In Atlantic Canada, getting an HIV test isn’t as easy as it should be.
With approximately 50% of Atlantic Canadians living in rural areas—and a lack of urban density—this often means fewer services. For example, there are only two community-based clinics specializing in sexual health in the entire four provinces—one in St. John’s and one in Halifax. What’s more, the Halifax Sexual Health Centre is the only place in Atlantic Canada where you can get a rapid point-of-care HIV test, despite the fact they have been common in other parts of Canada for over a decade (they’ll have to charge you for it too, as the tests aren’t covered by the provincial government like they are in other provinces).
When it comes to prevention, there is also a serious lack of leadership on the part of the provincial governments. Despite its efficacy, pre-exposure prophylaxis (PrEP) is not universally accessible in all of Atlantic Canada. In the provinces where there are options for PrEP to be covered, it requires enrolment into the provincial health insurance, which is a barrier for some. And in the provinces where there is coverage, the option is not widely promoted by government agencies. For example, when the Government of Newfoundland and Labrador added PrEP to its provincial drug plan, the responsibility of informing the public fell to the AIDS Committee of Newfoundland and Labrador. Also, there are few (if any) public health campaigns targeting STBBI testing or GBT2Q health. This despite recent upticks in STBBI rates in the past several years, including HIV.
Take Nova Scotia for example. The province’s only sexual health clinic is open twice a week for only a few hours at a time. This is in Halifax, which does nothing to help people outside the capital who can’t easily travel to get tested. The pandemic has also created additional barriers and burdens. In Nova Scotia, the provincial lab that conducts STBBI testing is the same lab that processes COVID-19 tests. The huge demand for COVID-19 testing has meant that twice in the last year, the province had to suspend STBBI testing.
While many primary care providers are able and willing to provide STBBI testing, some do not feel they have the professional competence to provide sexual health care for 2SLGBTQIA+ communities. Patients are often referred to community-based clinics, which tend to have a more comprehensive approach to sexual health and provide better screening. For example, not all primary care providers will think to do anal swabs or even ask their patients if that’s something they might need. Patients might also opt to go to a sexual health clinic because they feel discomfort talking about these issues with their primary care providers. This demonstrates the need to better educate providers on all sexual health services, especially unique needs of 2SLGBTQIA+ populations.
Despite all of these challenges, Atlantic Canadians continue to be resilient. We’ve accomplished much with very little in the past. HIV prevention efforts have largely been grassroots, and too often the burden falls to community-based organizations to pick up the slack. But the tools to drastically reduce HIV transmission are available to us. HIV self-testing is here, and our governments need to adapt and support this game-changing testing option. Atlantic Canada is a few steps behind but introducing point-of-care testing will provide an important boost to more effective testing and prevention efforts.
We need to mobilize communities and call upon governments to take action. We need provincial sexual health strategies that are comprehensive, informed by community, and guided by harm reduction principles. We need investment in technology and services related to sexual health, such as expanded capacity in HIV/STBBI testing. Collaboration between community-based organizations and the government is also essential. Community-based organizations have already been doing much of this work on a shoestring budget—imagine what they could do with greater funding!
The United Nations aims to eliminate HIV by 2030, and if that’s going to happen, we need government at all levels, in all regions, to step up and make HIV prevention a priority.
To learn about HIV self-test kits, available for free to those who complete CBRC’s Sex Now survey, click here.
Written by Kirk Furlotte, Atlantic Regional Manager, CBRC. He can be contacted at [email protected].