SEXUAL HEALTH

TESTING

If you're sexually active, getting routinely tested for HIV and sexually transmitted infections (STIs) is an essential! 🙏
Think of routine testing as a part of your sexual health regimen. It’s up there with consistently using condoms and openly communicating with your partners. You can talk to your healthcare provider about what your testing routine should look like.

Getting tested may feel a bit nerve-racking the first time, but don’t sweat it! 😘 You can bring a friend to get tested with you, or you can ask a peer community worker to support you so that you have someone to chat with before and/or after getting tested – whatever helps get you there!

What’s the Deal on HIV?

HIV stands for Human Immunodeficiency Virus. We have a whole page dedicated to HIV 101. Check it out to get the deets on how HIV is passed and what treatment looks like!

It should be noted that certain sexual activities increase the likelihood of HIV being passed on. Some examples include having condomless sex with multiple partners and not being on PrEP, having frequent anonymous sex with no forms of protection (i.e. no condoms or PrEP), or engaging in sex work with no forms of protection. If any of these activities are part of your sexual routine or experiences, you may consider more frequent testing so that you can stay on top of your sexual health. It’s always good to talk to your healthcare provider to get the best recommendation for you.
What are some possible signs and
symptoms of HIV?
When HIV is contracted, some, but not all, people will develop flu-like symptoms within the first 2-4 weeks of the initial infection. These symptoms are often described as the “worst flu ever” and can include fever, swollen glands, sore throat, rash, muscle and joint aches and pains, and headache. These symptoms may last for a few days or up to 4 weeks, then disappear, even without treatment. This period is called “acute retroviral syndrome” (ARS) or “primary HIV infection,” and it’s the body’s natural first response to HIV in the body.  

Because there is NOT a universal experience of HIV symptoms, it’s even more important to use prevention methods to reduce the likelihood of passing or getting HIV, as well as to get routinely tested. Of course, if you think you’ve been exposed to HIV and are experiencing any of the symptoms described above, get tested as soon as you can!
A certain amount of time needs to pass by after the initial exposure to HIV to get an accurate HIV test result. This is because it takes some time for HIV to build up in the body before it can be detected in a blood test. This timeframe is called the window period. It varies from person to person and depends on the type of HIV test being used. The window period can range from 2 weeks up to 3 months. If you’re not sure when to get tested, consult your healthcare provider or a local HIV/AIDS service organization.

**DISCLAMER ** If you think you’ve been exposed to HIV within the last 72 hours, you can go to your doctor or a hospital and ask for a medication called Post-Exposure Prophylaxis (PEP) which can help prevent HIV.
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Real Talk on STIs

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There are many different types of sexually transmitted infections (STIs), but the most common ones fall under two kinds: bacterial vs. viral. Bacterial STIs are caused by bacteria and most can be cured by taking antibiotic medication. Viral STIs are caused by viruses, and while most viruses can’t be cured, there are medications and effective treatment options available today that can manage the symptoms and allow people to have regular sex lives and maintain their health.
The most common STIs are chlamydia, gonorrhea, herpes, HPV, and syphilis.

Looking for more info?

Read below for a detailed description of each.

When it comes to STIs, most are passed from one person to another during sexual activity, which includes oral, anal, vaginal, or frontal sex. Some STIs are passed through skin-to-skin contact.

Chlamydia and Gonorrhea

Chlamydia (the most common STI among youth in Canada!) and Gonorrhea are similar bacterial STIs that are passed through oral, anal, vaginal or frontal sex with someone who has an active infection. Both STIs can infect the throat, the genital area, and the eyes 👀 (but this is rare!). Using condoms (including on shared sex toys) and using dental dams (for oral sex) are the most effective ways to prevent gonorrhea and chlamydia.
Most people who have chlamydia and gonorrhea don’t show any symptoms, which makes getting routinely tested important! If your test result comes back positive, don’t worry! These two STIs can be treated and cured with antibiotics. It is recommended to get on treatment as early as possible to avoid more serious health issues.

HERPES

Herpes is a viral STI that affects 1 in 7 Canadians. Herpes is passed through skin-to-skin contact with infected areas. If someone has active sores or blisters, it is recommended they do not have sex while the sores or blisters are present. Still, it is possible to pass the virus even when there are no active sores or blisters. To decrease the chances of getting or passing on herpes, it is recommended to use condoms and/or dental dams, and to avoid sharing razors or sex toys. For more extensive info on herpes, check out this article by CATIE.
There are two types of herpes: HSV-1 and HSV-2. HSV-1 usually causes oral herpes and shows up as cold sores, while HSV-2 usually causes genital herpes and shows up as blisters or open sores on or in the genital and/or anal areas. You can still get HSV-1 on your genitals if your sexual partner has cold sores and gives you oral sex. Likewise, it’s also possible for you to get HSV-2 on your mouth, if you give oral sex to someone with HSV-2 on their genitals. If you notice sores or blisters on or around your genital areas, go to your healthcare provider as soon as you can to get tested. They’ll take a swab of the sore or blister.

