HIV/AIDS SERVICES FOR IMMIGRANT AND REFUGEE WOMEN;
BRIDGING THE GAPS
AN ACTION RESEARCH EXCHANGE PROJECT FACILITATED BY THE SIMON FRASER PUBLIC
INTEREST RESEARCH GROUP FOR THE POSITIVE WOMEN’S NETWORK
BY HOLLY BUHLER
hollyb@sfu.ca
DECEMBER 2008
TABLE OF CONTENTS
LIST OF ACRONYMS & DEFINITIONS............................................................................................. 3
LIST OF TABLES & FIGURES........................................................................................................ 4
ABSTRACT………………………………………………………………………………………………………………………….. 5
1.0 INTRODUCTION......................................................................................................... 6
1.1 Current Trends in the HIV/AIDS Epidemic......................................................... 6
1.2 Canadian Immigration Process....................................................................... 8
1.3 Health and Immigration................................................................................ 9
1.4 Rationale for Research................................................................................ 10
2.0 METHODOLOGY...................................................................................................... 11
2.1 Literature Review....................................................................................... 11
2.2 Identification of Service Providers................................................................. 12
2.3 Informal Telephone Interviews..................................................................... 12
3.0 RESULTS............................................................................................................... 14
3.1 A Framework for the Problem...................................................................... 14
3.2 A Journey through the Vancouver Health System............................................ 16
3.3 Experiences of Immigrant Women Vulnerable to HIV/AIDS............................... 17
3.4 Sketches from the Field…………………………....................................................... 20
3.5 Settlement Services in the GVRD................................................................... 23
3.6 Language & Cultural Competence................................................................. 24
4.0 DISCUSSION........................................................................................................... 26
4.1 Barriers to Access....................................................................................... 26
4.2 Recommendations...................................................................................... 27
4.3 Future Research......................................................................................... 28
4.4 Conclusions............................................................................................... 29
4.5 Acknowledgements …………………………………………………………………………………. 29
REFERENCES........................................................................................................................ 30
APPENDIX I The Refugee Process in Canada........................................................... 32
APPENDIX II Refugee Settlement Patterns in the GVRD............................................ 33
APPENDIX III HIV+ IME Tests Listed by Country of Origin........................................... 34
APPENDIX IV Organizations Providing Services to Recent Immigrants.......................... 35
2
LIST OF ACRONYMS & DEFINITIONS
ACS Abbotsford Community Services
AIDS Acquired Immune Deficiency Syndrome
ASIA Asian Society for the Intervention of AIDS
ASO AIDS Service Organization
CIC Department of Citizenship and Immigration Canada
CIDPC Centre for Infectious Disease Prevention and Control
GAR Government-Assisted Refugee
GVRD Greater Vancouver Regional District
HIV Human Immunodeficiency Virus
IDP Internally Displaced Person
IDU Injection Drug Users
IME Immigration Medical Examination
IRPA Immigration and Refugee Protection Act
ISSBC Immigration Services Society of British Columbia
MCC Mennonite Central Committee BC
MSM Men who have Sex with Men
PHAC Public Health Agency of Canada
PICS Progressive Intercultural Community Services Society
PWN Positive Women’s Network
RAP Resettlement Assistance Programme
SES Socio-Economic Status
SOS Storefront Orientation Services
UNAIDS United Nations Programme on HIV/AIDS
VRSA Vancouver Refugee Services Alliance
3
LIST OF TABLES
TABLE 1: Persons Testing Newly Positive for HIV by Ethnicity and Year of Testing from 2001 to 2007
in BC (Males & Females)......................................................................................... 6
TABLE 2: Persons Testing Newly Positive for HIV by Ethnicity Cumulative from 1995 to
2007.................................................................................................................... 7
TABLE 3: Stresses of Migration & Resettlement..................................................................... 13
TABLE 4: Commonly provided Settlement Services.............................................................. 22
TABLE 5: Barriers to Access of HIV Information and related services......................................... 25
TABLE 6: Actions to Improve Health Service Provision to Immigrants........................................ 26
TABLE 7: Actions to Facilitate Leadership in Immigrant Communities..................................... 27
LIST OF FIGURES
FIGURE 1: Framework of the associations between migration and HIV infections as described by
Soskolne and Shtarkshall...................................................................................... 14
FIGURE 2: Diagram of front line resources for HIV+ immigrants in Vancouver.............................. 15
4
ABSTRACT
The Canadian AIDS epidemic has recently seen a disproportionate increase in the incidence of
HIV cases attributable to ethnic minorities. The Positive Women’s Network has recognized this
changing demographic and is working to identify what additional services might be needed to
support recent immigrants vulnerable to HIV. Although immigrant migration experiences may
range from the uneventful to the unimaginable, this process has the potential to increase the
risk of being impacted by health issues such as HIV. In particular, the migration experiences of
refugees often result in extreme challenges upon arrival and the luxury of addressing personal
health issues can be low on the list of daily priorities. Working together with Settlement Service
Organizations to address this issue will be critical to delivering effective services through the
creation of synergistic partnerships and referral networks.
5
1.0 INTRODUCTION
1.1 Current Trends in the HIV/AIDS Epidemic
According to the latest estimates released by UNAIDS1, the global percentage of adults living with HIV
has stabilized since 2000 and access to treatment has increased. Unfortunately, there are still many
obstacles to be overcome in order to provide care and improve quality of life for the estimated
33,000,000 people living with HIV/AIDS, with each country presenting its own unique set of
challenges [1]. Within Canada, there are estimated to be over 60,000 people living with HIV and
approximately a quarter of these cases may be unaware of their infection [2]. Two trends that have
been increasingly evident within Canada’s epidemic and recently highlighted in the latest Public
Health Agency of Canada’s November 2007 HIV/AIDS Epi Update2 are the rising number of women
being diagnosed and the increasingly disproportionate representation of ethnic minorities [2].
HIV/AIDS in Women
Although the majority of new HIV cases in Canada are still attributable to men, the proportion of
women being infected has increased from 7% of total cases from 1979-94 up to 24.2% of new
cases in 2006 [2]. The main explanation for this is related to the changing transmission patterns
of HIV in Canada. Early in the epidemic, the primary group affected were men who have sex
with men (MSM) but the number of cases associated with heterosexuals and injection drug
users (IDUs) have been steadily increasing. Of the 9,569 positive HIV tests in women that have
been reported to the PHAC since the beginning of the epidemic, 66.9% have been attributed to
heterosexual contact, 24.7% to injection drug use, and 8.4% as a result of occupational exposure
or the receipt of blood or blood products [2]. According to the data reported between 1998
and 2006, women also account for almost half of all positive test reports with ethnic status
information [2].
