Webinar: Comprehensive STBBI prevention strategies for ...

This transcript is the automated English captions in the recordings. The text may not align with the audio and there may be errors the transcript.

Jessica Helwig: My name is Jessica Helwig. Thank you for joining the Public Health Agency of Canada's Communicable Disease and Infection Control webinar series. We are pleased to have you join us today for our webinar.  

As we gather virtually today, I do want to start off by recognizing the different lands that each of us are calling from. I myself am currently located on the unceded, unsurrendered territory of the Anishinaabe Algonquin Nation. Indigenous communities have long understood that sexual health is not simply about the physical body, but an integral part of a holistic understanding of one's well-being, with traditional teachings often emphasizing the interconnectedness of spirituality culture and community. Thus, as we delve into discussions today, let us strive to think of sexual health as a communal responsibility rooted in the values of care, respect, and reciprocity, and let us honor the wisdom of Indigenous People whose holistic approach to sexual health provides valuable teachings to us all. 

A short disclaimer for today's webinar: it includes presentations from those who are external to the agency, which may not reflect the views of the Public Health Agency of Canada. 

This webinar will be conducted in English. Simultaneous interpretation in French can be accessed through selecting the interpretation button in the menu at the bottom of your screen. 

Following today's webinar, a copy of the presentation deck as well as a feedback form will be sent to you.  

A few technical notes. Your audio has been muted to reduce noise, and your video has also been disabled for this webinar. If you are having technical problems and need help, you can reach us through the chat function. Please feel free to communicate in either English or French. If you have a question for the presenters, please submit your question using the Q&A function and we will look to answer them during the panel discussion at the end of the webinar. Note you can check send anonymously if you do not want your name attached to your question.  

I will now introduce today's speakers. Dr Andrea Chittle is a Medical Advisor in the sexually transmitted and blood-borne infection surveillance division at the Public Health Agency of Canada. In addition to her work with the Agency, Andrea works in the city of Hamilton sexual health clinic and is a Consultant Physician with the Sexual Assault and Domestic Violence Care and Treatment Center at Guelph General Hospital. She is located in Guelph Ontario, which is the traditional lands of the Attiwonderonk, Anishinaabeg, and Haudenosaunee people and on the treaty lands of the Mississaugas of the Credit.  

Andrew Townsend is the Health Promotion Officer with Action Canada for Sexual Health and Rights based in Toronto, Ontario covered by treaty 13 with the Mississaugas of the Credit. He oversees Action Canada’s Youth STBBI Test Awareness Campaign, which you can learn more about at onceayear.ca.  

Emma Antoine-Allan is a 2S Anishinaabeg youth from Sharbot Lake, Ontario. Raised up in Tkaronto by their mother and a host of urban Indigenous aunties and cousins. They are currently living in Lekwungen, the place of smoked herring. They have worked for more than 10 years on reproductive justice for Indigenous lands and bodies with the Native Youth Sexual Health Network. 

With that I now welcome Andrea for her presentation. 

Andrea Chittle: Thank you, Jessica, and hopefully everyone can see my screen.  

As Jessica mentioned my name is Andrea and I'm a Medical Advisor working in sexually transmitted and blood-borne infection surveillance at the Public Health Agency of Canada.  

For today's presentation I'd like to share some perspectives on how the Government of Canada is approaching STBBI prevention and take a deeper dive into the suite of STBBI prevention tools currently available. I want to start by reviewing some high-level information about sexually transmitted and blood-borne infections to help situate my presentation within the broader context.  

The term “sexually transmitted and blood-borne infections” includes infections that are passed primarily through sexual contact like chlamydia, gonorrhea, syphilis, herpes simplex virus, human papillomavirus, monkeypox virus, and infections like shigella.  

STBBI also refers to infections that can be passed through sexual contact and through blood like hepatitis B and C and human immunodeficiency virus.  

Although STBBI are preventable, and in many cases treatable or curable, many people experience negative impacts on their health and well-being. STBBI can cause psychological distress, pain, certain cancers, a weakened immune system, infertility, and adverse birth outcomes such as miscarriage, still birth, and congenital infections and disease.  

Rates of sexually transmitted and blood-borne infections have been rising around the world and in Canada in recent years. Increasing the uptake of effective STBBI prevention strategies will be critical to reversing these trends.  

As you may know, last February the Government of Canada released a renewed STBBI Action Plan. It outlines federal efforts to accelerate prevention, diagnosis, and treatment to reduce the health impacts of STBBI and meet global targets by 2030. For those interested in learning more, the link to the Action Plan will be posted in the chat. Briefly, the Action Plan is broken down into four main pillars: prevention, testing, initiation of care and treatment, and ongoing care and support. Each pillar is supported by the foundation of an enabling environment.  

STBBI prevention is an integral part of the Government of Canada's comprehensive approach to reducing the health impacts of STBBI. The prevention pillar of the Action Plan outlines five priorities, these include: promoting comprehensive sexual health and well-being across the life course, enhancing awareness of and access to biomedical STBBI prevention tools, advancing the development and uptake of vaccines and prevention innovations, supporting harm reduction programs and services, and responding to emerging and reemerging infections. These priorities reflect the breadth of STBBI prevention strategies.  

I'd like to get a better understanding of everyone's familiarity with STBBI prevention tools. A polling question should pop up on your screen now. I will give a few moments for people to select their top choice, and the question says ‘what STBBI prevention tool are you least familiar with? HIV PEP and HIV PrEP, harm reduction, vaccines, barriers including condoms, screening, U=U, or routine practices.  

Okay, it looks like more than half of attendees have answered the poll and the most common options that people identified as being least familiar with are HIV PEP and HIV PrEP and the concept of U=U, and I will explain these in greater detail in the next few minutes.  

Broadly prevention methods reduce the risk of acquiring sexually transmitted and blood-borne infections and/or the impact and spread of sexually transmitted and blood-borne infections.  

Our STBBI prevention toolbox contains a range of effective strategies. While some tools have broad use and benefit, others are more tailored. Generally, they complement each other, and a comprehensive approach to STBBI prevention will incorporate all relevant tools.  

I'll take a few minutes now to review each method. I'll start by reviewing the methods on the left side of the toolbox.  

Education here refers to comprehensive sexual health education as well as counseling delivered by a health care professional. Comprehensive sexual health education is critical for overall health and well-being; it gives people accurate age-appropriate information and skill building opportunities about sexuality and sexual and reproductive health. Healthcare professionals can build on this foundation to provide tailored information to individuals about risks for STBBI and the range of effective prevention strategies.  

