Experts say official case counts for some infectious disease in Saskatchewan don’t tell the full story.
Saskatchewan health ministry data indicates over the past three years, syphilis has skyrocketed, while cases of HIV and hepatitis C appear to have dropped.
Preliminary data shows 843 cases of syphilis were confirmed in 2020, up from 390 in 2019. Last year, 175 people were diagnosed with HIV and 438 with hepatitis C, down from 199 and 655 in 2019, respectively.
“We do know that’s an artificial dip,” said Dr. Ibraham Khan, Saskatchewan medical health officer for Indigenous Services Canada (ISC).
“The numbers are really high, but as you do more tests, you will find more.”
Some lab testing capacity was diverted for COVID-19 tests, said health ministry spokesperson Colleen Book. Additionally, fewer people have sought testing during the pandemic, meaning some cases go undiagnosed.
‘Alarming increase’ in syphilis cases
Health officials declared syphilis outbreaks in northwest Saskatchewan last summer — a trend Khan is troubled to see continuing across the entire province.
“The syphilis situation is very alarming in the province of Saskatchewan, but when we look at the First Nations communities, the numbers are even more alarming,” Khan said.
There were 242 syphilis cases confirmed in Saskatchewan First Nations last year, he said.
Syphilis rates are highest in major cities, and are increasing in rural areas and reserves, Book said.
“A particular concern with the recent outbreaks is the number of cases occurring among women of childbearing age and pregnant women,” she said in an emailed statement.
Last year, there were six confirmed congenital syphilis cases, according to the ministry. Two babies died from complications.
“Not every woman and man in First Nations has access to a primary care doctor,” Khan said. “That poses a major risk when somebody’s pregnant.”
Access to treatment, education and condoms is limited in some remote communities, he said, making syphilis and other sexually transmitted infections (STIs) more likely to spread.
The ISC is developing an STI outreach program with the province and public health teams on reserves, Khan said. Mobile health-care professionals will help connect people to testing and treatment.
‘Needle sharing is the main driver’
Like syphilis, HIV and hepatitis C are likely trending upward, said Viddya Reddy, education specialist with AIDS Programs South Saskatchewan.
“There’s no way that hep C or HIV would’ve come down in Saskatchewan because injection substance use and needle sharing is the main driver for these infections,” Reddy said.
The organization doled out more than 1.4 million needles in 2020, as overdoses spiked.
Of the 438 people diagnosed with hepatitis C in Saskatchewan last year, 166 reported they injected drug use, Book said.
Roughly 74 of the 175 people diagnosed with HIV in 2020 reported injected drug use. Sexual contact was the source for 79 cases.
‘Break these chains of transmission’
Reddy echoed the health ministry’s assertion that testing has dropped. AIDS Programs South Saskatchewan usually offers HIV and hepatitis C testing, but had to stop during the pandemic, he said.
Despite the murky data on case counts, Saskatoon-based infectious disease specialist Dr. Siddharth Kogilwaimath said HIV and hepatitis C are on the rise.
“Being on the front line, any one of us would tell you it really hasn’t slowed down,” Kogilwaimath said. “We’re not ahead of the HIV fight.”
Many people who are at-risk struggle with synergistic epidemics like addiction, mental illness and homelessness, Kogilwaimath said. Meanwhile, pandemic shutdowns restricted access to testing and care.
He said health officials must drive up testing to identify people in need of medication and other supports.
“We can break these chains of transmission and we can potentially get ahead in fighting this… local epidemic of HIV and STIs,” he said.
The province said it’s focused on testing, expanding hard reduction services and connecting people to treatment, along with educational campaigns to reduce the stigma.