Is the NWT doing enough to combat an unprecedented syphilis crisis?
The NWT’s syphilis crisis is scaring healthcare workers, who say it’s on a scale Canada has rarely seen before, if ever. They worry HIV isn’t far behind.
Adding to that worry is a concern that the territory is not deploying some weapons against syphilis quickly enough as case counts grow, while a pill that helps prevent HIV is too costly for some NWT residents to obtain.
This summer, the NWT acquired new rapid tests that can detect both syphilis and HIV and deliver a near-instant result.
Yet three weeks after the territory received its first shipment of 2,500 tests, all of those tests are sitting on a shelf somewhere. None have been used.
The NWT’s health authority says this is because staff need to be trained and have the right processes in place – everything down to the right forms and updated software – before the tests are rolled out.
David Maguire, a spokesperson for the health authority, said the tests are a “supplementary tool used to support the current syphilis management that is already occurring which includes health promotion, case management, contact tracing, testing and treatment.”
But two NWT officials with direct knowledge of this initiative told Cabin Radio the tests are much more valuable than that in the middle of a crisis. Both spoken on condition of anonymity to discuss sensitive details of their work.
Because the rapid tests deliver results while a healthcare worker is still with a patient, one senior official said, immediate decisions can be taken rather than waiting for lab results to come back.
Lab tests are still carried out to make sure of each result, but the rapid tests provide a result that reinforces instant action while patients are in the room on their initial visit.
That has the potential to be extremely important in halting the rapid spread of syphilis, where rates are increasing at a worrisome pace across the NWT and particularly in the Dehcho and Tłı̨chǫ.
The official expressed exasperation at the pace of the rollout, given training began in July and the NWT government held a press conference that month at which the tests were hailed as “transformative” by healthcare workers who had used them elsewhere.
Another official compared the rollout to that of Covid-19 rapid tests, stating that a delay this long in deploying rapid tests against Covid-19 would have drawn significant public scrutiny.
Maguire said that comparison was “not reasonable” because the new syphilis and HIV rapid tests are not yet approved by Health Canada and are only cleared for use in the NWT as a “special usage case” given the scale of the outbreak. (They’ve already been used in some southern provinces, too, in specific circumstances.)
“The use of these tests prior to Health Canada approving them comes with additional requirements and responsibilities that had to be put in place prior to their use,” Maguire stated by email.
“As to the training in July, this was an initial overview of the test and how it was rolled out in Alberta. We needed to take that information and apply it to our operations and context, and then train any staff who may be using this new testing method on the specifics of the implementation in the NWT.”
While physicians called the tests transformative in July, Maguire said this week they were “another tool to add to our already existing toolkit to address this outbreak.”
“If anyone is concerned they may have a syphilis infection,” he wrote, “they should see their healthcare provider right away. If symptomatic, they can and will be treated immediately, regardless of whether or not they get a [rapid] test.”
Petition calls for HIV PrEP access
The tests are not the only item missing from the NWT’s toolkit, some healthcare providers and residents say.
HIV PrEP is a prophylactic, a pill that helps to prevent infection if you are later exposed to HIV. Taking one PrEP pill per day is understood to reduce a person’s risk of HIV infection by up to 99 percent.
In the NWT, PrEP is sometimes covered by residents’ benefits – but often isn’t. When it isn’t, it can cost $250 or more per month, a sum beyond the reach of many people especially as inflation spirals.
Yellowknife resident Will Gagnon this month started a petition to have the NWT government fully cover the cost of PrEP for northerners, as he said is the case in Yukon, Alberta, Saskatchewan and British Columbia.
Gagnon said the move would be “timely and relevant” as the NWT is already considering other changes to its health coverage that would expand the scope of some benefits.
“Multiple studies have proven PrEP’s benefit in preventing HIV in men who have sex with men, persons who inject drugs, as well as through heterosexual transmission. It has been shown to be cost-effective in multiple jurisdictions across the world, including Canada,” Gagnon wrote.
Responding in a written statement to Cabin Radio, health minister Julie Green said HIV PrEP is covered by “most employer insurance plans,” the Non-Insured Health Benefits program for First Nations and Inuit, and the Métis Health Benefits program.
“Currently, the GNWT’s existing Specified Disease Conditions Extended Health Benefits program cannot cover HIV PrEP as coverage requires a diagnosis of a specified condition,” Green wrote. “With that said … under the proposed new system, the GNWT would cover the cost of this treatment for those who have limited financial means. Also, under the proposed changes, individuals who use their insurance until it is exhausted can then access the drug benefit plan for coverage.”
Gagnon said that was “some next-level GNWT-style red tape nonsense,” asserting that there are 2,200 NWT residents without coverage, “some of whom may need PrEP.”
“The NWT is currently experiencing one of the worst syphilis outbreaks in the country,” he said. “Soaring syphilis rates have a proven syndemic relationship with HIV. To get syphilis under control, it only makes sense to cover PrEP as well.”
Why are HIV and syphilis part of the same issue?
If Gagnon just used a word you don’t understand, you’re not alone. The term “syndemic” hasn’t been used much but is increasingly popular in academic studies.
At its simplest, it means multiple epidemics happening at the same time and interacting so that the impact on residents’ health is worse than if both were taking place separately.
Some NWT healthcare workers say syphilis and HIV are having a syndemic health impact.
“We are seeing soaring rates of syphilis. I have never seen anything on this scale over the course of the past year,” said Alix Robertson-Salsberg, a sexual health worker in Yellowknife.
“Where syphilis lives and thrives, HIV is soon to follow. Without managing one, we’re going to get the other. And it’s an entirely preventable situation.”
Robertson-Salsberg recently wrote to Dr Kami Kandola, the territory’s chief public health officer, urging that PrEP be publicly funded.
Dr Kandola told Cabin Radio funding for PrEP is the form of political assessment that belongs with a government minister and is “not something I can make the decision on.”
Kandola instead turned the conversation back to the rapid tests.
“If there is an increase in HIV transmission, that test will be able to show it in real time,” she said.
The health authority says the tests will be rolled out in Yellowknife at the end of September or in early October, with availability either at the same time or soon after in other communities.
Robertson-Salsberg said the number of people seeking PrEP has increased in recent months, adding many did not qualify to have the pill’s cost covered, either in full or in part, and declined the offer of HIV PrEP because of that financial barrier.
“We’re talking about proactive instead of reactive measures,” Robertson-Salsberg said, pointing to the pill’s status as a prophylactic and the tests’ ability to detect infection quickly and help curb outbreaks.
“This is a dual issue and we know, living in the North, that things take time. But we don’t have time.”