Report to/Rapport au :
Ottawa
Board of Health
Conseil de santé d’Ottawa
Monday June 20, 2011/le lundi 20 juin 2011
Submitted by/Soumis par :
Dr./Dr Isra Levy,
Medical Officer of Health/Médecin chef en santé publique
Contact
Person/Personne-ressource :
Dr./Dre Vera Etches, Associate Medical Officer of Health/Médecin adjointe en santé publique
Clinical
Programs/Progammes cliniques
Ottawa Public Health/Santé
publique Ottawa
613-580-2424, ext./poste 23675, Vera.Etches@ottawa.ca
|
ACS2011-OPH-CP-0002 |
|
SUBJECT: |
FUTURE DIRECTIONS FOR OTTAWA PUBLIC HEALTH’S SEXUAL HEALTH PROGRAM |
|
OBJET: |
DIRECTIVES FUTURES POUR LES PROGRAMMES DE SANTÉ SEXUELLE DE SANTÉ
PUBLIQUE OTTAWA |
That the Board of Health for the City of Ottawa Health Unit receive
this report for information.
Que le Conseil de santé de la circonscription sanitaire de la ville d’Ottawa
prenne connaissance de cette présentation à titre d’information.
BACKGROUND
Purpose of this
report: To inform the Board of Health
about the current sexual health program and activities, and to discuss
community needs and proposed strategies to address them.
Sexual health has many dimensions: promoting healthy sexual behaviour and healthy relationships; reducing unwanted pregnancies; halting the spread of sexually transmitted infections (STIs); and knowing when and where to seek testing and treatment if needed. Ontario Public Health Standards require health units to promote healthy sexuality and reduce the transmission and burden of sexually transmitted infections (STI) and blood-borne infections. Since the late 1980’s, Ottawa Public Health’s (OPH) Sexual Health Unit has been one of the city’s primary sources of sexual health treatment, counselling and a wide variety of related programs and services.
OPH’s Sexual Health Centre provides: specialized education and counselling on healthy sexuality; testing for and treatment of sexually transmitted infections, such as Chlamydia and syphilis, and blood-borne infections such as Hepatitis C; anonymous HIV testing; pregnancy testing; and affordable contraception. Approximately 80% of these services are provided at the Centre’s main clinic, located at 179 Clarence Street in the Byward Market, where a multidisciplinary team of health professionals counsels and treats people of all ages and from all walks of life – from teenagers learning to negotiate condom use, to elderly men or women needing treatment for an STI. OPH runs one of the few public health sexual clinics in the province with an on-site laboratory, which speeds up diagnosis and early treatment. OPH diagnoses and treats approximately 30% of all Chlamydia cases and 40% of all gonorrhoea cases in Ottawa; staff provided treatment for over 650 Chlamydia cases and 100 gonorrhoea cases in 2010.
In addition to the Clarence Street clinic, OPH operates a number of satellite clinics in schools, community health centres, resource centres and bathhouses throughout Ottawa, reaching out to increase access to service. Some of these clinics are targeted to special populations, such as The Gay Zone, at the Centretown Community Health Centre, which operates under a unique model of health promotion implemented specifically for men who have sex with men (MSM); and weekly clinics at Operation Come Home and the Youth Services Bureau for street-involved youth.
OPH also has a team of nurses dedicated to investigating all
cases of STIs and blood-borne
infections diagnosed in Ottawa,
to ensure that partners are notified and properly treated to reduce further transmission.
In 2010, OPH investigated over 3,100 such infections, and made over 7,000 calls
to cases and partners. This team is moving ahead with alternative communication
modalities to reach youth through mobile devices.
The Sexual Health Unit also operates the Site Clean Needle and Syringe Program (SCNSP) to reduce the transmission of Human immunodeficiency virus (HIV), Hepatitis B and C among people who inject drugs. The SCNSP has a fixed location at 179 Clarence Street and a mobile van that operates seven days a week.
In addition to treatment and case investigation, the Sexual Health Unit provides a variety of innovative health promotion and outreach initiatives to both the general population and priority populations. Last year, public health nurses conducted over 75 presentations in schools to educate students about sexual health, healthy relationships, STI prevention and contraception. OPH staff provide training and capacity building sessions for school staff to increase their knowledge and comfort about discussing sexual health issues with students. The Sexual Health Unit also distributes about 900,000 condoms a year to clients who access our clinics and to community partners who request them.
