Since the recent slew of syphilis diagnoses in the region, local health authorities are emphasizing the importance of regular STI testing.
They’re right to do so: most STIs are asymptomatic or easily missed, and testing is the only way to know your status so you can access appropriate treatment, which lowers transmission rates and halts the development of related complications; complications that can be debilitating or deadly.
A sizeable minority of the recent diagnoses had progressed to neurosyphilis, meaning so much time passed between the contraction of the infection the diagnosis, that the illness penetrated the central nervous system. This is much harder to treat, and neurosyphilis usually takes 10-20 years to develop, meaning while we may be seeing a recent spike in new infections, we are also looking at some very old infections that were never detected.
Given the state of STI and HIV testing in this province, it doesn’t shock me that people do not or cannot get access to this basic health service.
Test 1: Botched Results
Since I moved to St. John’s I’ve gotten tested three times, twice at the MUN clinic and once at Planned Parenthood. Every experience has left me more frustrated with the logistics of the process, and less confident in the capabilities of local sexual health service providers.
The first time I went to MUN for testing, the doctor did not ask me about any specific sexual practices, but I offered up that I had engaged in some barrier-free oral sex.
The doctor looked at me silently as I waited for her to react, until I finally continued, “so you… probably want to swab my throat” (the throat can house infections, like the increasingly drug-resistant gonorrhea, that might not co-exist in the genital area and so won’t be detected in a urine sample).
When it came to swabbing my anus, she had me do it myself, awkwardly, in the shared clinic washroom. I don’t know who she was trying to make more comfortable by doing it that way, but wouldn’t you know I botched the sample and had to come back to redo it because I’m not a doctor.
Test 2: A Round-about Inconvenience & Dangerous Assumption
The second time I got tested here, I went to Planned Parenthood with a person I was sleeping with, thinking “Ahh, these are the pros, this will go much better.”
I was dumbfounded when the doctor handed us blood and urine requisition forms, explaining that we needed to make a second trip to an outpatient blood clinic (I later learned that Planned Parenthood actually can collect urine on site, so I’m not sure why the doc didn’t suggest this).
The first blood draw site we visited had already closed up for the day (it was 3PM, after all). The second had a long wait, and though I was bursting with urine by that point, I was not allowed to go collect my sample until I was registered a very painful half hour later (but I’m more than entrusted with gathering my own butt swabs?).
When we went back to Planned Parenthood for results, weeks later, the doctor noted that my Hep B vaccine was still active. I asked about Hep A and she – looking at me and the other person, perhaps seeing what appeared to be a heterosexual couple and making several assumptions about our sexual activity – confidently declared that Hep A could not be passed sexually. I asked if she had ever heard of rimming, and haven’t been back there since (Hepatitis A is passed through fecal matter, so any oral/anal contact is a risk factor).
We have a problem when the pros are too awkward to ask about, or worse, are unaware of the risks entailed by basic sexual practices that people of all genders and sexualities engage in.
Third Time Not a Charm
Now the last time I went to the MUN clinic, I saw a different doctor. I explained that I wanted a panel of STI tests after ending a fluid-bound relationship, and without asking me a single question about my sexual history or current practices, she said “Oh you’re probably fine. Chlamydia at best.”
How on earth she felt entitled to offer a patient that kind of guarantee without knowing anything at all about their life boggles my mind and sounds like a recipe for malpractice. American public health officers in the late 19th century used to make ‘snapshot’ diagnoses of immigration hopefuls by simply surveying the gait of their clothed bodies – who knew that we were operating with the same technology today?
There Are STI Outbreaks Because Our System is Broken
These are my experiences as a first-language English speaker with a lifetime of experience navigating Canadian health services, as a cisperson, as someone with a very flexible schedule, normative physical mobility, a bus pass, and enough money to get a cab to the far corners of the city if I need to, and as a person with a background in sexual education and public health, who feels fairly confident speaking up to doctors and advocating for herself around sexual health.
I can’t speak to the experiences of people trying to get these health services outside of their first language, or in an unfamiliar setting, or as a transperson, or as someone with more limited time, mobility, and financial resources, or with less knowledge and comfort confronting medical authorities or talking about sexual acts and STIs — but I can only assume that this system is failing people in those positions even more extensively than it has failed me.
If the health region and wider province are actually concerned about STI rates, they need to dedicate some resources towards sexual health services.
As it stands, services are too few and needlessly cumbersome. Planned Parenthood should be able to draw blood as well as urine samples on site. Throat and anal swabs should become part of the standard sampling, when applicable. Accessibility needs to be improved by offering more walk-in services, reasonably extended hours, and anonymous testing. Rapid testing for HIV should extend beyond what the recent APPROACH Study offered.
Services outside the city and in other health regions are extremely limited and efforts should be made to improve those services, perhaps through home tests or mobile clinics, which might also help mitigate the persistent concerns around confidentiality. And medical professionals offering sexual health services need to be trained in conducting educated, comprehensive, non-judgmental screening interviews.
As the VOCM coverage of the recent syphilis increase suggests, “Anyone who is sexually active is encouraged to get tested every three months to ensure treatment before serious damage is done.” Sure thing. But if public health officials would like us to do our part and get tri-monthly testing, they need to do their part and make that practice more feasible.
STI/HIV Testing Services in Newfoundland and Labrador
Sexual Health Clinic*
760 Topsail Road, Mount Pearl
(709) 752-4882 or 1 (877) 752-4358 firstname.lastname@example.org
203 Merrymeeting Road, St. John’s
Mon-Wed, Fri 9:00am-4:30pm
(709) 579-1009 or 1 (877) 666-9847
Choices for Youth*
12-16 Carter’s Hill Place, St. John’s
Mon-Fri 8:30am – 4:30pm
Priority given to youth aged 16-29
33 Cathedral Street, Harbour Grace
(709) 945-6579 email@example.com
*by appointment only
Central Newfoundland Regional Health Centre
50 Union St, Grand Falls-Windsor
James Paton Memorial Regional Health Centre
125 TCH, Gander
(709) 651-6234 or (709) 292-8881
Labrador West Health Centre
1700 Nichols-Adam Hwy, Labrador City
Charles S. Curtis Memorial Hospital
200 West St, St. Anthony
Labrador Health Centre
Happy Valley-Goose Bay
Western Memorial Regional Hospital
1 Brookfield Ave, Corner Brook
**A Family Doctor/ GP or Nurse Practitioner can also request STI and HIV testing for you.
Thanks toMaggie Power and Nabila Qureshi for helping compile the list of services, and a shout out to Maggie for her extra fact-checking.
Article By Valerie Beth Webber