Specialized clinics

Among existing resources, there is La Licorne, a medical clinic that groups family doctors and nurses trained in sexual health. Like other clinics specialized in sexual health, La Licorne prioritizes the LGBTQ+ communities, homeless people, sex workers and people injecting or inhaling drugs.

"Since we are located in the Village, more than half of our patients are men who have sex with men (MSM). We are however open to all types of publics," explains Mathieu Guindon, Director of La Licorne. "In fact, we are seeing more hetero people from Greater Montréal come use our services."

A specialization in sexual health is not only measured by an expertise regarding STBBI's but also by an anchor in the most vulnerable communities and knowledge of the public's diversity. "Our niche is an inclusive space where everyone is comfortable and welcomed with dignity," explains Mathieu Guindon. "For example, we have developed an expertise with the trans and non-binary communities. Our staff is trained, we use the correct pronouns, even a fake name if the person wishes. We want everyone to feel comfortable."

Besides La Licorne, other clinics provide similar services at the heart of, or around, the Village such as Clinique L'Actuel, a pioneer in the field of sexual health in Québec, the Urban Medical Clinic of the Latin Quarter, Quorum and SIDEP+ Clinic.

These different resources are themselves multi-disciplinary within their own structure. The teams are generally very diversified (doctors, nurses, social workers, psychologists, addiction counselors...) as well as their services.

Other than screenings, the clinics can also prescribe certain vaccines if the person is at risk (hepatitis A and B, HPV). Regarding HIV, prevention tools have significantly advanced, and it is now possible to prescribe Pre-Exposure Prophylaxis or PrEP. It is a medication that if taken daily, reduces the risk of contracting HIV up to 97%.

If someone thinks that they have been exposed to HIV (either by having unprotected sex or by sharing needles/inhalation equipment...), specialized clinics can also provide access to post-exposure prophylaxis or PEP if the health professional considers there is a real risk. This medication must be administered within 72 hours following the exposure.

A constant connection with the community sector

Prevention and efficient help regarding STBBI's are based on a constant synergy between community organizations, laboratories, medical clinics and pharmacies. This collaboration allows organizations to offer communities a range of thorough services from general information to medical assistance without forgetting support and accompaniment.

"We need organizations that provide psychosocial expertise. We provide the medical expertise."

"We are interdependent" states Mathieu Guindon. "We need organizations that provide psychosocial expertise. We provide the medical expertise." He illustrates the example of an initiative called Zone Rose first established in 2023 from the RÉZO organization. It is a container placed in the Village during two months in the summer which allows access to professionals in psychosocial counseling, outreach workers and nurses for screening services, in collaboration with neighbourhood specialized clinics.

RÉZO is at the heart of STBBI prevention in Montréal, with multiple services such as condom distribution, prevention in the field (bars, saunas...), the implementation of community screening clinics and various partnerships with specialized clinics.

In Laval, there is la Sphère, an organization which provides a global approach to sexual health. "We offer a harm reduction approach that is inclusive and anti-oppressive" explains Camille, Sexologist and creator of sexual educational content for the organization. These services are available to people from Laval and its surroundings, but not only. "We can also help people from Longueuil and Montréal, for example, if our services are better suited for them."

La Sphère houses much information on STBBI's and in collaboration with SIDEP of Laval, offers a free weekly screening service that is anonymous and for which the Medicare card is not necessary. Accessibility criteria is on their website. For 20 years, this organization has been providing a prevention, information and a screening program called Vénus for sex workers. "We will sometimes go meet this public, in bars for example, to hand out information, condoms, lubrication." specifies Camille. "It has also happened that a SIDEP nurse came along with us to conduct screenings."

With or without Medicare (RAMQ)

The services presented above are generally covered by Medicare (Régie de l’assurance maladie du Québec (RAMQ). Such is the case with La Sphère and RÉZO. However, some organizations and clinics may charge a small fee ranging from 10$ to 20$ for example, for the laboratory samples shipping costs.

In the case of treatment following a positive test result, it will mostly be covered by Medicare, fully or partially.

What happens if someone is not covered by Medicare?

Temporary workers and foreign students, newcomers, refugees, tourists...many people temporarily established in Québec do not have a Medicare card.

This card is required for most services, but many organizations such as La Sphère in Laval and RÉZO in Montréal offer free screening services without the card anyways. Access to these services though is reserved for vulnerable publics (MSM, drug users, sex workers...). For the rest of the population, there are gaps in the services, particularly outside Greater Montréal.

"A screening can cost 400$. […] Oftentimes private insurances do not cover screenings because they consider this population to be at-risk."

"It can become an issue for hetero students because there is a lack of programs, even in universities. […] A screening can cost 400$. […] Oftentimes private insurances do not cover screenings because they consider this population to be at-risk." deplores Mr. Guindon.

As for foreign students with Medicare, it often comes without medication coverage. They have access to screenings but must pay for the treatments when an infection is found, or a vaccine is recommended. Thus, these treatments are expensive while this population is often vulnerable.

"When Monkeypox (mpox) arrived on our territory, Québec was highly responsive: everyone was getting vaccinated, with or without Medicare. We can do it. […] It represents an initial cost, but in the end, everybody wins", because when it comes to STBBI's or vaccines, it is also about protecting others, with or without Medicare. Mr. Guindon reminds us: "Everybody has sex, we cannot bury our heads in the sand, it is an important issue."