1
The United Nations Program on HIV/AIDS releases a new ‘Report on the global AIDS epidemic’ every two
th
years. The latest report was launched on July 29 2008 http://www.unaids.org/en/KnowledgeCentre/HIVData
2
The Public Health Agency of Canada releases yearly HIV/AIDS Epidemiology Reports. See the following link for
these and other related publications http://www.phac-aspc.gc.ca/aids-sida/publication/index-eng.php#er
6
HIV/AIDS in Ethnic Minorities
In the period between 1998 and 2003, the proportion of positive HIV tests from white Canadians
decreased from 68% to 56.7%; unfortunately, this also means that the proportion of positive
diagnosis in other ethnic communities has increased [3]. This trend has been largely attributed
to the number of refugees and immigrants coming from HIV endemic countries3. New infections
in this exposure subcategory comprise 12% of all prevalent infections in Canada despite the fact
that only about 1.5% of the Canadian population was born in an HIV-endemic country prior to
2007. The estimated infection rate in this group is thought to be at least 12.6 times higher than
among other Canadians in 2005 [2, 3].
TABLE 1. Persons Testing Newly Positive for HIV by Ethnicity and Year of Testing from 2001 to 2007
in BC (Males & Females) [4]4
Table 1 shows the magnitude of the problem particularly within Black, Asian and Hispanic ethnic
populations; however, it is also an important reminder of the scale of the problem within the
First Nations community. Although this report does not focus on the situation within the First
Nations community it remains a pressing issue and merits further discussion about how best to
support them in their fight against HIV/AIDS.
3
Countries considered to be endemic were characterized by having 50% or more HIV cases attributed to
heterosexual transmission; a male to female ratio of 2:1 or less among prevalent infections; or HIV prevalence
greater than or equal to 2% among women receiving prenatal care.
4
Since 2002, ethnicity is no longer captured on the HIV requisition form. For this reason, the number of HIV
tests performed is no longer published in the HIV tables associated with ethnicity. It is also important to note
that ethnicity data for 2007 wasn’t all available at the time the cited report was published.
7
TABLE 2. Persons Testing Newly Positive for HIV by Ethnicity Cumulative from 1995 to 2007 [4]
Although the above statistics alone may be cause for concern they do not, in all likelihood,
capture the full extent of the problem. Changes to HIV reporting protocols, reporting delays and
under-reporting are all barriers to accurate surveillance data [2, 3].
1.2 Canadian Immigration Process
There is no Canadian law that definitively excludes individuals living with HIV/AIDS from entering
Canada and this should not impact an application for temporary residence5 unless the applicant
intends to stay longer than 6 months [5]. In order to obtain a permanent residence, most
people living with HIV are subject to two “protection regulations”. The Immigration and
Refugee Protection Act6 does not mention HIV or AIDS but says that individuals can be found
‘medically inadmissible’ if they:
1) Are likely to be a danger to public health or safety.
2) Might reasonably be expected to cause excessive
demand on health or social services [5].
5
There are two categories of foreign nationals coming to Canada, those seeking temporary residence and
those seeking permanent residence. Individuals from certain countries, but not all, require a temporary
resident’s visa in order to visit Canada for a short period.
6
The Immigration and Refugee Protection Act came into effect on June 28 2002. Visit http://www.irb-
cisr.gc.ca/en/about/publications/irpa/index_e.htm for more details.
8
As people living with HIV/AIDS are not considered a danger to public health or safety in Canada,
they may only be excluded on the grounds of being ‘expected to place an excessive demand on
publicly funded health or social services’. There are two exceptions to this regulation, one for
people applying for permanent residence as a refugee or as a person “in need of protection”
and another for “family class”7 applicants [5]. For all other applicants, demand on health or
social services is considered excessive if the anticipated costs would likely exceed the costs of
health and social services for the average Canadian8 or if there is a potential that the applicant
may add to existing waiting lists resulting in denied or delayed access to a Canadian citizen [5].
1.3 Health & Immigration
There are several ways for newcomers to immigrate to Canada. A person may come as a
professional, a student, a family member or a refugee; each of these groups will have a very
different migration experience. When applying for permanent residence, all individuals are
required to undergo an immigration medical examination (IME) which includes an HIV test9.
Temporary resident applicants may also be required to have an IME under certain circumstances
such as coming to work in an occupation where protection of public health is essential or if they
have, in the year before applying, lived for a period of six or more consecutive months in a
“designated country” 10 11. The visa officer also maintains the ability to order an IME at any time
if they feel it is warranted.
7
A family class applicant is a person applying as the spouse, common law partner or dependent child of a
Canadian citizen.
8
The average health or social service costs for Canadians are calculated each year. The estimate in 2004 was
at 4,078 CAD per year according to the Canadian HIV Legal Network 2007 Report on Immigration policy and
HIV/AIDS.
9
The Immigration and Refugee Protection Act (implemented in June 2002) made HIV testing a required
component of the IMCE. This policy is suggested to have had an impact on the national statistics which
jumped from 2,178 new diagnoses in 2001 to 2,494 in 2002 and then increasing minimally if at all in the next 3
years
10
Prior to May 2005, foreign nationals needing a temporary resident visa to enter Canada were required to
disclose their HIV status on the application however this is no longer usually a requirement.
9
The top countries of origin for immigrants who settled in Vancouver between 2001 and 2006
(overall) were China (15,675), Philippines (5,320) and India (2,085). This report, however, will
primarily focus on refugees as many of these individuals have experienced political or religious
persecution, war, poverty and often spent years in refugee or IDP camps, making them much
more vulnerable to health issues such as HIV/AIDS.
Refugees or other persons exempted from the “excessive demand” clause of the immigration
act often require special services not only relating to their physical health but also to their
mental health in order to deal with the circumstances that have required them to leave their
countries of origin [6]. According to the Canadian Council for Refugees, 28,179 Refugee claims
were made to Canada in 2007; five percent of these claims were made in British Columbia. The
highest number of refugees arriving between 2003 and 2006 were from places such as
Afghanistan, Sudan, Myanmar and Indonesia[7] (see Appendix II for a detailed breakdown of
resettlement patterns of refugees in the lower mainland). In order to facilitate the settlement
process, the Immigration Services Society of BC is contracted by the department of citizenship
and Immigration Canada (CIC) to administer a Resettlement Assistance Program (RAP) [7]. The
purpose of this program is to provide temporary accommodation, orientation, financial
assistance, a primary health care screening12 and other support services to refugees during their
first year in Canada.
1.4 Rationale for Research
The Positive Women’s Network has identified the above mentioned trends and recognized the
risk of gaps in appropriate service provision to immigrant women vulnerable to HIV/AIDS. AIDS
Service Organizations (ASOs) have historically focused on risk groups such as MSM or IDU
populations and many settlement organizations deal primarily with resettlement services such
as housing and employment. It is important to understand the place of health in the settlement
11
Designated countries are countries where certain communicable diseases are more prevalent than in
Canada. Visit http://www.cic.gc.ca/english/information/medical/dcl.asp for further information.
12
This screening is usually provided within their first 10 days in BC at the Bridge Community Health Clinic.
10
process and find ways for all service providers to work together for the most effective provision
of services.
2.0 METHODOLOGY
2.1 Literature Review
There are large bodies of literature related to the needs of recent immigrants and, separately, to
provision of services to people living with HIV/AIDS. The numbers of studies combining these
populations are limited. A review of literature was conducted using Google Scholar, PubMed
and Web of Science in an effort to identify research at the intersection of these two issues.
