Abstract
A national approach to addressing sexually transmitted and blood-borne infections (STBBIs) was recently articulated in the Public Health Agency of Canada’s new A Pan-Canadian Framework for Action: Reducing the health impact of sexually transmitted and blood-borne infections in Canada by 2030. This Framework promotes an integrated approach, with a focus on the key populations that are affected by overlapping epidemics (i.e., syndemics). We advance the idea that integrating surveillance would be helpful in characterizing and understanding the populations, locations, risk behaviours and other drivers that contribute to STBBI syndemics. The creation of matched or linked data systems that would allow routine reporting of integrated data is challenged by the technical barriers of integrating data silos as well as by the privacy and ethical considerations of merging sensitive individual-level data. Lessons can be learned from jurisdictions where an improved understanding of syndemics, through integrated STBBI surveillance, has led to more efficient and effective operational, program and policy decisions. Emerging enablers include the development of data standards and guidelines, investment in resources to overcome technical challenges and community engagement to support the ethical and non-stigmatizing use of integrated data. The Framework’s call to action offers an opportunity for national discussion on priorities and resources needed to advance STBBI syndemic surveillance for local, regional and national reporting in Canada.
Highlights
We applaud the Public Health Agency’s new document, A Pan-Canadian Framework for Action: Reducing the health impact of sexually transmitted and blood-borne infections in Canada by 2030, as a roadmap for federal, provincial/territorial and local public health jurisdictions to consider in their efforts to reduce the health impacts of sexually transmitted and blood-borne infections (STBBIs) in Canada [1]
Singer used the interaction of human immunodeficiency virus (HIV) and tuberculosis (TB) co-infections to typify the adverse interactions between two diseases, and the common conditions of health inequity that contribute to their clustering and spread [3]
Alberta’s 2013 Annual Report on sexually transmitted infections (STIs) and HIV included a matched analysis of the prevalence and timing of STI co-infection in individuals diagnosed with HIV between 2005 and 2013 [14]. These results demonstrated a change over time: before 2007, the majority of individuals were diagnosed with an STI before or at the same time as their HIV diagnosis, whereas in 2013, individuals were twice as likely to have been diagnosed with an STI after their HIV diagnosis
Summary
We applaud the Public Health Agency’s new document, A Pan-Canadian Framework for Action: Reducing the health impact of sexually transmitted and blood-borne infections in Canada by 2030, as a roadmap for federal, provincial/territorial and local public health jurisdictions to consider in their efforts to reduce the health impacts of sexually transmitted and blood-borne infections (STBBIs) in Canada [1]. Singer used the interaction of human immunodeficiency virus (HIV) and tuberculosis (TB) co-infections to typify the adverse interactions between two diseases (i.e., the more rapid progression of symptoms and illness occurring from concurrent infections versus single infections of either), and the common conditions of health inequity (e.g., poverty and marginalization) that contribute to their clustering and spread [3]. In a more recent example, a study from British Columbia characterized the epidemic of syphilis among gay, bisexual and other men who have sex with men, and its associations with substance use, mental health and co-infection with HIV. Applying a “syndemic lens” enhances efforts to measure and address known risk factors for single diseases by characterizing their multiplicative effects and impacts across diseases
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