Alarming Rise in Sexually Transmitted and Blood-Borne Infections

Rose pursuant to notice of October 22, 2024:

That he will call the attention of the Senate to the alarming rise in sexually transmitted and blood-borne infections in Canada, including HIV/AIDS.

He said: I rise today to draw the Senate’s attention to a critically important public health issue: the alarming rise in sexually transmitted and blood-borne infections, or STBBIs, in Canada, including HIV/AIDS. I’m undertaking this inquiry in the hope that those of you who are concerned about this important issue will be inspired to help by contributing your thoughts, expertise and experience.

Over the last decade, despite numerous public health interventions, we have seen a significant and alarming rise in the rates of many STBBIs in our country. Cases of chlamydia have risen by 49%, gonorrhoea by 81% and syphilis by 178%. Between 2018 and 2022, rates of infectious syphilis rose by 109% in Canada, and cases of congenital syphilis rose by 599%. Although we’re seeing half as many cases of hepatitis C as we were in the late 1990s, the number of cases hasn’t gone down since 2011. As for HIV, despite a 90% reduction in deaths since the mid-1990s, the infection is still being transmitted. In 2017, for example, the number of reported cases of HIV reached its highest level since 2008.

Behind these statistics, honourable colleagues, there are teenagers, young adults, women and men from every region of Canada, people of various backgrounds, sexual orientations and gender identities. STBBIs are infectious diseases transmitted sexually or through blood. They include, but are not limited to, human immunodeficiency virus, or HIV, hepatitis B and C, chlamydia, gonorrhea, syphilis, and human papillomavirus. They are transmitted through the exchange of genital fluids, through intimate skin-to-skin contact, or through contact with blood.

Colleagues, these infections disproportionately affect certain marginalized populations. In 2021, men who have sex with men accounted for nearly 40% of new HIV diagnoses, while people who inject drugs made up 21.9% of those infected.

Indigenous people accounted for 23.9% of new cases and Black populations for 15.4%. Finally, compared to the general population, people incarcerated under federal jurisdiction now have higher rates of HIV and hepatitis.

Colleagues, these disparities are the direct consequences of several factors stemming from social inequalities, colonialism, systemic racism, homophobia and other inequalities that marginalize these communities and increase their vulnerability to infections.

I would like to focus on HIV/AIDS, given the severity of its consequences. Unlike other STBBIs, there is no cure for HIV/AIDS. It is a chronic disease that requires lifelong care and treatment.

In 2020, approximately 63,000 people in Canada were living with HIV. According to the 2022 data, the rate of newly diagnosed HIV cases was 4.7 per 100,000 population, which shows that transmission is ongoing. In 2022, 1,833 newly diagnosed cases of HIV were reported in Canada, an increase of 24.9% compared with 2021 and the largest increase in more than 10 years. The hardest-hit provinces are Saskatchewan and Manitoba, with infection rates much higher than the national average, leading to especially serious consequences for their marginalized populations.

Because of its chronic nature and its co-morbidities, such as hepatitis and opportunistic infections, HIV has serious public health implications. Thanks to advances in antiretroviral therapy, of course, people living with HIV can now live a long and healthy life. We now know that U=U, meaning that an undetectable viral load means the virus is untransmittable. However, this therapy must be taken for life, and adhering to the treatment plan is vital for maintaining an undetectable viral load and preventing transmission.

The stigma associated with HIV remains a major barrier to accessing care and support, affecting the quality of life and mental health of people living with the virus. This stigma can lead to delays in testing, reluctance to seek treatment and social isolation. It also contributes to the under-reporting of HIV status, potentially increasing the risk of transmission.

Moreover, HIV treatments impose a substantial financial burden on Canada’s public health system. The Canadian AIDS Society estimates the present value of the economic loss attributed to newly diagnosed individuals at $1.3 million per person.

Colleagues, we know that it is possible to control sexually transmitted and blood-borne infections, or STBBIs, prevent their transmission and, nowadays, to cure some of them. Advances in scientific research have led to a better understanding of infection transmission and risk factors, resulting in new tools to prevent, diagnose and treat STBBIs.

However, despite these advances, the negative impacts of these infections on health and well-being remain significant, particularly when treatment is delayed. They can cause serious health problems such as chronic pain, cancers, immune deficiencies, psychological distress, infertility and adverse effects on pregnancy — not to mention that they continue to impose significant physical, emotional, social and economic costs on individuals, communities and society.

In 2018, the Government of Canada adopted a pan-Canadian STBBI framework for action, followed by an initial five-year action plan in 2019 and a second plan in 2024, setting out the government’s strategy until 2030. In 2022, the federal government invested $106.4 million in the fight against STBBIs. Still, despite these investments, persistent challenges are compromising efforts to curb the rise of STBBIs in this country.

The main challenge Canada faces in its response to the rise in STBBIs has to do with the adoption and deployment of technological innovations related to the prevention, screening and treatment of these types of infections. It is absolutely essential to further promote new diagnostic technologies, such as point-of-care rapid HIV and syphilis tests, self-testing for HIV and hepatitis C, decentralized community-based testing and dried blood testing.

