Q+A | N.W.T.’s chief public health officer on high STI rates, and the need for testing

A temporary clinic dedicated to testing for sexually transmitted diseases opened in Yellowknife this month.

In a news release, the territory’s Department of Health and Social Services said the clinic is in response to a N.W.T.-wide syphilis outbreak that has been ongoing since 2019 “and an increased rate for other sexually-transmitted infections.”

Health officials said the clinic will be open for at least a year.

The clinic will be at 487 Range Lake Rd, unit 103, with both appointments and walk-ins available.

Dr. Kami Kandola, the territory’s chief public health officer, spoke to CBC Trail’s End host Lawrence Nayally on why this clinic was needed.

This interview has been edited for clarity and length. 

Why did the territory open this temporary clinic in Yellowknife? 

If we look at our rates of sexually-transmitted infections, we are relatively high compared to the rest of Canada. We have the second-highest rate of chlamydia and gonorrhea compared to national rates. We have the highest rate of syphilis in 2022 compared to other provinces and territories. So it’s important that we do things differently.

I had declared an outbreak of syphilis in 2019 but we are still in an outbreak situation. As I sit back and look post-COVID and post-evacuation, I noticed that there’s been less ability to access some laboratory services, primary care services. So with this clinic open on evenings and weekends with online booking, I’m hoping that this would allow access and privacy, that we can get people tested and treated, and reduce these rates.

What kind of services will be offered at this clinic? 

These services are specifically targeted to sexually transmitted infections. So some of the [infections] you can pick up through swabs or urine specimens, like chlamydia and gonorrhea. Others require a blood test and those would be syphilis, HIV and hepatitis B.

We know that it’s important that people get tested and have all these services done at once. So it’s important that people make an appointment so they can get their urine processed and sent to the laboratory right away, that they can get their blood drawn and sent to the laboratory right away, and they don’t have to go to another location.

We also know that people work; it’s very hard for some people to take time off and get an appointment to get tested. So the fact that these clinics are available in the evenings and also available on Saturday, we’re hoping to improve access. You’re able to book online so you don’t have to call someone and necessarily self-disclose that you are wanting to be tested for an STI. And if you do get tested, that record stays with the Range Lake clinic as its own separate record system and it’s not part of your territorial medical electronic medical record.

STIs have long been a problem in the N.W.T.  Why hasn’t there been a clinic like this in the past?

So this clinic is initiated by my office. Typically the office of the chief public health officer doesn’t run programs and services, so we don’t run clinics. But in this scenario, I was able to leverage federal funding to run a one-year clinic.

We know that technology has also improved, so we have point-of-care tests that can test for syphilis and HIV on site. We have urine specimens that can also test for gonorrhea and chlamydia. Gone are those days where you would have to insert a swab in a very private area. So it makes it a lot easier for people to want to get tested.

The N.W.T. was one of the first places in Canada to start using rapid tests for syphilis detection. (Francis Tessier-Burns/CBC)

Even this year I’ve seen a decrease in testing the people accessing clinics and also accessing laboratory services. If you were to get tested for syphilis and HIV, you would get a laboratory requisition, but you would have to go and get your blood drawn. We need to expedite that when we look at sexually transmitted infections. For those particular diseases, it’s very important that you get tested right away so that you can get your diagnosis and not continue to spread.

What factors are contributing to the STI rates across the territory?

What we’re starting to see is people at risk who have multiple partners. There’s more anonymous encounters so that people don’t necessarily know their contacts. It’s very difficult to know that you’ve been exposed to an STI if you don’t know who your partner was. Basically, we’re seeing STIs in the throat, STIs in the anus and not just vaginal-penile transmission.

The best reassurance is that if you’re at risk and you have multiple partners, you should be getting tested every three to six months. However, we know accessing care has been difficult and accessing laboratory services have been difficult. We’re hoping that with this clinic, where primarily most of the cases are in Yellowknife, that people can find it a lot easier to get tested and diagnosed. This clinic requires a valid health care card. If you’re coming from another community and you have a valid health care card, we’ll see you as well.

You mentioned before that the N.W.T. had one of the highest rates of syphilis in the country at about 10 times the national average. Is that rate still the same?

The highest rate we had was in 2022. We were the highest in Canada. The rate in Yellowknife is lower, but we also have seen that the testing has significantly gone down. So if we are not testing, you won’t be able to detect syphilis because it requires a blood test. If you book at the STI clinic, you’ll get your blood drawn at the same time and so you don’t have to go to a lab to get your blood test. Hopefully more people will get tested and we can pick up more syphilis.

There are already poster campaigns in places like the Yellowknife airport, social media posts and more than 300 free condom dispensers across the territory. What other plans do you have around public-health messaging?

It’s really important that people self-test, not to wait for someone to call them that they’re exposed, not to wait till they have symptoms. If they’re at risk and they have multiple partners, anonymous partners, casual encounters, they need to get tested regularly. If more people came forth and got tested regularly, we would be able to catch and treat, and eliminate ongoing transmission.