What is the program?
The mobile STBBI testing program at SWAN Vancouver (SWAN) brings testing for sexually transmitted and blood-borne infections (STBBIs, such as HIV, hepatitis B and C, and syphilis) directly to the workplaces of immigrant and migrant women and gender-diverse people engaged in indoor sex work. Testing is free and anonymous with the goal of providing lower barrier services to people who may face barriers to accessing more traditional healthcare spaces. The program operates in partnership with the Vancouver Infectious Diseases Centre (VIDC), whose staff assist with follow-up and provide treatment.
SWAN Vancouver promotes the rights, health and safety of immigrant and migrant women and gender-diverse people engaged in indoor sex work through frontline service and systemic advocacy. This includes services related to addressing clients’ concerns about laws, immigration and safety.
Why was the program developed?
The mobile STBBI testing program was created to reduce barriers to testing services among immigrant and migrant women and gender-diverse people engaged in indoor sex work. This community can face multiple barriers to accessing services including stigma and discrimination within the health system, language barriers, privacy issues and the desire to avoid actions that could compromise immigration status or lead to arrests or even deportation.
The program was developed in response to feedback from SWAN’s Advisory Group, which consists of women and gender-diverse people with lived experience who guide the organization’s programs and advocacy approaches. The goal of the program is to decentralize services by bringing them to where community members work and address barriers related to safety and privacy. The pilot of the program launched in August 2025 with funding from the Provincial Health Services Authority.
How does the program work
The mobile STBBI testing program brings testing to places of work, specifically to places where the community engages in indoor sex work (e.g., massage parlours, apartments, condos or in whatever location participants feel most comfortable). The program uses a task-shifting model where SWAN staff (non-clinical providers) perform or facilitate testing within these locations and then transport testing samples to the laboratory for processing. To support this project, SWAN partners with the Vancouver Infectious Diseases Centre (VIDC), whose staff work with SWAN staff to help people access and complete treatment when needed.
The program uses an outreach model. It started by bringing STBBI testing to workplace locations where harm reduction supplies (e.g., condoms [internal, external], lube, personal protective equipment [gloves, masks, hand sanitizer, disinfecting wipes], safer drug use equipment) were already being distributed by SWAN. The program has since expanded to include additional workplaces. Testing at these locations is scheduled in advance and a reminder is sent out a day before that includes an estimated time of arrival. The program visits the same locations on a three- to six-month cycle to provide repeat testing and is advertised in a variety of ways, including the quarterly SWANzine, community connections, referrals from other SWAN programs and word of mouth. Drop-in testing is also available at the SWAN office during regular business hours for those who would prefer to test in that location.
SWAN staff bring all the required testing supplies to test for chlamydia, gonorrhea, hepatitis B and C, HIV and syphilis. When SWAN staff arrive at workplaces, participants can let them know what they would like to be tested for. Participants can use an alias and an alternate date of birth during testing to protect their privacy, but they must remember this information, to ensure linkage to care following any positive test results. If an alias is used, a SWAN staff member writes down the chosen name and date of birth on a reminder card. An accurate phone number or other method of contact must be provided so that staff can follow up with the participant if they have a positive test result.
Testing for HIV, hepatitis B and C and syphilis is completed using dried blood spot (DBS) testing, which uses a finger prick and requires a few drops of blood. SWAN staff received training on how to collect and transport DBS samples from the National Laboratory for HIV Reference Services (NLHRS) – DBS Program. DBS tests can be either self-administered or staff administered. Testing for hepatitis B and C, as well as HIV, includes confirmatory testing using the blood on the DBS card. However, syphilis testing is non-confirmatory and further bloodwork is required to confirm a new infection (SWAN staff assist community members to access accessing confirmatory testing at local clinics). Urine tests are used to test for chlamydia and gonorrhea.
Following testing sample collection, SWAN staff bring the test samples to the BC Centre for Disease Control (BCCDC) Public Health Laboratory, where they are processed. DBS test samples are then sent to the National Microbiology Laboratory in Winnipeg for processing and urine samples are processed by the BCCDC Public Health Laboratory. Results are available in two to four weeks. The BCCDC shares test results with VIDC staff, who then share them with SWAN staff so that they can support community members through the follow-up process.
All of SWAN’s frontline staff speak multiple languages and can help to provide interpretation services as needed during follow-up on positive test results. SWAN and VIDC staff work together to notify participants of positive test results and facilitate access to care and treatment.