This year, the Sexual Health Unit has enlisted the aid of technology to help expand its outreach. In March 2011, the team broke new ground in launching the “Get Tested Why Not?” web site (www.gettestedwhynot.ca), the first on-line chlamydia and gonorrhea testing initiative in Canada. The website includes a “downloadable” laboratory requisition that will enable symptom-free clients to get tested without the need of a trip to a physician’s office or the sexual health clinic. OPH follows up with positive cases, as with clients who visit the sexual health clinic.The campaign also includes a “Get Texted” initiative which allows people to request and receive expert sexual advice and information confidentially via text messaging.
DISCUSSION
In the past two years, targeted investments have enabled the Sexual Health Unit to expand and enhance its services as the staff investigated efficiencies in service delivery. The number of client visits at The Gay Zone doubled since its inception in 2008. Renovations and improvements to service delivery at the Clarence Street clinic, completed this past winter, have enabled staff to see almost 20% more clients, which is over 550 additional clients visits in the first five months of 2011. In 2010, the clinic received its highest number of clinic visits in over five years, despite being closed for renovations during most of November and December. In 2011, two new full-time nursing positions were allocated to the sexual health program which will help expand the number of community-based clinics we provide and reduce the time to follow up of STI cases to the recommended two days from receipt of the laboratory diagnosis.
Current Gaps in the Provision of Sexual
Health Services in Ottawa
Despite OPH’s enhanced services and investment, gaps in sexual health programming remain. While teen pregnancy rates have been declining, OPH has identified the following issues that it believes should be addressed:
· STI rates continue to rise. In the last ten years, Chlamydia and gonorrhoea rates in Ottawa have almost doubled (see Figure 1 and 2). This is consistent with a rise in rates of these infections across the province. The number of Chlamydia cases followed up by OPH in 2010 increased 14% over 2009, and gonorrhoea cases increased 25% Most of these cases occur in young people. Two years ago the Ministry reported that Ottawa’s Chlamydia rate was the highest of any urban centre in Ontario. Chlamydia infection is associated with up to 65% of all pelvic inflammatory disease, 70% of all tubal infertilities and 30% of all ectopic pregnancies.
Figure 1:
Age-standardized Incidence of Chlamydia by Sex, City of Ottawa, 2000-2010
Source: iPHIS, data extracted April 12, 2011 by Epidemiology
Section, Ottawa Public Health
Data Note: Incidence rates are age standardized to
the 1991 Canadian population.
Figure 2:
Age-standardized Incidence of Gonorrhea by Sex, City of Ottawa, 2000-2010
Data Note: Incidence rates are age standardized to
the 1991 Canadian population.
· Demand for OPH’s sexual health services continues to rise. The Clarence Street clinic had to turn away over 400 clients in 2010. While the recent renovations have increased the clinic’s capacity, there are concerns about whether our operations, even as expanded, are sufficient to meet the city’s needs over the longer term.
· Some neighbourhoods are under-served. Some areas of Ottawa have demonstrated a need for sexual health clinical services, because of the combination of a large youth population and a high number of STI cases. These are mainly neighbourhoods located outside the city core, such as Barrhaven, South Nepean and Orleans.
· Condom use could improve. Though use of condoms reduces the risk of STI transmission and unwanted pregnancy, in 2007 only 77% of 15-19 year olds in Ottawa who had sex in the past year used a condom the last time they had sex.
· Support from others in the community could be strengthened. OPH is concerned that young people may not be getting the sexual health counselling and support they need from parents, teachers and primary health care providers. For example, youth repeatedly report to Sexual Health Unit staff that they do not have a family physician, or if they have one, are hesitant to discuss their sexual health needs with that physician.
Future Directions for
the Sexual Health Unit
In addressing the gaps discussed above, and others that might be identified, OPH is planning the following strategic directions:
Improving Access to OPH’s sexual health services
Expanding access to OPH services will increase the availability of STI testing, and treatment and support for urgent sexual health needs. Staff estimate that providing 24 additional hours of front-line service per week: for example extending the hours of the Clarence Street clinic and The Gay Zone, and adding satellite clinics in suburban locations (see Figure 3), will result in an additional 6,000 clinic visits city-wide per year.