Routine practices are strategies and standards for protecting those who work with blood and body fluids, including from STBBI. Exposure is prevented through the usual use of precautions including handwashing, personal protective equipment, and engineering and environmental controls, like appropriate ventilation and standard waste disposal procedures.  

Safer tattooing and piercing means the use of new or sterilized equipment and is effective for preventing the spread of blood-borne infections including hepatitis B and C and HIV.  

Barrier methods create a protective layer that prevents the exchange of body fluids, including blood, semen, and vaginal discharge, and reduces skin-to-skin contact. Barriers include external and internal condoms and dental dams. Barriers are particularly effective for protecting against infections that are spread through body fluids such as chlamydia, gonorrhea, and HIV. They don't work as well against infections that are spread through skin-to-skin contact such as syphilis, herpes simplex virus, and human papillomavirus. This is because these infections can be transmitted through contact with skin that is not covered by the barrier.  

Harm reduction refers to the range of policies, programs, and services that aim to reduce the harms associated with drug use. Several harm reduction initiatives are effective for preventing blood-borne infections, these include the distribution of safer injecting and smoking supplies, which directly prevent STBBI by decreasing sharing of equipment, supervised consumption services or overdose prevention sites, and opioid agonist therapy also prevent drug rated harms. Specifically, they prevent overdoses, provide linkages to services and supports, including STBBI screening and treatment, and they often also provide safer supplies.  

There are several other prevention methods on the right side of the toolbox.  

Safe and effective vaccines have been developed that prevent certain STBBI including human papillomavirus and hepatitis B virus. Hepatitis A virus and monkeypox virus can also be passed through sexual contact and vaccination against these viruses is recommended for those at higher risk.  

Screening is testing that is done to detect infections in people without any symptoms. Screening is particularly important for STBBI because symptoms may not be noticed at all, or they may be confused with other conditions, or they may not present until very late, once complications have developed.  

Health care professionals are encouraged to incorporate STBBI screening into routine medical care to detect infections early. Early detection paired with timely treatment can prevent complications and reduce the spread of STBBI. Depending on the individual, screening usually involves blood tests along with a urine sample and/or swabs. Swabs may be self-collected or collected by a health care professional  

Testing is done to make a diagnosis in people who have symptoms that could be STBBI. For example, an individual who has noticed burning with urination or penile discharge may have gonorrhea or chlamydia. To make a diagnosis, testing would be done for these specific infections. Depending on the symptoms, testing would usually involve blood tests for urine samples and or swabs collected by a health care professional. Screening for other STBBI that an individual may have been exposed to is recommended anytime someone is tested for an STBBI. 

STBBI treatment can be considered a prevention method; this is because prompt and appropriate treatment can limit or prevent complications and also reduce STBBI spread.  

U=U or undetectable equals untransmittable is a message that communicates this idea as it relates specifically to HIV. U=U means that HIV cannot be sexually transmitted from someone living with HIV who is on treatment and has achieved viral suppression.  

HIV pre-exposure prophylaxis, or HIV PrEP, and HIV post-exposure prophylaxis, or HIV PEP, are highly effective biomedical tools for preventing people from getting HIV. HIV PrEP involves taking oral or injectable HIV medications on an ongoing basis. HIV PrEP is recommended for individuals who are at increased risk for HIV. HIV PEP involves taking oral HIV medications daily for four weeks after a high-risk exposure to HIV.  

Finally, I want to briefly mention a few novel and emerging STBBI prevention tools which you may have heard about.  

Point-of-care tests and home tests for STBBI can reduce barriers to screening and testing. In the last few years an HIV self-test and two dual HIV and syphilis point-of-care tests have been licensed for use in Canada. As with standard tests, we’re realizing the benefits of these novel tools will require that people with positive results can access confirmatory testing, treatment, and follow-up care. In addition, it is important to ensure that those with negative test results, who are recommended to have follow-up testing, or are at ongoing risk of infection, are effectively linked to care.  

Given the incredible effectiveness of HIV PEP and HIV PrEP there is also a lot of buzz about doxycycline post-exposure prophylaxis, or Doxy-PEP, and doxycycline pre-exposure prophylaxis, or Doxy-PrEP, for the prevention of chlamydia, gonorrhea, and syphilis. Doxycycline is an antibiotic that is used for the treatment of chlamydia and syphilis, and other infections. Studies have mostly focused on Doxy-PEP, which involves taking a dose within 72 hours after condomless sex. Over the short-term Doxy-PEP has been found to consistently prevent chlamydia and syphilis infections among cisgender gay bisexual men and other men who have sex with men and transgender women.  

Some studies have found that Doxy-PEP prevents gonorrhea over the short term and others have not. The effectiveness of Doxy-PEP for gonorrhea may depend on levels of antibiotic resistance. In Canada resistance to this class of antibiotics is high, especially among gay bisexual and other men who have sex with men. 

Some public health organizations around the world have published recommendations for the use of Doxy-PEP, and others have published recommendations against its use. Organizations that have recommended against Doxy-PEP have cited concerns about harms that the intervention could cause. Specifically, antimicrobial resistance in gonorrhea and other bacteria. In Canada, national recommendations on the use of Doxy-PEP are being developed. 

Coming back now to the Government of Canada's renewed STBBI Action Plan, I want to highlight the Action Plan's guiding principles. These principles serve as a compass guiding the creation and implementation of approaches to STBBI prevention to ensure their optimal reach. In other words, how we use these prevention tools is central to their success. For example, at an individual level, considerations around health equity remind us to account for the financial or social barriers an individual may experience before prescribing a high-cost HIV PrEP medication. Whereas looking at the community level, considerations around cultural relevance can ensure we tailor our health promotion efforts in a way that best aligns with the values, norms, beliefs, and needs of communities.  

Overall, utilizing these principles can ensure that prevention strategies are designed and applied in ways that are tailored to the specific needs of individuals and communities, and are grounded in the best available evidence and coordinated across services. 

The Public Health Agency of Canada has developed several resources about STBBI prevention, some are previewed on this slide, and we'll also post links in the chat. In addition, we will distribute a copy of the presentation containing all of the links after the webinar. 

Thank you so much for inviting me to speak and I will pass it to my co-presenter Andrew. 

Andrew Townsend: Awesome, thank you. I’ll just pull up my slides, cool!  

I just want to say thanks again everyone for having me. My name is Andrew I am a health promotion officer with Action Canada for Sexual Health and Rights.  

I am starting off my section here today by mentioning that it is a Sex Plus Week from February 10th to 16th. We're inviting everyone to join our national movement aimed at breaking barriers, sparking conversations, and celebrating curiosity.  

