Combatting STBBIs in Canada
What are the goals of the new action plan from the federal government, and where are we at now?
Attempting to reduce sexually transmitted and blood-borne infections (STBBIs) in Canada to adhere to the World Health Organization’s (WHO) global targets, the “Government of Canada’s sexually transmitted and blood-borne infections (STBBI) action plan 2024-2030” was published in February 2024.
WHO’s targets include eliminating epidemic levels of AIDS and viral hepatitis, along with reducing overall health impacts for individuals with STBBIs. The action plan defines infections targeted through this initiative: “chlamydia, gonorrhea, syphilis, human immunodeficiency virus (HIV), human papillomavirus virus (HPV), herpes simplex virus (HSV 1 and HSV 2), hepatitis B (HBV), and hepatitis C (HCV).”
It also cites a continuous and troubling rising trend in STBBIs globally – noting that Canada is no exception – and appears to outline measurable progress methods as well as Federal Progress Indicators to measure actual outcomes of this effort. Much like my earlier article “We should treat COVID more like an STI” published in January 2023, this action plan notes that our collective COVID experience will be useful in approaching sexual health going forward.
“This is a critical point in time where Canada’s response to STBBI can be informed by lessons learned from the COVID-19 pandemic.” is stated in the Ministerial Forward. “COVID-19 taught us the importance of clear and effective public health messaging, research, innovation, tailored interventions for key populations, and the need for collaborative and multisectoral action.”
The present action plan follows the “Accelerating our response: Government of Canada five-year action plan on sexually transmitted and blood-borne infections” published July 9, 2018, which also boasts the goal of reducing STBBIs by 2030. An easier-said-than-done vision is outlined in the document: “A Canada where STBBI are rare and people living with STBBI receive the care and support they need.”
The “2020-2022 Progress Report on Sexually Transmitted and Blood-Borne Infections (STBBI)” was published by the Government of Canada on May 25, 2023, outlining the measurable impacts of their five-year Framework for Action in preparation for the report published last month.
The progress report notes seven federal priorities: “moving toward truth and reconciliation with First Nations, Inuit, and Métis Peoples,” “stigma and discrimination,” “community innovation – putting a priority on prevention,” “reaching the undiagnosed – increasing access to STBBI testing,” “providing prevention, treatment and care to populations that receive health services or coverage of healthcare benefits from the federal government,” “leveraging existing knowledge and targeting future research,” and “measuring impact – monitoring and reporting on trends and results.”
Resources of note in this document include the Know Your Status (KYS) Program, an initiative based in the Saskatoon Tribal Council which advocates and aids in providing STI testing. As of the 2020-2022 Progress Report, KYS was fully functioning in 42 communities and partially in 72 communities in Saskatchewan.
The document also addresses the movement from the Canadian Guidelines on Sexually Transmitted Infections (CGSTI) to “Sexually transmitted and blood-borne infections: Guides for health professionals” which addresses individual STBBIs in detail. Information on screenings, diagnoses, and treatment are publicly available here, covering infections like HIV, chlamydia, genital herpes, anogenital warts, and much more.
One encouraging aspect of the progress report includes acknowledgement that unsafe drug use practices such as needle sharing contribute greatly to the spread of STBBIs. While this makes it all the more troubling that Saskatchewan – a province with some of the highest STBBI rates in the country – is restricting their support of needle exchange programs, the progress report encourages “supervised consumption sites,” needle exchanges, and overdose prevention services.
New technologies in the progress report include the November 2020 approval of the INSTI test, a self-administered HIV test, and research progress in home-tests for syphilis as well. More information can be found at catie.ca, the website for the Community AIDS Treatment Information Exchange.
Tracing back to the action plan released this month, it claims on page nine to be working toward the goals WHO has set out globally for reduction and treatment of STBBIs. Regarding HIV they desire no new infections, no deaths related to AIDS, and no discrimination based on the diagnosis. Regarding STIs more generally, WHO wants to see syphilis and gonorrhea reduced by 90 per cent globally, as well as the administration of the human papillomavirus (HPV) vaccine to 80-90 per cent of any given population.
A shift in trends worth noting from the action plan is that STBBI diagnosis incidence – the rate at which diagnoses are made – among men who have sexual partners that are men has remained fairly consistent, while diagnosis incidence has increased in women and heterosexual couples more generally. “Infectious syphilis rates increased by 109 [per cent] between 2018 and 2022, and the rate of congenital syphilis increased by 599 [per cent] between 2018 and 2022.”
Page 12 of the action plan describes identified “social determinants of health and their impact on STBBI,” placing a focus on anti-Black and anti-Indigenous racism and acknowledging that “STBBI do not affect all people equally.” These inequalities are systemically perpetuated through unequal access to education, marginalization, and lived experience with incarceration among other factors.
Antimicrobial resistance (AMR) – bacteria developing to defeat treatment – is another concern raised. It is “increasing globally due to the overuse and misuse of antimicrobials, the global movement of people, and socio-economic and health system inequities around the world. Specifically, multidrug resistance is rapidly increasing for gonorrhea, with resistance being reported against both first- and last-line antibiotics resulting in challenges to treatment including treatment failure. Antibiotic resistance increases the individual and health system burden of gonorrhea by prolonging infections and increasing the number of people with long-term complications of gonococcal infections.”
Thankfully there is an increase in research toward preventative treatments to complement the reactive treatments that can be taken post-infection and post-diagnosis, with HIV Pre-exposure Prophylaxis (PrEP) being a notable recent highlight that can protect individuals without HIV from potential exposure. Other preventative treatments in the works include a vaccine for gonorrhea, and antibiotics for bacterial STIs.