By promoting the adoption and deployment of these new technologies and maximizing new screening methods, we will improve access to prevention and treatment services in underserved areas. Canada’s geographic reality being what it is, there is a real inequity in access to health care depending on where Canadians live. The centralization of screening and treatment services in urban areas poses a real problem for rural, remote and isolated communities, especially for people without easy access to transportation.

Canada has to mount a large-scale rollout of effective new biomedical tools stemming from scientific breakthroughs. Antiretroviral therapies for HIV and curative treatments for hepatitis C, for example, have transformed the lives of many people living with these infections. Two new biomedical tools in particular deserve to be better known and more readily available to the public. The first is pre-exposure prophylaxis, commonly known as PrEP, which allows people who are not HIV-positive to take antiretroviral drugs on an ongoing basis prior to possible exposure to HIV. Similarly, post-exposure prophylaxis involves administering antiretrovirals following possible exposure to HIV. These innovative drugs should be available and accessible to everyone across the country, regardless of their socio-economic status or place of residence.

Nelson Mandela once said, “Education is the most powerful weapon which you can use to change the world.” Well, if we want to turn the tide and eradicate STBBIs and HIV/AIDS in Canada, we must provide appropriate sexual education programs in all schools across the country — a sexual education that does not simply promote abstinence but equips young Canadians with accurate and up-to-date information on sexuality, safer sexual practices and the risks associated with STBBIs. There are still too many taboos surrounding these public health issues in our country. The goal of such education must be to reduce risky sexual behaviour, improve risk perception and increase knowledge of prevention and screening tools to curb the spread of STBBI.

In this regard, it is imperative that the federal government collaborate with the provinces and territories to ensure that all young people in Canada receive comprehensive sexual education, enabling them to protect themselves effectively and thrive fully.

The alarming rise in STBBIs in Canada is not just a matter of medical innovation, public health or sex education, colleagues; it’s also a matter of ensuring that all Canadians’ human rights are respected. The rights to health and safety, which are two fundamental rights, are seriously affected when access to care, prevention and effective treatment is limited.

Sexual and reproductive rights, which include the ability of every person to make free and informed decisions about their sexuality, reproductive health and family life, are also threatened by the rise in STBBIs. When access to sexual health services, sex education and preventive tools such as condoms, PrEP or self-testing is compromised, these rights are directly affected.

Canada endorses the global health sector strategies on HIV, viral hepatitis and sexually transmitted infections for the period from 2022 to 2030, as formulated by the Joint United Nations Programme on HIV/AIDS, or UNAIDS and the World Health Organization, or WHO.

The goal of these strategies is to end the epidemics of viral hepatitis and eliminate sexually transmitted infections as a public health concern by 2030.

To accomplish this, Canada must meet the 95-95-95 targets by 2025. That means that, by next year, 95% of people living with HIV should know their HIV status, 95% of people who have been diagnosed should be on antiretroviral therapy and 95% of people currently on antiretroviral therapy should have an undetectable viral load.

With regard to hepatitis, the country must seek to reduce new cases of chronic viral hepatitis B and C infections by 90%, reduce hepatitis B and C deaths by 65% and diagnose 90% of infections.

There is also a target to reduce the global incidence of syphilis and gonorrhoea by 90%.

Senators, as you can see, we are far from meeting those targets. It is more than time to walk the talk.

We have a collective responsibility to intensify our efforts to curb the spread of STBBI, strengthen prevention measures and improve treatments, while honouring Canada’s national and international commitments.

Various levels of government, health care providers, schools, community organizations, parents, researchers and politicians must all be fully involved and contribute to achieving these objectives.

The federal government plays a crucial role as a partner in this effort. It has the responsibility to establish national frameworks, engage with provincial and territorial governments to ensure effective coordination, proper information sharing and the implementation of strategies tailored to regional realities. It must also mobilize stakeholders and make the necessary resources available.

The federal government must also ensure adequate financial support for community organizations that work hard to educate people and provide outreach services to young people and those Canadians who are most at risk.

It must also increase funding for the fight against HIV/AIDS to $100 million a year, in line with the recommendations of the House of Commons Standing Committee on Health and the motion adopted in this House in 2020. All the sums announced must actually be disbursed.

So I urge the federal government to fully honour its commitments in the fight against STBBIs, including HIV/AIDS, and to step up its efforts to respond to the current emergency.

On a more personal note, colleagues, I’d like to conclude by saying that, as I was doing my research for this inquiry, my thoughts turned to my many friends who have died of AIDS over the years.

Young artists, journalists, television producers and ordinary citizens of all ages and from all walks of life have left us far too soon because of this abominable virus.

I’m thinking of my friends, Bernard, Pierre, Laval and so many others who had prolific careers and rich family lives. They were devoted to their communities and actively contributed to Canadian society. I often wonder what their life would be like today. They were good people who had so much to offer to our country.

I want to pay tribute to them and tell their families and friends that we will never forget them. I’m also thinking of all those who are living with this chronic disease today and who often feel isolated. I want to tell them that they are not alone and that we will be their voice whenever possible.

Honourable colleagues, STBBIs and HIV are not things of the past. These infections are still very much around, and our young people especially are being affected all across the country.

December 1 is World AIDS Day. It would be great if we could offer hope to all those who are affected by these infections by sharing a series of speeches on the topic from the Senate of Canada.

Thank you for your attention. I invite you to contribute to this discussion that is essential to the health and well-being of all Canadians. Thank you.