So, led by us at Action Canada, empowered by a network of organizations and individuals across the country, Sex Plus, formerly known as Sexual Health Week, is an annual awareness dedicated to creating a future where sexual health is part of every conversation about health, where asking questions about sexual health isn't taboo, and where we challenge misinformation, confront stigma, and dismantle barriers that keep people from accessing the knowledge, care, and freedom they deserve.  

For many people, questions about sexuality, gender, gender identity, and sexual health go unanswered. Our quest to learn more is met with barriers like stigma, misinformation, and unequal access to care.  

We might have questions like where can I find sexual health information I can trust, does anyone else feel nervous talking about sexual health with their doctor, why isn’t sex ed the same for everyone everywhere.  

But, as governments and social media companies censor and suppress people's access to sexual information, how can clinicians become more involved as sources of accurate, accessible, and supportive safer sex tools and strategies?  

So, part of what prompted the topic for this webinar today was the response that we were seeing to a couple of reports which came out indicating a decline in condom usage amongst youth. There was the 2024 Sex Lives Report from Let's Stop AIDS, as well as the report called A Focus on Adolescent Sexual Health in Europe, Central Asia, and Canada Health Behavior in School Aged Children International report from the 2021-2022 survey out from the World Health Organization.  

As demonstrated by Andrea’s section, there condoms are just one of the tools in the toolbox of STBBI prevention and care, and while it's important to promote the benefits of condoms and to make them accessible for all who want to use them, we also want to make sure that people of all ages are aware of the full range of options that should be available to them.  

In the 2024 Sex Lives Report, which was a survey of about 1100 Canadians between 18 and 24 years old, amongst other findings, something that is notable for our audience today is that 60% of the young people surveyed did not recall their health care provider proactively discussing STI and HIV testing with them. 

This data is similar to findings from Statistic Canada's report published last year titled Where do 15 to 17 Year Olds in Canada Get their Sexual Health Information. 

So, as shown in the graphs on this slide, only about 17 to 25% of youth surveyed identified going to a health care professional as a source of information. 

Combining these two things together, we're seeing a majority of youth both not going to their health care professionals for sexual health information, and also not having this information offered by their clinicians. This is no doubt contributing to the 15% of youth, which is around 165,000 young people in Canada, who said that they did not have adult to talk to for sexual health information. 

Now, it's not a competition, providing good sexual health information is a team effort, we want to see a world where people can learn from their families, schools, health care professionals, and beyond. 

Because the more access people have to good information, the more likely people are to make safer sex decisions that fit their lives, and so ideally we can have more health care professionals be identified as places to go for sexual health information. 

From the Public Health Agency of Canada's own resource published last May, a person centered approach to care means being respectful of and responsive to the preferences, needs, and values of the person receiving care. Through this approach, patients are equal partners in planning, developing, and monitoring their care to ensure it aligns with their needs. 

So again, the goal is not condoms or bust, but being able to meet people where they are at to provide a range of information and services, and currently across Canada there's certainly room for clinicians to improve access on this front. 

This past November, Action Canada conducted a series of focus groups with youth in Winnipeg, and when asked what would make it easier for them to access STBBI testing, a number of participants said that they're having their primary care provider said, sorry, they said that their primary healthcare provider should offer this service, with the assumption that they did. 

Similarly, in talking about the family doctor shortage and Saskatchewan, staff from Saskatoon Sexual Health said that they are operating at over 125% capacity on providing cervical screenings. 

Part of this is from clients not having access to a primary care health provider, but in some cases it's because doctors are refusing to offer it. 

Now, whether it's because of billing issues, skill or comfort, clients are walking away from these health care settings with the impression that primary care providers cannot support them when it comes to sexual health, which we know is not true. 

But we know this is not the case for a vast majority of clinicians who are happy to provide sexual health information and services. There are lots of healthcare workers who want to create safe, supportive spaces for clients, and there are real health benefits to doing so. 

The Canadian Medical Association recently published findings from the 2025 Health and Media Annual Tracking Survey, where they identified that 37% of survey respondents indicated that poor access to healthcare and information has led them to trying medical advice that they find online. 

31% have taken medical advice found online instead of advice received from a medical professional, and 23% have had an adverse reaction or negative health impact from following health advice found online. 

So, whether it's because of a shortage of health care providers, or because of worries of rejection or stigma when trying to access sexual health care, whether that's real or assumed, people in Canada are turning online to answers for their health questions, and like many others around the world, people in Canada are susceptible to misinformation online. 

This report also identifies that people trust the information provided by physicians, pharmacists, and nurses even more than what is provided by Health Canada, or provincial and local health organizations. 

To me, this means that there's a huge opportunity for healthcare providers to combat misinformation by boosting themselves as sources of accurate and inclusive sexual health information and services. 

I want to close with highlighting some pieces from the World Health Organization Report. While the report does track a decline in condom usage amongst adolescence across a number of countries and regions, Canada is actually not one of them.  

According to the report condom usage has remained at about 60% over the last 10 years, but Canada is definitely seeing an increase in the percentage of 15 year olds who are not using either condoms or the pill, jumping from 16% in 2018 to 28% in 2022, though to be fair it is unclear in the report if these young people are using other safer sex methods.  

The report underscores the urgent need for targeted interventions to address concerning trends and promote a broad range of safer sex practices among young people. It calls for sustainable investments in three key areas:  

1. age-appropriate comprehensive sexuality education  
2. enabling policies and environments that support adolescent health and rights, and  
3. access to affordable non-judgmental sexual and reproductive health services that meet young people's needs and preferences 

This evidence, which consistently shows that high quality sexuality education delivers positive health outcomes with lifelong impacts. Young people are more likely to delay the onset of sexual activity, and when they do have sex to practice safer sex, when they are better informed about their sexuality, sexual health, and their rights.  

This is a great moment for healthcare providers to become more open and active in promoting safer sex tools and practices.  

I just want to close by saying thank you, like we're saying Sex Plus Week it's a great time to celebrate and to work together by asking more, learning more, and doing more. Together we can build a future that's healthier, freer, and more understanding.  

Thanks for your time and attention, and I'll pass it over to Emma.  

Emma Antoine-Allan: Thank you Andrew, that was excellent. Let get my screen up. Amazing. 

Hello everyone, my name is Emma Antoine-Allan, I'm Anishinaabeg from Sharbot Lake, and I'm here with the Native Youth Sexual Health Network, and we're going to be talking about beading condoms and Indigenous feminist condom cases.  

