Women's Health Care And Politics
During the 2018 New Brunswick provincial election cycle, access to healthcare services, or a lack thereof, was addressed by all political parties in their political platforms. This paper will examine the political platforms of three New Brunswick parties in relation to access to female health services, focusing on screening and treatment for Sexually Transmitted and Blood Borne Infections (STBBIs) in biological female individuals, aged 18-24, who use intravenous drugs.
Although other STBBIs will be mentioned, this paper will primarily focus on human papillomavirus (HPV) screening for women, due to its relevance to this particular population. The role of the nurse in providing alternative avenues of care will be identified, with suggestions to make STBBI screening more accessible to women aged 18-24 who use intravenous drugs. Identified Population STBBIs are sexually transmitted and blood borne infections, with sexually transmitted infections that are transmitted between people through the exchange of bodily fluids such as semen or vaginal fluid, and blood borne infections transmitted by contact with contaminated blood (MacLean, 2018). There is a correlation between women who use intravenous drugs and increased rates of STBBIs, due in part to an increase in risky behaviour patterns in this aggregate, such as multiple sexual partners, unsafe sexual practices, trading of sex for drugs and sharing of needles (Khan, et al. 2013). Women aged 18-24 who use intravenous drugs also have an elevated risk of negative physical and mental health outcomes and have been found to frequently engage in the sex trade industry, further increasing their risk for contracting STBBIs (Rash, Burki, Montezuma-Rusca, & Petry, 2017). In Canada, twice as many new HIV infections in females could be linked to intravenous drug use than in men (CATIE, 2018). Women aged 18-24 are considered to be at the peak of their reproductive age, and many STBBIs have long-lasting negative effects on the reproductive health of women (Khan et al. , 2013).
STBB
Is in Women Aged 18-24 The most common blood borne infection in Canada is Hepatitis C, which can be spread through the use of needles used by a carrier of the virus, that be detected through serology (Government of New Brunswick, 2016). The most commonly transmitted sexually transmitted infection is Human Papillomavirus (HPV), with 70% of women contracting HPV during their lifetime (Government of Canada, 2017). In Canada, women under the age of 24 have the highest rates of HPV infection compared to any other age group (Fernandes, Potter, & Little, 2018). HPV is spread through sexual contact and can cause genital herpes in both males and female, with certain strains of the virus acting as a causative agent for several types of cancer, including cervical cancer in females (Shapiro, Perez, & Rosberger, 2016). Many women with HPV do not show symptoms, so the virus is often detected during a routine Papanicolaou (Pap) test (Government of New Brunswick, 2017). The Society of Obstetricians and Gynaecologists of Canada (2015), describe a Pap test as “a simple internal exam used to detect abnormal changes in the cells of your cervix” and recommend that women have Pap tests every three years after age 21 or within three years of becoming sexually active.
For women aged 18-24 who use intravenous drugs, there may be challenges in accessing services such as Pap tests and other STBBI screening tests, resulting in the potential for undetected and untreated STBBIs. The Government of New Brunswick (2013) describes an upward trend in both chlamydia and gonorrhea rates in the province during the last decade, stating “young persons aged 15 to 24 make up a large proportion of the 1,923 cases of chlamydia diagnosed in the province in 2012 […] and females accounted for 73% of them” (p. 4).
Liberal Party Platform
The Liberal Party’s platform states that “since 2014 [they have] eliminated barriers to access reproductive health” (New Brunswick Liberal Association, 2018). When contacted and asked to clarify the statement found on his party’s political platform, Quispamsis candidate Aaron Kennedy stated that “in 2014 the Liberal party made abortion services accessible to women in New Brunswick in the hospital setting” (personal communication, September 16, 2018). When asked what his party was planning on doing to address the barriers to accessing female health services such as Pap tests after the coming election, Aaron Kennedy replied “the liberal party does not plan to undo what it has already done” (personal communication, September 16, 2018). Gerry Lowe, Liberal candidate for Saint John Harbour, described a need for more accessible screening services for sexually transmitted diseases and cervical cancer, especially in women of childbearing age (personal communication, September 17, 2018). When asked whether the liberal party would be open to exploring funding alternative avenues for screening services for women aged 18-24 who use intravenous drugs in the Saint John area, Gerry Lowe responded “we will have to see what happens after the election” (personal communication, September 18, 2018).
