Tackling Language Barriers in HIV Care (Montreal, QC): How AIDS Community Care Montreal Supports Allophone and Anglophone Communities

Introduction

AIDS Community Care Montreal (ACCM) is a volunteer-powered community organization based in Montreal, Québec. For more than 10 years, they have been improving the quality of life of people living with hepatitis C and/or HIV/AIDS through a holistic approach [10]. In fact, ACCM designs its programs to increase the health and overall wellbeing of the community it is serving, as well as to reduce inequalities, in line with Sustainable Development Goals 3 and 10 defined by the United Nations [41]. More concretely, this involves leading projects to fight discrimination and stigma by facilitating open dialogue around sexuality and sexual health, building community among people affected by hepatitis C and/or HIV/AIDS and queer folk, as well as helping them navigate Québec’s healthcare system [14, 15, 16]. They focus on serving anglophone and allophone communities in Montreal whose access to healthcare and information is affected by Québec’s language policies, as will be illustrated in the following sections [22]. Support services are currently offered in English, French and Spanish [15].

ACCM promotes their core values of compassion and human rights advocacy in all their actions. Their vision is of a society free from stigma of hepatitis C and HIV/AIDS [10]. Their work on the prevention of sexually transmitted and blood-borne infections (STBBI) is part of their goal toward community awareness and action. The goal is to understand the local community and encourage members to come together and enact change from within the group. This is reflected in the fact that most ACCM programs heavily emphasize peer-support, allowing service receivers to connect with volunteers who truly understand their situations. Moreover, in line with their holistic approach, ACCM also manages a monthly grocery basket service with affordability and health in mind [12]. In brief, ACCM empowers people to make informed decisions about their health and helps them obtain adequate care while building community [10].

The following sections of this publication aim to highlight the work done by ACCM in disassembling stigma around people living with hepatitis C and HIV/AIDS as well as to help the organization in its outreach.

Background: Key Local Challenges

Understanding Current HIV Incidences and Persistent Diagnosis Trends in Montreal

Since 2002, the Institut national de santé publique du Québec (INSPQ) has run the Programme de surveillance de l’infection par le VIH au Québec (PSI-VIH) [28]. This program paints a portrait of Québec’s STI diagnosis distribution and new diagnosis rates across populations and regions temporally. Since the COVID-19 lockdowns, the number of HIV diagnosis registered at the INSPQ has spiked in Montreal. From INSPQ's 2022 annual report, Montreal showed a rate of new diagnosis that was significantly higher than the provincial average, i.e. 15.2 new diagnosis per 100,000 Montrealers compared to only 4.9 for every 100,000 Quebeckers (the Table 2 figure: the body paragraph of INSPQ’s report reads 10,000 Montrealers, likely a typo) [28].

Moving forward along the timeline, according to a report of the Direction régionale de santé publique de Montréal (DRSPM), in 2024, the rate of HIV incidence increased by 72% compared to in 2019, right before the lockdown in Montreal [23]. Consistent with past data, men remain overrepresented in statistics of people living with HIV [28]. For instance, the ratio of new diagnosis for men and women in 2024 was around 2:1 [37]. However, looking at post-pandemic figures, the DRSPM has identified another priority population: Montreal residents born outside of Canada. From the sample of the 675 Montreal residents living with HIV registered at the INSPQ, 409 were newcomers who arrived less than 12 months ago in 2024 [28]. Around half of the transmissions (51%) were due to heterosexual sexual encounters, of which 80% of people involved were newcomers who arrived in Canada less than 12 months prior to their registration at the INSPQ [28]. These numbers show that HIV affects this population disproportionally.

An interesting trend observed over the recent years among immigrants who have lived in Canada for 6 years or more is that of a decrease in diagnoses, as opposed to the increase observed among immigrants who arrived less than 6 years before their registration at the INSPQ program [28]. According to the DRSPM, this could reflect the effectiveness of prevention tools available in Montreal such as pre-exposure prophylaxis, i.e. PrEP (a prevention medication), regular testing, and antiviral treatments, all of which must be continued to maintain this downward trend for local transmissions [23]. Results of a study featured in the Canadian Journal of Public Health, analyzing data from 2017 to 2019, illustrate the gap in prevention measures in Montreal. The study compared HIV prevalence in a sample of 2449 gay, bisexual and other men who have sex with men (GBM), a key population in HIV infection surveillance, from Montreal, Toronto and Vancouver [26]. From this sample, it was found that the HIV prevalence in Montreal used to be 14.2%, which was lower than the other two major Canadian cities [26]. STBBI testing rates in Montreal were relatively high. However, despite this, the city had the lowest rate of PrEP usage (9.6%) [26]. This could indicate an issue in prevention education and access to medicines.

