Canada

INTRODUCTION

Au Canada, vous trouverez de nombreux soins de santé. Les méthodes contraceptives, notamment les préservatifs, les pilules, les patchs et les injections, sont facilement accessibles. Bien que les contraceptifs ne soient pas remboursés par le système de santé canadien pour tout le monde, vous trouverez néanmoins des pilules et stérilets (insertion comprise) à moindre coût dans les cliniques publiques. Vous pouvez vous procurer la pilule contraceptive d'urgence ("pilule du lendemain") à la pharmacie (au comptoir du pharmacien, sans ordonnance) ou dans une clinique. Il n'y a pas d'âge minimal requis, mais la vente reste à la discrétion du pharmacien. De nombreuses cliniques publiques de santé sexuelle offrent des tests de dépistages des IST. Certaines cliniques ne proposent que des tests pour le VIH, alors que d'autres proposent des tests pour un grand nombre d'IST. Dans tous les cas, il vaut mieux prendre rendez-vous. Un programme de vaccination contre le VPH est également en place. Les prophylaxies pré-exposition (PrEP) et post-exposition (PEP) sont disponibles. Les avortements sont légaux et sans restrictions. Avec une carte valide de l'assurance-maladie, l'intervention, qu'elle soit médicamenteuse ou chirurgicale, est totalement gratuite. Si vous n'êtes pas citoyenne canadienne ou résidente permanente, il faudra vous attendre à payer entre $300-$900 pour la procédure, mais il existe des assistances financières qui pourront vous aider.

Contraception

Note : il existe de nombreux moyens de contraception, comme les DIU (dispositifs intra-utérins ou stérilets), les contraceptions orales, les patchs, les injections, les préservatifs, etc. Pour une liste complète, cliquez ici.

Lois et stigmatisation sociale

Au Canada, vous trouverez des préservatifs dans de nombreux magasins. Pour les autres contraceptifs, tels que la pilule, le stérilet, l'injection ou l'implant, il faut l'ordonnance d'un médecin ou d'une infirmière.

De manière générale, l'usage de contraceptifs est assez répandu dans tout le pays. On estime que plus de 70 % des femmes en âge de procréer utilisent une méthode de contraception moderne, et environ 22 % des hommes ont subi une vasectomie. Malgré tout, l'accès aux différentes méthodes n'est pas toujours sans difficulté pour les femmes. La Société des obstétriciens et gynécologues du Canada estime que les Canadiennes ont, de manière générale, moins facilement accès à la contraception que les femmes des autres pays développés. De plus, selon le rapport du Groupe d'étude canadien sur les soins de santé préventifs, 15 % des femmes sexuellement actives n'utilisent aucune méthode contraceptive, et 20 % le font de manière irrégulière. Le coût peut être une contrainte, quand on sait que les contraceptifs ne sont pas totalement remboursés par le système de santé public canadien. Néanmoins, des contraceptifs abordables sont offerts dans les cliniques de santé sexuelle (qui peuvent toutefois avoir une choix limité, des heures d'ouverture restreintes et de longs temps d'attente). Malgré ces quelques failles, ces cliniques demeurent une ressource incontournable pour la santé reproductive des femmes (et des hommes).

Que prendre et où?

• Vous pouvez acheter des préservatifs en ligne à Top Condoms Canada, IdealCondoms.ca et à Undercover Condoms. Il est aussi possible de se les procurer en pharmacie ou dans plusieurs dépanneurs (épicerie de quartier).

Pour des informations sur la contraception au Canada, allez voir les pages des villes, comme Toronto/fr, car les recommandations varient selon les villes.

Coûts

Bien que le Canada ait un système de santé universel, les contraceptifs ne sont pas gratuits. Différentes options à prix abordable sont toutefois offertes dans les cliniques de santé sexuelle publiques. Par exemple, le prix des contraceptifs oraux de base peut aller jusqu'à $10 pour une plaquette d'un mois, et les DIU peuvent coûter $60 environ. Les prix sont plus élevés dans les cliniques privées, où le stérilet Mona Lisa coûte environ $55, le Jaydess autour de $300 et le Mirena entre $360 et $380.

Contraception d'urgence (pilule du lendemain)

Note importante: La contraception d'urgence peut prévenir la grossesse jusqu'à trois jours (72 heures), voire cinq jours (120 heures) dans certains cas, après une relation sexuelle non protégée. Elle doit être prise le plus tôt possible après la relation.

