STBBIs and Public Health Law

What was the study’s goal in Lariat et al. (2023)?

• Objective: To understand young people’s experiences of partner notification (PN) after being diagnosed with an STI, especially the risks and challenges in patient-referral PN (where the patient tells their partner).

• Key Question: Is patient-referral PN an appropriate and safe strategy for young people in low-resource settings?

 

STIs are highly prevalent globally; __________ in sub-Saharan Africa, are particularly vulnerable.

young people, especially young women

Partner notification

Key in STI control — aims to prevent reinfection and onward transmission.

What are the types of partner notification?

1. Patient-referral — index case tells the partner

2. Provider-referral — provider tells the partner.

3. Contract referral (i.e. partner must do it within a certain time frame, if they don’t the hospital does it)

4. Expedited Partner Therapy — index gives partner medication/prescription

In resource-limited settings, ________ dominates (most common) due to lower cost but shows limited success and may carry social harms.

patient-referral

What are some youth specific vulnerabilities to Partner notification?

• Transient relationships, secrecy around premarital sex.

• Gendered power imbalances and intimate partner violence (IPV).

• Stigma, low STI literacy, fear of judgment, and barriers to accessing care.

In Lariat’s results, ____ took at least one PN slip

41.2%

In Lariat et al., Only ______ partners returned for treatment.

5.7%

 

Low partner follow-up rate highlights

poor PN effectiveness among youth.

In Lariat’s findings, how was the participants experiences with CHIEDZA

Positive

• Youth-friendly, compassionate, non-judgemental environment.

• Free, accessible, and confidential — encouraged testing and treatment.

• Many learned for the first time that STIs are curable (distinguishing from HIV).

“They explained everything to me… I will be fine.” — 21-year-old female

In Lariat’s results, how did the participants view partner notification?

• PN seen as intimidating and emotionally risky.

• Most felt unprepared to counsel or persuade their partner.

• Providers emphasized clinical necessity, but not the social challenges.

 

• Participants feared partner anger, violence, or breakup.

“Before I even finished my story, he slapped me.” — 23-year-old female

In Lariat et al., what were the fears of the participants in regards to partner notification?

Fears of:

 

• Physical assault, emotional harm, or relationship dissolution.

• Accusations of infidelity or promiscuity.

• Stigma and gossip in communities, reputational damage.

 

• Gender dynamics --> women more often blamed, shamed, and unsafe.

• Some avoided PN entirely or looked for indirect ways to get partners treated.

 

“I can’t tell him. I’ll just say we both need to get tested.” — 21-year-old female

In Lariat et al, how did the moral framing of PN influence participants?

• PN presented as a moral duty — “the right thing to do.”

 

• Participants internalized guilt and responsibility to “protect others.”

• This moral framing silenced discussion of fears or inability to notify.

 

“If I didn’t tell my partner, I’d be acting like the devil’s sister.” — 22-year-old female

 

• PN success became a measure of moral worth, not practicality.

In Lariat et al, what were the hidden dilemma’s and non-compliance seen in participants?

• Some concealed from providers that they couldn’t tell their partners.

• Others engineered situations to get partners treated indirectly.

• Many feared being judged by providers if they admitted non-compliance.

• PN caused disillusionment with CHIEDZA for some — even regret for attending.

“You people of CHIEDZA ended my relationship.” — 20-year-old female

In what ways are STBBI’s shaped by social factors?

• Shaped by social relations

• Treated as a social problem and a social problem to be governed

• Shaped by healthcare and healthcare access

• How states attempt to promote wellbeing and how its being achieved.

HIV is seen in ____ people per 100,000 population in Canada and ____ every year

6.1; increases

Saskatchewan and Alberta have the highest rates; men = 8.1, women = 3.9 rate.

for indigenous people, the increase in HIV manifests through

history of colonization and the lasting effects (ex. leading to drug use).

When assessing how law is used in relation to STBBIs, we need to consider the

historical and social context

political context

social perceptions about STBBIs

medical treatments available

the power dynamics at play.

STBBI stigma can shape people’s experiences with the _________, for example:

healthcare system and legal institutions.

• Ex. treated negatively based on their STI status; barrier to healthcare access; judgement from society and family and relationships.

