Two weeks after provincial health officer Dr. Bonnie Henry offered advice on dating and sex during the pandemic, getting tested for a sexually transmitted infection in Vancouver is still out of reach for many.
Sexual health clinics run by the BC Centre for Disease Control, Vancouver Coastal Health and non-profits remain open to test urgent or symptomatic patients by appointment.
But non-urgent or routine STI testing — recommended to take place before starting with a new sexual partner or at least every year if your partners stay the same — has been suspended in clinics across the Lower Mainland due to the pandemic.
“There is certainly concern that as things start to open again and people begin dating more there will be more need for sexual health services that ideally would have been in place already,” said Dr. Kate Shannon, executive director of the Centre for Gender and Sexual Health Equity.
“And there has been concern in general about sexual health services not being seen as essential.”
It is too early to tell what the impact will be on sexually transmitted infection rates and sexual health, Shannon said, but STIs are a serious issue in B.C.
Henry said this week that cases of chlamydia and gonorrhea have been increasing in recent years.
Syphilis has also been on the rise for the last decade, reaching 21.3 cases per 100,000 people in 2019, BC Centre for Disease Control spokesperson Heather Moss said in an email.
In the first quarter of this year the province had 234 cases, compared to 289 during the same time period last year. The cases are mostly among men who have sex with men, but cases among women have increased in recent years, Moss said.
Routine testing is essential to ensure people aren’t unknowingly infecting their partners because it can be months before STIs begin to show symptoms in some patients.
And if left untreated STIs that are normally resolved with antibiotics can develop into more serious illness or leave permanent damage.
A number of clinics in Vancouver normally do this testing for free, including the Health Initiative for Men network of clinics and youth clinics run by Vancouver Coastal Health.
An average of 150 to 180 patients would be tested at HIM’s five clinics in the Lower Mainland, a number that has plummeted as not all clinics are open to testing or treatment.
The network is “very concerned” sexual health practices could suffer due to the lack of access to testing, spokesperson Zaid Elbitar said in an email.
“For years, HIM has been the go-to place for GBT2Q men to gain access to testing and find answers about questions related to their sexual health and unfortunately all that has been limited due to the pandemic,” he said.
Testing is particularly important for marginalized and vulnerable communities, where individuals may not have access to a range of affordable and inclusive sexual health resources.
“Queer men have a long history with HIV and STI testing, because our community has been so impacted by HIV,” said Jody Jollimore, executive director of the Community-Based Research Centre.
The Vancouver-based non-profit promotes the health of gay, queer and trans men and two-spirit people through research and policy development.
“Testing has been one of the prevention pillars for sexual health in general and certainly for queer people as well,” said Jollimore, noting that queer men get tested at higher rates than the general population.
But many of the restrictions around not seeing anyone outside your immediate family or only engaging in sex with existing partners don’t reflect the structure of all families, particularly in the queer community.
“A lot of folks do rely on intimacy and physical connection as a form of support,” said Jollimore, noting his concerns about the pandemic exacerbating mental health challenges among queer men. “And from an equity stance, we need to recognize that not all families are the same.”
While queer communities were early adopters of online dating and apps, Jollimore is concerned that stigma attached to those who are still engaging in sex and physical dating during the pandemic will keep people from getting tested, especially given the limited available services.
“We know that shame and stigma really just drive testing underground,” said Jollimore. “The last thing we want [men] to do is to not seek out testing.”
Shannon stressed the importance of a harm reduction approach to sex during the pandemic, rather than shaming people for their choices.
“Some people are going to be sexually active, and some are going to have new sexual partners, and there needs to be access to services for them,” she said.
Vancouver Coastal Health acknowledged that sexual health care is a necessary service, stressing that suspending routine and non-urgent testing allowed the health authority to minimize the risk of COVID-19 infection and transmission in its clinics.
“Now that we’re in Phase Two of the province’s reopening plan, we’re looking at ways to bring back some of the health-care services that have been temporarily suspended during the first phase of the pandemic,” said Matt Kieltyka, a VCH spokesperson.
There is currently no timeline for when these services could resume, he added.
But Henry said during a briefing Monday that “we do expect sexual health services will increase and become more accessible” as the province’s second phase of reopening continues.
Shannon and Jollimore noted that this could be an opportunity to expand online and home-testing services, but that solution doesn’t work for low-income and vulnerable people without access to the internet.
“With the limits of online sexual health, there is a large portion of people who won’t be able to access sexual health services right now,” said Shannon. “And that might result in pockets of increased STIs, but it’s still too early to tell.”