Since the pandemic began, Toronto’s Hassle Free Clinic has reduced their hours from 55 per week to just 15. The busy clinic used to get 100 patient visits per day and now sees fewer than 100 per week.
The situation is similar at sexual health clinics across the city. Many have either closed or drastically reduced hours and services or switched from in-person to phone screenings. The barriers to access are putting already vulnerable LGBTQ people, who are the primary users of the clinic’s services, at greater risk.
“It’s a radical departure,” says Hassle Free’s director Jane Greer. “We were very cautious about how to approach this time. Our initial goal was to try and stay open, to first and foremost be there for our patients.”
The clinic now operates three days a week and services are available for “most urgent” issues like contraception and STI testing. HIV testing is no longer available in part because the clinic’s tests go to Public Health Ontario labs that are busy with COVID-19 tests.
“We didn’t want to add one more test into their mix, from a community responsibility standpoint,” explains Greer. “And with HIV, it’s very difficult to screen people. If they are displaying signs of seroconversion illness, it could mimic the signs of COVID-19. If that’s a possibility, then we’re not an appropriate place to see them.”
Prior to the pandemic, the clinic kept gendered hours, but have since scrapped that policy. It also used to operate on a mostly walk-in basis, but now an appointment is required, though virtual and telephone consultations are available.
“Our demand is down, but that’s not so much because people are having less sex right now, but because of access,” says Greer. “Is everyone even getting through on the phones, which ring constantly? With our screening process, are they excluded from being seen because they’re not falling into our current categories that we feel we need to be addressing? We don’t know what we’re not seeing and the fact is there are many unmet needs.”
Toronto Public Health (TPH) operates sexual health clinics that provide access to free birth control, low-cost emergency contraceptives, STI and HIV testing, pregnancy testing and a range of counselling services. However, many have temporarily shut down, including Talk Shop and the Jane Street Clinic, as doctors are diverted to the fight against COVID-19.
Scarborough Sexual Health Clinic, one of TPH’s busiest clinics, went dark as well. It’s located inside a civic centre, which were among the first places to close when lockdown measures began.
The only TPH sexual health clinic operating during the pandemic is the Crossways Clinic on Dundas West in the Junction.
“Clients with urgent health concerns are being seen by appointment only and are required to call ahead for assessment and screening by our nurses,” Dr. Rita Shahin, TPH’s associate medical officer of health, said in a statement. “We are assessing people over the phone and providing appointments only to individuals with symptoms suggestive of an STI, contacts of confirmed STIs and urgent contraception needs.”
Down to 50 patients a week, Crossways is seeing half of the reduced intake at Hassle Free, which is funded by TPH but is mainly an independently run community clinic, giving it greater freedom to continue operating.
For trans people, the reduction in health-care services has meant cancelled or delayed gender-affirming surgeries, which are considered non-essential. Many trans people are also worried about potential hormone medication shortages, which weren’t uncommon even before the pandemic.
The situation has led many LGBTQ people to feel as though their health-care needs are more on the backburner than ever and the impact could be considerable.
According to a team of University of Toronto researchers, LGBTQ people are more likely to have conditions compromising their immune systems, rate their health as poor and are less likely to seek urgent care, possibly due to the social barriers faced in accessing services. This puts them at greater risk of contracting COVID-19, a risk that is even higher for LGBTQ people of colour or those living with disabilities.
“That’s something that wakes me up at four in the morning,” says Greer, who isn’t sure what the future holds for sexual health care in Toronto, but clinics will certainly look and operate differently.
“Our ultimate goal is to get back to our usual service hours, when we would have a packed waiting room with 25 people during drop-in hours,” she adds. “But it’s hard to see that in the near future as physical distancing continues. There will be permanent changes. We will do whatever we can to keep everybody in the community as safe as we can and seen.”