Language as a Barrier to Receiving Adequate Healthcare Services in Québec

Regular HIV testing is well-documented as a crucial factor in increasing health and longevity, and in reducing transmission rates [35]. Despite this, in Canada, difficulty accessing testing services due to inconvenient locations, fear and stigma of HIV, low risk perception, patient confidentiality concerns and lack of resources have consistently been barriers to testing services before the COVID-19 pandemic [36]. Gaps in efforts to adapt testing services to the unique needs and contexts of key populations were also identified as a barrier to getting help in a systematic review of studies ranging from 2009 to 2019 in Canada [36]. The impact of COVID-19 on HIV testing services is still being studied. However, globally, the pandemic has been observed to have disrupted vital HIV/AIDS programs and services [34]. AIDS organization centers were the most impacted HIV testing facilities, partially explaining the 37% overall decrease in HIV testing observed since the onset of COVID-19 [34]. Lower to middle-income countries had a bigger decrease than higher-income countries [34].

More specific to Montreal, language is a common barrier for people trying to access Québec’s healthcare system according to Miguel Cubillos from the ACCM in an article in The Link [21]. Cubillos works closely with newcomers whose native language is not French or English, the two official languages of Canada [21]. English is considered a minority language in Québec, while in the rest of Canada, French is the minority official language. Language-concordant care, care given to people in their preferred language, is acknowledged as being key for equitable access to healthcare by a publication on the website of the Government of Canada [25]. In fact, a recent study conducted in Ontario, where francophones and allophones are minority populations, shows that those who received language-concordant care in hospitals had better outcomes, i.e. shorter hospital stays and lower mortality rates, as opposed to those who did not [38]. A similar study on perinatal health conducted among Anglophones in Quebec also agreed on the importance of language-concordant care [17]. English-speaking adults in Québec, a language minority, are more likely to feel the importance of receiving language-concordant care than French-speaking Canadians in provinces where French is a minority language [24]. In fact, according to a survey conducted in 2022, 91% of English-speaking Quebeckers feel that it was important to receive services in English [24]. Furthermore, 63% of Anglophones who received healthcare services in the 12 months before this survey insisted on language-concordant care [24].

In Canada, an allophone refers to a person whose first language is neither French nor English, the two official languages of the country. Across Montreal, only 2.4% of people speak neither of the two, while a majority, 58.5%, can hold a conversation in English and French [39]. However, these answers do not necessarily indicate whether an individual is comfortable or would prefer receiving health services in French or English. 32.8% of Montrealers have a mother tongue which is neither English or French and would be considered allophones [39]. Furthermore, for 19.0% of Montreal responders, the language spoken most often at home is a non-official language [39].

Stigma, Discrimination, and Social Exclusion

HIV stigma is associated with the groups of people historically most affected by HIV/AIDS: gay, bisexual and other men who have sex with men, Indigenous Peoples, and people who inject drugs [33]. It is often caused by fear, lack of knowledge and prejudices against the affected groups [1]. HIV-related stigma is defined as behaviours and actions that impact HIV response such as prevention work, healthcare services, testing and treatment according to UNAIDS [40]. Stigma can be formed by an individual’s pre-formed opinions on sex, gender identity, sexual orientation, drug use, sex work and HIV status [40]. In an interview in 2025, Jabulani Muzhizhizhi, the current program coordinator for ACCM’s Newcomers Support said that people living with HIV/AIDS can feel alienated from their own cultural background, especially if it is one “where queerness is stigmatized or where toxic masculinity is the norm” [21]. As for discrimination, it can include stigmatizing actions and can have legal consequences as it is a human rights issue. Across 25 countries in 2022, 13% of people living with HIV reported experiencing stigma and discrimination when seeking care for HIV. Even those seeking non-HIV related care reported facing discrimination. Of the 25% of people seeking non-HIV-related care, 12% were denied access to services [40].

In addition to negative impacts on physical health, HIV-related stigma is linked to an increased risk of developing mental health disorders, most commonly depression and anxiety [31]. This can be due to a person applying the prejudices associated with the disease to themselves, leading to feelings of isolation, shame, despair and fear of disclosure [32]. These sentiments in turn lead to a person being less willing to seek help such as STBBI testing and discourage conversations about safer sex. As for women living with HIV in Canada, the increased risk of depression is often due to high exposure to stigma and violence that lead to trauma [30].

