Building the foundations for effective syphilis testing in Indigenous communities

Syphilis is a preventable and curable sexually transmitted infection (STI) but the only way to know for sure whether or not someone has syphilis is to get tested. Amid a national syphilis epidemic, where some regions and communities are hit harder than others, access to screening and diagnosis is crucial to ending this public health threat in Canada. 

Syphilis rapid testing

Syphilis rapid testing is a promising tool that can help reach our goals but what is it exactly and why is it important? Syphilis rapid testing detects antibodies in a blood sample and provides results within minutes, making testing more accessible. The more testing options that people have, especially outside of hospital settings, the easier it is to get tested. Once people know their status, they take care of themselves and their communities, reducing transmission and helping to end the epidemic.

As we know from efforts to increase HIV testing, advances in technology must be offered equally to everyone to be effective. Although syphilis rapid testing is widely available in nearly every resource-rich country, this is not yet the case in the land now called Canada.

The Manaacii Wiithagapin study

An Indigenous-led needs assessment project in inner-city Winnipeg has shed light on practices that can help increase syphilis testing and better serve communities who have experienced harm in the mainstream healthcare system. 

Manaacii Wiithagapin is a partnership between Waniska/Ka Ni Kanichihk, Sunshine House and the University of Manitoba, funded by the Feast Centre for STBBI Research. The project is led by Elder Gayle Pruden and Dr. Ellen Cook with Melissa Morris and Dr. John Schellenburg as the co-principal research leads. Melissa Morris was granted a Community Fellowship Award with the support of Dr. John Schellenburg and, together, the team incorporated Indigenous practices with qualitative research in the form of sharing circles.

33 people with lived experience of HIV and STBBIs, community members and Sunshine House staff were asked about their knowledge and experience using rapid STBBI testing and self-testing, as well as their reflections on care and support following either a positive or negative diagnosis. The study team explored information shared during circle discussions to better understand what people needed before, during and after the testing experience.

What did the researchers find?

The team found that the testing environment and access to follow-up services were critical to increase testing, and that knowledge about syphilis was an important part of the testing journey.

The testing environment

Communities who have historically experienced harm within mainstream healthcare, such as racism or forced medical procedures, are less likely to access health services in clinical environments. Community-based settings, such as local organizations and community events, were perceived as safer spaces for testing services. Access to cultural services, like the opportunity to speak with an Elder before, during, or after the testing process, encourages regular testing by creating a culturally-safe environment.

Access to follow-up services

Participants said they would be more likely to get tested if they knew beforehand what to do if the test result was positive. Knowing what supports are available, or how to access treatment, would make the test seem less daunting. One participant said,

I think it would maybe work for somebody that was very familiar with testing, like, okay, I know what I’m going to do if I test positive: I’m going to the doctor the next day, I’m reaching out to my Elder, I’m reaching out to somebody. But I would need to know before I did that test what my supports would be.

Knowledge about syphilis

Participants were very knowledgeable about HIV, but less so about syphilis. For example, everyone had heard of syphilis but not everyone knew how it was transmitted or that it can be cured. Many people knew about different types of HIV tests – such as rapid point-of-care tests and self-tests – but were less aware about different types of syphilis tests or how to access them. 

What can be done to increase syphilis testing?

The research team found that syphilis testing could be increased by applying lessons learned from HIV testing:

• Educate the community about syphilis prevention, testing and treatment.
• Create training and education opportunities for Elders, peers, healthcare providers and frontline service providers to stay up-to-date on STBBI and harm reduction knowledge.
• Increase access to cultural support in community and clinical settings.
• Expand testing locations and settings.
• Leverage the infrastructure and public health initiatives that helped increase HIV testing.

Where do we go from here?

“De-clinicalizing” the testing environment will go a long way towards encouraging people to get tested for syphilis. Environments where non-clinical services are also provided – such as food programs, housing assistance or transportation services – offer an ideal setting to provide wholistic care. An Indigenous-led healthcare model rooted in love, understanding and kinship, is key to making the testing experience feel safer. This model emphasizes relational care networks and offers leadership in what empowering healthcare delivery can look like. These efforts increased HIV testing and can do the same for syphilis. 

To learn more about the Manaacii Wiithagapin project, contact Melissa Morris.

 

Melissa Morris is Two-Spirit/Indigiqueer and proudly holds citizenship with the Manitoba Métis Federation, tracing her ancestral roots to the Red River Settlement in Northern Manitoba and Saskatchewan. Melissa is a prominent activist, using her strengths-based narrative to address the disparities that Indigenous people living with STBBIs encounter. Melissa serves as the community coordinator at the Waniska Centre for Indigenous STBBI Research and works through their community partner Ka Ni Kanichihk, as well as being the manager of the Village Lab. In her spare time, Melissa volunteers with the Nine Circles Community Health Centre, where she serves on the board of directors and the Lived Experiences Advisory Committee.

Sugandhi del Canto is associate director of HIV and sexual health knowledge exchange at CATIE.