S'il n'est pas possible de vous procurer un contraceptif d'urgence, les contraceptifs oraux réguliers peuvent être utilisés. Il est toutefois important de savoir que: 1- ce ne sont pas toutes les marques qui peuvent agir comme contraceptif d'urgence; 2- les doses requises et les périodes d'action peuvent varier; 3- seulement les 21 premières pilules sur les 28 de la plaquette doivent être utilisées (celles qui contiennent des hormones); 4- ils peuvent être moins efficaces qu'un contraceptif d'urgence régulier. Pour plus d'information, cliquez ici ou ici

WhatsNextForMe.ca est un site internet canadien développé par un groupe de médecins et de chercheurs basés au Women’s College Hospital de Toronto. Il offre des informations sur quelles options de contraception d'urgence sont disponibles au Canada, comment elles fonctionnent et comment se les procurer. Des informations générales sur la contraception d'urgence sont aussi disponibles ici et ici.

Lois et stigmatisation sociale

In Canada, the emergency contraceptive pill (the morning after pill) is available at a variety of places, including women's clinics, sexual health centres, hospitals, and pharmacies. However, the laws around its availability vary by province. In Ontario and most provinces, emergency contraceptive pills are available over-the-counter, except for Ulipristal-based pills, such as ellaOne, which requires a prescription. In Quebec, emergency contraceptive requires a prescription, and in in Saskatchewan, it is available behind the counter at pharmacies.

Generally speaking, age restrictions on emergency contraception vary by province. In many provinces, there are no age restrictions, so young people and teenagers are legally allowed to purchased emergency contraceptive pills without a prescription or parental consent. However, there are some age restrictions when purchasing EC. As reported by the International Consortium for Emergency Contraception, "In May 2008, the National Association of Pharmacy Regulatory Authorities (NAPRA) recommended full OTC access for the LNG regimen with no age restriction. This recommendation is being applied Under Common Law; however, pharmacists have the discretion to restrict sale of EC if a woman does not appear mature. All provinces follow Common Law with the exception of Quebec, which follows Civil Code, and Saskatchewan."

What to Get & Where to Get It

• You can obtain most emergency contraceptive pills (morning after pills) without a prescription from a pharmacy, doctor, women's clinic, sexual assault centres, sexual health clinics, or hospital emergency rooms.

In Canada, if you want dedicated progestin only EC, you can take NorLevo 0.75 mg (available over the counter) or Plan B (available over the counter). You should take 150mgs available in some places as 2 pills, or sometimes just 1 pill, within 120 hours after unprotected sex. If you can't access dedicated EC, you can use some oral contraceptives as replacement EC -- but, remember: in 28-day packs, only the first 21 pills can be used. Some of the contraceptives you can use are Ovral (take 2 pills within 120 hours after unprotected sex and take 2 more pills 12 hours later), Minovral (take 4 pills within 120 hours after unprotected sex and take 4 more pills 12 hours later) and Alesse (take 5 pills within 120 hours after unprotected sex and take 5 more pills 12 hours later).

Note: The longest-lasting EC is currently ellaOne. It lasts up to 5 days (120 hours) after unprotected sex. It seems like ellaOne is available in Canada. However, a prescription may be require to purchase it. Check with your pharmacist or local sexual health clinic for details.

Costs

Prices vary, depending on where you bought the emergency contraception. If you go to a pharmacy, you can expect to pay around $23-$30 (as of 2013). If you go to a community health clinic, you can expect to pay around $13-$20 (as of 2013).

Sexually Transmitted Infections (STIs/STDs)

Important Notes - Learn about PEP and PrEP: If you think that you've been recently exposed to HIV (i.e. within 72 hours), seek out PEP (Post-Exposure Prophylaxis). It's a month-long treatment to prevent HIV infection after exposure, and it may be available in your city. Take PEP as soon as possible. For more information, click here. If you are at risk of HIV exposure, seek out PrEP (Pre-Exposure Prophylaxis). It's a daily oral pill that can prevent HIV infection before exposure. To learn more about PrEP, click here.

Laws & Social Stigmas

In Canada, there are no travel restrictions attached to STI or HIV status. However, if you wish to stay in Canada for over 6 months, you'll need to get an HIV test. If you test positive, you probably won't be granted a residency permit. You will still be issued a residence permit if you fall into one of the following categories: you're an HIV-positive refugee, you're an HIV-positive sponsored spouse or common law partner of a Canadian citizen or permanent resident, or if you're an HIV-positive sponsored and dependent child of a Canadian citizen or permanent resident.