The Affected Community and Its Needs

AIDS Community Care Montreal (ACCM) mainly supports people living with hepatitis C and HIV/AIDS within the anglophone and allophone communities in Montreal. In line with their goal of helping their community holistically, they also serve newcomers, queer folk, aging people, youth and people who use drugs for sex. For example, in 2024-2025, ACCM helped 1927 youths through workshops and kiosks, taken in 23 new members through their Aging with HIV program [12, pp. 6, 11]. In the words of Ferney Mendoza from an article in The Link, a Colombian immigrant diagnosed with HIV and recipient of help from ACCM’s newcomers support program: “Human beings are dimensions: emotions, family, work and money”. He adds that “[ACCM] really took [him] as a whole individual.” [21]

As discussed previously, allophones, people whose first language is neither French nor English, made up 32.8% of Montreal’s population in the federal census from 2021, making the city very culturally diverse and a popular choice for new immigrants [39]. A neighbourhood where new migrants cluster is Parc-Extension. In fact, nearly half of Parc-Extension's population are immigrants, while the Montreal average is one in three residents [17, 18]. Due to the high rate of poverty, it is often seen as a “transitional” initial landing ground that people leave once their financial situation improves [19]. Historically, a large majority of immigrants report being able to carry on a conversation in at least one of Canada’s official languages. From 1996 to 2001, that proportion was more than 9 in 10 [27]. Bilingualism in French and English is extremely common in the youngest age bracket of 15- to 24-year-olds [27]. However, the higher the age, the less likely it is for an individual to speak both languages [27]. Under Québec’s Bill 96, which controls the language used in public services, courts, small businesses, municipalities, and CEGEPs, immigrants could be having serious difficulty trying to access justice, the healthcare system, and to socially integrate [18]. This rings especially true for foundation-building neighbourhoods for newcomers like Parc-Extension. It has one of the lowest rates of French speakers in Montreal and more than a tenth of its population speak neither of the official languages [20].

Queer folk are another group of people struggling to access healthcare and have their rights respected. The majority of Canadians agree that transgender individuals seem to face a lot of stigma in day-to-day life [25]. Furthermore, 77% of sexually and gender diverse youth report having been the target of bullying, leading to worse mental health than cisgender youth attracted exclusively to a different gender. The consequences of stigma about the 2SLGBTQ+ community are reflected by their overrepresentation in the rate of homelessness, greater likelihood of health challenges, and lower income due to workplace discrimination [25]. Examples of stigma queer folk encounter the most are being harassed and threatened, being shunned by family and feeling like they are not understood [21]. It can therefore be concluded that these are individuals in need of community support provided from various angles to increase the quality of life.

AIDS Community Care Montreal (ACCM)’s Programs and Initiatives Addressing Local Challenges

AIDS Community Care Montreal’s (ACCM’s) extensive work in aiding their community holistically can be divided into three categories: support services, education for prevention and treatment information.

Support Services

ACCM’s support services department is distinguished by its breadth. They offer a program addressing food insecurity benefiting 60 people every month (Sylvain’s Buyers Club), one dedicated to helping migrants, refugee claimants and protected people living with hepatitis C or HIV (Newcomers Support), discussion groups for allophones and anglophones, as well as outreach and support for queer folk and youth [4, 6, 12, 13]. These services address inequalities in food insecurity, immigration status, knowledge of language, mental and physical health, all key local challenges discussed above. For instance, Sylvain’s Buyers Club addresses poverty which is prevalent in Montreal neighbourhoods such as Parc-Extension. Newcomers support is a program that has been rapidly growing since its creation in 2019-2020, with Miguel Cubillos as its first project coordinator [7]. Over the years, this program has expanded its network to connect with other frontline organizations and professionals such as clinics and social workers. Listening to the language needs of their community, ACCM has further adapted the program to increase its reach. Spanish peer-facilitated groups were developed in partnership with community members in 2023-2024 [11]. From 2024 to 2025, these support services have managed to offer 155 referrals for people living with HIV and/or hepatitis C to external services such as treatment, housing and physicians, just to name a few [12, p. 8].