• Ex. Police interactions and possible records of being HIV positive, etc.

• Ex. associated stereotypes on cheating, promiscuous, irresponsible.

When examining STBBIs, it is vital to take up _________

intersectional analyses

“HIV-related stigma and discrimination intersect with other forms of stigma and discrimination such as those based on __________” (HIV Legal Network, p.6).

sexual orientation, gender, gender identity, race, immigration status, poverty, drug use and/or sex work

Contagious Diseases Act, 1864 (in Britain)

• Intent of regulating people involved in sex work (particularly women in sex work, involved with men in the military)

• Allowed police to arrest people suspected of being sex workers (working class women often targets), and have them undergo a medical examination to see if they had Venereal Disease.

 

Both brothels and individuals on the street were targeted.

On Contagious Diseases Act, 1864

"while the act sought to prevent the spread of diseases such as syphillis, they also resulted in __________ but not potential male cilents. Under these laws, any woman walking alone at night could be arrested and subjected to invasive exams and placed on official lists that were practically impossible to get off of."

harassment and stigmatization of usually single working class women

“The united provinces of Upper and Lower Canada enacted their own ________________in _____” (Kirkup, 2023, p.614).

Contagious Diseases Act; 1865

Canada’s Contagious Diseases Act in 1865

• Also intended to target women involved in sex work.

• Able to detain sex workers for up to 3 months in the hospital certified If they were suspected to have an STBBI.

• This law ended up shaping a lot of the current laws in Canada

In Canada, Men in the military were

cautioned through posters, etc. about STBBI's ("another war to contend with")

"only 74,711 cases of trench foot were treated during the whole entire war, ________ encountered 416,891 hospital admissions."

venereal disease

veterans compensation case

• Man served in military, when in later years developed health problems (could be related to a STBBI gotten when younger in the military)

 

• Seeking compensation, argued that the STBBI was contracted in a "workplace environment"

  • Blaming military for him getting this STBBI; young Christian family had not taught him about sex and disease; the military had responsibility to teach the soldiers.

 

• Military argued that it wasn’t part of his workplace duties and have no duty to teach him.

In 1919, laws against “________________” were included in the Criminal Code of Canada.

communicating venereal disease

In 1919, laws against “communicating venereal disease”

• The laws stipulated that those with a “venereal disease” (syphilis, gonorrhea, or soft chancre), “who knowingly or by culpable negligence communicates such venereal disease to any other person” could be charged under the law.

 

• First and only STI specific offense in the criminal code.

• At the time, there was no medical treatment for these diseases (Ex. Syphilis)

According to Mcgunnies, why did the law against communicating venereal disease not have many cases?

• because of the concerns that STBBIs were being treated unlike other communicable diseases.

• Shift from criminal law responses to public health law?

Venereal disease laws were repealed in _____.

1985

• At a time where HIV and AIDS cases were increasing and become a large problem (1982)

• While other disease were more manageable, but HIV was not at all.

Public health law

“Public health law has been defined as the ‘study of the legal powers and duties of the state to promote the conditions for people to be healthy ... and the limitations on the power of the state to constrain the autonomy, privacy, liberty, proprietary, or other legally protected interests of individuals for the protection or promotion of community health’” (Gostin quoted in von Tigerstrom, 2017, p.481).

Internationally, Canada is a member state of the World Health Organization, which then includes being a signatory on agreements related to

international health concerns.

Why is there confusion in Canada as to who has authority in relation to health?

Constitution act (1867) did not include health; so there was lots of confusion as to who has authority.

 

"both levels of government exercise legal authority with respect to public health concerns, lack of  clear authority however can lead to _______________."

federal-provincial disputes and impede a timely response to public health concerns

“______________ (PHAC) was created in 2004” in response to SARS and then became established by statute in 2006. PHAC “has a broad mandate relating to public health, including prevention and control of infectious diseases” (von Tigerstrom, p.483).

The Public Health Agency of Canada

Infectious diseases are legally governed in relation to

• Surveillance/collection of information/data (ex. some are reportable)

• The “use of coercive powers for infectious disease prevention and control” (p.490).

  • Informed consent, but also allowing for intrusions on individual freedoms in certain cases.

• Vaccinations