In Canada, the most recent outbreaks of syphilis have mostly affected men who have sex with men. But on the Prairies, a new trend has also emerged in recent years: higher rates among heterosexual people, particularly women. One Prairie city especially hard-hit by outbreaks is Winnipeg, where cases of infectious syphilis more than doubled in 2018. These infections seem to be associated with inadequate housing and substance use, methamphetamine in particular. It’s also known that a disproportionate number of these women are Indigenous.
In this conversation, the first in a series about syphilis produced by the National Collaborating Centre for Infectious Diseases in conjunction with the National Collaborating Centre for Aboriginal Health, we sit down with Laverne Gervais, program coordinator at Ka Ni Kanichihk and a sexual health educator. Here, she discusses the circumstances Indigenous women can face, the corresponding risk factors, as well as ways public health can better support them. She spoke with NCCID’s Jami Neufeld.
Jami Neufeld: What factors do primary healthcare practitioners and public health personnel need to know and understand about Indigenous women’s risk of syphilis in the communities that you’re working with?
Laverne Gervais: There is so much stigma around sexually transmitted infections, generally. There is so much stigma, racism, and discrimination just in general for being a young Indigenous woman, that to combine that on the outside role, and then to not be able to go into a healthcare facility, and to be assured that that won’t be there either is not guaranteed. So essentially, there’s a feeling that there’s as much stigma inside the healthcare institution as there is on the outside. So at the end of the day, sometimes people are weighing up. You know, like, is it worthwhile for me to go and seek care when I’m going to be treated so badly anyways? I’ll just, you know, forget about it. Or I’d rather just not know, because why get my name officially – or to get my identity officially attached to this illness? I’m thinking of the constant conversations I’ve had with young women of – like, it’s something else to put on top of me; another yuck to put on top of me. And I’d really rather not know then. Which is not the most effective way of promoting healthcare.
Many young women are very active agents in their own healthcare, but accessing their experiences and accessing services is sometimes enough of a deterrent to just say forget it. So not only if you had the stigma of being sexually active, potentially, and everything that – all of those really negative stereotypes around female identity, you’re also going to potentially be judged for using or not using contraception. But then you’re also potentially facing being judged on using drugs, if that’s how it came into play, because now syphilis and intravenous drugs are now being more closely associated and linked. So there’s so many things you have to think about, you’re being judged on, when you walk into any room – and especially a doctor’s room, right?
So when I think about how much education is actually out there, how much miseducation is out there, my experience is also with youth that are not engaged in educational systems, which is traditionally how that’s – education is given out or disseminated, right? People go into the schools and they educate on that. But if you have a lot of youth that are, like, say for particular, are struggling or having to deal with having to be in CFS care, or they are just avoiding school altogether, because schools tend not to be safe places sometimes too. The question is where are they getting that education as well?
And so they’re not maybe getting all of the information they need. So there’s been some great work in peer stuff, where peers are educating and informing each other. And that needs to be increased too. It’s one of the best ways to kind of get in contact with youth. So that’s one of the other barriers to promoting sort of a health reproductive justice sort of approach to healthcare, to their sexual healthcare needs.
Neufeld: So what do you think are the ways to support Indigenous women who have or are at risk for syphilis?
Gervais: Indigenous women know what they want. You know, they have their own agency. Like, we know our own bodies. We know what we need and respect that when we walk into a doctor’s office that we are actively engaged in our own healthcare, that we are capable too of our own healthcare, and have our own ideas and goals for our own healthcare. That’s first, so when people just walk into, you know, a doctor’s office, that they be treated with respect. Like, they are educated – we are educated, we’re smart, we come in with our own cultural ways. Or we come in with our own healing methods as well, and we’re there for some additional support. In many cases, it’s that: It’s additional support.
People are in vulnerable situations, and that’s when they deserve to be treated – you know, especially with some safety and concern. Like, we’re not disposable, we’re not vacant of feelings. What I say when I mean that is I’ve heard too many stories of women who felt like they’ve been poked and prodded like they have no feeling and no consideration for their feelings, for their sense of pain, quite literally. You know, they’re there for support in their health. If they’re there, be happy; they’ve just walked in the door – like, that’s pretty cool. You know, treat them as active agents in their own care, engage and talk to them about their ideas in their own healthcare. I think that could go a long way, especially for young Indigenous women who, you know, have to deal with enough negative stuff thrown at them every day, violence thrown at them every day. Changing our approach to sex being stigmatised, and also substances being stigmatised and using substances.
