Mobile STI Testing Options Heading to the Lower Mainland

SWAN, an organization that supports immigrant and migrant women who do indoor sex work, is in the process of setting up a mobile service that could offer testing for sexually transmitted and blood-borne infections to sex workers in the Lower Mainland.

Immigrant and migrant sex workers face language and cultural barriers when accessing testing. They are also often afraid of being outed as sex workers because for many of them that could mean arrest, detention and deportation, said Angela Wu, executive director of SWAN.

Canada has laws that prohibit migrants from doing sex work.

According to research led by the AESHA project, these laws deter women from accessing sexual health testing services, especially if they are Black, Indigenous or other people of colour, or immigrant or migrant sex workers.

AESHA, which ran for 15 years and wrapped up this summer, was offering mobile testing as part of its research.

This has left a large gap in services, Wu said.

AESHA’s mobile health clinic, which started in 2010, brought a multilingual nurse to the workplaces of sex workers in the Lower Mainland in order to provide voluntary testing for HIV and STIs, said Andrea Krüsi, an assistant professor at the school of criminology at Simon Fraser University and principle investigator for AESHA. The mobile team also distributed harm reduction supplies, including safer sex supplies, and conducted interviews as part of the project.

The research cohort included around 900 women and gender-diverse sex workers, Krüsi said.

The van could visit one to three businesses per day and do outreach twice a week, which meant offering between eight and 12 sex workers testing per week.

Building trusting relationships with sex workers took a lot of time, said Ran Hu, an assistant professor in the college of social work at Ohio State University who did her post-doctoral research in 2023 with the AESHA outreach team.

“Sometimes we’d just spend a lunchtime chatting about culture, our daily life and sharing our experiences as migrants, which helped build trust and helped them feel safe and be willing to come back to the team,” Hu said.

Krüsi and Hu applauded SWAN’s initiative to take over where AESHA left off.

SWAN started in 2002 as a health initiative and has grown today to offer outreach, online outreach and peer programs, Kelly Go, SWAN’s program manager, told The Tyee. SWAN offers services in English, Mandarin, Cantonese and Japanese. The organization does outreach in 90 massage businesses and visits women working independently in apartments and condos spanning 13 cities across the Lower Mainland.

SWAN supports sex workers who are immigrants, meaning they have Canadian citizenship or permanent resident status, and migrants, meaning they are in Canada with a temporary residence permit, for example international students or people with a work or travel permit, Go said. They also support people with precarious immigration status or no status, or who have applied and are stuck waiting, she added.

SWAN wants to offer mobile testing for sexually transmitted and blood-borne infections, or STBBIs, because that’s what the women they already support have asked for, Go said.

“We get a lot of calls from the community about testing and health-care access,” she added. “Because the community that we support are within the intersections of sex work, race, gender and also potentially precarious status with immigration, or migration status, there are many different challenges they face when accessing health care in general.”

Currently SWAN can help connect women with one low-barrier health clinic in the Lower Mainland, or help women navigate the free GetCheckedOnline service.

GetCheckedOnline allows for free, anonymous STI testing at participating LifeLabs locations with no government ID or Medical Services Plan number required. Participants just need to provide an email address their results can be sent to.

However, the “demand is huge and it’s very difficult for us to support a woman in a timely manner,” Go said.

There are also long wait times to be seen at the low-barrier clinic and language barriers when visiting a participating LifeLabs, Wu said. Distance is also an issue, either with women not being able to drive or commute long distances to visit the one low-barrier clinic, or with GetCheckedOnline being offered only at LifeLabs locations in Nanaimo, Victoria, Kamloops, Nelson, Kimberley, Dawson Creek and the Lower Mainland.

Krüsi said AESHA was working with GetCheckedOnline to offer the service in simplified Chinese but that there are still language barriers when someone goes to a LifeLabs location itself for their testing appointment.

A member of SWAN can tag along to a medical appointment to offer translation or support, but a health-care worker might recognize the SWAN member, which would then out the patient as a sex worker, Wu said.

Hu said she heard how important it was to be able to offer linguistically and culturally sensitive services while working with AESHA.

Sex workers want services to be offered in a way that understands the nuances of their culture, she said. Sex workers are also deeply afraid because they are caught in the intersections of criminalization of their work, stigma against sex workers and fear their work could affect their immigration status.

“Some study participants had family doctors they could go to for testing, but they were afraid their doctor would find out about their sex work involvement,” she said. Others were afraid a sexual health test would somehow be connected by government to their immigration applications, even though that does not actually happen.

“Mistrust in the health-care system is nothing new,” SWAN’s Go said. “That’s why we feel like the mobile STBBI testing will really be the thing that is needed to bridge this gap.”

Wu said SWAN is working on partnering with a health-care provider that could order tests, which the outreach workers could then distribute to workplaces, allowing women to self-test.

She says the organization is in preliminary talks and many details haven’t been decided on yet, such as what tests will be offered or what training outreach workers might need to complete.

Wu said SWAN also wants to offer these testing services provincewide and to avoid having the services fragmented under different health authorities.

SWAN has been working to open its own mobile STBBI testing service ever since AESHA’s research-based clinic finished this summer, Wu said.

Offering mobile testing as soon as possible feels “urgent,” because every day that passes is another day where a woman is unable to access care and treatment, Wu added.

If SWAN could offer mobile testing, the team could offer testing at the places they already do outreach. That would reduce the distance a sex worker might have to travel for testing and improve trust in the process because SWAN has pre-existing relationships with these women, Wu said.

“I feel we’re really well positioned to leverage that trust to ensure that someone gets the care that they need,” she added.

Last winter the Canadian Public Health Association released recommendations on a public health approach to sex work, including, among other things, that provincial and territorial governments fund community sex worker groups to advocate, educate and deliver programming supportive of sex workers’ security, health and well-being.

A mobile STBBI testing service fits within that nicely, Wu said.