So, a little bit about NYSHN, or the Native Youth Sexual Health Network, we are an intergenerational Network that's led by Indigenous youth working throughout the United States and Canada. We’re as far down south as New Mexico, up north in the Arctic Circle, and then pretty much coast to coast. We work across issues of sexual and reproductive health rights and justice. So we say everything and anything to do with our bodies and our spaces.  

We like to note that we've been youth lead, organizing as mentioned, for about 20 plus years in our territories, but we know that Indigenous communities have been organizing with and on our lands for our bodies and our spaces since time immemorial. 

For our key areas of work, I have this long list for you all, and when I'm in a smaller group setting, I'll sometimes ask if we have anyone feeling especially brave, and they have a particularly sexy voice today, to read them all out. But instead, maybe I'll invite you all to take a moment and read through our diverse key areas of work, and also to contemplate why we made this slide.  

I will also invite you, if there's anything that you maybe haven't seen before, anything you're not familiar with, or you might be curious in hearing more about, to write that into the Q&A box, and we can cycle back to it.  

The idea here is that NYSHN really commits to focusing on the inter relation of our health and well-being. We understand that, as Indigenous Peoples, we are not single issue people, and that it's inaccurate to talk about STBBI transmission rates without also talking about the disproportionate amount of Indigenous youth who are in custody, jail, prison, and the child welfare system on our lands, or to talk about sex trade, sex industries, and street economies without talking about resource extraction in our territories; these are deeply interconnected.  

What we believe in. I'm going to touch on some of our core values now.  

Culturally safe sex-ed. So, some of you might be familiar: cultural safety is a term that comes from nurses in Aotearoa, or Māori relatives. To us, it means that it is our birthright to feel safe and be our whole selves when we're in any spaces.  

As I said earlier, our nations are not all the same. We have the right to talk and share about our different cultures, spiritualities, teachings, and the realities of our own communities when we talk about our bodies. It also means that the reclamation and restoration of our nationhood includes addressing how colonization has impacted the cultures around our bodies. This is sort of leading us into why bead condoms. What does it mean to implement culturally safe sexual health education?  

I'll come over to the next one. So, we want to recognize that culture is protection, just as condoms and barrier methods can protect us from sexually transmitted and blood-borne infections, culture is also a protective factor for Indigenous youth.  

Connection to language has been proven to reduce rates of suicidality in Anishinaabeg communities, and we similarly believe that being connected to our cultures allows us to access increased autonomy over our bodies and our lands.  

So, we talk about, you know, beading is a tactile art of patience and love. We bead things that are sacred, special, and to express ourselves within those pieces. So, that could look like moccasins and regalia but we also bead everyday household objects like lighters, wallets, and now condoms.  

Its the way of showing that we value condoms in our lives and also that these are a part of everyday 21st century Indigenous life.  

We also adapt to survive. For example, the glass beads we use now in beading were picked up in trade as part of the arrival of Europeans, and add different features to our bead work, like more variation in color and different durability than shell or wood, for example. Condom usage is another way that Indigenous youth are adapting to survive.  

I have some photos here from, lets see, this would be in Nome, Alaska, we were hanging out with Indigenous youth at one of their tribal gatherings.  

An advantage to beading condoms with young people is that it gives us a very sensory experience of handling condoms outside of the sexual context; we find that it builds familiarity and skill with young people so we also often practice applying condoms, we do vocabulary building around the rim of a condom, the tip of a condom, building familiarity around understanding latex and non-latex options.  

We often use flavored varieties because they come in different colors. And this familiarity and skill can then be applied in sexual scenarios to build and boost confidence.  

There's also all the usual beading teachings around how do we talk to ourselves when we're in a challenging situation; how do we have patience, how do we follow instruction, how do we like express ourselves and have fun? These are all teachings that also apply to our sexual health and well-being. 

Another piece around beading condoms is about building our cultures of consent, and so it's a warm space for everyone to come through, the sort of tongue-in-cheek or joking way that I sometimes explain it, is we found that when you offer a free sexual health training at the band office on a Thursday night you get maybe a few people, but if you offer free beading at the health clinic, you tend to get a lot more uptake, and from there we can talk about what sexual health um looks like our community.  

Okay, another core value for NYSHN is that we prioritize understanding that we are more than at risk. So, a lot of times the conversation around Indigenous youth is that we are at increased of risk of suicidality, STBBI transmission, pregnancy, domestic violence, incarceration, and we want to challenge these narratives to say that actually we are more than just at risk and vulnerable, and that being Indigenous and being young are not the risk or vulnerability factors in and of themselves, right?  

We want to commit to naming the risk and what actually puts our lives at risk are things such as racism, colonialism, and not having access to culturally safe resources and support. We're not at risk all by ourselves.  

There are things in our lives that make us less safe, and we want to commit to naming the risk instead of blaming young people for the violence we experience.  

The other piece here is recognition that sometimes we have to have access to justice before we can meaningfully access choice. So, when we're talking through, with young people, different options for STBBI prevention, it can be important to recognize that it's, for instance, difficult or challenging to regularly take a dosage of PrEP or PEP if you're not accessing stable housing at the moment, right?  

Sometimes you need to have access to justice, which could look like housing on your own lands, before you can meaningfully even choose, you know, a treatment option that involves a daily commitment like that.  

The other piece I want to talk about today is our Indigenous Feminist Condom Cases. These began as a riff on the Standard Condom Case for Sexual Health Promotion Activity. People often incorporate words in their language, and different local motifs into theirs, trying to encourage the carrying of condoms across our territory.  

Okay, our last kind of core value here, we have many more available on our website but for this presentation I thought I touch on this idea that resistance is sexy.  

It means that responding to oppression can be done in a way that recognizes the organizing of our ancestors and Indigenous youth who are living resistance every day. Reclaiming our bodies and restoring our cultures are part of this process. 

It also means resisting the over and de-sexualization of Indigenous people by renaming where we find beauty in our communities and ourselves on our own terms.  

So, we want to think about how do we address stigma as a community. Beading condoms is a way to bring things out into the open, lift up the rug and see what's been swept under, and normalize asking questions.  

It's an opportunity to do education in a culturally safe and appropriate manner that keeps people's hands busy, that invites joy and humor, and creates opportunities to discuss the barriers and the ways that we resist colonization and colonial harm.  

So, for example, a standard part of this workshop is discussing where are the local clinics, in relation to our communities, where we can get tested, but also what are the barriers when we access those spaces. Are we experiencing racism from the staff at the front desk and does that also translate over to our provider experience? Do we have concerns about confidentiality in a small community?  

