HALIFAX • 2018-06-11 • Jordan Parker
The Halifax Sexual Health Clinic has suspended drop-in blood work.
"We have had to temporarily suspend the services due to our nursing staffing issues. We do not have the funds currently to support the drop-in blood services," she said.
"We have had problems with recruitment, as well as an increase in expenses due to compassionate programs and other services, including the safe sex program."
Though government funding has stayed the same, Calnan says it has not gone up with inflation.
"Smaller grant funds were lost because we were no longer eligible, and we asked for an increase from the Nova Scotia Health Authority and government to sustain our collaborative practice."
But after denials on all fronts, she says they're already stretching the resources they have.
"Right now, we have one permanent nurse on staff. Our funding comes from community and government grants, donations and fundraising. But we would need another one to replace the one who left," Calnan said.
"Nursing plays a larger role. It's up to nurses to monitor lab results. If something can't wait a week until a physician comes back, it's handled by a nurse. They monitor and respond to the phone line and support the clinic side."
They are offering blood draws on Tuesday, but drop-ins have been suspended since the end of April, and will be offline until the end of June.
"The HIV and STI program is strictly nurse-run, and when they're doing that, they can't do other tasks. With one nurse on alone, it's increasingly more difficult to do drop-in services," she said.
For a member of the LGBTQ+ community with former ties to the clinic, the problem goes much deeper than this hiccup: it's a mismanagement of resources.
"The issue is if you go in there, you'll spend an hour being educated before you even get your test. They also focus on helping everyone, and there should be more accessibility for people in the higher risk categories, including intraveneous drug users, First Nations people and gay and trans men," the source said.
"There was a clog long ago as well, and when you're waiting three weeks for an appointment, you may not even show up. Nurse availability is so difficult too."
He suggested education pieces in appointments be reduced by 15 minutes each, to allow more people through the clinic.
"You should be able to opt out, or should have the knowledge you can do so. If you've been gay your entire life and getting tested regularly, it shouldn't be an issue to say you know the risks, and ask for just the blood work," the source said.
"When you're doing blood draws and flobotomy, that requires special training. Then STis, dealing with pregnancy and counselling is another strain. There's just so much going on there, and those who may really need HIV testing have limited time."
The source suggested that there be a larger focus on the LGBTQ+ community when a nurse does get hired.
"It's been this way for a long time, with pregnancy and condom use for straight couples a large part of the equation. Is the clinic the ideal spot for blood testing for gay men? Maybe not. But this really has to be prioritized," said the source.
"Maybe just pick a Thursday, and make it for gay men or men only, and get people to drop in. That way those who are at more serious risk can get testing when they need it."
Calnan, when asked about shortening education in sessions and making more space for gay men and risk groups to get tested, was open to all possibilities.
"Individuals do consult us about birth control options, prescriptions, and we have transgender clients too. We discuss sexual and reproductive health as well as do STI and HIV testing and treatment," she said.
"When we were doing drop-ins, there was a protected period, but it was never isolated to one demographic. Some people prefer not to identify in the room, and wouldn't want their sexuality to be known, so that could be an issue."
She said they could consider their options after dealing with the staffing task at hand, but said cutting education down comes with its own issues.
"When discussing pregnancy, sexual health, HIV and STIs, it can be a nerveracking experience. That's where education can be helpful," she said.
She maintained that keeping people informed was important.
"We do education because we want to adhere to a standard of care, and we want clients to have accurate and valid sexual health information. We need people to understand risks and be safe. We don't want people just coming in and out, and education is crucial," she said.
"There are certain steps we also need to follow for anonymous or non-nominal testing, and we do need to remind people of some risks. We could look at some changes, but we'd still need to maintain that standard of care without keeping people too long."
Calnan believes there's a responsibility within the Nova Scotia government to help these health services thrive and continue.
"There's a need for the government departments and the health authority to support in whatever way they can. We are trying to provide service and quality, and nurses add so much," she said.
"We are currently hiring for a casual sexual health nurse for the summer, but that's also to contend with staff vacations. We need to get some help to continue to give the services we offer."
Chris Aucoin, the Gay Men's Health Coordinator with the AIDS Coalition of Nova Scotia, says this staffing issue is just another in a long history of Halifax's issues with access to HIV testing.
"It's always been a barrier in terms of HIV, and testing is something we push for on a regular basis. But beyond this speedbump at the clinic, testing can be limited at the best of times in the province," he said.
"We are painfully aware of the broader concern that there are so few options, and this news just takes another one away. Sadly, because the LGBTQ+ community has been used to these difficulties for some time, that's now the expectation."
Aucoin said if access isn't the issue, then discretion is the next concern.
"The Dixon Building does a broader STI clinic, and other than that, you need to see a general practitioner. But for those sensitive about people knowing their business -- around their sexuality and HIV status in particular -- these options can be problematic," he said.
"I do online outreach on Squirt and Manhunt, and one of the largest concerns is, 'where do I go get tested where everyone won't know my shit?' It's so prevalent, and it's not a unique question."
He says with so much of the population in rural areas, things get more complicated.
"Even if there's a clinic or a doctor in Kentville, say, that someone can go to, a man may not want to see them. Maybe the doctor knows who they are, or knows who their father or wife is," he said.
"Discretion is so big, and it's so hard to find somewhere to get that. This bottleneck at the Sexual Health Clinic here just makes the issues that were there more pronounced in the short-term."
Aucoin remembers at one point PrideHealth has a part-time nurse to draw blood in queer spaces, but that also fell victim to perilous circumstance.
"She made herself available, but it had its own built in limitations. She went to the Youth Project and the bath house at designated times. But the position went vacant and all their momentum was lost," he said.
"That's the only time in the last decade we had someone taking blood where it was specifically for the queer community. I'd love to see it revived in some way, and in my conversations with the clinic executive director (Kate Calnan), she appeared receptive."
Aucoin understands all too well the problems that come with being a non-profit, and sympathizes with the clinic.
"The coalition here is also underfunded, and we didn't get a grant and moved offices last week as a result. The reality is both organizations can't do everything we want to do. We have to make difficult judgement calls that affect things in the long-term and the short-term," he said.
"The resources are already inadequate and they're shrinking. Part of my job is to encourage people to get tested, but if their options continue to be limited, it becomes an exercise in futility."'