Search terms included combinations of the following Keywords: Assessment*, Service prov*,
Immigrant*, Asylum Seeker, Refugee* AIDS, HIV, Women, ethnic*, needs, barriers. The majority
of research in this area was working with African Immigrant populations in the United Kingdom
[8-13] or United States [14] and with Latin American Immigrants in the United States [15, 16]
although other ethnic groups have also been studied to a lesser extent [17].
Results from the above searches were briefly skimmed for relevant content and the articles
directly relating to previous research assessing barriers to accessing services faced by recent
immigrants were manually searched for further relevant citations. In addition to academic
journals, there were a number of valuable Community Based Research Reports and other grey
literature that greatly enriched this search.13 Several large scale initiatives in the area were also
identified in literature citations, one of the most prominent of which was facilitated through
Sigma Research14 and included projects such as The Nasah project15 and a more recent needs
assessment project ‘What do you need? 2007’16.
13
Two abstracts were also found directly relating to gaps in HIV/AIDS related service provision among
immigrants in Canada. The most recent, published in the 2008 proceedings of the International Conference
on AIDS was entitled ‘African Refugee Resettlement in Vancouver and HIV Infection’ by Brandson and Barrios.
Personal communication with Brandson resulted in the expanded report on which the abstract was based.
14
Sigma Research is a social research group specializing in the behavioral and policy aspects of HIV and sexual
health. They provide a large amount of project output (reports and survey instruments) freely available online
11
2.2 Identification of Service Providers
There are several directories of local NGOs and other service providers in Vancouver. By far the
most exhaustive currently available is ‘The Red Book’17, a resource published and maintained by
Information Services Vancouver. This directory was used to search for all community, social
and government agencies currently providing services to immigrants or to people affected or
infected with HIV/AIDS. Websites from the resulting list of organizations were also searched for
links to further resources. Finally, several organizations were identified through word of mouth
or informal discussions with other community based researchers and service providers.
2.3 Informal Telephone Interviews
Informal telephone interviews were found to be the most practical for the purposes of this
report due to limited time-frame of the front line professionals in this field. Cold calls were
made to various settlement organizations to identify individuals working with immigrants and
health issues.
The same key contacts were consistently referred to by settlement workers and HIV/AIDS
support workers. These included the support & outreach workers at the Bridge Clinic and SOS,
the social & outreach workers at the Oak Tree Clinic, the social workers at the John Ruedy
Immunodeficiency clinic in St. Paul’s Hospital and the Case Managers at AIDS Vancouver. One
individual from each of these organizations was contacted (with the exception of SOS due to
scheduling difficulties) and asked about what health or emotional support related resources
they knew of that were available to immigrant women. Follow up questions were asked about
their experiences working in this area, any recent trends they’ve noticed with their clients
15
Project Nasah is one of a number of HIV focused projects undertaken by Sigma Research, a social research
group specializing in the behavioral and policy aspects of HIV and sexual health.
(http://www.sigmaresearch.org.uk/go.php/projects/african/project19)
16
What do you need? 2007 is an assessment that that was launched on March 2007. The proposed outputs
(a report of findings) to this work will be launched on World AIDS Day 2008.
http://www.sigmaresearch.org.uk/go.php/projects/hiv/project36/
17
Visit ‘The Red Book Online’ at http://www2.vpl.vancouver.bc.ca/DBs/Redbook/htmlPgs/home.html
12
(ethnicity, gender, demographics, etc.), as well as questions about who they most commonly
referred to, what they felt was needed to support this population and what they felt the most
significant barriers were.
In addition to the above informal telephone interviews, a sample of settlement organizations
including: Family Services of Greater Vancouver (FSGV), DiverCity, Mennonite Central
Committee (MCC), Pacific Immigrant Resources Society (PIRS), Progressive Intercultural
Community Services Society (PICS), MOSAIC, Immigration Services Society of BC (ISSBC) and the
North Shore Multicultural Society were contacted. These calls were follow ups to website
searches that had revealed or implicated that the organization might be interested in health
related issues. When contacted, it was first established if there were any people or projects
dealing with health related issues at the organization. If so, an effort would be made to get the
appropriate contact information in order to follow up. In several cases (ISSBC, PICS and
DiverCity) the receptionists or switch board did not believe there was anything related to health
dealt with by their organization or that those issues would be referred to another collaborator.
If a contact person could be reached, they were then asked to describe a bit about the related
initiative whether or not HIV/AIDS related issues were a part of it. If yes, they were asked to
elaborate and if no, they were asked if they would be interested in collaborations and welcomed
to refer to the Positive Women’s Network.
Although no formal interviews were conducted, this limitation was partially mitigated through
access to Brandson’s 2006 study summary. Although she did not specify the names of any of her
interviewees, she obtained most of her contacts from the same four organizations as were
found to be the most relevant during the background research for this report. Direct citations
from her interviews will be referenced in several of the results sections.
13
3.0 RESULTS
3.1 A Framework for the Problem
HIV/AIDS related interventions that are targeting immigrant populations need to consider a
wider range of issues than just health and education [18, 19]. In many studies of service
provision to immigrant women, the researchers’ initial assessments are quickly broadened to
acknowledge the impact and importance of the stresses of resettlement (Table 3), disclosure &
stigma, access issues, and everyday necessities of survival [15, 17, 18, 20].
TABLE 3: Stresses of Migration & Resettlement [21]
Resettlement Stresses
• Diversity within diversity: (i.e., diversity within
• Social integration and adaptation
the same nationalities)
• Gender roles and family adaptation • Ways of coping with difficulties
• Social networks, help-seeking and mutual aid:
• Language
implications for service delivery
• Help-seeking and barriers to settlement
• Employment
service utilization
• Kinship and family relations, Marital concerns, • Health and well-being including health
Parenting, and Children care information
• Migration and displacement experiences and
• Housing
stressful life events
• Information needed prior to arrival • Finances
• Arrival and reception (specific needs on
• Education
arrival)
• Initial challenges during the first 6 to 12
• Transportation
months in Canada
• Expectations of Canada • Legal matters and crime
Another critical consideration is the recognition of the uniqueness of every immigrant’s
migration experience, local cultures, customs and perceived norms [11, 18, 22]. When these
things are not factored into the design of an HIV/AIDS prevention or support initiative, it will
likely ‘strike out’ in its efforts to impact the targeted immigrant community.
14
FIGURE 1. Framework of the associations between migration and HIV infections [18] 18.
Incorporating all of the above mentioned issues into an initiative is a difficult task and those who
have come from the same culture and shared similar experiences will know how best to reach
their own community. There is a pressing need to support and facilitate leadership in
immigrant communities by allowing individuals to feel secure in their new life. This could enable
people to take on leadership roles in their communities and start their own, culturally
appropriate, initiatives.
18
This framework was also used as a tool to analyze a recent needs assessment of HIV/AIDS related services to
immigrant and Refugee communities in Winnipeg and Brandon, Manitoba.