For both types of herpes, the symptoms may come and go, and for some people, herpes can live in your body for many years without causing any symptoms. There’s no cure for herpes, but your doctor can prescribe medication to heal the sores or blisters more quickly.

HPV

HPV (AKA Human Papilloma Virus) is one of the most common STIs in Canada. Most adults have it (though the human body can clear certain types of HPV on its own). HPV is a viral STI that can be passed through oral, vaginal, frontal, or anal sex with a partner who has HPV, and from rubbing genitals or sharing sex toys with a partner with HPV. Oftentimes, HPV does NOT have any signs or symptoms, but in some cases, it can cause genital warts to appear on or in the vagina, front hole, penis, or anus. There is no cure for HPV, but if warts are present, they can be treated.
If you’re presenting HPV symptoms, go to your healthcare provider or a local sexual health clinic to get tested, which typically involves a visual inspection of the warts. There is a vaccine available that prevents some strains of HPV (mainly ones that cause cancer and/or the most common strains), which you can ask your healthcare provider for more information about. Check out this article by Action Canada for Sexual Health & Rights for more info on HPV.

SYPHILIS

Syphilis is a bacterial infection that normally shows up as hard, round spots or sores, on the mouth, vagina or front hole, penis, or anus. Symptoms can also include a rash or fever. Syphilis is passed through oral, anal, vaginal, or frontal sex when a person comes into direct contact with one of these sores. Using condoms and/or dental dams can help prevent from getting or passing syphilis. If you believe you have syphilis, it’s a good idea to get tested as soon as you can because if left untreated, it can lead to more serious health conditions.

Spotting STIs 👀

If you managed to read all the details on the most common STIs, you deserve an applause! 👏 If you’re a TL;DR kind of person or need a general overview, this section’s for you!

When it comes to STIs, it’s a good idea to regularly check in on with what’s going on down in your nether regions! That way, you can tell if something’s out of the ordinary. But remember, not all STIs show signs or symptoms, so it’s a good habit to get tested regularly if you’re sexually active.
In addition to going for routine testing, we recommend getting checked out and tested if:
  1. You have red lumps and/or bumps down there
  2. Your parts are itchy and/or sore  
  3. Your parts are leaking fluids and/or you have discharge with an unusual odour or colour
  4. You’re experiencing pain or discomfort during sex  
  5. You’re experiencing a painful or burning sensation when you pee  
Most STIs can be treated and cured successfully. It’s easier to take care of them when you detect them early and get on the medicine as soon as you can!

Where to go for testing?

HIV411.ca is the best resource for finding out where you can get an HIV test closest to you.  

Most of the time, you can get tested for STIs at the same place. But if you’re wondering where to go for STI testing specifically, you can typically get it done at clinics (including walk-ins), hospitals, and some community health centres. Check out your local public health website for more info.

Types of Tests

STI Tests

There are a few different types of STI tests, and the type you get depends on what you’re being tested for. Generally, there are urine tests, blood tests, genital swabs, and oral/throat swabs. In some cases, a physical exam by your doctor is needed, or another type of test may be used.


HIV Tests

The HIV test is a blood test. There are 3 different ways this test can be done: a standard (lab) test, a rapid test, or a self-test. Each is a little different, so we’re going to explain them below!
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Standard Tests

A standard test involves a healthcare provider drawing blood from a vein in your arm. You may feel a little discomfort when the blood is being drawn and might want to look away if it makes you nervous, but it’s not bad at all and only takes a minute or two. The blood is then sent to a lab for testing. Results can take up to two weeks.  

Depending on the clinic you go to, you may need to return to the clinic for your test result. In most cases, the clinic will give you a phone call to come in only if your test results came back positive. If you don’t hear back from them, it’s likely that your test result was negative. You can always call the clinic to confirm.  

Standard tests are available in all provinces and territories.

rapid  Tests

A rapid test, also known as a “point-of-care" test, is fast and doesn’t hurt much or at all. A healthcare provider will prick your finger for a few drops of blood, then drop the blood in a special solution. This test will provide a result within just a few minutes.

If the rapid test result is negative, the healthcare provider will speak to you about the window period and let you know if you should have a follow-up test. If the test result is positive, you will need to have a follow-up standard (lab) test to confirm that you have HIV. In this way, the rapid test is like a screening before the standard test.

Rapid tests are only available in some provinces and territories.

Self Tests

Self-tests just got approved and are now available for purchase in Canada via www.insti.com. You must be 18 years or older to purchase an HIV self-test, and the kit costs $35 plus shipping charges. More information on access to HIV self-tests are coming soon.

Like a rapid test, an HIV self-test will involve YOU pricking your own finger for a few drops of blood, then dropping the blood into a special solution. You’ll get your result within minutes.

If the self-test test result is negative, think about the window period of 3 months and if you will need a follow-up test to confirm your negative result. If your self-test result is positive, you will need to have a follow-up standard test to confirm that you have HIV. Similar to a rapid test, a self-test is like a screening before the standard test.

