Programming Connection

Providing health promotion case management to gay, bisexual and other MSM in the Fraser Health Authority 

AIDS Vancouver
Surrey and New Westminster, BC
2017

Overview

The Health Promotion Case Management (HCPM) program provides short-term (less than six months), outreach-based case management to individuals at ongoing high risk for HIV infection who could use support to remain HIV negative. The program works with clients to decrease their vulnerability to HIV by providing case management to clients to help them develop the self-efficacy and personal skills that strengthen their resiliency. Case managers support clients to make the changes they want to their behaviour, lifestyle, relationships, and emotional and mental health. Case managers also address structural barriers to wellness that impact people at ongoing high risk for HIV, including support to access social assistance, housing and healthcare, and referrals to community, immigration and legal services.

The program provides support to at-risk individuals from the following groups:

  1. Indigenous peoples
  2. HIV-negative partners in serodiscordant couples
  3. Women
  4. Newcomers, immigrants and refugees
  5. Gay, bisexual and other men who have sex with men (MSM)

 The objective of HPCM is to improve clients’ self-management skills and, through a care plan, to develop a network of service providers that helps clients remain HIV negative in the long term. Through strong community partnerships, HPCM reduces silos and improves integrated healthcare for people at ongoing high risk for HIV infection.

This program element complements a case study and another program element that describe the Health Promotion Case Management program. For more information about the work of the health promotion case managers in general, see the HPCM program case study. For more information on the work of the case manager who works with Indigenous peoples, see the program element on providing services to Indigenous peoples.

This program element focuses on the work of one of the HCPM case managers who works with MSM in Surrey and New Westminster, which are suburbs of Vancouver located in the Fraser Health Authority. Although the case manager works at AIDS Vancouver, which has long worked with gay, bisexual and other MSM, they also work twice a week in Surrey and New Westminster. This work is facilitated through partnerships with Health Initiative for Men (HIM) and the Fraser Health STOP Team who offer clinics in those cities.

Providing services to gay, bisexual and other MSM in the Fraser Health Authority

Unlike Vancouver, the geographical area covered by the Fraser Health Authority does not have access to a host of queer and trans-friendly and/or queer and trans-specific services; in some parts of the health authority, homophobia, transphobia and stigma related to substance use and HIV is still high. Without local services, people travel to cities such as Surrey, New Westminster and Vancouver to receive lower barrier and judgment-free healthcare.

Drop-in services for gay, bi and other MSM

Twice a week, the case manager has drop-in hours when HIM clinics are open in Surrey and New Westminster. The clients are mostly men who identify as gay, bisexual or other MSM. Many clients seek brief counselling and support from the case manager related to sexual health, healthy relationships, mental health, and substance use. Some clients are interested in accessing pre-exposure prophylaxis (PrEP). The case manager provides sexual health counselling and brief counselling to clients, and information and referrals for PrEP access, and substance use and mental health treatment services, when needed.

Having drop-in hours, rather than specific appointments, makes the case manager available to build trust and respect with clients over time, to provide brief counselling to those who may need it, and to identify clients who may need long-term support.

Intensive case management for gay, bisexual and other MSM

In addition to drop-in support, the case manager also has gay, bisexual and other MSM clients in the Fraser Health Authority who need more intensive support services. With these clients, the case manager identifies goals the client wants to achieve, such as finding stable housing and connecting with social assistance; provides ongoing counselling; and makes referrals to local services that may be able to support clients to achieve their goals. Although support for these clients can be short—between three and six months—the case manager sees some clients for longer if they continue to need and want support to achieve their goals.

Lack of queer and trans-friendly services is an ongoing challenge

There is a need for additional queer and trans-friendly services to address the needs of gay, bisexual and other MSM who live in the area covered by the Fraser Health Authority. The lack of queer and trans-friendly services in the region to which clients can be referred is a significant challenge to the work of the case manager. In addition, there are increasing referrals from more rural parts of the health authority that the case manager does not currently serve in person. The case manager works with these clients over the phone and through text messaging, and some clients agree to travel to see the case manager at one of the two clinic locations in Surrey and New Westminster.