We've really seen a lot of effective uptake of point of care and at home HIV testing for smaller communities where it can be of concern to go to the health center and feel like everyone's going to know your business.  

That brings me to an early close to our presentation. Hopefully we’ll create more space for us to speak to a Q&A and in the panel and have a little bit more of a conversational approach.  

I just want to close by really inviting everyone to keep in touch and saying miigwetch, or HÍSW̱KE, many thanks to you all for your time. At NYSHN we like to say we believe in ongoing relationality, not one night stands, so I'd really encourage you all to reach out to us via our email or our social media and let us know how we can keep this conversation going.  

Thanks all. 

Jessica: Thank you Emma, and thank you to all our presenters for those insightful and informative presentations.  

I think it is evident from each of your presentations that STBBI prevention requires a comprehensive approach that moves beyond just focusing on risk-based messaging, but looking at what an individual needs holistically, to kind of achieve that health and wellness within their unique lived realities.  

I think if we walk away with nothing else, let it be a reflection on how providing good information in a good way has an incredible impact on one's ability to make informed decisions regarding their sexual health.  

But thankfully we aren't walking away just yet, and we are actually going to move now into our panel discussion, where we have a few questions prepared that will allow us to dive deeper into some of the topics that we've already begun to discuss.  

I will invite all of the presenters to have their videos on, thank you, and I'll invite those of you in the audience to enter any questions you may have within the Q&A function. 

To get us started, though, I do have a couple questions for Emma. I really appreciate how the process of beading condoms was such a sensory experience and allowed individuals to become familiar and comfortable with condoms outside of a kind of a sexual context. Can you elaborate, though, on how facilitators incorporate that education element into the workshops and what sort of approaches are used to navigate these sometimes awkward conversations?  

Emma: Yes, so we're big believers in humor as a culturally safe intervention. Sometimes I will joke that really me coming into do our sexual health education is more like my stand-up routine. But often times we'll access whatever is in the space, so a whiteboard, a flip chart um, a presentation if we can access it, or on the other hand if we're outside and doing land based education you can also like draw in the grounds the sticks.  

We've done it all to create diagrams, visuals, that assist young people with understanding applications. But really what we try to do is we try to avoid sort of speaking at young people and create as many opportunities as we can to speak with our communities in a dialogue.  

So we try not, we try to save the slideshows for clinicians, and when we're coming into community, we try to really create a space where youth can ask about what they're curious about, what they're worried about, what they're concerned, what they're excited to speak about.  

By creating a space that can be really participant lead, it's so much more effective and efficient than anything I could prepare.  

I think that's also really applicable for clinicians, you know, as much as we can come in with our own set of notions about what will be helpful to a patient, it's a really important reminder that when we offer a space for young people to speak about their own curiosities, concerns, exciting things, we can create a really rich conversation that way.  

Jessica: Great, and I guess to kind of build on that, in order to have these kind of participant lead conversations, that element of cultural safety is really important in creating a safe space where they can feel like they discuss those topics freely. What role does relationship building have in cultivating that safe space?  

Emma: Yeah, relationship building is everything. So, if we're invited into a community, there's sort of two pieces to NYSHN’s work.  

One piece is Indigenous youth working within our own communities, so you're already there, you're already known as the person who has condoms at their house, you're already known as, you know, the person who goes, once I was buying bedding at Walmart, in Tkaronto or Toronto where I grew up, and I hear “hey!” I’m like, that's not me. I kept checking out at the Walmart Super Center and it goes “that's the lady who taught me about sex!” and I look over and there is like a little like 14-year-old Anishinaabeg kid shouting across the Walmart Super Center, which was great, and also I was like in a professional educational capacity, yeah uhhuh, there was a classroom involved.  

But that continued an ongoing relationality really matters for, I think, not just Indigenous communities, but everyone, but certainly in Indigenous communities there's an aspect of cultural safety there.  

Yeah, I think that's also what is so dire about a shortage of clinicians right now, is that if you can't access a consistent relationship and opportunity to build trust to be a little bold and venture, and then see how someone reacts over time with your provider, often there's so many conversations we'll never even get to broach. 

Jessica: Thanks Emma. There are lots of questions coming in through the Q&A that are for you so we will be circling back quite quickly, but I am going to move on now to Andrew.  

Andrew, you had mentioned that sexual health education could be a team effort. Beyond health professionals, can you speak of what other institutions, services, or individuals are positioned to provide this information as well?  

Andrew: Yeah totally. When I say it's a team effort, I think we really mean that it does involve a lot of people, you're not going to get all the information you need from one source.  

Definitely people should be able to get it from their families, schools obviously are a huge place where people go and get information, healthcare providers would be awesome. 

There are lots of community organizations that provide it, whether they are specifically sexual health centers, or like a guidance counselor who has resources that they give out. 

It's not just like a one space thing, it is finding ways that you can incorporate sexual health stuff into more other spaces. 

So I think about like food banks that are also giving out menstrual supplies, right? It's normalizing that sexual health stuff happens in other places in our lives, not just in one institution or another. 

It's like prompting conversations, it is providing resources, it's putting up posters, it's just normalizing it across the board. 

If you have that space, whether you are a healthcare provider, whether you are a guidance counselor, or whatever, like if you have people coming in and it's an appropriate space to be talking about sexual health stuff, then I think people should try to do it. 

I think it could be really valuable in normalizing it, and, you know, I think to what Emma mentioned, that like when we don't have as broad access to individual healthcare providers that we can build relationships with, there are other people in our lives that we can build relationships with who can be supportive, and they're not going to offer the same thing as a healthcare provider, but they can still offer lots of useful information. 

I came up doing peer education programs, and so just being able to have young people who are informed with accurate information and are open to talking about sexual health, it just becomes your friend who's the one who knows lots of stuff, and that's amazing, because maybe they're not going to be able to diagnose something for you, but they can be that person, and I saw a question come up in the chat about like at home testing, and it's like yeah, maybe there's not a clinician who can be there to offer support and counseling immediately after you've done at home testing, but if you have a friend, or a trusted adult, or family member that can be there, that's huge. 

So it's finding ways that we can have sexual health discussions as part of multiple relationships in our lives, not just my teacher who gave me the lesson, not just my doctor is going to give me information, or the person that I'm sleeping with. It is like there's a wide range of people you can talk to about different aspects of sexual health. 

Jessica: Perfect, I love that answer, and I think acknowledging that, at the end of the day, there are still going to be youth who turn to the internet, is there ways that these same individuals can help at least ensure that the knowledge that they're turning to on the internet is credible? Is there something Action Canada has been doing to help with that? 

