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Despite the pandemic, provincial sexual health centres are dealing with increased demands for information and a steady stream of requests for STI (sexually transmitted infection) testing.
“I know through friends and clients that there are a lot of people who aren’t necessarily respecting all of the social distancing policies and there’s probably still a substantial amount of risky or moderately risky sexual behavior taking place,” Kate Calnan, executive director of the Halifax Sexual Health Centre (HSHC), said in an interview.
Calnan said despite public health restrictions instructing people to avoid being within six feet of anyone who isn’t in their immediate household “bubble,” people are still using various apps and meeting up for sexual encounters.
“I would completely disagree that people aren’t hooking up. Maybe for the first couple of weeks (of the pandemic), sure, but that wears off pretty quickly and we’re several months in and that’s just not the case,” she said.
Her fear is many are avoiding routine STI tests and not seeking help even when displaying minor STI symptoms.
“This worries me significantly because I think there can be stigma, or judgment. They might not want to admit that ‘Oh yeah, I had an encounter with someone that’s not in my bubble, and now I have to come and tell my doctor and I don’t want to be scolded for that so I’m just not going to come in,’” Calnan said.
“That’s a problem. That’s not good. So I do worry we’ll actually see an uptick in the continuation of some of the STIs or the syphilis outbreak when we actually get a handle on testing again. I’m just not sure how it’ll go.”
Syphilis outbreak concerns
Shortly before the province was hit with COVID-19, Nova Scotia was in the midst of a syphilis outbreak. Calnan said the pandemic has created some unique challenges around sexual health, and the impact on the province’s syphilis response was one of them.
“There was a lot of effort from Public Health going into creating a response for that, and then when COVID took priority, that was that,” Calnan said.
“Obviously Public Health had to redirect resources so they weren’t able to follow up with any of the syphilis response planning that was in the works.”
The STI clinic at the Victoria General site of the QEII Health Sciences Centre had to close and redirect staffing to COVID testing, leaving Calnan’s centre to pick up STI and sexually transmitted blood borne infection (STBBI) testing for the Halifax area and further afield.
“That’s had its own challenges during COVID as well. The access to swabbing and testing and having to change how we do things and what is considered essential even with regard to STI testing for sending things to the lab,” she said.
“So given the syphilis outbreak, we had a strict screening criteria to ensure that anyone who possibly could have syphilis was still being tested and treated throughout the pandemic. We didn’t want to defer that.”
In an emailed statement, Nova Scotia Health Authority (NSHA) spokesperson Lesley Mulcahy said the authority has continued to conduct case and contact management for any lab-reported syphilis cases. She said it will also continue to monitor cases and rates of STBBIs to understand how to support further case detection and management throughout the COVID-19 pandemic response and beyond.
However, she also noted that reduced testing could possibly skew the numbers.
“While testing for syphilis has continued throughout the COVID-19 pandemic, there is a concern that the reduction in services (and potential reduction in people seeking care) may have impacted testing for all sexually transmitted and blood-borne diseases (STTBIs),” Mulcahy said in her email. “This would impact detection.”
Calnan said her centre had trouble keeping up with demand for its services before the pandemic hit. While the number of people accessing the centre’s services has remained on par with pre-pandemic figures, she believes that’s only because a large number of people are avoiding STI testing. She likened it to the phenomenon that has led to a dramatic decrease in the numbers of people showing up in emergency departments with heart attacks and strokes.
“That’s because they’re scared to go to the hospital. I think it’s the same thing for STIs right now,” she said.
“It’s not because people aren’t having sex, they most definitely are. They just don’t want to come in and get tested for various reasons, one of which could be that they don’t want to be stigmatized.”
Seek STI testing ‘now more than ever’
Calnan stressed that now more than ever people need to call if they require any kind of sexual health service. She said HSHC has stringent protocols in place to protect clients, staff and the community from COVID-19, and it remains a judgement-free zone.
“No matter what is going on in your life right now, regardless of what public health orders are there, if you know you need STI testing, and all of us should be getting routine testing, please give us a call,” she said.
She said her centre’s desperate need for more funding and nursing support before COVID-19 has been further highlighted since the pandemic.
“Sexual health is always the first thing to get overlooked anyway when it comes to health care, but certainly at a time like this where it (syphilis) did require a public health initiative, COVID just took precedence,” Calnan said.
“Obviously we needed the response that we did, but it is challenging from our perspective to then fulfill the role of an NSHA clinic and all of public health to try to continue the syphilis response work in a little charitable nonprofit for the entire HRM and really, provincially.”
Calnan points to the fact clients from the Sexual Health Centre for Cumberland County must also travel to Halifax because that county is the only place in the province without STI testing outside of hospitals.
Online sex ed for youth
Unlike the Halifax Sexual Health Centre where clinical services are on offer, the Sexual Health Centre for Cumberland County is focused on outreach, counselling and sexual health promotion.
“We might be in quarantine but people are still hooking up. Some people are suggesting too that people are just suddenly going to become more monogamous as well,” the centre’s executive director Rene Ross said in an interview. “I’ve found those conversations to be not particularly onpoint with what I’m currently seeing.”
Ross said although the Sexual Health Centre doesn’t offer STI testing, it remains the most requested service with demand having doubled over the last year.
Before the pandemic, Ross said demand for their services had increased to the point where the centre needed to find a new space. It just moved into a far more spacious location in Amherst on Tuesday.
While demand for services was already on the increase in the last year, she said it has exploded since the pandemic.
“I’ve certainly been busier online and really with everything. There’s a greater need now than ever before,” Ross said. “There’s really been a big sense of urgency for me the last few months, and especially when we think of how broad sexual health is.”
Before the pandemic, Ross fielded questions from youth via social media a few times each month. She now gets questions daily. She believes this is due to the fact most sexual education classes take place at the end of the school year. Like so many other things, COVID-19 quashed those lessons, and now youth in her region are reaching out with a wide range of questions and concerns.
“Because this is the time of year when most sex ed happens we’ve moved it online and the response has been pretty unbelievable,” she said. “We’ve gone viral a few times on Tik Tok and the questions from the youth just keep on coming.”
Ross’s social media pandemic plan included a heavy focus on developing educational videos on social media. She said the centre’s Tik Tok videos were widely viewed by local youth and many further afield. During the month of April, there were more than 390,000 views of those videos.
The two most popular videos focused on the history of birth control (174,400 views) and on sexting and consent (51,000 views). Her account grew from 4,000 followers to more than 12,000, and she doesn’t expect it to slow down as young people continue to seek reputable information.
Ross said ensuring youth receive proper sex education is key to addressing issues like toxic masculinity. She said we must acknowledge the strong connection between comprehensive sexual health education and violence prevention in our community.
“One thing that I have learned and that I want everybody to know is that you cannot have sexual health, that you cannot have sexual violence prevention, or violence prevention, without good comprehensive sexual health education and the connection between those two is undeniable,” Ross said.
“That’s what I talked about in my classrooms to youth. This behavior is learned. So this is actually at the core of that work.”
The questions she receives from youth range from having sex for the first time to gender and sexuality, coming out to family members, birth control, masturbation, and orgasm.
“It’s everything that you would really expect to be receiving. It’s across the board,” she said. “The few videos we’ve had go viral, I couldn’t even keep up with all the questions in the comments. So then there’s all these sub conversations that are going on.”
For those who do engage in risky sexual practices with people outside their household bubbles, the New York City health department recently updated its Safer Sex and COVID-19 fact sheet to provide tips on how to enjoy safer sex and reduce the risk of spreading the virus.
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