Syphilis is spreading at advanced rates in the Cree Nation of Eeyou Istchee and healthcare workers say the stigma around sexually transmitted infections [STI] is partly to blame.
That’s why the Cree Board of Health and Social Services of James Bay (CBHSSJB) wants to get the word out that syphilis is a simple bacterial infection that can be cured with as little as a single dose of antibiotics.
“This is part of a national trend, and we are working with provincial and federal level partners,” said Marie-Eve Perron, RN, nurse-counsellor with the CBHSSJB’s public health department, “[but] also for other STIs. This is something that we see for chlamydia and gonorrhea as well.”
Perron said the CBHSSJB has seen the same number of syphilis cases in the last four months that it has seen in each of the past four years.
The Cree Nation of Eeyou Istchee consists of nine member-nations around the east coast of James Bay in the north of Quebec. Because some of the individual communities are quite small, and syphilis is associated with such negative stigma, the CBHSSJB doesn’t share case counts per community.
Perron said the CBHSSJB’s most recent awareness campaign is hoping to reach a new patient.
“What’s changing is that people who were traditionally at higher risk for STIs are not driving the increases,” she told APTN News.
In other eras, she said, STIs were more prevalent among men who have sex with men, people of all genders who have many sexual partners, and people who have sexual contact with people they don’t know very well (like partners met on dating apps, or while travelling).
“But now we see that it also includes women and infants,” Perron noted, “because you can have congenital syphilis, which is the transmission from the mother to the infant during pregnancy or at birth.”
Syphilis is caused by a bacterium called Treponema pallidum.
“It’s transmitted through vaginal, anal and oral sex, but also it can be passed through skin-to-skin contact if there’s a skin lesion or a rash,” Perron said. She noted the condition is often called “the great imitator,” because its symptoms are vague and can easily appear to be those of other illnesses, allowing it to go undetected for a long time.
“It’s really hard to diagnose,” Perron stressed. “That’s why we emphasize the importance of getting tested, because it’s really the only way to know if it’s syphilis or not.”
Even if its symptoms are vague, syphilis will not go away on its own. The bacteria can remain in the body for years, with the potential to cause serious illness.
“[Over] many years,” she said, “it can lead to damage to the brain, to the heart, and other organs, and blood vessels.”
The awareness campaign, which includes pamphlets and social media posts, emphasizes the use of condoms to contain the spread of syphilis, as well as routine STI testing.
“We really aim to normalize the screening, the treatment, and the conversation that goes with it,” Perron explained. “Syphilis is an infection. It can be compared to other infections. It’s not because it affects genitals or it’s related to sexual health that it should be stigmatized.”
Emma Antoine-Allan is a member of the Native Youth Sexual Health Network (NYSHN), a youth-led group working to improve sexual and reproductive health for other Indigenous youth in Canada and the United States.
A youth holds up a beaded condom during an Indigenous sexual-health workshop. Photo: Native Youth Sexual Health Network
Antoine-Allan (who uses they/them pronouns) said syphilis and other STIs are spreading in non-Indigenous communities as well.
But there’s a difference in the variety of medical services available to Indigenous youth, along with less privacy and sometimes more gossip. Even ground-breaking initiatives for remote reserves and towns, like a project for mail-in STI tests that began in northern Alaska, need to be scaled to specific needs of people living in those communities.
“It’s challenging if you’re living in a multigenerational home,” they said.
“And, if you’re in a tiny fly-in community, you have to really trust that whoever is handling your mail is being discreet. So they actually shifted their program to [emailing] your results or [calling in] your results and making sure that it’s you on the phone.”
Antoine-Allan, who is Anishinaabe, said their organization hopes to challenge the very stigma that makes STIs difficult to talk about. In order to do that, they say, health-care advocates have to provide STI services in culturally safe environments.
“Having somebody who can speak your language,” they suggested, “or having somebody who’s familiar with how it is to greet you—[serving] coffee or tea, you know? To have a conversation and watch your kids with you while you get tested. It’s a really transformative experience that ideally all of us would deserve in our communities.”
Another piece for the NYSHN is to bring their message to where people are already going. Because free beading workshops bring out more people than free sexual health talks, the NYSHN offers workshops in beading condoms.
“Obviously they’re not usable!” Antoine-Allan said with a laugh. “But you get a little medallion that you can wear to the powwow.”
Another successful move for the NYSHN has been bringing sexual health messaging tables to community bingo, because that’s where everyone in the community is going to be. They’ve found success giving out free bingo-dabbers to attendees who come over to talk.
The key, Antoine-Allan said, is not to focus on the rising STI rates, but to tie community health responses to the ways communities are already thriving.
“Where I’m from,” they chuckled, “we thrive at bingo.”
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