Andrew: Yeah, totally. So, I mean some of this is helping anyone, not just young people, but truly anyone to have a baseline media literacy analysis of what they're seeing online, so when stuff seems too good to be true, and stuff has is not backed by like resources or sources or things like that, being able to recognize just the basic media literacy and then also applying that to sexual health stuff. 

I see people who are really good at media literacy when they're like I'm watching a TV show and that's not actually how a police procedural goes, and they know that that's entertainment, but when it comes to sex or sexual health they don't have that same critical lens. 

So it's combining those pieces, so any organizations, like Media Smarts, is a great organization that does media literacy resources and offers that, I think those are great spaces to go and start looking to build up those skills individually. 

For us at Action Canada, we are all about modeling that, so we have our sexual health information hub where we provide information, we have our access line where people can contact to ask questions about sexual health stuff, we're also interested in helping people do sexual health advocacy, so that helps to cut through just relying on what they see online, but really engaging with the material, engaging with decision makers, and not just like getting mad at links that they see pop up. 

I mean right now we're working on another, uh, thing that's going to be going up on our site in the next month or so, specifically around changes in how social media companies are sharing information, or not sharing information, especially as it relates to sexual health and gender, so that people can understand sort of what they're up against, and not saying that everything you see on social media is going to be wrong, but it's also being able to diversify your media diet. 

So, yes, you can get great stuff from social media, Action Canada puts information up, there lots of healthcare educators put information on there, and that's awesome, but it's also being able to be like I'm going to the library, I'm going to go talk to someone who's a professional. 

It's not just relying just on social media. I think that's part of the thing, is breaking out of that, because hear from young people all the time that they want real stuff, they're tired of the online space, they're tired of not being able to trust what they see online. 

Giving people the tools and encouragement to get offline, to go into their communities and access resources that are there, not every community has all of the resources, but there's often something there or someone you can talk to, and try and build that up for sure. 

Jessica: Thanks Andrew. I think this Sexual Health Awareness Week, or Sex Plus Week, is such a great time to kind of bring forward all these resources, and I know a lot of them have been shared in the chat so I do encourage our audience members to check out some of those links to find out some of that information that they can use in their own organizations.  

Moving over to Andrea now. Misconceptions about sexual health are not exclusive to youth, health professionals have them as well, so could you kind of speak to what you think is a key misconception that health professionals may have with regard to available STBBI prevention tools, and how would you correct it, what would you respond to them to let them know?  

Andrea: Thanks, Jessica. Public Health Agency of Canada did do some consultations with health care professionals, and in those consultations heard some messages that I've also heard in my professional and collegial conversations, that some strategies are sort of in the domain of specialty care, like U=U messaging or prescribing HIV pre-exposure prophylaxis, and that that is the work for infectious diseases specialists. 

I have to acknowledge that health care professionals are working under really very real and significant constraints right now, and that Emma and Andrew also alluded to that in their remarks. But I would respond to those misconceptions by letting health care professionals know that that these types of strategies actually can be used broadly. 

The U=U message is really powerful and its simple, and all health professionals can understand and convey that message as a part of routine sexual health discussions. We know that open and clear discussions about messaging, like U=U, can dismantle HIV related stigma and discrimination and can normalize STBBI prevention and care. 

Then around HIV pre-exposure prophylaxis, for sure prescribers who are not infectious disease specialists can learn about and prescribe HIV PrEP, and we have Canadian guidelines that can support clinicians and incorporating HIV PrEP into their practices, the guidelines are currently in the process of being updated, but they contain tables and resources and they actually make HIV PrEP prescribing fairly formulaic. 

Often communities will have champions of HIV PrEP, and that might be an infectious disease specialist, or a primary care provider, a family doctor, nurse practitioner, it might be a pharmacist, so there often are resources that people can draw on that have expertise and experience to support them if they're wanting to incorporate that in into their practices. 

Jessica: Great, and I also saw in the chat that our host has put some great resources that are specific to health professionals, we actually do have an accredited course on U=U now available through the University of British Columbia, so definitely a great resource specific to that prevention tool. Of all the prevention tools available, curious Andrea, what your thoughts are on which ones being overlooked but could play a key role? 

Andrea: I think one that's maybe not overlooked but has fallen a bit out of fashion is barrier methods, including external and internal condoms and dental dams.  

As Andrew highlighted, we have recent Canadian and international survey data that has shown decreasing rates of condom use among adolescents, and that concerns me because we know that STBBI rates are increasing and we know that youth are disproportionately impacted by STBBI.  

We know that barriers are easy to use, cheap, accessible, and effective for preventing many STBBI, so to me barriers are timeless and a really fundamental part of our prevention toolkit.  

I was super inspired by and really glad to hear about Native Youth Sexual Health Network’s condom beading project, I thought that was so fascinating and just a really interesting way of kind of keeping condoms timeless, as I say.  

Jessica: Thanks Andrea. Yes, I think we are all quite a big fan of the Beaded Condom Project, there is lots of comments in the chat about it.  

Emma we do have some more questions about that, so I'm going to jump back to you. I guess, could you share a little bit about what do they use the condoms for afterwards, is it something that you keep, is it something that is a good reminder, and then are these workshops kind of ongoing, is it kind of a one time event that youth attend, maybe speak a little bit about those two questions that we've seen.  

Emma: Absolutely, I mean we do we give all participants a little handout as after the workshop, so they take it home, we bring we give them like a nice little container to carry home that has some storage instructions, you know latex is degrades with exposure to light, so try not to keep it right beside your window, but actually we find a lot of participants, the popular thing is to turn it into a medallion. 

Beaded medallions have a big like cultural relevancy in Indian Country. There's lots of jokes about, you know, ‘the bigger the medallion,’ and some penis size jokes that happen in these workshops for sure. We've seen some really beautiful beaded necklaces that go with the these condoms. 

They also, you know, just make great conversation pieces. I did see a question that was about their use as barriers and that always comes up, I can't believe I forgot to speak to it, but absolutely they are no longer effective barriers once you poke a thousand holes in them with a needle, that is part of the process of beading them. 

We do discuss that with our participants, but it's also impossible to roll it down, you know, it's not a misunderstanding that can happen. 

As to frequency or regularity, I mean we're very consent based, and so we only operate on invitation unless we're from the community. 

If we don't have a youth leader who's living in the community that's from there, then we're only going to come in if we've been asked, and that's part of our amalgamated protocols around hosting and visiting. 

There's no currently standing monthly or weekly engagement, although in some communities before they've made those agreements, so you know every other Wednesday they'll there will be a NYSHN youth leader and maybe like a sexual health nurse at the clinic who are going to do some kind of art activity and be on hand to answer questions and do education. 