As reported by HIVTravel, "Accessing health care in Canada is expensive for non-Canadian residents or visitors and the cost varies from one province to another. Canada is a federation of provinces and territories and health care is the responsibility of each province or territory. Access to services can vary a bit from one province to another. In general, visitors to Canada need private health insurance from their home countries to pay for major medical costs here." For more details on HIV treatment for foreigners in Canada, click here.

What to Get & Where to Get It

Testing Facilities

For information on STI testing facilities in Canada, please visit the city pages, like the Toronto page, as recommendations will vary by city.

Support

• Canadian Liver Foundation: Helps people with Hep B and Hep C. "The Canadian Liver Foundation is a national non-profit organization committed to promoting liver health and providing hope to people living with liver disease."
• CATIE: "CATIE is Canada’s source for up-to-date, unbiased information about HIV and hepatitis C. We connect people living with HIV or hepatitis C, at-risk communities, healthcare providers and community organizations with the knowledge, resources and expertise to reduce transmission and improve quality of life."
• AIDS Committee of Toronto: "ACT provides support services that empower men, women and young people living with HIV to achieve self-determination, informed decision-making, independence, and overall well-being."
• BLACK CAP - Black Coalition for AIDS Prevention: "Since 1989, the Black Coalition for AIDS Prevention (Black CAP) has worked to respond to the threat of HIV and AIDS in Toronto’s African, Caribbean and Black communities." "Black CAP is Canada’s largest Black specific AIDS service organization."

Medications & Vaccines

Laws & Social Stigmas

PrEP was approved for usage in 2016.

What to Get & Where to Get It

• There are two HPV vaccines available in Canada: Cervarix® (HPV2) and Gardasil®9 (HPV9). For some people, the vaccine is free and, for other groups. it is available but not free. For example, the HPV9 vaccine is provided for free to all girls and boys in Canada in Grade 6. Other people who can get free HPV vaccines are girls born in 1994 or before who were not immunized, HIV-positive people (9-26 years of age), transgender people (9-26 years of age), men who have sex with men (9-26 years of age), men who are questioning their sexuality (9-26 years of age), and men who participate in street activity (9-26 years of age), and some other groups. You can visit the Immunize BC website to learn more.
• You can get the Hepatitis B vaccine at many sexual health clinics.
• If you want Post-exposure prophylaxis (PEP), you should contact a hospital emergency department or their doctor for treatment. Generally, no appointment is required since patients should be counseled and treated ASAP.
• If you want Pre-Exposure Prophylaxis (PrEP), it is available in Canada. In February 2016, Health Canada approved Truvada as prevention, and generic versions of TDF/FTC are approved for prevention. There are an estimated 900-1,100 people on PrEP in Canada, as of 2018. According to ACT Toronto, "Any doctor can prescribe PrEP. If you have a family doctor that you feel comfortable with, that is a good place to start. There is ongoing testing and medical care required with PrEP, so accessing PrEP through a doctor that you already have a connection with is ideal." CATIE has compiled extensive resources on PrEP for Canadians, which you can check out here. For updates on PrEP access in Canada, PrEPWatch is also a great resource.

Menstruation

Note: In addition to pads and tampons, you can also use menstrual cups and menstrual underwear for your period. To learn more about menstrual cups, click here. To learn more about menstrual underwear, click here.

What to Get & Where to Get It

You can easily finds pads and tampons in Canadian stores. If you want to buy a menstrual cup, you'll also find quite a few vendors. For DivaCup, check out Shoppers Drug Mart, PHARMAPLUS, Yonge Pharmacy, Nutrition House-Eaton Ctr Dund and Condom Shack. For MoonCup, you can deliver online. For Lunette, check out the Lunette North America website. For eco-friendly menstrual products, check out London Drugs, Loblaws, Save on Food, Whole Foods, Well.ca and Overwaitea.

Gynecological Exams

What to Get & Where to Get It

For information on gynecologists in Canada, please visit the city pages, like the Toronto page, as recommendations will vary by city.