15
3.2 A Journey through the Vancouver Health System
Upon arrival to Canada the first contact with any form of health service in Vancouver for most
refugees is through the Bridge Clinic. If a person is found to have a positive HIV test during the
IME, they are referred to the Oak Tree Clinic,19 the John Ruedy Immunodeficiency Clinic20 or the
BCCDC for follow up tests and support. The Bridge Clinic also refers to SOS21 for counselling and
support including education and awareness programming.
FIGURE 2. Diagram of front line resources for HIV+ immigrants in Vancouver
19
The Oak Tree Clinic provides specialized HIV care for infected women, pregnant women, partners, children
and youth and support services for affected families. There is also a tertiary referral outpatient facility
providing specialized care in HIV/AIDS. * NOTE * Oak Tree Clinic does list PWN on its resource & links page.
20
The John Ruedy Immunodeficiency Clinic is located at St. Paul’s Hospital and is a specialty care clinic for HIV
infected patients. This clinic has 3 social workers in its outpatient unit and 2 in its inpatient unit. The clinic
also consists of nurses and family doctors providing primary care in addition to nutritionist, psychologists and
pharmacologists, acting as a ‘one-stop-shop’ for patient needs.
21
There are two health workers, employed by SOS, who provide support to newly diagnosed immigrants.
16
There are also many other clinics that do HIV testing including Spectrum health, Dr. Peter
Centre22 and the HIV consult clinic in Vancouver’s Downtown Community Health Centre23, these
clinics, however, do not specialize in immigrant health and so are not included in the above
diagram. Where a person lives usually determines where they are referred to for further
assistance, case management services or other referrals in the community. AIDS Vancouver or
similar organizations in Chilliwack, Surrey or Richmond were the main recommended resources
in discussions with social workers from both the Oak Tree Clinic and the Immunodeficiency
Clinic. AIDS Vancouver reviews everyone on a case-by-case basis and depending on the needs of
the individual the case manager will provide information regarding housing, employment,
transportation and language services and resources.
3.3 Experiences of immigrant women vulnerable to HIV/AIDS
It was noted in a conversation with a local social worker that the number of new immigrant
women being referred to her clinic, particularly from Africa, is growing; it is not uncommon to
have 2 or 3 new immigrant women in a week (informal communiqué). She also commented on
the rise in pregnant HIV+ women coming to the clinic and the lack of emotional support services
available to these women.
The purpose of this section is to reflect on the experiences of immigrant women living with HIV.
The articles being cited include the experiences of women who have immigrated to London [11]
and, separately, of women who have immigrated to Philadelphia [14]. The similarities in
experience are striking despite the differences in their final destinations.
In the first study, three African women, KH, SB, and CD, living with HIV in Philadelphia were
interviewed. All three women were single mothers and undocumented immigrants from
francophone countries :
22
The Dr. Peter AIDS Foundation runs a combined Day Health Program and 24 hour nursing care Residence at
Dr. Peter West End. Visit www.drpeter.org
23
See AIDS Vancouver for a more detailed list of HIV/AIDS clinics in the Vancouver area:
www.aidsvancouver.org/info/testsites
17
“K.H. speaks little English and had to rely on a translator when she received her HIV
results. The translator revealed K.H.’s status to others and rumors circulated in her social
networks. Since her diagnosis three years ago she leads a private life that consists of work,
home, and a few social outings. She tries to maintain normalcy and appears at events in the
African community ‘to keep people guessing about whether or not she has HIV’. K.H. is
extremely lonely and isolated, and she laments that she will never be able to get married,
have children, or have a casual or serious sex partner. She has almost no support networks,
no family living in the US, and very few friends. She commented that she ‘has only the
Americans who give me free medication’.”[14]
…………………………………………………………………………………………………………………………
“S.B. was diagnosed with HIV during routine pre-natal care in 2001. Devastated by the
diagnosis, she thought about terminating her pregnancy. (Medical personnel at the hospital
had encouraged her to do so.) S.B. has disclosed her status to a cousin and her son’s father,
who claims he is negative. She says she cannot tell anyone else for fear of ‘killing them’. S.B.
had a therapist during her pregnancy and found it helpful because she was not able to
discuss being HIV positive at home. She has suffered from depression, and in early 2003 she
was tempted to give up and stop taking her HIV medications. S.B. is very afraid of exposure
and she continues her treatment at a particular city health centre because it has few African
patients. She says that if she begins to see other Africans there she will seek care elsewhere
for fear of them learning about her status..”[14]
…………………………………………………………………………………………………………………………..
“C.D. was unaware of his status until she became pregnant with her second child in 1999.
At the time of the interview C.D. was not taking anti-retroviral medication as her viral load
was low. During her last pregnancy in 2003 an HIV case manager helped her find adequate
housing and offered other emergency financial assistance and social support. In addition to
acute financial problems, her main medical problems have been complications following her
C-section in June 2003 and trying to comply with anti-HIV treatment for the youngest of her
three children. C.D. complied with treatment to prevent vertical transmission during
pregnancy, but she was unable to afford infant AZT after her child was born. In spite of her
case manager’s best efforts they were not able to enroll the child in government medical
assistance, which would have covered the cost of the prescription. As there had been an
interruption in the infant’s care it was too late to start him on AZT. She has told almost no
one about her HIV status; instead she lives ‘in her little corner’ and doesn’t interact with
others because she is afraid they will learn she is HIV positive.” [14]
………………………………………………………………………………………………………………………..…
The Second article looked at the experiences of HIV positive African women living in the United
Kingdom.24 The need to recognize the migration experience, legal status and reason for leaving
their country was again emphasized. The situation of each woman in this study was unique and
greatly affected their everyday realities. The following statements related particularly to the
uncertain legal status and economic constraints many of these women were facing:
24
These statements are generated from interviews with 62 immigrant women from different parts of Africa
18
“it is really horrible because you want to go and buy your African food from the African
shop but you can’t buy with the food vouchers you have to go to the supermarket.”[11]
- W30, Uganda (on stigmatizing affect of food vouchers)
………………………………………………………………………………………………………………………..…
“Once in a while you want to eat something good but you can’t and with children you
can’t say that because I am taking this medication this special meal will be for me, this is
for mummy”[11]
- W2, Burundi (on difficulty of food choices with children)
………………………………………………………………………………………………………………………..…
“it was difficult because of the 9 year old in a single room and then having to share a bath
and toilet with strangers and we shared with one person who was a drug user, every time
you get in the bathroom there was syringes everywhere.”[11]
- W9, Kenya (on housing conditions when first arriving to UK)
………………………………………………………………………………………………………………………..…
“every ring of the doorbell, they’ve come to deport me, that’s what it feels like, the sight
of a police car, are they looking for me, you know; that’s the kind of life you have to live and
definitely with the virus you don’t need that.”[11]
- W38, Uganda (on fear of deportation)
………………………………………………………………………………………………………………………..…
“I’ve been like cut off you know... It would have been really nice for me to go back and
get back my job, go back to my family, go back to my friends…my home, the sunshine, the
work, the holidays and everything which for me is very different from being here…here life is
miserable, for me its miserable”[11]
- W50, Zambia (on constraints on travel imposed by legal status and illness)
………………………………………………………………………………………………………………………..…
“if its people from my country and maybe they know my family you have to make it a
secret because they tell them, they won’t keep quiet, it would go straight to Africa.”[11]
- W17, Tanzania (on disclosure)
………………………………………………………………………………………………………………………..…
Some key themes that were expressed by nearly all of the women interviewed in both
papers related to the fear of disclosure and the impact that disclosure would have on
their families. Social circles of many immigrant communities are quite connected and
though this is often a positive attribute and can be a source of support, in the case of an
HIV diagnosis, many women perceive it to be a threat. The fear of stigma and being
ostracized in their community (as well as financial pressures) were discussed to a much
greater extant than the impact of the virus on their physical health or well being.