Progressive Conservative Platform
The Progressive Conservative (PC) party plans to “establish a provincial advisory council on women’s health” as well as “enhance the health system’s responsiveness to the needs and concerns of women and girls” (Progressive Conservative Party of New Brunswick, 2018). PC candidate for the Saint John Harbour riding, Barry Ogden, described how the party is dedicated to addressing gender as a variable that is a key determinant to the health of an individual (personal communication, September 16, 2018). This is a reiteration of the platform found on the PC’s website, and Barry Ogden was unable to elaborate further on what specific actions would be taken to address this variable; however, he did describe a mandate to establish a trust, with an initial endowment of $5 million, to fund research related to women’s health (personal communication, September 16, 2018). The topics of research for this trust were not immediately available, although the need to have women describe their primary health concerns to direct research was emphasized, although Barry Ogden was unable to provide any form of timeline for this (personal communication, September 16, 2018).
Green Party Platform
While the Green party does not have any part of their platform that specifically relates to female health care services, they have promised to “create 40 new nurse practitioner positions and allow nurse practitioners and pharmacists to bill Medicare for health services to reduce wait times for primary health care” (Green Party of New Brunswick, 2018). Mark Woolsey, Green party candidate for Quispamsis, emphasized a need for primary health care providers within the province for the general population, but stated that funding could be allocated specifically for reproductive health services such as STBBI testing and Pap tests at walk-in clinics and sexual health clinics if it was thought to be beneficial to the community it is located in (personal communication, September 18, 2018). When asked about funding or resources specific to women aged 18-24 who use intravenous drugs, Mark Woolsey stated that resources would not be allocated to a specific population, but that allocation of resources would be decided in conjunction with community health care providers familiar with needs related to a specific geographic area (personal communication, September 18, 2018).
The Role of the Nurse
The Nursing Association of New Brunswick (2012) states that registered nurses have the responsibility and accountability to “advocate for and contribute to the development and implementation of policies, programs and practices relevant to practice setting and the nursing profession” (p. 9). It is the duty of registered nurses to be aware of the issues and challenges that each community faces and be champions of equity for those who need it most. One way that registered nurses can address the issue at hand is by being vocal during election cycles, asking representatives what their stance is regarding the problem and finding non-traditional avenues to deliver care to at-risk populations, such as women who use intravenous drugs. Gardasil 9 is a vaccine offered to women aged 9-45 years, and men aged 9-26 that can provide protection against 9 strains of HPV that cause up to 90% of cervical cancer cases, as well as reducing the rate of genital warts by 90% (Society of Obstetricians and Gynaecologists of Canada, 2015).
One non-traditional avenue of care option discussed is the idea of increasing the availability of Gardasil 9 in conjunction with education offered to parents of youth. Education for parents is required due to evidence showing parental conceptions of the HPV vaccine include the belief that it will increase the rate of adolescent sexual behaviour; this is preventing children from being vaccinated due to lack of parental consent (Morris & Nguyen, 2008). Gardasil 9 is offered for free to youth of New Brunswick during grade 7 (Government of New Brunswick, 2018). If an individual does not receive the vaccine through New Brunswick Public Health, the out of pocket cost is between $400 and $500, making the vaccine unaffordable for some individuals (Shapiro, Perez, & Rosberger, 2016). Another possibility for addressing the issue of accessing female health services is to fund non-traditional avenues of care for screening and treatment of STBBIs, such as walk-in clinics. While there are sexual health clinics in Saint John, developing resources in areas identified by the population may be an option, such as at local clinics already utilized by this population. Women who use intravenous drugs may have less insight when it comes to their sexual health, and providing accessible walk-in services is a way to provide them with immediate sexual health screening and treatment. Providing free condoms at these locations, as well as increasing availability of safe injection materials, may also address this issue through harm reduction techniques.
Conclusion
Political parties in New Brunswick made many promises related to access to women’s health initiatives, but few were able to elaborate on their promises with anything concrete. Access to primary healthcare is hard to come by across Canada for vulnerable populations, including women who use intravenous drugs, and inadequate availability of services can be detrimental to their long-term health. Funding alternative methods of care related to screening and treatment of STBBIs in this population would improve access, as well as take pressure off the traditional health care system.
