Toronto: Difference between revisions

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'''OVERVIEW'''  

As the largest city in Canada, you will find an incredible range of health care options. You will find all major contraceptive methods, including condoms, pills, patches, shots, etc. in Toronto. While contraceptives are not subsidized by the Canadian health care system for all people, you can find lower-cost pills and IUDs (including insertion) at public sexual health clinics. You can purchase emergency contraception ("the morning after pill") at pharmacies or obtain it at sexual health clinics. There are no formal age restrictions but pharmacists can refuse to dispense EC to people who do not seem "mature." There are many public sexual health clinics that offer STI tests. While some only cover HIV, other clinics can test for a range of STIs, especially if you make an appointment rather than dropping in. There is an HPV vaccination program in place. You can access Pre-Exposure Prophylaxis (PrEP) and Post-Exposure Prophylaxis (PEP). Maternity and paternity leave is covered under Employment Insurance (EI). Regarding abortions, you can receive them at hospitals, free-standing clinics or at Birth Control Sexual Health Centre. If you're a Canadian citizen or permanent resident, the costs are covered. If you're not a Canadian citizen or permanent resident, you can expect to pay $300-$900 for the procedure, but there are some financial assistance resources available.

'''General Note:''' There are many types of contraceptives, also known as "birth control," including IUDs, oral contraceptives, patches, shots, and condoms, etc. If you would like to view a full list, click [https://www.plannedparenthood.org/learn/birth-control here].

In Canada, you can find condoms sold in many stores. For other birth control options, like the pill, IUD, shot or implant, you will need a prescription from a physician or nurse.  

Generally, Canada has a high rate of contraceptive use. It's estimated that over 70% of Canadian women (of reproductive age) use modern contraceptive methods, and about 22% of Canadian men have underwent male sterilization.<ref>[http://www.un.org/en/development/desa/population/publications/pdf/family/trendsContraceptiveUse2015Report.pdf Trends in

Contraceptive Use Worldwide 2015]</ref> Yet some women still face difficulty when trying to access birth control. The Society of Society of Obstetricians and Gynaecologists of Canada found that Canadian women have less birth-control options than women in other developed countries.<ref>[http://www.theglobeandmail.com/life/health-and-fitness/health/canadians-feel-the-cost-of-health-policies-limiting-access-to-birth-control/article23883108/ It's time to give Canadian women more options when it comes to birth control, experts say]</ref> Furthermore, the Canadian Contraception Consensus report found that 15% of sexually-active Canadian women aren't using any form of birth control, and 20% are using birth control inconsistently. The largest barrier  is probably cost. Contraceptives aren't free under Canada's universal health care plan, and affordable birth control options are typically found through the public sexual health clinics (which can have limited drug choices, limited opening hours and long wait times). It should be stressed, however, that these clinics do provide affordable options and are an invaluable resource in Canada.<ref>[http://www.metronews.ca/life/health/2016/01/11/canada-birth-control-policy-needs-overhaul.html Canada lags behind other nations in birth control access, and it's costing us]</ref>

* You can buy condoms online at [http://www.topcondomscanada.com/ Top Condoms Canada], [http://idealcondoms.ca/ IdealCondoms.ca] and [https://www.undercovercondoms.com/ Undercover Condoms].

* For low-cost birth control (e.g. condoms, pills, IUD, etc), you can visit a public sexual health clinic. There are about 14 of these public clinics, including Jane Street Clinic, Black Creek Community Health Centre, Scarborough Sexual Health Clinic, etc. Some are drop-in and some require scheduling an appointment. Here is a [http://www1.toronto.ca/wps/portal/contentonly?vgnextoid=30865e67bbee0410VgnVCM10000071d60f89RCRD complete list] of all these clinics in Toronto.  

* If you want to get an IUD at a private clinic, one recommendation is [http://www.womenscollegehospital.ca/programs-and-services/bcbc/ Women's College Hospital - Bay Centre for Birth Control]. You buy the IUD at their pharmacy and then they do the insertion. They charge around the following prices: Mirena: $363.40. Jaydess: $290.06. Mona Lisa: $57.70. They're known to be sex-positive and a good experience overall. As someone wrote, "You can go during walk-in hours or make an appointment. You'll see a nurse and they talk to you about all your options, side effects, pregnancy rates, etc. It's run by Planned Parenthood, so there's no selling happening and no pressure that some doctors may have, or any pressures about not having sex etc etc (they're a "sex-positive atmosphere.") The nurses make you feel so comfortable and are honest and compassionate."<ref>[https://www.reddit.com/r/toronto/comments/362rqd/best_place_to_get_an_iud_in_toronto/?st=ix49re6c&sh=15fa2b7f Best place to get an IUD in Toronto?]</ref> You can also go Planned Parenthood Toronto. You buy the IUD at the pharmacy and then Planned Parenthood does the insertion. Here are their rates: Mirena: $380. Jaydess: $306. Mona Lisa: $54-63

While Canada has a universal health care system, it does not offer free contraceptives. You can get lower-cost birth control at the public sexual health clinics (for example: birth control pills ranging from free to $10/per month supply, and IUDs for $60). If you get IUDs at a private clinic, you can expect to pay around $55 (for Mona Lisa), $290-$300 (for Jaydess) or $360-380 (for Mirena).