19
3.4 Sketches from the field
The following section summarizes the informal conversations had with four individuals working
with HIV+ immigrants on a regular basis. This is solely anecdotal information and does not
necessarily reflect the opinions or protocols of the institutions for which the individuals work:
Bridge Clinic
A common perception in the country of origin of many immigrants is that HIV equals death.
The social worker at the Bridge Clinic works with people to help them see the big picture, that
other people are dealing with this too and that there is treatment. Though no statistics were
readily available she noted global events often dictate where immigrants are coming from at
any given time and people come to Canada for very different reasons. Lack of resources such as
funding and staff is always an issue to providing the most effective services however they do
what they can to connect people to a wide range of resources including the other clinics (Oak
Tree, St. Paul’s, BCCDC) and organizations such as SOS (for education and awareness programs
in addition to counselling) and AIDS Vancouver. She noted that there were cross cultural
workers and an African Kitchen initiative that had been funded by BC Multicultural Health
Services Society but that the funding had recently been cut.
Oak Tree Clinic
Women, children and their families who are diagnosed with HIV are often referred to the Oak
Tree Clinic for follow up tests and support. The Social worker here works together with two
outreach workers to provide counselling and support. She discussed the increase in the
number of immigrant African women seen in the clinic as well as a rising trend in the number of
pregnant women within this group. She knows of a large number of resources and
organization that people can access when they are diagnosed with HIV and the organizations
she suggests most often depend on where a person is living; the distance to get to many
services is a large barrier for many people, especially those that can’t afford to live in the city.
AIDS Vancouver was thought to be an excellent resource and the case managers there were
spoken of very highly. She also mentioned other clinics (Bridge and St. Pauls) as well as a
number of other ASOs including the Positive Women’s Network.
20
John Ruedy Immunodeficiency Clinic - St. Paul’s hospital
This clinic is a ‘one-stop-shop’ for the needs of a person dealing with HIV/AIDS. The clinic has
Councillors, Social workers, Nutritionist, Psychologists, Pharmacologists, Nurses and Doctors and
provides both inpatient and outpatient services. In a discussion with a social worker in this
clinic, it was mentioned that there were no definitive trends in new cases but the number of
immigrants with HIV seemed to be increasing. She also mentioned that Oak Tree and AIDS
Vancouver were excellent resources and would be good to talk to. When discussing what
resources are available and what is needed, she emphasized the need to deal with issues of
everyday survival; transportation, stigma, language issues, financial concerns, housing and many
other issues all take precedence over health. She was very knowledgeable of different
resources available in the community, mentioning both a group at the PWN and a group called
‘Suwanya’ which started out with Kitchen meetings lead by a woman who had worked with HIV
issues in Africa before moving to Canada. These initiatives are some of the few (if only)
successful attempts to reach African immigrants and are very new.
AIDS Vancouver
Case Managers at AIDS Vancouver provide information, support and care coordination for
people living with HIV/AIDS. When asked about what kinds of emotional support were available
to immigrants with HIV, the case manager I talked with expanded on the idea that up until now
the main support groups have been for IDU or MSM groups. She commented that there were
support groups that weren’t necessarily targeted towards immigrants but that could be joined
if the person spoke English and somewhat identified with those in the group. She emphasized
that each person was taken on a case by case basis and the ability of people to take part in the
current support groups depended on their language, culture, disclosure status and a host of
other things. She commented that the idea of a ‘support group’ was somewhat euro-centric
and that HIV related initiatives targeting immigrants must be defined by the needs of each
community. When asked about the role of local ASOs in supporting HIV+ immigrants she
responded that assisting immigrants, most of whom are struggling to survive, with everyday
necessities would allow them to address their HIV status and to become leaders and advocates
in their own communities.
21
A variety of Settlement Organizations were also contacted to provide background for this report.
Many did not see health issues as a part of their mandate, however listed below are brief
descriptions of several initiatives being conducted by settlement organizations.
SOS Health/AIDS Project
Storefront Orientation Services (SOS) is one of the four pillars of the Vancouver Refugee Services
Alliance (VRSA)25 and includes the orientation of immigrants with the Canadian health system as
part of its mandate. HIV/AIDS information sessions are given both before and after the IME HIV
test as part of the immigration procedure. VRSA health staff at SOS also provides private
counselling depending on the test results. There is also a PWA support program where staff will
work with people on personal health plans to meet their needs and link to other groups and
individuals for support.
PICS HIV/AIDS Foundation
This is a new partnership of community agencies, researchers, scholars and experts in the field
facilitated by the PICS to address the growing concern of HIV and AIDS in the multicultural
communities. The goal of this partnership is to begin research projects in order to generate
discussion and reliable information to conduct orientation programs concerning HIV/AIDS
awareness and its prevention for health educators, community workers, social activists and
others dealing with multicultural communities.
NSMS Immigrant Women’s Health Project
This is a new project being run by the North Shore Multicultural Society (NSMS) as the result of
an NSMS immigrant health research project demonstrating that a significant issue for many
newcomers on the North Shore is the lack of access to the health care system. The goal of this
program is to assist Chinese and Korean women to find out about health care options on the
North Shore and share health care information and resources with their community.
25
VRSA includes Immigrant Services Society of BC, Mennonite Central Committee of BC, Storefront Orientation
Services and Inland Refugee Society of BC
22
3.5 Settlement Services in the GVRD
There are over 35 organizations or agencies currently providing services to immigrants and
refugees from many parts of the world (Listed in Appendix IV). Although not all organizations
provide health related services they are critical in facilitating the settlement process, an issue
which has often been shown to trump personal health considerations for immigrants infected or
affected by HIV/AIDS [9, 11, 14, 20, 21]. This is exemplified through the following two excerpts,
the first from a HIV Case Manager in Vancouver as cited by Brandson [21] and the second from a
Health Promoter based in Ontario as cited by Narcisco [20].
“Housing first… then income…. HIV is a health issue but you can’t look after those things if
you can’t look after yourself… people cannot look after their health if these other things are not
looked after first”
~HIV Case Manager [21]
“A high percentage of immigrant and refugee clients are surviving in fragments of their family.
There are a lot of gaps there that in a different context might not be present within the family.
There are settlement issues. They are too busy making ends meet to go out and get information
about good health.”
