If public health nurses go on strike next month as planned, Toronto will likely see a spike in sexually transmitted infections, says one Toronto Public Health nurse.

TPH is currently studying the rate at which STIs occurred after the 2009 Toronto city workers' strike. The data, which has not yet been released, shows there was an increase, says the nurse, who asked to remain anonymous to protect her job.

For 36 days in the summer of 2009, Canadian Union of Public Employees (CUPE) Local 416 and Local 79 -- representing inside and outside city workers -- were on strike. 

“There were only two managers servicing the entire public health STI program," the nurse says. "The official statement at the time was that all STIs are being followed up. It was a bold-faced lie." 

The STI program is responsible for all follow-up calls relating to new STIs, she says. There are six reportable STIs: HIV, syphilis, gonorrhea, chlamydia, chancroid (which is not found in Toronto) and hepatitis B.

"When a person is [diagnosed with an STI], we get a copy of the lab report and ensure people got treated, and with the right medicines, because that's not always the case. Then we do all the contact tracing, making sure that every person that has potentially been exposed knows to get tested."

That potentially life-saving service is not happening during a labour disruption, the nurse notes. “Also, a person with HIV may not want to out their status, so we will do it anonymously on their behalf. We call and say, 'We can't tell you who, but we have reason to believe that you need to go get tested for HIV.'”


While on the phone the nurse will explain the situation, perhaps do some counselling and later follow up. That call prevents countless others from infection, she says. “If we're on strike, all that work is being done by a couple managers, and they really can't do mass contact tracing. So there will be a lot of people out there who have been exposed and won't know. And they will likely transmit STIs to other people. The impact is clear. When we're on strike, that contact tracing is not happening.”

Toronto workers could face another lockout or strike as early as Feb 5. CUPE Local 416, representing 6,000 outside workers, has offered a wage freeze to settle its contract. The city has refused and countered with a proposal to strip most workers of a job security clause. Talks continue with CUPE Local 79, which represents 23,000 inside workers, including TPH and frontline nurses.

AIDS Action Now’s Tim McCaskell says Mayor Rob Ford’s plan to reduce or contract out city services, particularly frontline health workers, puts many lives at risk.

“This dramatically illustrates that the kind of cuts that Ford is contemplating and the kinds of attacks on city employees are a danger to everybody’s health. Not only will it cause misery and poor health to more people, but it also affects Toronto’s bottom line in increased medical expenditures.”

Effie Gournis, manager of the communicable disease surveillance unit at TPH, has been working with Dr Andrew Pinto, from St Michael’s Hospital on a project. The findings will not be ready for publication for about a year, Gournis says.

“The study we are looking at, even in its preliminary form, shows there was an increase in some STIs after the strike,” she says. “It shows there were missed opportunities during the labour disruption to prevent further infection.”


There is no way to say definitively that the spike was caused by the labour disruption, she stresses, but there is “quite likely” a connection, particularly with young people 24 and under.

“I can tell you that preliminary data did show an association with an increase in chlamydia in the younger age group,” she says. “It is much more difficult with HIV because there is a longer period between the acquisition and when they find out about it, which could be years after they got it.”

Gournis says the study highlights the important work done by city frontline staff. “There is evidence to support these city services' work, so having to scale back on those services for any reason can result in increased risk to the population of Toronto. This study underscores the value of the work we do at Toronto Public Health.

“Any kind of cut that prevents us from offering programs that have been shown to work repeatedly are a threat.”

Each HIV infection costs the city $1.2 million, says Ward 27 Councillor Kristyn Wong-Tam. "That's what it costs to care for someone with HIV." Preventing even one infection is a financial savings for the city, she says.

Wong-Tam says TPH has similar concerns with bedbugs, which is an escalating problem in the Church and Wellesley area.

“It's very difficult to stay on top of it. In an apartment building, it's very likely that will spread, so you need people trained and ready to go,” she says. “We are losing the war against bedbugs now. Can you imagine if we remove public health staff that help people unable to take care of themselves? All it takes is a lockout and we will definitely fall very far behind."

At the Hassle Free Clinic, health information custodian Jane Greer says staff felt the pressure from the heavy overflow in 2009. The strike put a major strain on all sexual health services in Toronto, she says. Greer worries how long the community will be without sexual health services this time.

“My biggest concern is people have less access to testing, because it’s not just nurses; it’s all the Toronto sexual health clinics. If those [city] clinics are closed like they were before, clinics like ours are completely overwhelmed. Everyone talks about the garbage. No one talks about sexual health.”

During the 2009 strike, all city-run sexual health clinics, which provide testing for STIs, pap smears, birth control and emergency contraceptive pills, were closed, and many other clinics that partner with TPH operated at reduced capacity.

“Not everyone has a family doctor,” Greer says. “People depend on community-based clinics. Even if people access testing, can they access the appropriate treatment during a strike? We lose access to testing, access to treatment and yes, access to partner notification. It’s multifaceted if those services go on strike.”
 
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