'''Important Notes:''' Emergency contraception may prevent pregnancy for three days (72 hours) and sometimes five days (120 hours) after unprotected sex. Take EC '''as soon as possible''' after unprotected sex. If you don't have access to dedicated EC, oral contraceptives can be used as replacement EC, but remember the following: 1) Only some contraceptives work as EC 2) Different contraceptives require different dosages and time schedules to work as EC 3) You must only use the first 21 pills in 28-day packs and 4) They may be less effective than dedicated EC. For general information on emergency contraceptives, click [https://www.plannedparenthood.org/learn/morning-after-pill-emergency-contraception here] and [http://ec.princeton.edu/info/ecp.html here].

In Canada, emergency contraception (also known as "the morning after pill") is available over the counter. They can be found in public sector hospitals and pharmacies.  

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."<ref>[http://www.cecinfo.org/country-by-country-information/status-availability-database/countries/canada/ EC Status and Availability: Canada]</ref>

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 2 pills 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).<ref>[http://ec.princeton.edu/worldwide/ Princeton EC website]</ref>

'''Note:''' The longest-lasting EC is currently [http://www.ellaone.com/ 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.

If you can't afford to purchase EC at a pharmacy, you can get it for a lower cost at a public health clinic. Here are the public clinics that provide EC (Plan B) in Toronto:

* Planned Parenthood Toronto: 36 B Prince Arthur Ave, Toronto, ON, M5R 1A9. Phone: 416-961-0113, Fax: 416-961-2512.

* Immigrant Women's Health Centre: 489 College Street, #200, Toronto, ON, M6G 1A5. Phone: 416-323-9986. Fax: 416-323-0447.

* Toronto Public Health: 399 The West Mall, Toronto, ON. M9C 2Y2. Phone: 416-338-1517. Fax: #N/A.

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).

'''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 [https://www.aids.gov/hiv-aids-basics/prevention/reduce-your-risk/post-exposure-prophylaxis/ 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 [http://www.whatisprep.org/ here].

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 [http://www.hivtravel.org/Default.aspx?PageId=143&CountryId=39 here].

* [http://hasslefreeclinic.org/ Hassle Free Clinic]: They do anonymous HIV testing (including the rapid HIV test). Welcomes cisgendered and transgendered clients (but they have separate drop-in hours for men and women, so check the website for details). Also test for chlamydia, gonorrhea, syphilis. It's recommended to schedule an appointment. "All STI testing (other than for HIV) can be done by appointment or by walking in for our drop-in program. Appointments are usually booked a week or two in advance. The drop-in is first come, first served." Address: 2nd Floor, 66 Gerrard Street E. Toronto, ON M5B 1G3. Work: 416 922-0566.

* [http://birthcontrolsexualhealth.ca/ Birth Control and Sexual Health Centre]: They do anonymous HIV testing (standard test or rapid test) by appointment. Welcomes cisgendered and transgendered clients. No Ontario Health Card is required. Address: Suite 403, 960 Lawrence Ave W, Toronto, ON M6A 3B5. Work: 416 789-4541.

* The Talk Shop: Does rapid HIV tests. It seems like you can drop-in (no appointment required). Address: 5110 YONGE ST, Toronto, ON M2N 6M1. Work: 416 338-7000.

* [http://www.torontoherpes.com/ The Phoenix Association]: "Since 1982, we've been offering a friendly, supportive environment where members in Toronto and the surrounding areas can get accurate information and share experiences with others who have genital herpes.  All information is held in strict confidence."

* [http://www.thehelpernewsletter.org/index.php?option=com_content&view=article&id=174:toronto-help&catid=169:emotional-support&Itemid=230 Toronto HELP]: "We started in 1982 as a social group for people with genital herpes under the name The Phoenix Association. In the early 90’s we discovered ASHA, which we associated ourselves with in order to receive direction and guidance on offering self help to our members. Every second Tuesday of the month, we have an Orientation Meeting for new members followed by a two-hour session where people gather in a circle and share their feelings, experiences or ask questions."

* [http://www.black-cap.com/ 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."

PrEP was approved for usage in 2016.

* You can get the Hepatitis B vaccine at many sexual health clinics, such as [http://birthcontrolsexualhealth.ca/ Birth Control Sexual Health Centre].

* Ontario has an HPV vaccination program: "Ontario now offers vaccination against cancer-causing Human Papillomavirus (HPV) free of charge to all boys and girls in Grade 7. The program is run through school-based clinics by local public health units."<ref>[http://www.health.gov.on.ca/en/ms/hpv/ Ontario's HPV Immunization Program]</ref>

* Pre-Exposure Prophylaxis (PrEP) is available in Canada. In February 2016, Health Canada approved Truvada as prevention.<ref>[http://www.prepwatch.org/canada/ PrEPWatch: Canada]</ref> 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."<ref>[http://www.actoronto.org/PrEP/how PrEP - How do I get it?]</ref> CATIE has also compiled extensive resources on PrEP for Canadians, which you can check out [http://www.catie.ca/en/prep here].