~Health Promoter, WHIWH [20]
Table 4 lists some of the services frequently provided by settlement organizations. Although
these services are not all usually provided by one organization, there has been a lot of work,
particularly by the Immigrant Services Society of BC (ISSBC), the Affiliation of Multicultural
Societies and Service Agencies of BC (AMSSA) and the Mennonite Central Committee (MCC), to
create searchable directories of relevant service providers.
It is important to note that if these services are to be accessible to immigrant women living with
or without HIV, they must be provided in a way that is linguistically, culturally and gender
appropriate [23].
TABLE 4: Commonly provided Settlement Services
Settlement Services
Trauma counselling Outreach services
ESL services Tax clinics
Translation & Interpretation Advocacy & Legal services
Orientation Mentoring programs& Buddy programs
Housing services Referrals & Information
Mental Health services Career Planning & Skill training
23
3.6 Language & Cultural Competence
The ability to communicate is an essential component of daily life and miscommunications are
frequent, even amongst native speakers. In recent Vancouver-based interviews of service
providers and immigrant women, language was the most commonly mentioned challenge to
providing and receiving health care. The following is an excerpt from an interview as reported
by Brandson [21].
“Language is a barrier for both service providers and clients… understanding how things work,
for clients explaining the Canadian health systems, for service providers understanding the
client’s experience. The subtle things are okay… food, clothes… but the big issues like death or
planning for children… are difficult to discuss.”
~HIV Case Manager
Many immigrants and refugees come to Canada with limited knowledge of English and are
dependent upon translation services to facilitate their initial settlement. Large Multicultural
Organizations such as Immigrant Services Society of BC (ISSBC), the Progressive Intercultural
Community Services (PICS) Society and MOSAIC offer limited services or information in a
multitude of languages including:
Arabic German Omoro Spanish
Cantonese Hindi Pashto Swahili
Dari Japanese Persian Tagalog
Farsi Khmer Punjabi Turkish
Filipino Korean Russian Urdu
French Mandarin Somali Vietnamese
A health-focused interpreting and translation resource called the Provincial Language Service
(PLS) provides interpreters or translations in over 100 languages26. Other organizations also
provide Translation and Interpretation services to settlement service providers; these include
Abbotsford Community Services,27 MOSAIC28 and DiverCity29.
26
Registration is required and there is a fee for translation and interpretation services.
27
Professional Interpreters and Translators in 26 languages: General fees for these services are quoted at
$40.00/hr for oral interpretation, $0.20 per written English word for translation services and $0.25 per word
for ‘express’ translation (done within 3 days).
The government funds a program called ‘English Language Services for Adults’ (ELSA)30 which is
available to newcomers to Canada who are 17 or older. Refugee Claimants are not eligible for
this program, however, organization such as the Burnaby Family Life Institute, the Family
Education and Support Centre, the North Shore Multicultural society and the Pacific Immigrant
Resources Society offer special English language classes for immigrants who are ineligible for
ELSA.
Cultural Competence
The majority of settlement service providers and other organizations working with immigrant or
multicultural populations have a relatively wide array of programs targeted towards various
cultural groups31. Such competencies are critical as discussed in the following excerpts from
Vancouver based health professionals [21]:
“We don't understand who blends with who... and we don't know where we get that information
from... lets say you are from the Ivory Coast, are you going to feel comfortable with someone
from Haiti? We know there are issues for both but we don't understand that… it’s difficult
because our focus is medical HIV care”
~Nurse [21]
“I think you always have to be culturally sensitive to what is going on… and to what their beliefs
are… but I think too if you can attach them to somebody that is aware of their cultural beliefs…
that is great… I think they are still receptive to anybody who is there willing to help them… and if
you have the language of course.”
~Nurse [21]
An example of such an initiative from the ISSBC is the Tri-Cities Newcomer Mapping Project, the
output of which are four maps with containing information about what resources immigrant
interviewees found helpful in their settlement process. The four maps are targeted to Afghan &
28
Interpretation services are provided to the private and public sectors in 50 languages with Interpretation
rates based on the nature, location and duration of the appointment, the number of parties involved and the
amount of notice given.
29
Provides translation services in 46 languages
30
Visit ELSA Net for more information about this program and a map of program locations in the lower
mainland: http://www.elsanet.org/schools/index.html.
31
The Multicultural Organization Database, an initiative of the Vancouver Community Network, indexes a large
number of multicultural organizations in Vancouver: http://www.vcn.bc.ca/multicultural/the_index.html
25
Iranian newcomers, Chinese newcomers, Korean newcomers and Eastern European
newcomers32. Examples of other types of multicultural initiatives in Vancouver include: An
African Children's Homework Club (Burnaby Family Life Institute); An African ESL Mother and
Preschool Program, Arabic-Speaking ESL Women’s Group and a Latin American Counselling
Services (Family Education and Support Centre); A Vietnamese Family Counselling Program
(MOSAIC); and Filipino parenting workshops (Multicultural Helping House Society).
4.0 DISCUSSION
4.1 Barriers to Service
The recent increase in of HIV+ immigrants in Vancouver is a relatively new phenomenon and
health providers, settlement organizations and AIDS Service organizations are all learning how
best to serve this population as the situation progresses. When designing services it will be
important to remember what kinds of barriers immigrants may face in their everyday lives.
These barriers may reduce their abilities to utilize services or access information. Table 5
presents a summary of barriers as discussed by Tharao [24] and compiled by Brandson [21].
TABLE 5: Barriers to Access of HIV Information and related services [24]
Barriers
Stress of the settlement process (housing, education, employment, immigration issues, language
training) reduces time available for healthcare needs
Experiences of racism and cultural discrimination by others (especially service providers) can lead to
mistrust of system
More immediate issues and needs such as finding employment, affordable housing, feeding their
family etc, takes precedence over any issues related to HIV/AIDS
The fear of being identified as HIV-positive and the subsequent stigma can prevent access to services
and programs such as food banks that are located within AIDS service organizations even when they
may not have enough money to pay for the proper foods/diet required to enhance their medication’s
effectiveness
Being diagnosed as HIV-positive during the immigration process adds an overwhelming burden to an
already stressful time
Difficulties attaining recognition for the educational qualifications and experience they received in
their country of origin
Participants expressed that there was a ‘code of silence’ around sexual matters in their cultures
32
To access these maps in PDF form, follow this link http://www.issbc.org/newsletter.htm and find the
contents below the ‘Tri-Cities Newcomer Mapping Project’.