Follow-up appointments are typically conducted by phone and can be provided in a variety of languages (e.g., Mandarin, Cantonese, Japanese or English). A VIDC physician or nurse and SWAN staff participate in these calls, with the SWAN staff providing interpretation support if required. VIDC can arrange for community members to have a liver ultrasound free of charge if needed.
Treatment medication is provided free of charge for those who need it. To ensure that medication provision is private, SWAN staff can pick up medications at VIDC and deliver them to participants when requested. Participants who test positive for HIV or hepatitis C can be referred to VIDC or the Oak Tree Clinic for ongoing care and treatment. SWAN staff can provide ongoing support by referring and connecting community members to other services and healthcare providers in the community and accompanying them to appointments to provide interpretation and emotional support if wanted.
Resources required
- DBS and urine testing equipment (e.g., lancets, alcohol swabs, latex-free gloves, DBS cards, blood collection cards, urine test cups, biohazard bags, cooler, ice packs, plastic containers)
- A testing manual to guide staff through the process
- A partnership with a clinical service provider for requisitions and any required treatment services
- Vehicles to transport supplies
- Training for non-clinical staff on how to perform testing and transport samples
Evaluation
From September 2025 to March 2026, 94 people accessed testing through the program and among these people, 177 tests were performed (84 DBS tests and 93 urine tests). The rate of testing increased beginning in January 2026 as word of mouth started to spread.
The program uses an anonymous client feedback form that collects information related to participants’ feelings of safety, privacy and ease in the program, and it also includes open questions related to potential program improvements. The feedback form is optional and is available in English, simplified Chinese and Japanese. A total of 32 responses were received. The top reasons that respondents reported accessing the program were as follows:
- convenience (e.g., the program comes to people and fits their schedule)
- safety and confidentiality
- it is free / has no medical fees
- it offers supportive and non-judgmental care and support
Additional survey feedback indicated that a few respondents want to see the program include more general reproductive health / gynecology services (e.g., swab testing for bacterial vaginosis and urinary tract infections), as well as cervical cancer screening.
Challenges
- The SWAN team consists of non-clinical staff with no formal healthcare training, so there was a learning curve when the program started. It took some time to determine the best processes for labelling, moving and dropping off samples, as well as filling out lab requisitions.
- As the program moved beyond the pilot phase, the SWAN team had to determine how to offer it in a sustainable way. The team is small and many team members are already engaged in pre-existing frontline programming – staff capacity and funding can be a challenge and are important considerations.
Lessons learned
- Ensure that each staff member is assigned clear roles in the testing process. This can streamline the process and allow staff to feel more confident in knowing their tasks. The testing process can be fast paced with a lot of moving parts, so having clearly assigned tasks can help to ensure that nothing gets missed.
- Arrange for a point of contact who is a clinical healthcare worker to be available to answer questions and support staff, especially when staff do not have clinical experience.
- It is important to be mindful of how testing and harm reduction supplies are transported to and from each location to ensure discretion and protect participant privacy.
- Create a testing manual as soon as possible, as it is crucial to have a document that staff can refer to. The SWAN testing manual is a living document that is constantly updated.
- Be realistic about where (e.g., how many locations) and how often you can offer testing. SWAN staff spent a lot of time determining testing schedules, locations and timing to ensure that they could be as efficient and realistic as possible. Planning out timing also helps to ensure that samples are dropped off to the laboratory in a timely manner.
- Know your community’s needs and adjust accordingly. The SWAN team adjusted their approaches to add flexibility by offering testing at the SWAN office during regular business hours for community members who felt that it was more convenient. They also started to bring mini testing kits (i.e., kits with testing supplies for one person) during outreach/supply deliveries so that people could see what the testing supplies looked like and test during outreach visits.
- Since DBS testing may be a new approach to some, it can be helpful to slowly introduce it (i.e., people can start with only urine testing if that feels more comfortable). Information on DBS testing can be provided in person so that people can see the supplies, ask questions and decide what they feel comfortable doing.
- Learning and relearning is part of the process — it is okay to make mistakes. Go into the program with the expectation that it will be a learning process. Mistakes will be made, but the important part is to address, learn and then move on from them.
Resources
Contact
Chantel Lee
Community Projects Coordinator
SWAN Vancouver
chantel@swanvancouver.ca