But don't currently have anything active similar to that. We are available on requests, we will come to your community, we'll come to the middle school, we'll do arts based culturally safe sexual health interventions. 

Jessica: Fantastic. I am not a youth anymore, but I feel like I would love to come to one of these workshops, they have sounded so incredibly insightful and like a very good time on top of that.  

Jumping over to you Andrew, we've seen it a few times in the chat, do you want to explain a little bit about the rationale as to why Action Canada went from Sexual Health Week to Sex Plus Week?  

Andrew: Yeah, sure, it is partly that we are, like we do sexual health promotion year round, and it is great to have a week that's dedicated to that, that we could throw a lot of effort and get the community really rallied behind, but we also want to keep that attention throughout the year, and so sometimes, as we were discussing about it, campaigns like this that are beyond just ‘Sexual Health Week’ can become Sex Plus. 

It’s something that we can share out when we're doing something in November, when we're doing something in the summer, and use that same kind of branding. 

I know that Sexual Health Week is the officially recognized week across, like I mentioned, different government healthcare bodies, and that's awesome, we want people to be able to recognize it as officially and formally as that. 

The Action Canada spin is just that we're in the transition year of trying to find what the new version could be that we are able to spread along. 

All the feedback is super helpful, I really appreciate it, and it's really it's that transition between doing things that are more internally for healthcare providers, policy makers, and then something that is more public facing, and we're learning as we go, so yeah, appreciate all the feedback. 

Jessica: Great, thanks Andrew. I have a question I think perhaps that all of you can touch on but I'm going to turn it to Andrea first.  

Acknowledging that if you do a at home test you might be doing it alone, what kind of supports are available to help with that kind of pre-test and post-test counseling that has traditionally been done by a health professional, in the cases where an individual is now doing that testing in a private at home environment. Are there resources available, are there tips that you would recommend? Again, I think all of you will have some good insights on that, but Andrea over to you.  

Andrea: Thanks, Jessica. I actually think others may have a better answer than me because a lot of the home tests have been distributed through community-based organizations, and so in hearing back from community-based organizations and being involved in some discussions about HIV self testing, my understanding is that there's been a lot of work at the community level to develop resources to help people administer the tests, interpret the tests, and then understand what follow up might entail, and there's role for peer support and other folks at the community level in helping people navigate accessing tests and then any follow up. 

I might maybe turn it to Emma because I think you mentioned specifically that there was some HIV self-testing that you were involved with, so you might have some insight based on that. 

Emma: Yeah, I think during my presentation I may have slightly misspoke, so yes NYSHN has participated in the roll out, or in what was the roll out, of sort of this point of care testing. 

I would say the majority of its application for us was actually in community, for example something we're really excited to do is to bring this on the Pow Wow trail. The Pow Wow trail is sort of an understanding of various connected cultural gatherings between different communities, and some families will spend the summer, take sometime off work, and travel to the different communities, and then at each there's a gathering hosted. 

Mostly, we've really encouraged folks to do their testing on site, like with some of our youth leaders, or with aunties and mentors present, who are then equipped discuss results, discuss where in that community they can access follow-up care, talk about care plans between their friends, families, partners. However, we do also support people to take home the kits themselves, especially if they don't have time. 

Something that is interesting, that is maybe not that the folks who gave us the kits would love for us to focus on, but we have seen like a proponent of what we would call like aunties, uncles, so relatives who lived through the sort of first wave of the HIV crisis, who want these kits as part of processing their grief. 

People want to have a kit to process, that it feels meaningful to process that this is available now, and it feels like it's a change that would prevent the loss that they experienced in their youth. 

They're not souvenirs, they are health interventions that expire, they can't sit on the mantle in perpetuity, so we really encourage people to you know take this in memorial but also put it into action, use it with someone in their life, but I will say that's not something I had anticipated going into this. Yeah, that's a great question, thank you. 

Jessica: Thanks, and Andrew I'm sure you've got something too, would you like to add anything about resources available for at home tests?  

Andrew: Yeah, I think that just speaks back to that relational piece, and that's why, as Andrea is mentioning, that so much of the roll out of those programs was through Community organizations, because they are trusted providers in the community of resources, of support, of information. 

And so, being able to support community organizations in doing that, I think is really key. Being able to fund those tests to be distributed through there is really an important initiative that that we would love to see come back. 

You know, and if people are doing at home testing, like mentioned, Action Canada's access line, there are also public health access information lines that people can call in different areas around the country to get kind of that support. 

One of the things that we do hear a lot consistently as well is that there's so much information about STBBI prevention, STBBI testing, ahead of time, and there's not as much of an emphasis on, even if you have a clinician who you talk to, what do you do afterwards, how do you get treatment, how do you get support? 

And I know that for some STBBI, like say like herpes or HIV, that are things that people live with, there is information and resources out there, but there's not as much time or energy spent having that on hand. 

So, I think again, if I'm thinking about like someone like a guidance counselor, who has like maybe info about like testing and how to prevent STBBIs, they're probably not also filling their portfolio with herpes pamphlets and HIV pamphlets, the same way, because of maybe questions that they often get. 

So people are trying to become spaces where they are providing supports and information. Having the treatment and after care stuff is just as important as the like prevention information, because yeah, we don't, you know, as much as we love that home testing as a method that lets people test in spaces they feel safe, test in spaces on their own time in a controlled way, we don't want it to skip the part where they're connected to supports. 

We want healthcare professionals to be a site information and support, and so we want to make sure that people know that those relationships exist where they do, and so that they can get that kind of help afterwards if they need it, so they're not alone dealing with an STI diagnosis by themselves somewhere. 

Jessica: Great, thanks Andrew. I think it is important to remember that while today we're gathering on the topic of prevention that it is what we call a care continuum and it is important that we stick with people all the way through from prevention, to testing, to treatment, and the care that exists afterwards.  

We do have time for a few more questions, so if you do have anything that you'd like our presenters to know, please feel free to add them into the Q&A. 

Emma, I'm going to turn it back to you now. There is a few topics that you had in your list of things that the organization kind of covers. Could you briefly describe what was meant by rites of passage as well as hearing more about environmental justice and what environmental violence means?  

Emma: Absolutely. Yes, I saw those, I'll give them a brief speedrun and also try to tie them back to these particular theme of prevention. 

For rites of passage, this looks different for many different communities, but many nations had protocol for how you guide a young person into adulthood in relation to also like healthy sexuality, different forms of dating and, fluid bonding. 