Figure 3: Proposed
Sexual Health Clinics in Ottawa
Implementing a Campaign to Promote Condom Use
Providing condoms is a cost effective intervention to prevent the transmission of STIs and reduce unintended pregnancies. OPH already distributes nearly a million condoms every year, but in order to make condoms more accessible, especially for young adults, a targeted and comprehensive program is required. A literature search of successful condom campaigns has revealed that:
· For maximal effectiveness, distribution strategies must be specific to targeted groups (i.e. youth, MSM, sex industry workers);
· Multifaceted condom promotion campaigns that incorporate the use of technology, social marketing and web-based initiatives can be effective. A comprehensive condom campaign in New York City (www.nyc.gov/condoms), implemented in 2005, resulted in a 500% increase in condom distribution; and
· School-based healthy sexuality programs promoting condom use result in reduced unprotected sex and delayed initiation of sexual activity.
Building Capacity among Primary Care Providers, Parents
and Schools
Increasing the capacity of parents, schools and primary care providers to discuss sexual health with young people can reduce the stigma associated with sexual issues, and lead to improved overall sexual health (1, 2). OPH plans activities to build the capacity of these key groups of people, as follows:
Primary care providers. Outreach and education for health care providers in the community will include:
· professional development sessions and tool kits to facilitate sexual health service provision;
· programs to raise awareness among primary care providers of programs provided by the Sexual Health Unit, such as Chlamydia and gonorrhoea screening programs and safer-sex education; and
· better linkages between primary care providers and sexual health clinics to facilitate referrals.
Parents. OPH can provide parents with knowledge
and tools to help them establish dialogue with their children about sexual
health. A recent survey done by Waterloo
Public Health (3) revealed that parents/caregivers
remain the top source for students from whom they most want sexual health
information. OPH will pilot a “Have the Talk” campaign for parents,
using online technology in late 2011.
Schools. Peer-reviewed literature indicates that the most important components of successful school-based sexual health programs are sufficient classroom time for discussion and ensuring that teachers are adequately trained and motivated to teach the topic (4, 5). OPH will build on its current school programs by providing teachers with tools and information to bolster their level of comfort with discussing sexual health issues.
Using New Technology to Spread Sexual Health Messages
Staff intend to build on existing initiatives by:
· Developing mobile phone applications to increase awareness of and access to local sexual health services;
· Enhancing the existing text messaging campaign to reach priority populations such as MSM;
· Using internet chat-rooms to connect with priority population, such as youth and MSM, who are known to use chat rooms as a venue to meet sexual partners; and
· Using text messaging and other social media for case and contact investigation.
There are many partners that work collaboratively with the Sexual Health Unit to improve the sexual health status of Ottawa residents. These include Planned Parenthood Ottawa, Youth Services Bureau, Ottawa community health centres, Ottawa School Boards, Universities and Colleges, Public Health Agency of Canada, Ottawa Academy of Medicine and various AIDS service organizations such as the AIDS Committee of Ottawa and the Ottawa Coalition on HIV/AIDS. OPH will engage in consultation with these partners as part of the development and design of future sexual health programming.
RURAL IMPLICATIONS
The Sexual Health Unit operates satellite clinics in Dunrobin and Metcalfe. The “Get Tested” web site and text-message service can be accessed in rural as well as urban areas.
There
are no financial implications with this report. The Board would be made aware
of any associated future financial implications associated with the strategy
noted in this report should they arise.
There are no legal implications related to this report.
Technology
Implications
Technology supports to the sexual health strategy are key, as described above, and will require support from external agencies.
Ottawa Public Health will use this report to further engage community partners, policy-makers and Ottawa residents in designing and developing specific elements of future sexual health programming.
References
1.
Bissell,
M., McKay, A. Taking Action on
Chlamydia Literature Review. Sex
Information and Education Council of Canada; 2005 Dec.
2. Moses, S. Elliott, L. Sexually transmitted
diseases in Manitoba: evaluation of physician treatment practices, STD drug
utilization, and compliance with screening and treatment guidelines. Sexually Transmitted Diseases 2002; 29,
840-846.
3. Waterloo
Public Health. A Review of Public Health’s Sexual Health Services for Secondary
Students in Waterloo Region. Waterloo, ON; 2010.
4. Kohler, P.K., Manhart, L.E., Lafferty, W.E.
Abstinence-only and comprehensive sex education and the initiation of sexual
activity and teen pregnancy. Journal
of Adolescent Health 2008; 42,
344-351.
5. Public Health Agency of Canada. Canadian guidelines on sexually transmitted
infections. 2006 Edition. Ottawa, ON: Public Health Agency of
Canada; 2006 Jan.