Sexual health, like physical and mental health, is an important part of life. We all make choices about our health that can lead to different consequences. Whether we eat too many fatty foods, smoke cigarettes, have more drinks than the recommended daily amount, or engage in unprotected sexual activity, we still deserve a public health system that can respond to the illnesses we face without bias, shame, or stigma. Why is it that when we are faced with discussing our sexuality and any medical issues that may arise from sexual activity, we often cringe and hide our faces in shame? Why are we letting our shame make us sick?
Follow along this week as we share educational resources about sexual health, talk about the power of listening to those with lived experience, discuss the access we need to create for those who need sexual health services, and consider how to change the way we think about sexual health, to influence better health outcomes in the future.
An Alarming Trend of STBBI Increases in Canada
Why is it that Canada is the only G7 country where HIV rates are increasing? Canada has seen an increase of over 35% in newly diagnosed HIV cases from 2022-2023, making it more difficult to meet the UN’s goal of eliminating HIV and other Sexually Transmitted and Blood-Borne Infections (STBBI) as a health concern by 2030. According to Vancouver Coastal Health, rates of infectious syphilis in British Columbia have also been increasing over the last few years. In 2022, 1,964 infectious syphilis cases were reported in BC — the highest in the last 40 years. Rates of other forms of bacterial sexually transmitted infections (STI) like chlamydia and gonorrhea have risen rapidly in Canada, and rates of hepatitis B (HBV) and hepatitis C (HVC) have not decreased in line with global targets. Alarmingly, the rate of congenital syphilis, a type of syphilis that can be passed from pregnant mother to fetus resulting in potential pregnancy loss or morbidity in newborns, increased 599% between 2018-2022.
What Factors are Influencing this Increase?
Certainly, access to testing and treatment is a barrier for many seeking care. The COVID-19 pandemic did not help matters, resulting in service reductions and less access to testing, screening and treatment of STBBI.
People living in rural and remote (RRI) communities have even less access to services where they can be diagnosed and treated. And that’s not taking into consideration those who cannot access online/remote services. For example, as of 2020, only 25% of Indigenous communities in BC have basic internet access. And what if a person seeking testing does not have housing, the identification needed to see a healthcare provider, or a phone number to be reached when the results are available? This is the case for some people in our province. Nicola Gale, a Clinical Pharmacist who works for Clinical Prevention Services at the BC Centre for Disease Control (BCCDC), explains this problem further:
“As digital technology has become an integral tool for accessing healthcare, individuals without access to a cellphone are at a disadvantage when searching for health information, participating in telehealth, and following up with their healthcare providers. As a result, this divide in digital health equity has been recognized as a super social determinant of health that intersects with all other social determinants.”
The toxic drug poisoning crisis that was declared a public health emergency in BC in 2016 is also impacting STBBI rates. We have lost over 16,000 people to toxic drugs since the emergency was declared, and we know that the use of substances either through injection or inhalation increases the risk for people who use drugs (PWUD) of contracting STBBI.
These factors have contributed to an environment of increased STBBI in all parts of Canada, including BC. But they are also exacerbated by unnecessary shame and harmful stigma. Shame can actually increase one’s chance of contracting STBBI because those who feel they are at risk for these infections are embarrassed and/or stigmatized when accessing testing and treatment. Keeping sexual health a taboo subject leads to less conversation, communication, education, access, and poorer health outcomes.
Consider this: If someone lives in a small town and the only way to obtain a STBBI test is through a doctor who treats many others they know, including friends and family members, perhaps that person would choose to ignore their concerns rather than face judgment. And that’s if there is a healthcare provider available when needed, as BC faces a primary care physician shortage. In many instances, there is no provision of culturally safe care, underscoring the inequities Indigenous People face when seeking testing and treatment.
Sexual Health Resources
One of the main roles of public health is to provide the resources necessary for people to make informed decisions about their health. To that end, we’ve curated some culturally safe and helpful information that can be used to learn more about sexual health:
- The Smart Sex Resource, a website created by the BCCDC, offers great information for BC residents about all things sexual health, from finding a clinic, to an explanation of STIs, and even professional guidelines for health providers.
- Undetectable = Untransmittable is a health promotion campaign that promotes the scientific fact that that HIV cannot be sexually transmitted when a person living with HIV is on treatment and the amount of HIV in their blood is very low (200 copies/ml). This campaign is very important to help combat the historic and continued stigma faced by those living with HIV.
- Chee Mamuk, the Indigenous-led program within the BCCDC offers culturally appropriate resources and educational materials on STIs, HIV and hepatitis.
- The First Nations Health Authority (FNHA)’s STBBI web page offers resources created by and for Indigenous, two-spirit people, and their allies.