In the spirit of community building, Dinner and Discussion events are held weekly. Members gather for home-cooked suppers prepared by volunteers over which they can connect and discuss topics relevant to the community. As Muzhizhizhi told The Link, “there is power in sharing. If you know someone also faced the same stuff that you faced, that's how bonds form.” [21] More details on all the programs can be found on their website. ACCM hosts drop-in hours for anyone wanting to know more about their work and/or seeking help.

Education for Prevention

ACCM has ties with queer folk and youth, key groups for early diagnosis and education. These programs aim to inform people about sexual health and risk reduction [14]. For example, Queer and Trans Outreach (QTO) offers peer support for topics on gender, sexual orientation, coming out and accessing hormone replacement therapy in Québec [4]. This addresses the stigma faced by queer folk and by people diagnosed with HIV/AIDS discussed previously. More concretely, the program aims to develop and deliver multiple trans-related trainings. For example, in 2020-2021, two Trans 101 workshops, which teach people about the reality of trans folk, were delivered, marking the start of QTO’s endeavors in developing Trans-related training [8, p. 9]. In the following years, Trans Sexual Education was developed using feedback from community members [9]. In a similar vein, SextEd is a texting helpline that aims to answer questions about sex and dating for youth in a non-judgmental manner, thereby reducing the taboo surrounding these subjects [5]. Furthermore, ACCM offers workshops and kiosks on safer sex, healthy relationships, preventing online sexual violence, gender and sexuality, and introductory knowledge of HIV for schools. From 2024 to 2025, they offered 64 of these workshops and reached 1927 youths through these and kiosks [12, p. 11]. Another group of people ACCM serves are people who use drugs for sex. Kontak is a program that offers help based on the principles of outreach, education, harm reduction and peer support, and entirely revolves around the help receiver’s agency and intentions. They can offer help in harm reduction by distributing sex and drug materials to reduce STI transmissions, provide one-on-one or group counselling, as well as give tools to help people make informed decisions about their health [29]. They have conducted 207 individual interventions and distributed thousands of safer sex materials, such as dental dams, condoms, HIV self-test kits, Naloxone kits, etc. [12, p. 11]. Every aspect of the program is informed by the needs and wants of the beneficiaries.

Treatment Information

In line with their goal of enhancing the quality of life, health, and longevity of people living with HIV, many of ACCM’s activities target Montreal residents over 40 years of age [2]. For example, HIV and Aging is a service that supports people entering long-term care facilities and the caregivers [2]. As part of the program, ACCM hosts workshops about stigma and discrimination for residents and staff, and inform them about medication conflicts [2]. Furthermore, ACCM has compiled essential information that out-of-province residents might need to avoid interruptions in medication coverage [3]. ACCM’s support services' objectives overlap with those of the treatment information department. As mentioned previously, they have been effective in referring people to healthcare providers and external mental health services, showcasing ACCM’s strength in the Adoption dimension of the RE-AIM framework. Adoption is the measure of how many organizations and people, those who can provide services to communities, are willing to take up and participate in the program. All of the above addresses the key local challenge ACCM has identified, which is difficulty accessing adequate healthcare that many people living with HIV/AIDS face.

In short, AIDS Community Care Montreal provides services for people living with HIV/AIDS in support services (e.g.: Sylvain’s Buyers Club’s food baskets, Newcomers Support’s discussion groups), education for prevention (e.g.: QTO’s kiosks) and treatment information (e.g.: Aging and HIV’s workshops).

AI Use Statement

For this CKP, I used Copilot and ChatGPT to support initial source discovery and for formatting the reference list. All sources surfaced by AI tools were independently verified by me before being included in this publication. I wrote all CKP text myself.

Acronyms

• ACCM: AIDS Community Care Montreal
• CEGEP: Collège d'enseignement général et professionnel (the Quebec post-secondary stage)
• CKP: Community Knowledge Publication
• DRSPM: Direction régionale de santé publique de Montreal
• GBM: gay, bisexual and other men who have sex with men
• HIV/AIDS: Human immunodeficiency virus / acquired immunodeficiency syndrome
• INSPQ: Institut national de santé publique du Québec
• MSM: men who have sex with men
• OQLF: Office québécois de la langue française
• PrEP: pre-exposure prophylaxis
• PSI-VIH: Programme de surveillance de l'infection par le VIH au Québec
• QTO: Queer and Trans Outreach
• RE-AIM: Reach, Effectiveness, Adoption, Implementation, Maintenance
• STBBI: sexually transmitted and blood-borne infection
• 2SLGBTQ+: Two-Spirit, Lesbian, Gay, Bisexual, Transgender, Queer, and additional sexual and gender minority identities