Note: There is a Canadian website called Pap Test Info: "Every year, almost 400,000 Canadian women receive a call that their Pap test result is abnormal. In many cases, the call is made by a nurse or medical receptionist who cannot discuss the results or implications over the phone. Often women are not given any information about what that means and are left feeling nervous or unsure about what happens next. This website has been developed to provide women with information about Pap testing and what it means to have abnormal test results. All of the information contained in this website has been reviewed by physicians."

Pregnancy

Laws & Social Stigmas

In Ontario, Employment Insurance (EI) provides maternity and paternity benefits to people who are waiting for a child, have recently given birth, are adopting a child or are caring for a newborn. For details, click here.

Abortion

Important Note: There are two main types of abortions: medical (also known as the "abortion pill") and surgical (also known as "in-clinic"). For medical abortions, you take a pill to induce abortion. For surgical abortions, a procedure is performed to induce abortion. For general information about medical and surgical abortions, click here.

Laws & Social Stigmas

In Canada, abortion is legal at all stages of pregnancy with no restrictions. It is governed by the Canada Health Act. However, it should be noted that some reports indicate that third trimester abortions are not generally available.

Historically, there were significant challenges to abortion in the past. Until 1969, abortion was not generally legal. Following the Criminal Law Amendment Act, 1968-69, abortion became legal in cases where physicians decided the abortion was necessary for the physical or mental well-being of the woman. However, the Criminal Law Amendment Act also imposed restrictions on abortion access, as it was not generally accessible to all women. In 1988, the Supreme Court of Canada ruled that the existing abortion laws were illegal, and they were struck down. Since then, there have been no official laws on abortion in Canada, making it available to women without restrictions. Today, one-third of all hospitals in Canada perform abortions.

What to Get & Where to Get It

For information on abortion in Canada, please visit the city pages, like the Toronto page, as protocol and recommendations will vary by province.

Costs

• Generally, abortions in Canada are funded by Medicare (for Canadian citizens and permanent residents). If you have a valid health card from Ontario, medical and surgical abortions at free-standing clinics and hospitals are fully covered.
• If you're not a Canadian citizen or permanent resident, you'll need to pay between $300-$900 or an abortion at a free-standing clinic. The costs will vary, depending on how long you have been pregnant, the clinic and the type of procedure.
• If you need help paying for your abortion in Toronto, call Planned Parenthood Toronto (416-961-0113) or the Bay Centre for Birth Control (416-351-3700) to learn about your options.

Advocacy & Counseling

What to Get & Where to Get It

• The Kids Helpline: Call 1-800-668-6868. Toll-free, 24-hour, bilingual and anonymous phone counseling for teenagers and children.
• Distress Line 416-408-HELP (4357): Provides telephone support for people facing crisis situations and suicide prevention.
• Barbra Schlifer Commemorative Clinic: "The Barbra Schlifer Clinic offers legal representation, professional counselling and multilingual interpretation to women who have experienced abuse. Our diverse, skilled and compassionate staff accompany women through personal and practical transformation, helping to build lives free from violence. We are a centre by, for and about women"
• Family Services of Toronto – David Kelly Services: Provides counseling and support for LGBTQ individuals. "We are committed to trauma-informed, anti-oppression practices to help empower LGBTQ+ individuals, couples and families, as well as people living with, affected by or concerned about HIV/AIDS, and to enhance participation in their communities and in the broader society. For more information about DKS, contact Service Access Unit at t. 416-595-9618 | sau@familyservicetoronto.org"

List of Additional Resources

• Telehealth Ontario — a free 24/7 service which uses nurse practitioners to answer your health concerns: 1-866-797-0000. 1-866-797-0007 (TTY).
• Sexual Health Information Line - Toll free: 1 (800) 668-2437; Local: (416) 392-2437. Hours of operation: Monday to Friday 10 am – 10:30 pm; Saturday and Sunday 11 am – 3pm
• The Sex Information and Education Council of Canada (SIECCAN): "The Sex Information and Education Council of Canada (SIECCAN) is a national registered charitable organization founded in 1964 to foster professional education and public knowledge about sexuality and sexual health. SIECCAN works with health professionals, educators, and community organizations to ensure that all Canadians have access to high quality sexual health information, education and related health and social services."
• The 519: "The 519 is committed to the health, happiness and full participation of the LGBTQ community. A City of Toronto agency with an innovative model of Service, Space and Leadership, we strive to make a real difference in people’s lives, while working to promote inclusion, understanding and respect."
• Scarlett Teen: This website offers sex education to teenagers.
• Teen Health Source: This website offers sex education to teenagers.