The outbreak no one is talking about
Unequal Access
How the syphilis outbreak is impacting Albertans inequitably
By Lily Dupuis with videography from Abbie Riglin and Astrid Cunanan
Photos by Lily Dupuis and Abbie Riglin
To get a handle on the syphilis outbreak in Alberta, testing becomes one of the most important parts of this equation, but not everyone has equal access to sexual health services and medical care.
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Nolan Hill, gay men’s health specialist from the Centre for Sexuality located in Calgary, says that while anyone who is sexually active can contract an STI, there are specific social challenges towards healthcare for marginalized communities.
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“Sexually transmitted and blood borne infections (STBBIs) often disproportionately impact [marginalized populations], particularly within the healthcare system. That can be 2SLGBTQ+ communities, Indigenous individuals, racialized folks, folks who are unhoused and folks who are in the sex-trade industry,” says Hill.
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“We know that those populations often disproportionately experience negative health outcomes related to not just sexual health.”
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He explains that there is an increase of syphilis among the population he works with, including gay, bisexual, and other men who have sex with men (MSM).
“Sexually transmitted and blood borne infections (STBBIs) often disproportionately impact [marginalized populations], particularly within the healthcare system, so that can be 2SLGBTQ+ communities, Indigenous individuals, racialized folks, folks who are unhoused and folks who are in the sex-trade industry."
Nolan Hill
Gay Men's Health Specialist, Centre for Sexuality
Marginalization & Access to Healthcare
Hill explains that the inaccessibility of healthcare services for so many people is a barrier to getting syphilis under control.
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“If people don't have the ability to get tested, they're never going to know that they have an infection. They will continue to pass that on to their partners, and those partners continue to pass it on to their partners.”
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Hill says that in Alberta – and beyond – society is in desperate need of testing that is accessible and specifically devoted to underserved populations, as access to healthcare is a basic human right.
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Clinical professor from the University of Alberta, Dr. Ameeta Singh, says the syphilis outbreak is disproportionately affecting certain communities.
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“I wanted to learn why this was happening,” says Dr. Singh. “I learned so much about the impact of people's social situation, specifically income, poverty, and the historical effects of what has happened to Indigenous people in Canada.”
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Even though Indigenous peoples make up only 6.5 per cent of the population in Alberta, syphilis disproportionately affects Indigenous communities. Dr. Singh says that systemically we should be aware of the "intersection between the social determinants of health, as well as the complexity of syphilis itself."
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“That is not to say that all of the cases have been occurring among Indigenous persons,” says Dr. Singh.
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“Essentially, I think the message is that anyone who is engaging in sex with multiple partners, and without using barrier protection, is at risk for getting syphilis and other sexually transmitted infections.”
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Hill elaborates on this, noting the systemic issues within the healthcare system that lead to the inability to manage outbreaks such as syphilis.
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“Really making sure that people have access to accessible, culturally specific, culturally relevant, and culturally safe care is huge,” he says.
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The MSM health specialist explains that stigma, fear of judgement, and possibility for embarrassment keeps people from being honest with their healthcare providers, especially for members of the 2SLGBTQ+ community who may not be “out” to their providers.
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This is why he believes the Centre for Sexuality provides more accessible care for Alberta’s underserved queer community.
Emphasis on Sex Ed
The Centre for Sexuality also exists as an educational resource for Calgarians looking to access sexual health and relationship resources.
“We know that comprehensive sexual health education is an incredibly important component of reducing STBBI transmission, unintended pregnancies, reducing the ‘negative outcomes’ or ‘harms’ that can come with sexual activity,” explains Hill.
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Hill says that if people can access comprehensive sexual education and well-informed STI knowledge at a young age, they're more likely to make decisions that are right for them and incorporate protection during sexual activity.
This need for comprehensive sexual education is what Hill explains will be a valuable part of the multi-pronged approach needed to understand and control the syphilis outbreak in the province.
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“It's about making sure that people know where they can get tested, making sure that people know what resources are out there when it comes to prevention and testing,” he says.
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“All of those pieces come together.”