Syphilis and HIV in Windsor-Essex County
Syphilis and HIV are sexually transmitted and blood-borne infections (STBBIs) of public health significance. Although they are largely preventable, data for these infections in Windsor and Essex County (WEC) is showing cause for concern. Syphilis cases are steadily increasing at a significantly higher rate when compared to Ontario incidence rate. Between 2017 and 2019, there was a 134% increase in syphilis infection rate in WEC, compared to a 25.6% increase in Ontario. There has also been a recent increase in local HIV cases. From January 1st to March 31st, 2021, there were 9 cases of HIV reported in WEC. In comparison, there was an average of 4.6 cases in the first quarter of the previous 5 years, with a range of 2 to 7 cases.
The majority of syphilis and HIV cases have been found in men, although women are also at risk. Between 2010 and 2019, men comprised 81% of syphilis cases in WEC, and all cases of HIV in the first quarter of 2021 were men. Syphilis can also increase the risk of HIV infection. One-third of the HIV cases diagnosed in the first quarter were found to be co-infected with syphilis. Individuals at highest risk for syphilis and HIV infection share the same common risk factors. These factors include: engaging in unprotected sex (vaginal, anal, and oral), men having sex with men, and having sex with anonymous/multiple partners. Among the recent HIV cases, 78% reported having anonymous sex. This increasing trend of engaging in sex with anonymous partners found on the internet has created challenges in being able to notify contacts of exposure.
The Infectious Disease Prevention department is developing a sexual health strategy to address the increased prevalence of syphilis and HIV in WEC. One key part of this strategy was the creation of a Sexual Health Advisory Committee to increase stakeholder collaboration. Membership includes representatives from community partners such as the HIV Care Clinic, the Windsor-Essex Community Health Centre, Pozitive Pathways, as well as WECHU nurses who specialize in sexual health. A survey was recently conducted with the committee to identify factors that have contributed to the increased syphilis rates. Survey findings highlighted a significant lack of knowledge and awareness of syphilis among the general population and local health care providers. Specific barriers to testing, treatment, and safe sex practices were also identified. The data collected from the advisory committee, along with data previously collected from Clinical Services clients, is being used to further direct the sexual health strategy.
Moreover, interventions to increase public awareness are currently in progress. Strategic planning for a social media campaign is underway, and social media posts will soon be shared on the WECHU’s Facebook, Instagram, and Twitter accounts in order to engage our community. The media campaign will focus on increasing knowledge and awareness regarding risk factors and infection prevention, as well as increasing testing and treatment. The WECHU will also be collaborating with Pozitive Pathways in an upcoming podcast and various webinars to target high-risk individuals. Targeted advertisements for high-risk populations will also be placed on Grindr, an online dating site for men who have sex with men. Furthermore, the Windsor-Essex Pride Fest is held in August and initiatives are underway to actively participate in the community event.
Currently, all syphilis cases are referred to the WECHU for treatment and follow-up. The Clinical Services Nurse Practitioner will also be providing educational sessions for the testing, treatment, and follow-up of syphilis to key health care providers in the community in an effort to build capacity. Additional strategies to support health care providers and increase capacity in sexual health services are continuing to be explored.