All these pieces that presently in the 21st century we are addressing through our educational systems, communities also had cultural ways of communicating this knowledge. So, at NYSHN, we've both partnered in community to help with the revitalization of rites of passage. So, for example, you know Akwesasne, they have like an Aunties and Uncles Council that shares cultural teachings with young people as they move into transitioning to the place of adulthood. So they might start at like age 10 and continue with the young person all the way through to their early 20s. We've both supported, you know, just that cultural revitalization, but we've also been invited to share sexual health information as part of those rights of passage. 

So, to understand that, well it is sacred and important that we access cultural teachings to guide us, it's also sacred and important that we access the knowledge we need to keep our bodies safe in our sexual health, and so yeah everything like beading condoms, making punk patches, we've, uh, been invited to go into the long house or go into these cultural spaces and do some education work. 

And then we had a piece about environmental violence and environmental justice, I will link to our report on this. This really comes out of our recognition that as we are connected to our bodies, we're also connected to our lands as Indigenous young people, and what happens to our lands also has an impact on our bodies. 

Some very like straightforward examples of this that are like explored through studies in the report are, for example, in Akwesasne again, Akwesasne Mohawk Nation, um, and Aamjiwnaang First Nation, these are sites where there's been contamination of drinking water through resource extraction, and the community are experiencing increased rate of miscarriage or disruption to the menstrual cycles, for example. 

That's a very straightforward example of there has been resource extraction that is negatively impacting the land, and it is also impacting people's reproductive health. And so, NYSHN, we're committed to like naming this, we're committed to supporting organizing about this. It has to be part then of the teachings that we give, and it has to be part of recognizing that we're not at risk all by ourselves. 

Our menstrual cycles, our miscarriage rates aren't being impacted just because we're Indigenous and we're young, it's being impacted by resource extraction in those communities, for example. 

Another format that we talked about, but sort of in like BC in the interior a bit more, is that, when resource extraction happens there in the form of like logging sites, but particularly the building of pipelines, can bring a lot more workers to small communities who are not from those communities. 

And this means there's a decrease in relational accountability, so, for example, if you are like having a sexual partner who's from a town over, you know, maybe your siblings or your cousins went to school together, maybe there's like different examples of that relational accountability. 

That changes what it looks like to negotiate for condom use, for example, but it also changes what it means if you have a sexually transmitted infection, right? How do you get a hold of that person? How do you tell them? What is your trust for that repercussion in all of your social circles, versus if you had someone new who's coming in as part of resource extraction in your territories that you maybe can't get a hold of, or who doesn't feel responsible to have to tell you that they know they have an active infection, right? They don't feel like there's any relational accountability there. 

So those would be some examples of sort of environmental violence, environmental justice, it's about recognizing that, to borrow the reproductive justice term, sometimes we have to have justice before we can meaningfully access choice. Putting that link. 

Jessica: Thanks Emma. Yes, a little wider than the topic we started talking on, but I think all of those things are very interconnected and very relevant to the audience so thank you for elaborating on that.  

I am going to ask all of our presenters to start thinking of one key takeaway that they can end our webinar with today.  

I am going to ask one more question first, so giving you that warning so you can begin to think about what your key takeaway is, but a bit more of a pointed question, going to back to you Andrea. Could you explain the different types of at home tests that are available? I think terms such as point of care test, self test, are all kind of circulating and they are relatively new to some people so do you think you could give a high level overview of sort of the buckets of options that are available?  

Andrea: I will do my best. So, the only test that's available as a home test, or licensed for that use in Canada, is an HIV self-test. 

For many years we've had point of care testing for HIV, which would typically be done in a health care professionals office or sexual health clinic, and so both that point of care test for HIV and the home test for HIV use a finger stick specimen, so it's like when people are collecting a specimen to check their blood sugar, just a lancet at the tip of the finger and collect a specimen of blood. And so we've used that in office settings for a while for some populations to be able to provide a more rapid result. 

Generally, those types of test results are not considered a confirmed result, so people would then need to have standard lab blood tests if they had a positive result, or the test might not show positive very early after someone has had an exposure, in which case someone might be recommended to have the standard blood testing to feel more confident in their result. 

In recent years, we've had some new point of care tests approved, and I mentioned some, two syphilis and HIV point of care tests, so those ones check for HIV and if anyone has ever been exposed to syphilis before. 

Right now, there are no home tests that are for HIV and syphilis, so those would need to be done in a health care setting by somebody who's trained according to the Health Canada licensure for those tests. 

Then there are also dried blood spot tests, so those ones are a bit different. Those ones collect a sample of blood on a filter paper and then dry it to be transported to the lab, and those types of tests have really most applicability in Northern and remote locations, where otherwise it may take quite a while for specimens to get to the lab. 

So it's sort of a different way of collecting a specimen, and then the lab processes it, and that, depending on where you are, might be considered a confirmatory test, or standard lab testing might be recommended again to confirm the diagnosis. 

The point of care tests are meant to be done in a setting where a result can inform an immediate action, whether that's confirmatory testing, or initiation of treatment, or if somebody is at risk for infection but tests negative, then ideally that would also be an opportunity to talk with that individual about what range of prevention services would be available and effective to reduce the risk of that infection. 

I hope that answers those questions, and I don't know if others might have anything additional to add. 

Jessica: I think you did a great job Andrea that was a very clear explanation.  

We are going to begin in wrapping up our webinar now, so I am going to ask what I know is a challenging question, but in one sentence, what do you think is the most important takeaway that our audience should leave here with? And Emma, you were the last to present so I'm going to let you go first in sharing your words of wisdom for the group. 

Emma: Oh dear, you warned me and everything. I would say relational care is culturally safe care. 

Jessica: Great thank you Emma. How about over to you Andrew. 

Andrew: I think that I hope that people take away and remember that there is more than just condoms when it comes to preventing STBBIs, and to go out and learn more about those options.  

Jessica: And last but not least, one more time, Andrea. 

Andrea: Building on and hopefully complimenting Andrew’s and Emma's, still condoms are timeless, that's going to be my tagline going forward, so those are sort of foundational and the other methods build upon those.  

Jessica: Wonderful, and I think having both Andrew and Andrea’s piece on condoms and the other options available just goes to show that STBBI prevention really does require a comprehensive approach that allows individuals to choose the options that are best for them, and at the end of the day, it is important that we empower individuals with the knowledge that they can use to take control of their health.  

With that, I will thank all of our audience members for joining us today, all of our presenters for the great presentations, and a fabulous discussion. Reminder we will be sending these slides to all participants in an email, as well as a feedback form.  

Thank you so much and have a great afternoon everyone.