STIs are spreading aggressively in Canada as testing and prevention are abandoned during the pandemic
After gonorrhea cases spiked during the pandemic in New Brunswick — which nearly quintupled between 2020 and 2021, then tripled in the first few months of this year compared to last year — public health officials are are turned to TikTok, Instagram and dating site Tinder with a warning campaign.
“Gonorrhea is on the rise in New Brunswick. Pass it. The message – not gonorrhea,” read the public service announcements, shaded in black and yellow like caution tape with an audible squeaky bed in the background.
Launched last month, the campaign targeted sexually active people between the ages of 20 and 39 in Fredericton, Moncton and Saint John, where an outbreak of gonorrhea that took hold in 2019 among this cohort intensified throughout the pandemic.
“It’s a problem and we’re trying to fix it,” said Jennifer Russell, New Brunswick’s chief medical officer of health, who has also seen more chlamydia cases this winter.
“Whether it’s a sexual health issue or some other health issue, there’s a lot of stuff that’s been really overshadowed by COVID-19,” Dr. Russell said. “Now is a good time to address them.”
After having testing, treatment and prevention campaigns were abandoned during the pandemic. Less detection equals more spread: With many asymptomatic STIs, more Canadians are transmitting infections without knowing it.
“A lot of people expected that we wouldn’t need to offer STI testing because no one was going anywhere and having sex. It was simply wrong. We expect to come out of a pandemic in another really dire situation,” said Natalya Mason, Education and Outreach Coordinator at Saskatoon Sexual Health.
Syphilis is growing aggressively across much of the country, with outbreaks reported in Saskatchewan, Alberta, British Columbia, the Northwest Territories and Ontario, which recorded 2,678 cases last year , the highest number in at least a decade. Gay and bisexual men are the populations most affected by syphilis, according to a prevention campaign in British Columbia, with several provinces reporting a majority of cases among those aged 30 to 39.
In Newfoundland and Labrador, more cases of gonorrhea were reported in the first three months of this year than in all of 2019, according to figures provided by the Department of Health and Community Services. Several provinces noted evenly split gender distributions for people with gonorrhea and chlamydia, although women were more often asymptomatic.
In some areas, HIV is on the rise: Saskatchewan saw a 29% increase in cases last year compared to 2020, an influx that ‘partly reflects the impact of the COVID-19 pandemic on factors risk of disease transmission and access to testing and care,” according to an emailed statement from the province’s health ministry.
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Experts are troubled that the latest numbers could be an undercount, given that the pandemic has limited testing, regular medical care, public health tracking and data entry. Lab capacity was often overwhelmed with PCR testing, and many of those working in sexual health were redeployed to help with COVID-19. According to a national report from the Public Health Agency of Canada, more than 45% of service providers who test for STIs have described significant decreases in their ability to do so during the pandemic, with 31% having stopped testing entirely at times of crisis. .
“The fallout is huge. We are seeing this now with an increase in cases across the country in various STIs,” said Gary Lacasse, executive director of the Canadian AIDS Society in Ottawa.
In June 2020, staff from her organization urged Health Minister Patty Hajdu and PHAC needs to consider testing for sexually transmitted and blood-borne infections an essential service nationwide (it hasn’t been done, Lacasse said). During a week of free HIV testing last November, his group screened about 800 Canadians through self-testing kits, rapid tests and blood draws, administered in a variety of ways through pharmacies, community centers, colleges and universities in all provinces, and some kits were also mailed out. Of 213 test results shared with the Canadian AIDS Society through clinics involved in the campaign, five were HIV-positive, “which is huge,” Lacasse said.
“Sexual health and STI prevention efforts have clearly been compromised during COVID,” said Alex McKay, executive director of the Sex Information and Education Council of Canada, a nonprofit organization that focuses on sexual and reproductive health.
Today’s rate hike is part of an upward trend that spans more than two decades, Dr. McKay said. He pointed to the large-scale decline in condom use as a major cause: More people are having unprotected sex, he said, due to the decline in HIV anxieties since the advent of preventive drugs such as PrEP. Today, HIV is widely seen as “a chronic infection, not a death sentence”, he added, thanks to antiretroviral treatments that can make the infection intransmissible.
For decades, the safer sex message has focused on HIV prevention, with diseases such as chlamydia and gonorrhea being neglected.
“People never paid as much attention to these other sexually transmitted infections as they should have – and they still don’t today,” said Dr McKay from Toronto.
During the pandemic, some who chose to have fewer sexual partners or only one partner assumed they were safe and stopped using condoms, he said. This amounted to a false sense of security: “It’s riskier to have unprotected sex with one partner who has an STI than to have multiple partners who may have an STI, if you use condoms.
Another factor in the increase in STIs may be the reluctance of Canadians to seek help: health care providers who focus on sexual health, 66% reported a drop in demand during the first months of the pandemic. Some people felt a kind of double stigma admitting to their primary care providers that they were having unprotected sex and contracting STIs during the lockdowns.
In Saskatchewan, as Ms. Mason’s center struggled to create an engaging syphilis prevention campaign, staff grappled with people’s COVID-19 fatigue – a growing sense of exhaustion from being constantly on their guard for their health.
“How are we going to talk to people about the importance of testing, protecting and preventing syphilis at a time when they are bombarded with messages about their health? »
They decided to echo COVID-19 in their syphilis campaign, Mask Up Down There, which focused on both masks and condoms. “He used the new health literacy that people have acquired through the pandemic” on the risk of transmission, Ms Mason said.
In Saskatchewan, preliminary figures for 2021 showed 1,749 cases of infectious syphilis, up from 397 in 2019. “We have seen a 929 per cent increase in syphilis cases over the past five years,” Ms. Mason said, citing the figures reported in Saskatoon between 2016 and 2021.
In 2020, the province had the highest rates of new HIV diagnoses in the country, with cases increasing 29% in 2021 from the previous year. Last January, the province launched a free HIV self-testing initiative in health centers, pharmacies and community organizations.
Experts said it will be crucial for primary care providers to proactively and non-judgementally raise this issue with their patients, without shame or scare tactics, which keep people from seeking testing and treatment.
“People feel anxiety, stigma, shame. We have to get past that,” said Brenda Wilson, a public health physician and professor of community health at Memorial University of Newfoundland.
Dr. Wilson was part of a PHAC-funded national task force that updated STI screening guidelines to recommend annual chlamydia and gonorrhea testing for patients in under 30 who are sexually active. The two infections often overlap, Dr. Wilson said, with chlamydia often being asymptomatic. “Even though women often have no symptoms, chlamydia can still cause long-term damage, pelvic inflammatory disease or infertility. It can damage people and they don’t even know they have it.
Dr. Wilson and other experts believe the conversation about sexually transmitted infections needs to change in Canada. The latest brand of public health messages positions sexual health as part of sexuality and overall health: people should give it the same kind of attention they give to their nutrition, exercise and health mental.
“It’s a positive and enjoyable part of our lives,” Dr. McKay said, “and we need to take care of it.”
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