Infected and outta luck

Crouching in the bathtub last month waiting for the pubic lice shampoo to work its magic before fine-tooth combing the crabby buggers out of my bush, I smiled in solidarity with all the teenage girls crouching in their bathtubs across the continent.

A new study by the US Centers for Disease Control and Prevention reports that at least 25 percent of that country’s girls aged 14-19 have a sexually transmitted infection (STI). A staggering 48 percent of black teen girls have an STI, while the prevalence rate among their white peers is 20 percent.

This is new data, released in early 2008. It adds to what we already know in the Canadian context with respect to Canada’s First Nations, Métis and Inuit. In 2001, Aboriginals made up 3.3 percent of the Canadian population. Yet since 1998, the proportion of positive HIV test reports attributed to Aboriginals has remained steady at just over 20 percent. HIV-positive Aboriginals also tend to be younger than non-Aboriginals: 32.4 percent of HIV-positive Aborginals from 1998 to 2006 were younger than 30, as compared to 21 percent among HIV-positive non-Aboriginals.

“Race itself is not a risk factor for STIs,” says CDC researcher Dr. Sara Forhan. Instead, she attributes the difference in STI rates to limited access to health care, overall community prevalence of STIs, misperceptions about individual risk, and poverty.

So what does that have to do with Ottawa gay men and the insects breeding in my pubic hair? For marginalised communities in Ottawa — including African-Caribbean and Aboriginal folks, teens and queer men — accessing health services that are adapted to our cultures in meaningful ways can be difficult. It means fewer of us opt to get tested and too many of us have negative testing experiences when we do.

For example, Ottawa syphilis rates are on the rise and the bulk of infection is among gay men. Of the 102 syphilis cases in Ottawa between Jan 2001 and Jun 2006, 97 were men and a whopping 81 of those men have sex with other men. It begs the question: why do gay dudes account for almost 80 percent of syphilis infections in our city? Well, if there is more syphilis among gay men to begin, with and if gay men underestimate or don’t protect themselves from that risk when hooking up, continued syphilis transmission is bound to result.

But what about access to health care, another factor mentioned by Dr Forhan? Don’t Ottawa gay guys, Aboriginals and teens have the same access to STI testing as everyone else? Yes. Local testing sites serve homos and heteros, blacks and whites, teens and seniors. But how many Aboriginal nurses or gay social workers are employed at Ottawa testing sites? How do we verify that testing staff have a context-relevant understanding of the cultures they’re serving? How do we ensure the staff champion approaches that facilitate equitable health outcomes?

That said, Public Health staff sometimes work wonders given the under-funded system in which they work. A recent New York Times article reported that many cases of sexually transmitted infections among gay men are escaping detection each year. In addition to inadequate understanding of gay men’s needs, the article noted that “sexual disease clinics do not have adequate staffs and budgets to do comprehensive testing.” Our own Sexual Health Centre in the Byward Market serves ever-increasing numbers despite budget constraints and occasional hiring freezes imposed by city hall.

Recently, a partner called me up to say he had chlamydia. When I visited my neighbourhood community health centre the next day, I was told I couldn’t be tested because they had neither the staff nor the resources to accept new patients. I was directed to the Sexual Health Centre, the catch-all testing site for everyone who’s been rejected elsewhere. Which means the Sexual Health Centre, despite the dedication of some hard-working staff, is being pushed beyond capacity. Wait times for appointments are two weeks or more. Arrive an hour after walk-in hours start and you risk being turned away.

It all adds up to unnecessary STI transmission. It leaves gay dudes like me, who are taking all the right steps by immediately showing up for testing and treatment, infected and out of luck. I can only imagine the barriers it creates for an infected 14-year-old girl or suburban gay boy breaking parental, cultural and religious rules by secretly having sex with their boyfriend.

“Resources are a challenge at the federal, [provincial] and local level,” says the CDC’s Dr John M Douglas Jr. “We are trying to be as innovative as we can with public health resources.” Ottawa benefits from this innovation thanks in no part to government, but rather the commitment of local sexual health workers. Twice a year the Sexual Health Clinic ventures into gay bars late at night to meet their clients where they’re at. Testing staff throughout the city can now attend optional anti-oppression trainings. And Centretown Community Health Centre and the Sexual Health Clinic are in talks with local HIV and gay organizations to create a weekly testing clinic specifically aimed at gay men.

Nonetheless, one in four teen girls with an STI is a crisis. A disproportionate STI rate among black communities is a crisis. Aboriginals as one-fifth of HIV-positive Canadians is a crisis. And rising transmission rates among Ottawa gay men is a crisis.

We all deserve better and we now know who our allies are to demand change. Hassle-free access to culturally competent testing throughout the entire city — regardless of age — needs to happen now.