And who's the clinic, the clinic isn't just Toronto, or who does the clinic provides services for?
Well the clinic is based in downtown Toronto, but we all learned through COVID, how we can actually do work virtually. So in particular, with mental health services and substance use care, we can provide support to our service users virtually as well. So there is the potential there to offer services beyond Toronto, or for the people who can't come down to the center of themselves. That is, I think, a very exciting opportunity to increase our number of people that can use our services.
And you know, there was a lot I'm sure there was a lot of discussions, a lot of years that went by in meetings to put this whole thing together. And I and I wonder, is there anything that you would like to see or has been talked about, you'd like to see as part of HQ services that they currently do not offer or unable to offer at this time that's in the works?
Well, the social programming, it's in the works. So basically, this is an opportunity to break down the social isolation and foster a sense of community that so many of us feel to make HQ home away from home, in conjunction with our partner organizations where offering, for example, movie nights or lectures or book readings or spiritual gatherings. And it not only provides a sense of community and social isolation, but it also provides an opportunity for people from different communities to get STI and HIV testing the same evening if they wish. So at HQ is a is a collaboration between 10 community partner agencies that will work with gay bi, trans and non binary folk. And those agencies represent people from the Two Spirit, black, Latinx, Francophone Asian, South Asian and Middle Eastern communities. So the work we do is very much done in cooperation with those organizations, from those communities.
And how will the clinic ultimately determine its success? Is it about data or?
it's very much about data. We have a robust data collection process, it's not something I'm terribly familiar with. So I'm not the best person to ask about it. But we're being very careful to collect demographic data and utilization data. And we will be using that data along with client satisfaction surveys to determine whether we are providing services that are needed, and where we might need to rethink what we're doing or adjust somewhat what we think we're doing.
Right. Well, that's, you know, because I was reading there's a lot of descriptors, like in the mission statement, and in the promotion, we're using words and terms like welcoming and person centered and sex positive and shame free and stigma free and Bully Free. Right. So, too, I guess you'd have to have satisfaction surveys or you'd have to or a committee or something to figure out make sure that you're meeting those targets?
Yes. Well, I mean, we are very much in the beginning stages of HQ, we've only been open a couple of months, So, you know, our processes and systems are serving developed. But quality assurance is something and quality improvement is something that we're very much focused on.
Right. It's all very exciting.
Yeah, we have to, we have to demonstrate that what we're doing is meaningful to the communities. So that kind of data collection is very important.
So let's talk about the funding structure about who funds HQ?
Well, our funding, James comes from many sources, the Ontario government is providing a $600,000 a year in annual funding for us, and the Ontario HIV treatment network whose funding also comes from the ministry, so that is essentially taxpayers money. The whole build out of HQ, the physical plant, and the equipment. And the furnishings inside it was from a grant we got from the OHTN, who are also providing in kind support things like HR and back office financial and accounting services and communication.
Oh, that's fantastic.
Yeah. And and so we also get our physicians, of course are reimbursed by OHIP. And our lab fees, will we hope by next year be reimbursed by the government as well. We also have a number of research grants that provide us operating money and other organizations, including banks and big pharma. We've been fortunate and getting funding from them. And our partner organizations that I mentioned earlier, our course providing inkind support, particularly through the provision of staff and volunteers to support our programming.
And they're assuming that the a lot of the funding was like, there wasn't a challenge to get funding, or was it?
Well, I think there's a real commitment amongst the government, I would say, and organizations like the OHTN. They recognize that this was a sorely needed resource that gay men still account for the majority of, of HIV infections in the province. And although those rates of first time infections are now coming down, they're still pretty high. Most of the HIV transmissions are occurring amongst gay men, and mostly in Toronto across the province, then the largest number, so there was a recognition that this was a service that was needed. And so we were fortunate in getting that commitment from the government. And I would particularly want to acknowledge the support provided by the OHTN, without which we really couldn't achieve what we had achieved,
Right. So just I guess, to bring this back to a personal level, so, you know, as an older gay person living with HIV, how do you think HQ might have impacted your own health journey if it had been around?
Well it would, it would have made me feel good about myself, it would have made me feel that I have a community here that cares about me, it would have enabled me to meet other people who are like me who have just been newly diagnosed with HIV. It would have helped, I think, address stigma that I might be experiencing. And I think it would just make me feel that my whole mental health and sexual health care was being prioritized and that I was important. I grew up at a time when, when people who were gay were discriminated against, and there's a tremendous amount of homophobia throughout the community. The church regarded us as sinners. The government regarded us as criminals, and the healthcare system regarded us as sick. So if there had been a place like, HQ, in my dreams, when I was first coming out in my late teens, I think my life would have been completely different. And so I'm hoping for young people today and those not so young. This will be a very positive experience that will stand them in good stead in terms of there well being throughout the rest of their lives.
Yep, me too. Do you think, Because I know you're involved in HIV and aging work, Do you think HQ will have an impact on how older queer people manage their sexual health?
I hope so. I think the thing about HQ is that there's no judgement. I was just speaking to a friend of mine the other day, you know, who was talking about so often people think I'm a non sexual person. And so, you know, I feel a bit embarrassed in my 70s to kind of go and ask for an STI test for fear that people might say to me, Oh, you're still having sex? So, this particular friend of mine said that he went into HQ and he was treated like no big deal, you know, well sure you're a sexual being well, we give you all the support you need. So, you know, I think that is that is that's great the way that we're hoping to be seenby people.
Excellent, excellent. Okay. So we are at a close here and I always close pozcast with some this or that questions for my guest. These are nonsensical so you don't have to worry about a right or wrong answer. Okay. Okay. Okay. So, see the future or change the past? one of my favorites.
Oh, let's see the future. See the future.
Shopping online or in store
Sleeping with door open or closed?
Closed me too.
Logic or emotion?
Art Museum or History Museum?
Excellent. All good answers. Well, thank you, John, very much. I wish all the best with HQ.
Thank you, James.
You're very welcome. We'll see you next time.
That's it for us this month. Thanks for tuning in. We hope you'll join us next time on pozcast. And if you have any comments or questions or ideas for new episodes, send me an email at firstname.lastname@example.org. That's the number four and the letter U pozcast is produced by the Positive Effect, which is brought to you by Reach Nexus at the Map Center for Urban Health Solutions. The Positive Effect is a fact based lived experience movement powered by people living with HIV, and can be visited online at Positiveeffect.org. Technical production is provided by David Grein with the Acme podcasting company in Toronto.