Like, if we could get rid of the stigma, we might have a better chance of getting these illnesses under control or under – like, brought there. There’s some general harm reduction practises and strategies, but the greater one, that bigger system change towards the stigma of these illnesses, of the use of these – substance use and all of that. That’s going to be – that’s what needs to happen for those rates to really – those rates to really come down. Based on my experience with HIV, one of our challenges has been – and when you ask about supporting Indigenous young women or Indigenous women, it’s getting access to the other traditional or Indigenous ways of healing. Because really, this other method, this Western method is really – and like I was saying before, it’s a way to assist, to help support your healthcare needs.
But we often don’t get enough support to enable people to access Indigenous methods. That’s again about relationships, it’s about developing – getting to know the different people in our community, and respecting the way – their ways of healing. These are valid ways that people have been using for centuries, to help in their own healthcare. Because that’s a huge part of our healing process. And in many cases, sometimes that’s, unfortunately, still a lot of people living without the connection to their culture and their sense of identity, sense of belonging. And that’s… I mean, for our agency, that’s really important to be there; but also, that’s what some of our young women are calling for as well – like, to not only be treated with respect for themselves, but also have access to the resources that are out there in a way that meets them where they’re at in some ways, right? So where they feel safe, where they feel welcomed as well.
Neufeld: So what role do you think that your organisation or other Indigenous organisations can play in providing services to the community?
Gervais: It’s sort of ensuring that we have some voice at the decision-making tables, at the policy tables, at the health tables. Culture is a huge part of what we do. It’s a huge part of who we are. So we look at health in a very – like, they use the term “holistic way,” right? There’s more to an individual than just their physical health. So like STBBIs tend to be a very physical health approach. There’s also the mental, spiritual, and emotional components that often get left out of health. And some of it gets – you know, there’s the emotional or mental health components, so – but everything is separated. And so we try to – when we do our work and our cultural work is bring all of those aspects together, including especially spiritual aspects, however an individual defines spiritual, right? Because it’s, for us, spirituality is, a big part of it is relationships and developing relationships with community. And we don’t have clients, which is a very common phrase or reference to the people that walk into a medical facility. We have participants; but more importantly, we have people that we also view as relatives – sometimes quite literally, sometimes just in that sort of basis of understanding, Indigenous way of understanding, is that these people are our relatives. Yeah, there’s too much of an individualist approach in health.
And really, it’s about a community taking care of each other, right, and taking accountability for each other. And that’s what a lot of our Indigenous agencies and organisations here in Winnipeg do – and us as well – is just try to create safe spaces for our people to come here, to come together, to have a place where their voices will be heard, their experiences heard and acknowledged, and respected.
Neufeld: So what can public health personnel and primary care providers do or learn to work with agencies such as yours, to stop or slow the progression of syphilis?
Gervais: The TRC [Truth & Reconciliation Commission] has a series of calls to action [PDF]. And it’s surprising how few people have actually maybe read it, because you know, if you are having to educate people who have no idea of what colonization is or who don’t know about residential schools or who don’t know so many things about basic Canadian history, right? So every time you’re going in, you’re having to educate people on your reality, on your own history, on your own culture. And that’s exhausting.
So there’s lots of little things, but I think right away, I think that simplest one people can do, easily accessible one is – ’cause they’re online, you can go on the Truth and Reconciliation [website], and there’s definitive health ones in there. So I think there’s a lot of self-education that could be done, taking that responsibility to educate yourselves. Or I say “you” in terms of the health personnel. Yeah, just kind of read up a little on that. I think that would be like a great first step. Or not even first step, but a great step, period.
That concludes our conversation with Winnipeg-based sexual health educator, Laverne Gervais; the first in our series on syphilis and public health. A production of the National Collaborating Centre for Infectious Diseases in conjunction with the National Collaborating Centre for Aboriginal Health, this content has been made possible in part through a financial contribution from the Public Health Agency of Canada. Note that the views expressed here do not necessarily represent those of the Agency. The host organisation of the NCCID is the University of Manitoba. Learn more at NCCID.ca.