What to Expect: Pre and Post-Test Counselling

Whether it’s a standard or rapid test, the healthcare provider giving you the test should talk to you about your knowledge of HIV and give you some information. Before your test (during pre-test counselling), they may talk to you about:
  1. Your knowledge of HIV transmission and prevention
  2. Your behaviours related to sex and substance use that may have increased your likelihood of getting HIV
  3. How the HIV test works
  4. If/when you should come back for another test
  5. Other sexually transmitted and blood-borne infections (often people get tested for other STIs when they get tested for HIV)
The healthcare provider may also talk to you about how you’re feeling that day (like if you’re anxious or worried). They may ask you how you think you’d react if you tested positive, or if you have friends or family that you can talk to if you test positive. Remember, it is their job to help you feel as comfortable as possible during this process.

After your test, if your result was positive, the provider should offer you post-test counselling. During post-test counselling, the provider will explain the results. This may take a while, as it is meant to support the person coping with their new HIV diagnosis. Post-test counselling is also intended to link people to care and to allow people to ask questions and find out more information for next steps.

Consent in HIV Testing

All HIV testing should be based on consent! Consent here means that it’s your choice to have an HIV test, and no one can force you to have one if you don’t want to.

To give consent to an HIV test during a standard or rapid test, the healthcare provider should ensure that you:  
  1. Understand the advantages and disadvantages of HIV testing
  2. Can interpret the meaning of the test results
  3. Understand how HIV is transmitted
Just so you know, if you volunteer to have an HIV test, you are giving consent to a healthcare provider to do the test for you.

Sometimes, healthcare providers may offer you an HIV test. This can happen in a couple of different ways: HIV testing may be offered to people through opt-in testing or opt-out testing.
  1. In opt-in testing, a service provider would ask you if you’re interested in the test, and you have the choice to agree or not.
  2. In some cases, opt-out testing is offered. In this case, a provider would tell you that HIV testing is a part of routine testing for everyone, but you have the option of saying no. (If you don’t say no in this case, providers are legally allowed to do the test.)

HIV as a Reportable Illness

So, here’s the unique thing about HIV: In most provinces and territories of Canada, HIV is a reportable illness. While all HIV tests are confidential (meaning that a person’s choice to get tested and their HIV status are part of their private medical information), when a nurse, doctor, or other healthcare provider comes across a positive test result, they have a duty to report that result to public health. Quebec is only province in Canada where HIV is not a reportable illness, and your test result will not be reported to public health.

Btw, your healthcare provider should inform you about HIV as a reportable illness during pre-test counselling!
You might have heard about the partner-notification system. This system exists to notify people who may have been exposed to HIV to get tested as soon as they can. It’s kind of like the COVID app! In Canada, when you test positive for HIV, you would be asked by your healthcare provider or the public health official to get in touch with the people who may have been exposed to HIV since your last test. This would include anyone you were sexually active with, as well as anyone you shared drugs with.  

If you don’t want to be the one to let people know, you can share these people’s contact information with Public Health, and they will contact your partners for you, letting them know that they may want to get tested for HIV. They will NOT reveal your identity (including your name) to anyone. However, in cases of monogamous relationships, people may be able to guess how they were potentially exposed to HIV.

Anonymity in HIV Testing

Now that you know HIV is a reportable illness, you may be wondering if HIV testing can be anonymous, meaning your name would NOT be reported to public health? Unfortunately, there’s no clear-cut answer: HIV testing is sometimes anonymous, but it sometimes isn’t. It just depends on the clinic you go to. Plus, different regions in Canada have different rules around what HIV reporting looks like.

If you’re concerned about this, make sure you read about the options below and ask your healthcare provider about anonymity before you consent to a test.
There are 3 kinds of HIV testing: nominal testing, non-nominal testing, and anonymous testing.  

*Remember, even if you don’t have access to an anonymous test, your decision to get an HIV test and your test result are part of your private medical information. And in the case of the partner notification system, your name will not be shared with your partners.

Nominal testing

In most cases, if you ask your family doctor for an HIV test, the test will probably be ordered using your name. This is called nominal testing. Nominal testing is available through hospitals, clinics, and other healthcare providers across Canada. With nominal testing, your result...
  1. Will NOT be anonymous
  2. If positive, will be shared with public health using your name
  3. If positive, will be documented in your healthcare record (but this is confidential - i.e. private, and only shared between you and your healthcare provider)

non-nominal testing

There’s also an option called non-nominal testing, which is available across Canada in hospitals and clinics. With this option, the HIV test is ordered using a code or your initials, not your name. With non-nominal testing, your result...
  1. MAY be anonymous
  2. If positive, will be shared with public health, but possibly with your name (it depends on the province/territory)
  3. If positive, will be documented in your healthcare record

Anonymous testing

Finally, there is anonymous testing. Anonymous testing is only available in some provinces or territories, usually in specialized or community-based venues. If you get an anonymous HIV test, you do NOT need to provide your name. The test is ordered using a special code that is not linked to your identity. With anonymous testing, your result...
  1. Will be anonymous
  2. If positive, will be shared with public health, but WITHOUT your name or contact information
  3. Will not be documented in your personal healthcare records
Rapid tests are often anonymous forms of testing. Self-tests are also anonymous.
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