Researching Environments that Affirm 2S/LGBTQ+ Identities, Relationships & Mental Health (REAFFIRM)

The REAFFIRM Collaborative is an interdisciplinary team committed to promoting 2S/LGBTQ+ health equity. Evidence shows that 2S/LGBTQ+ populations experience multiple, co-occurring and avoidable health disparities, particularly with regard to mental health. We use a broad range of approaches, including epidemiology, qualitative research, and mixed methods, to explore factors contributing to health inequities and to identify strategies for improving health among 2S/LGBTQ+ populations.

In our work, 2S/LGBTQ+ refers to Two-Spirit, lesbian, gay, bisexual, trans, queer, and other sexual and gender minority people. Two-Spirit is a term used to facilitate connections to pre-colonial gender and sexually diverse roles that were part of many cultures Indigenous to Turtle Island; see Pruden & Salway.

Threats to 2S/LGBTQ+ health equity

Our research seeks to understand the ways in which minority stress, stigma, and other social and environmental influences shape patterns of mental health outcomes. In particular, our research explores conversion therapy practices and other sexual orientation and gender identity and expression change efforts (SOGIECE), which are associated with a range of adverse health and social outcomes. Using a broad conceptualization of SOGIECE practices, we aim to understand the multitude of avenues and environments in which 2S/LGBTQ+ people in Canada experience SOGIECE. For example, current research explores the role of 2S/LGBTQ+ – affirming, anti-oppressive sex education in promoting well-being. Research findings have helped to inform the development of legislative action to end conversion therapy practices in Canada and to identify opportunities to better support survivors of conversion therapy.

Related, ongoing research projects:

Supports for 2S/LGBTQ+ health equity

Our team works with a range of stakeholders to improve public health interventions and access to mental health supports for 2S/LGBTQ+ populations, including improved screening and referral options. In collaboration with sexual health service providers, we developed a resource aimed to support sexual health providers to recognize and respond to sexual health-related anxiety among people accessing services. This was informed by our research that indicated sexual health service users experience disproportionately high rates of unmet mental health needs.

Both community members and service providers have described difficulty locating 2S/LGBTQ+-affirming mental health supports. In response, our team worked with The Roundtable to develop MindMapBC, an online database of mental health supports that are 2S/LGBTQ2+-affirming, free or low-cost, and/or low barrier. Our team works with community partners to ensure that research projects and findings address the needs and priorities of community members.

Related, ongoing research projects:

  • Identifying patient-oriented models for sexual and mental health service integration (supported by CIHR, 2021-2022)
  • Adapting BC’s health care system for equitable and tailored service provision to sexual and gender minorities (supported by MSFHR, 2019-2024)
  • Development and implementation of a patient-informed health care provider guide for responding to anxiety in sexual health service settings (supported by BC SUPPORT Unit Fraser Centre, 2020-2021)
  • The feasibility of measuring multifactorial anxiety among sexual health service patients in BC (supported by MSFHR and BC SUPPORT Unit, 2020-2021)
Research Objectives
  • To quantify and explain health inequities that disproportionately affect sexual minority populations
  • To explore how, why, and among whom sexual and mental health concerns interact
  • To identify public health and community-based sites to intervene early and prevent mental health and substance use concerns among sexual minority people


Principal Investigator: Dr. Travis Salway

Research team members: Sarah Watt, Amirali Mallakzadeh, Amrit Tiwana, Andrés Delgado-Ron, Martha Gumprich, Miranda Tomyschuk, Reilla Archibald, Stéphanie Black, Thiyaana Jeyabalan


BC Centre for Disease Control, Community-Based Research Centre, No Conversion Canada, Roundtable: BC’s 2S/LGBTQ Mental Health & Substance Use Netwokring Space, Two-Spirit Dry Lab


Canadian Institutes of Health Research, Social Sciences and Humanities Research Council, Michael Smith Foundation for Health Research, BC SUPPORT Fraser Centre, Andrew Beckerman, Victoria Foundation, SFU Community-Engaged Research Initiative, BCCDC Foundation for Public Health