Advocates call for easier access to STI testing in Montreal as cases continue to rise

Dr. Maxim Ethier co-founded a chain of Quebec clinics that offer quick and easy access to testing for sexually transmitted infections (STIs).

But lately, access to his busiest clinic in downtown Montreal has been drastically limited by the laboratory he relies on for screening patients' blood, urine and swab samples.

That clinic, located in the Village, has been forced to essentially halve its testing capacity, causing a serious concern for public health after years of trying to destigmatize screening and encourage people to get tested regularly, Ethier said.

He's not alone in worrying about access to testing in the city, as nursing shortages have limited access at other clinics. This is why Ethier and other community advocates are calling for solutions that will minimize barriers to STI screening.

"It's an emergency and we need to work together to increase access," Ethier said, calling on all stakeholders, including the Ministry of Health and Montreal public health, to take action.

"If we want to address this public health concern, we need to have power and support from public health, the labs and the ministry. It's all together that we are going to find a solution." 

At its location on St-Hubert Street, just steps away from the Berri-UQAM Metro station, Prelib has the infrastructure in place to see more than 100 patients per day, and the positive rate there has been up near seven per cent since it opened a few years ago, Ethier said.

It's clear Montreal is seeing a rise in STIs and testing is an important tool that helps curb transmission and treat people who could face long-term health consequences if their infection goes unchecked, Ethier said.

Private clinics offer fast appointments, results

Prelib relies on the Centre hospitalier de l'Université de Montréal (CHUM) to test samples, but recently the lab told Prelib to send no more than 65 per day. 

That means infections are going to be missed and spread to others, said Ethier, who says that translates to three or four people per day who could go unaware that they have an asymptomatic infection like chlamydia, syphilis or HIV.

Each year, more than 40,000 Quebecers are diagnosed with sexually transmitted and blood-borne infections.

Prelib is a private entity, though its services are covered by Quebec's health-care system. Patients pay only a small sample-transportation fee and they get their results in about a week.

Prelib does offer an option for more rapid results: A patient can pay about $200 to get results from a private, for-profit lab in a couple of days, a bargain compared to most private clinics in the area which also rely on private labs.

But those relying on Quebec's health plan don't have that luxury.

Prelib used to offer appointments in a few days, but with CHUM's new restrictions, the clinic has had to reorganize its scheduling. Patients now have to wait 10 days for an appointment.

This is disconcerting because people are easily discouraged by such hurdles and may not get tested at all if they can't get fast access, Ethier said.

CHUM testing thousands of samples per day

CHUM spokesperson Andrée-Anne Toussaint said the lab is processing between 18,000 and 25,000 analysis requests on a daily basis from both private and public health establishments throughout the province. 

There are 202 private-partner agreements, she said, and the lab's processing capacity determines the number of samples the CHUM agrees to accept from these partners.

Priority is given to hospitals, but demand for sample analysis is growing, said Toussaint.

"We want to find a solution that is respectful for the parties involved, " she said, noting discussions with Prelib are ongoing.

But to continue offering Prelib's service for nearly free in the Village, Ethier said he has no choice but to rely on the CHUM. 

"It's making the situation really hard," said Ethier. "I am supposed to help people."

Montreal public health says in a statement that, because most STIs are asymptomatic, testing is the only way to detect infections. It recommends people get tested when they have a new sexual partner.

Concerned about access, Montreal public health is working with partners to increase the availability of testing for those at highest risk, said Luc Fortin, a spokesperson for the CIUSSS du Centre-Sud-de-l'Île-de-Montréal.

"Anyone wishing to be tested should be able to benefit from a free test within an appropriate time frame," he said.

Nursing shortage causes slow downs

Alexandre Dumont Blais, executive director of the community organization RÉZO, said STI testing services have been slower since the pandemic.

He said the issue on his end has been staffing at a time when nursing shortages are affecting health services across Quebec.

La Zone Rose, a testing kiosk on Ste-Catherine Street in the Village that offered walk-in testing five days a week this summer, was forced to temporarily close at times because nurses were called to other obligations, he said.

The kiosk started in early August and closed this month. During that time, there were 239 tests performed and staff spoke with more than 3,000 passersby.

Improving access and minimizing barriers to STI screening is crucial, Dumont Blais said.

"What we can do, I think, is just work together and see how we can manage things differently to give quicker service when people need it," he said.