26
4.2 Recommendations
Between January 2005 and March 2006, AMSSA coordinated the ‘Promoting Health Living in
BC’s Multicultural Communities Project’ to support effective intercultural communication in the
area of public health. This project resulted in a final report, the ‘Mapping Key Multi-ethnic,
Multilingual Communities, and the BC Multicultural health Directory [25]. Below are listed the
recommended actions to improve health service provision to immigrants:
TABLE 6: Actions to Improve Health Service Provision to Immigrants [25]
Recommended Actions to Improve Health Service Provision to Immigrants
Develop multilingual service directories and free
Use plain language in translated materials;
phone lines in each community;
Implement diversity and cultural competence Use bilingual advocates to educate clients about their
education programs; rights, how to navigate the system and what to expect;
Produce and use audiovisual resources, especially
Increase funding assigned to train and hire videos in other languages about pre and post natal
bilingual staff and interpreters; care, prevention of tooth decay and parenting in
Canada;
Organize health forums, fairs and mobile Develop urban agricultural programs, community
multilingual educational health clinics in kitchens and gardens, mobile multilingual educational
communities; health clinics;
Build partnerships among agencies to avoid Training of community health promoters/ educators
service duplication; from own ethnic communities;
Provide diversity education in variety of settings
Increase the number of primary health and (schools, hospitals, recreation centers, libraries,
specialized services in smaller communities; shopping centers, doctors' and dentists' offices,
pharmacies);
Increase availability of low cost ESL classes with
Conduct frequent surveys to assess community needs;
child minding services;
Recognition of foreign credentials to promote greater
Provide culturally and linguistically appropriate
involvement of immigrant professionals in the health
Adult Day Care and residential care homes;
and social sectors
Provide more culturally competent detox
More parent support services for newcomers;
treatment and acute care services;
Although these recommendations relate to general health services, they are also very relevant
in the context of providing HIV/AIDS related services and information to immigrant populations.
Table 7 outlines suggested actions, specific to HIV/AIDS service providers, which could be taken
to help support immigrant individuals and communities.
27
TABLE 7: Actions to Facilitate Leadership in Immigrant Communities
Community Level Individual Level
Partnership with settlement organizations to provide
information to immigrant communities in a culturally Training
appropriate manner (PICS, NSMS, SOS, etc.)
Awareness initiatives to reduce stigma and
Outreach
discrimination towards HIV+ Immigrants
Fund Raising Initiatives Scholarships
Support Current Initiatives within immigrant Employment or Volunteer
communities opportunities
4.3 Future Research
Heterogeneity within immigrant populations
The term ‘immigrant’ is a blanket statement referring to people of many different backgrounds,
even when targeting services to a specific ‘ethnicity’ it is still important to bear in mind the
heterogeneity in experience and culture of that community. In order to better understand what
affects a person’s ability to learn of services, access services and then fully benefit from these
services, it is important to know how they typically find out about events and resources (eg.
Word of mouth, radio, TV, paper, etc.); what their perceptions of these services are (eg. Is there
stigma associated? What are the perceived attitudes of service providers?); and how services
can be delivered in a culturally appropriate manner. Future research in these areas would be
very informative in the development of any initiative targeting a specific ethnic group.
Perceptions of Translation Services
Translation and interpretation services are often necessary in dealing with settlement and
health related issues, however there have been many issues of mistrust directed towards these
services and it is important to know how that might affect health seeking behaviour as well as
the effectiveness of knowledge transfer when using these services.
Geographic Analysis of Service provider locations
Transportation has been discussed in many studies as a large barrier to accessing services.
Many immigrants can not afford to live in Vancouver proper and move to Surrey or an area that
28
is more affordable but also further away. Geographic analysis comparing service locations with
immigrant resettlement patterns can help to determine where new services should be built.
There are several studies using a similar form of analysis in other cities to determine gaps in
service provision [26, 27].
4.4 Conclusions
Immigrant women from HIV endemic countries are increasingly overrepresented in the number
of reported HIV cases per year in Canada. Upon arrival to Vancouver, many of these women
face challenges to their everyday survival which take priority over health related issues. There
are a number of opportunities on their path through the health system for immigrant women to
be connected to relevant resources upon being diagnosed with HIV. Most cases are directed to
AIDS Vancouver case managers who provide more information about HIV specific resources and
help to access other relevant services in the community.
Vancouver offers few resources for emotional support to immigrant women living with HIV. This
is in part due to fears of stigma and disclosure in addition to a lack of culturally appropriate
modes of support and a lack of funding to front line service providers. In order to improve in
this area it will be important to facilitate leadership in immigrant communities and promote
initiatives based on the unique needs of each group. As this situation progresses we may learn
from what is being done parts of Canada that host larger number of immigrants. Organizations
in these areas have gone through similar ‘growing pain’ and may offer valuable insight into what
has worked and what has not.
While there are several promising initiatives to provide support, these groups will only reach
those who are willing to disclose their status. Awareness and campaigns targeted at reducing
stigma in these communities will be a necessary step in allowing women to access the services
