Promoting Health in Canada’s Far North

UBC Reports | Vol. 51 | No. 11 | Nov. 3, 2005

Research Reveals Challenges in Infection Prevention

By Hilary Thomson

Sexually transmitted infections (STIs) among some Canadian Inuit people may be almost six times the rate previously estimated, according to research done by a UBC graduate student.

Audrey Steenbeek, who receives her PhD in Health Care and Epidemiology at this month’s Congregation ceremonies, spent a year in a Nunavut community, exploring STI prevalence, screening and sexual partner networks.

It is the only such study ever done in Nunavut.

“Government bodies need to understand that northern communities are not being well represented in research,” says Steenbeek. “You have to live up there to get the data and get the trust to really find out what’s going on.”

Steenbeek is the first PhD graduate and one of 30 students in the Western Regional Training Centre for Health Services Research (WRTC), an interdisciplinary centre designed to support training of applied health services researchers.

A UBC alumna, Steenbeek spent a year working as an outpost nurse in the Baffin region and collecting data for her study.

Individuals living in the region have particular challenges in combating STIs, she says. Isolation — most communities are accessible by plane only — and a relatively small population create a limited pool of potential sexual partners. In such isolated communities, groups of friends can have sexual partners in common, allowing re-infection to occur within the sexual network.

Steenbeek surveyed 181 Inuit men and women aged 15-65 years and tested them for chlamydia and gonorrhea. Survey questions asked about use of health services, knowledge of STIs, high-risk behaviours and perceived risks and barriers of condom use.

In addition, a random sample of 100 individuals from this group was followed up in an additional four visits. At each visit, people were screened for chlamydia and gonorrhea and asked about sexual / social networks and condom use.

Steenbeek found 35 cases of chlamydia during the entire study period. The number of cases gave an overall prevalence of 15.6 per cent in comparison with 2.7 per cent estimated from previous STI counts. No gonorrhea was detected.

National rates of chlamydia infection were 179.3 cases per 100,000 people, in 2002, according to Health Canada.

Infections were most prevalent among 15-25 year-olds, with many individuals unaware of the consequences of STIs, which for women can include pelvic inflammatory disease as well as being a risk factor for cervical cancer. Nunavut has some of the highest rates of cervical cancer in Canada.

Reducing STIs is often not a high priority in Canada, especially in these regions where they are struggling to establish a basic health-care system, says Steenbeek. Challenges to delivering health care in the far north include the high turnover of health-care personnel and costs of travel to hospital — which alone can eat up more than half of overall health budgets.

“Prevention programs need to be customized to northern communities,” she says. “Residents and community health nurses often aren’t involved in developing disease prevention and health promotion strategies so community members don’t feel like they have ownership. Also, there’s a paternalistic view of heath care in these areas — people and programs ‘parachute’ in and then leave. Ideally, Inuit people should be assisted to run their own health programs.”

Existing prevention strategies offered by Nunavut Health and Social Services do identify some infections among women at the time of prenatal or other exams. None of the prevention strategies include men, however, creating a potential pool of undetected infections. Because chlamydia can be asymptomatic for both men and women, infected individuals may transmit infections without being aware of it.

Steenbeek recommends that individuals who live in Inuit communities, and who are not in monogamous relationships, be screened every six months or annually. Results can be available within 48 hours, even in remote locations, and effective treatments are available.

“We need to use initiative, effort and money to break these destructive patterns of infection. Inuit people are incredible people, who deserve better access to health care, screening and prevention programs,” she says.

She has shared some results with the community and has presented her findings to the Nunavut Research Institute and in Siberia at a conference on circumpolar health.

After Congregation, Steenbeek will take up a faculty position in the Dept. of Nursing at Dalhousie University in Nova Scotia.

The WRTC, headed by Sam Sheps, a UBC professor of Health Care and Epidemiology, operates in collaboration with the University of Manitoba. WRTC recently received renewal funding of $1.2 million over six years from the Canadian Health Services Research Foundation. For more information on WRTC, visit