- If you would like more information about the plan to treat hepatitis in our province, we helped fund a roadmap and knowledge products created by the BCCDC and the BC Hepatitis Network that outline how we can eliminate viral hepatitis as a public health threat in BC by 2030.
Information and education help combat shame and stigma. When we have the answers we need, we can make more informed decisions about our health.
Listening and Learning
Listening to those with lived experience is key when creating and implementing programs that will positively impact those who are being treated for, at risk of, or are living with STBBI. Listening also includes incorporating those with lived experience as peer navigators in different programs, helping others newly diagnosed with STBBI understand their care and treatment options, while providing a sense of community and connection.
Listening to the priorities of equity-deserving communities is what inspired Test, Link, Call (TLC), a project from the BCCDC that we are so proud to support. Here, Nicola Gale explains this project, created through community collaboration:
“(Test, Link, Call) was developed to help improve STBBI testing, treatment, and cure for people who use drugs, people experiencing unstable housing, and people with experiences of criminalization and incarceration. TLC incorporates a unique service delivery model that provides participants with a free cellphone, a 6-month unlimited talk and text phone plan, and support from a Peer Health Mentor (a person with lived experience) for system navigation and help connecting with a clinic….Working in frontline care myself, being involved in a project like TLC gives me hope that it’s possible for our systems to be reoriented towards addressing the needs of the community. This requires a crucial shift away from wondering why we can’t find the ‘hard to reach clients’ and instead refocusing instead on how to make our ‘hard to reach services’ better. Collaborations like these allow the medical community to benefit from the expertise of people with lived experience, and highlights how health and social care can be treated as not just separate spheres, but as one and the same.”
Listening to people from equity-deserving groups, who are at a higher risk for, or are living with STBBI, will always be important when planning programs that aim to provide services. Meeting people where they are at with non-judgmental care will help improve health and well-being in these populations in future.
Providing Access to Sexual Health Support Services
Providing more access to information, safe sex tools, testing, and treatment for groups at higher risk of STBBI is essential to stop the spread of illness, which is why we support a variety of programs that promote increased access to STBBI testing, treatment, and support for equity deserving groups.
Due to the historical and ongoing colonization, control, and oppression of Indigenous Peoples, Indigenous communities in Canada are a key population identified as disproportionately affected by STBBI. We are proud to work in partnership with Chee Mamuk, the Indigenous-led, self-determining program within the BCCDC, to help build trust and relationships with Indigenous communities through the gifting of Kloshe Nanitch medicine bundles. Originally co-designed with communities, these bundles support a full spectrum of Indigenous Peoples’ lived experience, and continue to evolve to reflect the current priorities of communities across the region. Some of the bundles include practical sexual health information and supplies, harm reduction tools, and resources to learn more. Importantly, these items are gifted in a culturally appropriate and respectful way. This critical work within communities promotes health and well-being, and builds relations, cooperation, and a new way of thinking that puts the emphasis on striving for better health, well-being, and inter-generational healing that helps to overcome the harms and inequities that have impacted Indigenous People.
Another project created by our partners at the BCCDC is a great example of providing stigma free and convenient access to STI testing and care. GetCheckedOnline is a free online STI testing site. It is a private and easy way to get tested, currently available in 7 communities across the province. Users do not need a BC services card, and can create an account online with their contact information. A lab form is generated based on assessment questions, and the user can print the form and bring it to a participating lab location. After giving the sample at the lab, users get their test results via email, and if there is a need for follow-up, a nurse will be in touch. This program has been available for ten years, and the administrators hope to expand to more RRI communities in the future, and engage more actively with Indigenous populations.
Let’s Change the Way we Think and Talk About our Sexual Health
We hope this series on sexual health has been informative, maybe even sparking discussion with your healthcare providers, family, friends, and partners, and motivating you to make sexual health a priority in your life. By simply talking about sexual health and STBBI as a normal part of healthcare — like Diabetes, Cancer, or seasonal flu — we can all help to eliminate the shame and stigma associated with these infections, and hopefully lead to more people getting tested and treated in the future.
Everyone experiences health challenges in life, and we all deserve non-judgmental, accessible, and stigma-free care. People living with STBBI are no different. We are committed to funding different projects that increase access to STBBI programs for equity-deserving communities, meeting people where they are at so that everyone can receive the care they need and deserve. Please join us in supporting STBBI care in BC by donating to help fund important initiatives like these.
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*We would like to thank Dr Troy Grennan, Physician Lead for the Provincial HIV/STI Program at BCCDC, and Dr Muhammad Morshed, Clinical Microbiologist and Program Head of Zoonotic Diseases, Emerging Pathogens and Parasitology at the BCCDC Laboratory, for their help providing background information for this series.
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