Senator Rosemary Moodie

Honourable senators, I stand between you and your beds. My apologies. However, I’m honoured today to contribute to this inquiry on the crucial public health issue of sexually transmitted and blood-borne infections — I will refer to these as “STBBIs” — in Canada.

As I begin, I want to thank Senator Cormier for his leadership on this issue. In his opening speech, Senator Cormier told us about the critical state we find ourselves with respect to the prevention, diagnosis and treatment of STBBIs, especially concerning HIV.

In my short time, I want to focus more specifically on the impact on children because, although it may surprise some of us here, STBBIs can have life-altering impacts on children and youth — an impact I have witnessed first-hand as a pediatrician and newborn specialist.

I would like to begin by countering the misconception that STBBIs only affect people who are sexually active. In fact, mother-to-child transmission can occur in utero before a child is born and with devastating consequences. Fetal demise, or stillbirth, occurs in about 30% to 40% of pregnancies with untreated syphilis, for example. Those who survive may go on to experience neurological impairment, bone abnormalities and deafness. Even babies who are not born with congenital STBBIs but are at risk for infection must undergo extensive testing, which comes with risks and can be quite invasive.

This should concern us because between 2018 and 2022, the rate of congenital syphilis has risen by 599% — you heard me — according to a 2022 Canada Communicable Disease Report. Therefore, making sure prevention, screening and treatments are widely available should be an urgent priority for public health authorities.

There is some level of recognition of the need to address this issue. Senator Cormier mentioned in his speech both the Pan‑Canadian STBBI Framework for Action and the STBBI action plan, which have outlined crucial goals for Canada, including zero new HIV infections, zero AIDS-related deaths and a 90% reduction in syphilis and gonorrhea incidence by 2030.

Evidently, the statistics shared earlier showed that despite policies and action plans, we’re heading in the wrong direction. One reason is that we’re failing to provide youth and young mothers the care they need. Despite the existence of screening guidelines and treatment recommendations, Canada is failing to provide sufficient prenatal care and STBBI treatment.

Among the 3,700 cases of babies born with syphilis in 2022, 40% were born to mothers who received no prenatal care.

Another potential reason is that, for decades, safer-sex messaging in Canada has been focused on preventing HIV, leaving diseases such as syphilis, chlamydia and gonorrhea largely overlooked. I would argue this has led to a public perception which has resulted in a decrease in safe-sex practices and in condom use, especially during the post-pandemic, as STBBI prevention efforts fell by the wayside.

This is a clear case where screening would have made a difference, and there is a significant cost to inaction.

According to a 2021 study conducted in Manitoba, the direct short-term cost of treating only one uncomplicated case of congenital syphilis was almost $20,000. In 2021, with 81 cases, this translated to approximately $1.5 million that year. This is the cost of the burden of this illness on Manitoba’s health care system for that year. In comparison, the cost of applying thorough prenatal syphilis screening to all 16,800 yearly pregnancies in Manitoba would have equalled less than $140,000. There is quite a disparity between prevention and treatment.

From a cost perspective, the argument for increased preventative screening is clear. Canada has failed to eradicate or to blunt the spread of STBBIs, which leaves us with an important question: How will we ensure that mothers and children and youth across Canada are able to access the STBBI prevention and treatment services they need?

Canada’s STBBI action plan for 2024-2030 outlines essential strategies, such as increasing access to testing and improving data surveillance. However, there is an opportunity to learn from our comparator countries. To be frank, we in Canada are not alone in facing these gaps in sexual health services.

The COVID-19 pandemic set back many countries. They reported decreases in prevention, testing and treatment services for sexually transmitted infections, or STIs. This has led to a resurgence of STIs globally. Countries which were previously good at STI surveillance, such as the U.K. and the U.S., are also reporting an increase in STBBIs. For example, a highly resistant strain of gonorrhea is increasingly reported in countries such as Australia, Denmark, France, Ireland and the U.K.

This highlights that the challenges we face are really not unique to Canada, but we can learn from both the successes and the failures of these nations. Germany has had one success. The LIEBESLEBEN campaign, which translates to “Love Life,” has, for nearly 40 years, combined mass media and personal communication to target specific groups and raise awareness on the risks and impacts of STBBIs. Creative campaigns, such as cartoons in public spaces and efforts on social media, contribute to this program. This sort of intentional targeting in Canada could help in the obvious gaps in education and awareness among Canadians that have led to a rise in STBBIs in recent years here in Canada.

The conversation in Canada about sexually transmitted and blood-borne infections needs to evolve. We need to prioritize STBBIs in our education, much in the same manner we devote attention to nutrition, exercise and good mental health. As a country, we need more robust screening programs. We need to improve prenatal access to care, particularly for disadvantaged moms and in rural and remote areas.

I’d like to draw from an example from the U.K. In A Framework for Sexual Health Improvement in England, strategies mentioned include the use of technology to support self-care. For example, the online My Contraception Tool helps people to choose which contraception method is right for them, and the myHIV online resource helps people to manage aspects of their HIV.

To achieve success in lowering STBBI rates in Canada, sexual health services should be adapted to the needs of young people and should address the unique challenges they face when accessing care. I believe the way we reduce STBBIs in Canada is by supporting innovative strategies in sexual health education, anti-stigma efforts and preventative screening.

We have witnessed the importance of public health infrastructure and the need for investment in health care and education.

Honourable colleagues, I see value in the ongoing efforts nationwide to address the issue of STBBIs in Canada. There is still much to do to make sure that everyone in this country can have good access to the screening programs and treatments they need.

I’m mindful that certain populations are particularly vulnerable — Indigenous peoples, marginalized communities and people who face social barriers, including homelessness, substance use and incarceration. In this regard, I want to highlight the need for rapid and intense implementation of concrete policies and programs to support people who face difficulty in accessing care.

Now is the time for action. Let us not just be on track; let us lead the way in combatting STBBIs, learning from global experiences and ensuring a healthier future for all Canadians. Thank you.