'''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 [https://en.wikipedia.org/wiki/Menstrual_cup here]. To learn more about menstrual underwear, click [http://menstrualcupreviews.net/best-period-panties-reviews/ here].

You can easily finds pads and tampons in Toronto 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 [https://store.lunette.com Lunette North America] website. For eco-friendly menstrual products, check out London Drugs, Loblaws, Save on Food, Whole Foods, Well.ca and Overwaitea.

* [http://birthcontrolsexualhealth.ca/ Birth Control Sexual Health Centre]: Performs annual paps. Prescribes birth control. Does IUD insertions. Welcomes cisgender and transgender patients. Open to all ages.  

* [http://womenscareclinic.ca/index.html Women's Care Clinic]: Has an all-female staff. "Women's Care Clinic was established in 1996 to provide the very best reproductive health services available in the Greater Toronto Area. Emergency Contraceptive: "Morning After IUD" can be inserted at our Clinic. We perform medical and surgical procedures, gynecological exams, birth control counselling, check-ups, STD/pregnancy/PAP tests and IUD insertion/removal. We are located in Toronto, 960 Lawrence Ave. West."

* [http://www.womenscollegehospital.ca/programs-and-services/gynecology/general-gynecology Women's College Hospital]: "The general gynecology program serves as a resource for women with a variety of benign medical and surgical conditions requiring short-term gynecologic care: menstrual disorders, ovarian cysts, menopause symptoms, fibroids (especially submucosal fibroids), endometriosis, family planning." "The gynecology program is unable to provide general well woman care such as annual PAP smears."

'''Note:''' There is a Canadian website called [http://www.paptestinfo.ca/index_e.html 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."

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 [https://www.canada.ca/en/employment-social-development/services/benefits/having-baby.html here].

* [http://www.ontariomidwives.ca/ Ontario Midwives]: "Midwives work all across Ontario in cities, towns and remote settings. You do not need a referral to book an appointment with a midwife – find the clinic nearest to you and give them a call."

'''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 [https://www.plannedparenthood.org/learn/abortion here].

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.<ref>[https://en.wikipedia.org/wiki/Abortion_in_Canada Abortion in Canada]</ref>

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.

* If you want to get an abortion in Toronto, the process is fairly straight-forward. You should first decide where you want to get an abortion. You have three options: 1) a hospital 2) [http://www.womenscollegehospital.ca/programs-and-services/bcbc/ Bay Centre for Birth Control] or 3) a free-standing clinic. The main difference between these options is that hospitals use general anesthetic (you will be asleep) during the procedure. Meanwhile, The Bay Centre For Birth Control and free-standing clinics use local anesthetic to numb your uterus (you will be awake). Also, some free-standing clinics only offer surgical abortion (not medical abortion). If you're not a Canadian citizen or permanent resident, there may also be differences in price, so you should contact them and see which one works best for you.<ref>[http://teenhealthsource.com/pregnancy/abortion-providers-gta/ Abortion Providers in the GTA]</ref>

* Note that the Bay Centre for Birth Control offers surgical abortions if you are under 8 weeks pregnant and medical abortions if you are under 7 weeks pregnant. If you have been pregnant for longer than 7-8 weeks, you'll probably need to get an abortion at a hospital or free-standing clinic.

* You don't need a referral to make an appointment. You can also call Teen Health Source (416-961-3200) to find abortion service providers in your neighborhood.

If you want to get an abortion at Bay Centre for Birth Control, call 416-351-3700 for details.

If you want to get an abortion at a free-standing clinic, here are the some clinics in the Toronto area:

* [http://morgentaler.ca The Morgentaler Clinic]: Surgical: up to 19 weeks GA. Medical: not offered. No admin fees. 727 Hillsdale Ave E (Bayview & Eglinton), 416-932-0446/1-800-556-6835.

* [http://choiceinhealth.ca Choice in Health]: Surgical: up to 15 weeks GA. Medical (OHIP clients only): up to 7 weeks GA. No admin fees *limited availability without OHIP. 301-1678 Bloor St. W (Bloor & Keele). 416-975-9300/1-866-565-9300.

* [http://bramptonwomensclinic.com Brampton Women’s Clinic]: Surgical: up to 18.5 weeks GA. Medical: not offered. Admin fees: $60 – $150.2250 Bovaird Dr E, Suite 602 (Torbram & Bovaird). 905-789-7474.

* 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, call Planned Parenthood Toronto (416-961-0113) or the Bay Centre for Birth Control (416-351-3700) to learn about your options.

* 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.

* [https://familyservicetoronto.org/our-services/programs-and-services/david-kelley-services/ 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"

* 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

* [http://teenhealthsource.com/ Teen Health Source]: This website offers sex education to teenagers.

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