they need without fear of stigma and discrimination.
4.5 Acknowledgments
I would like to thank Kamal Arora, Janet Madsen and everyone at the Positive Women’s Network for
their support of this project as well as Francisco Ibáñez-Carrasco and all of the services providers
who were so generous in providing their time, insight and feedback for this report. Finally, I would
like to acknowledge Itrath Syed and the Simon Fraser Public Interest Research Group for facilitating
this Action Research eXchange.
29
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[19] Foster CaM, Nancy. Improving Access to Services for Immigrant and Refugee Communities.
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31
APPENDIX I: THE REFUGEE PROCESS IN CANADA –‘FACES OF REFUGEES’ 2006 [7]
32
APPENDIX II: REFUGEE SETTLEMENT PATTERNS 2003 – 06; ‘FACES OF REFUGEES’ 2006 [7]
33
APPENDIX III: HIV+ IME REPORTS IN CANADA BY COUNTRY OF ORIGIN 2000-07 [4]
* HIV Endemic Country
APPENDIX IV: ORGANIZATIONS PROVIDING SERVICES/SUPPORT TO IMMIGRANTS
ABBOTSFORD COMMUNITY SERVICES (ACS) * CHILLIWACK COMMUNITY SERVICES *
2420 Montrose Avenue 7112 Vedder Road
Abbotsford, V2S 3S9 Chilliwack, V2P 2C7
604-859-7681 604-792-4267
abbycs@paralynx.com ccsinfo@comserv.bc.ca
www.abbotsfordcommunityservices.com www.comserv.bc.ca
AFFILIATION OF MULTICULTURAL SOCIETIES AND CITIZENSHIP AND IMMIGRATION CANADA (CIC)
SERVICE AGENCIES OF BC ** 1148 Hornby Street
205-2929 Commercial Drive Vancouver, V6Z 2C3
Vancouver, V5N 4C8 1-888-242-2100
604-718-2777 www.cic.gc.ca
amssa@amssa.org
www.amssa.org COLLINGWOOD NEIGHBOURHOOD HOUSE *
5288 Joyce Street
ASIAN SOCIETY FOR THE INTERVENTION OF AIDS Vancouver, V5R 6C9
(ORCHID PROJECT) # 604-435-0323
210-119 Pender Street West www.cnh.bc.ca
Vancouver, BC V6B 1S5
604-669-5567 DIVERSECITY COMMUNITY RESOURCES SOCIETY
asia.bc.ca (DCRS) *
1107-7330 137th Street
BC SETTLEMENT AND INTEGRATION WORKERS' Surrey, V3W 1A3
ASSOCIATION (BCSIWA) 604-597-0205
32-150 Willingdon Avenue www.dcrs.ca
Burnaby, V5C 5E9
604-689-7222 THE FAMILY EDUCATION AND SUPPORT CENTRE *
bcsiwa@telus.net 22554 Lougheed Highway
www.bcsiwa.jibby-jab.com Maple Ridge, V2X 2V1
604-467-6055
BURNABY FAMILY LIFE INSTITUTE (BFLI) familyed@telus.net
Burnaby Heights Resource Centre www.familyed.bc.ca
17-250 Willingdon Avenue
Burnaby, V5C 5E9 FAMILY SERVICES OF GREATER VANCOUVER (FSGV)
604-659-2200 1616 West 7th Avenue
www.burnabyfamilylife.org Vancouver, V6J 1S5
604-731-4951
BURNABY MULTICULTURAL SOCIETY * www.fsgv.ca
6255 Nelson Avenue
Burnaby, V5H 4T5 HISPANIC COMMUNITY CENTRE SOCIETY OF BC
604-431-4131 4824 Commercial Street
bmsdirector@uniserve.com Vancouver, V5N 4H1
www.bby-multicultural.com 604-872-4431
hispanic@vcn.bc.ca
www.vcn.bc.ca/hispanic/hcc.html
35
IMMIGRANT SERVICES SOCIETY OF BC * MENNONITE CENTRAL COMMITTEE BC (MCC BC)
530 Drake Street 31414 Marshall Road, Box 2038
Vancouver, V6B 2H3 Abbotsford, BC, V2T 3T8
604-684-7498 1-888-622-6337
settlemt@issbc.org www.mcc.org/bc
www.issbc.org
MISSION COMMUNITY SERVICES SOCIETY (MCSS) *
INLAND REFUGEE SOCIETY OF BC * 33179 2nd Avenue
430-411 Dunsmuir Street Mission, BC, V2V 1J9
Vancouver, V6B 1X4 604-826-3634
778-328-8888
directservice_inland@vrsa.ca MORE THAN A ROOF MENNONITE HOUSING SOCIETY
500-12500 Trites Road
KIWASSA NEIGHBOURHOOD HOUSE * Richmond, BC, V7E 3R7
2425 Oxford Street, 604-241-9009
Vancouver, V5K 1M7 mtrhousing@telus.net
604-254-5401 www.morethanaroof.org
pat@kiwassa.bc.ca
www.kiwassa.bc.ca MOSAIC (SETTLEMENT PROGRAMS) *
2nd Floor-1720 Grant Street
LA BOUSSOLE Vancouver, BC
612, Broadway V5L 2Y7
Est Vancouver, V5T 1X6 604-254-9626
604-683-7337 mlarrivee@mosaicbc.ca
pnsekera@lbv.ca www.mosaicbc.com
www.lbv.ca
MULTICULTURAL HELPING HOUSE SOCIETY *
LANGLEY COMMUNITY SERVICES SOCIETY (LCSS) * 4802 Fraser Street
5339 207th Street Vancouver, V5V 4H4
Langley, BC, V3A 3E6 604-879-3277
604-534-7810 info@helpinghouse.org
info@lcss.ca www.helpinghouse.org
www.lcss.ca
NATIONAL CONGRESS OF BLACK WOMEN
LAW COURTS EDUCATION SOCIETY OF BC FOUNDATION #
260-800 Hornby Street 208-5066 Kingsway
Vancouver, V6Z 2C5 Burnaby, V5H 2E7
604-660-9870 604-605-0124
info@lawcourtsed.ca natbwf@telus.net
www.lawcourtsed.ca www.nationalcongressofblackwomenfoundation.org
LITTLE MOUNTAIN NEIGHBOURHOOD HOUSE NORTH SHORE CRISIS SERVICES SOCIETY -
SOCIETY * MULTICULTURAL OUTREACH SERVICES (MOS)
3981 Main Street 119-255 West 1st Street
Vancouver, BC, V5V 3P3 North Vancouver, V7M 3G8
604-879-7104 604-987-0366
info@lmnhs.bc.ca admin@nscss.net
www.lmnhs.bc.ca www.nscss.net
36
NORTH SHORE MULTICULTURAL SOCIETY * SOS (LATIN AMERICAN HEALTH/AIDS/EDUCATION
207-123 East 15th Street PROGRAM) *
North Vancouver, V7L 2P7 430-411 Dunsmuir Street
604-988-2931 Vancouver, V6B 1X4
office@nsms.ca 778-328-8888
www.nsms.ca acharlton_sos@vrsa.ca
www.vrsa.ca
OPTIONS: SERVICES TO COMMUNITIES SOCIETY –
MULTICULTURAL SERVICES PROGRAM * SOUTH VANCOUVER NEIGHBOURHOOD HOUSE
100-6846 King George Highway (SETTLEMENT SERVICES) *
Surrey, V3W 4Z9 6470 Victoria Drive
604-596-4321 Vancouver, V5P 3X7
info@options.bc.ca 604-324-6212
www.options.bc.ca svnh2@attglobal.net
PACIFIC IMMIGRANT RESOURCES SOCIETY (PIRS) * SUCCESS *
205-2929 Commercial Drive 28 West Pender Street
Vancouver, V5N 4C8 Vancouver, V6B 1R6
604-298-5888 604-408-7255
info@pirs.bc.ca www.successbc.ca
www.pirs.bc.ca
VANCOUVER AND LOWER MAINLAND
PROGRESSIVE INTERCULTURAL COMMUNITY SERVICES MULTICULTURAL FAMILY SUPPORT SERVICES SOCIETY
SOCIETY (PICS) * 5000 Kingsway Plaza - Phase III
109-12414 82nd Avenue 306-4980 Kingsway
Surrey, V3W 3E9 Burnaby, V5H 4K7
604-596-7722 604-436-1025
pics@pics.bc.ca www.vlmfss.ca
www.pics.bc.ca
VANCOUVER COMMITTEE FOR DOMESTIC WORKERS
PROVINCIAL LANGUAGE SERVICE (PLS) AND CAREGIVERS RIGHTS (VCDWCR)
INTERPRETING/TRANSLATION: 2150 Maple Street
604-875-3402 or 1-877-BCTALKS (228-2557) Vancouver, V6J 3T2
pls@phsa.ca 604-874-0649
www.phsa.ca
SETTLEMENT WORKERS IN SCHOOLS (SWIS)
REACH COMMUNITY HEALTH CENTRE - PROGRAM - VANCOUVER SCHOOL BOARD (VSB)
MULTICULTURAL FAMILY CENTRE 2530 East 43rd Avenue
1145 Commercial Drive Vancouver, V5R 2Y7
Vancouver, V5L 3X3 604-713-5698
604-254-6468 swis@vsb.bc.ca
www.vsb.bc.ca
RICHMOND MULTICULTURAL CONCERNS SOCIETY *
210-7000 Minoru Boulevard * = Organizations currently registered with
Richmond, V6Y 3Z5 AMSSA as Immigrant Serving Agencies in the
604-279-7160 Vancouver Region or Fraser Valley
rmcs@rmcs.bc.ca
www.rmcs.bc.ca # = AIDS Service Organizations
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