What is the program?
Zone Rose aims to reach populations disproportionately affected by sexually transmitted and blood-borne infections (STBBIs). It provides a safe, non-judgmental space for testing, support, harm reduction and STBBI prevention and education. This includes free walk-in testing for a range of STBBIs, such as HIV, hepatitis C, syphilis, gonorrhea and chlamydia, on the basis of individual needs. The program has established partnerships with clinics that perform onsite testing.
Zone Rose is a program developed and managed by the community-based organization RÉZO, located in Montréal. RÉZO offers HIV and other STBBI education and prevention services as part of its overall health promotion activities, including promoting sexual, mental, physical and social health, for gay, bisexual and queer (GBQ) men, other men, and trans people who have sex with men.
Why was the program developed?
The Village de Montréal is a festive and inclusive LGBTQ+ destination recognized all over the world, which welcomes millions of visitors every year. The area turns into a pedestrian zone every year from May to October and provides an opportunity for local organizations to interact with and support communities in the Village, including many people who are unhoused and who use drugs. Zone Rose was developed to meet the needs of these communities by providing accessible resources and supports directly in the Village.
Before the development of Zone Rose, RÉZO used a mobile booth located in the heart of the Village de Montréal to make connections with various populations in the community for more than 15 years. However, this small booth had limited visibility and could not be used in bad weather. To address these limitations, RÉZO launched Zone Rose in 2023. In partnership with Direction régionale de Santé publique de Montréal (DRSP) (Montréal’s public health department), the Société de développement commercial du Village (the Village’s business development association) and various suppliers, a shipping container was installed in the pedestrian area of the Village to provide a more accessible, visible and weather-resistant space to offer harm reduction, STBBI prevention and testing services, and other supports to community members.
This new space has an electrical connection and is more welcoming and visible, marked by a four-metre-high pink cone and distinctive branding. It has allowed RÉZO to offer the same services that it offered in the previous booth but with fewer limitations, as well as to add STBBI testing capabilities in partnership with clinics. This is how Zone Rose was born.
How does the program work?
The program has two components: (1) support and education and (2) testing.
The program is delivered through a large shipping container measuring 20’ × 10’ × 8’. The container has two rooms: a larger room for testing and a smaller room for storing supplies. The container is equipped with an air conditioner, electricity, a sink and industrial doors. In 2024 a special partnership was established with the owner of the building behind the container, to set up a more reliable electrical connection.
In 2024, Zone Rose was open to the public from July 3 to October 5, from Tuesday to Saturday in the afternoons and evenings (except for Thursdays starting September 3).
Support and education services
Zone Rose’s support and education services are provided by RÉZO staff with the help of volunteers. These services are provided outside of the container in a booth covered by a 10’ × 10’ tent. When the RÉZO support team first meets with someone, they introduce them to RÉZO and Zone Rose, including its goals, and try to start building a relationship with the person. The RÉZO support team shares information and resources on a number of topics, including the following: STBBIs; safer drug use practices; and diversity as it relates to sex, gender and sexual orientation.
The booth distributes safer sex supplies, such as condoms (internal and external), lubricant and dental dams. Safer sex supply distribution can be used to open up conversations about safer sex options based on a community member’s preferences (e.g., which combination of prevention methods to use).
The RÉZO team also distributes harm reduction supplies. New drug use supplies are provided by the DRSP: injection kits, Pyrex pipes, crystal pipes, GHB kits and snorting kits. Naloxone is also distributed. The distribution of harm reduction supplies creates opportunities to talk with people about their drug use and also to refer them to other RÉZO services, such as the Chemsex/Party and Play program.
Testing services
Partner clinics
RÉZO works with local Montréal clinics that provide nurses who staff the container to offer testing for a wide range of STBBIs every day that Zone Rose is open. In 2024, RÉZO collaborated with the following two clinics:
SIDEP+ clinic nursing staff operated a testing clinic at Zone Rose on Tuesdays and Thursdays. This clinic tests people who don’t hold a card for the Régie de l’assurance maladie du Québec (RAMQ), the province’s public health insurance program. The SIDEP+ clinic only tests people from the following nine populations (not in priority order):
- men who have sex with men (MSM)
- bisexual people (excluding cis women who don’t have sex with MSM)
- people who inject or inhale drugs
- at-risk young people
- people who are or have been incarcerated
- Indigenous people
- people from regions where HIV infection is endemic
- people who do sex work
- trans people
The Clinique médicale urbaine du Quartier latin provides a testing clinic on Wednesdays, Fridays and some Saturdays. Testing is available at this clinic to anyone who comes to Zone Rose, but they require a RAMQ card.
Testing process
When a person comes to Zone Rose for testing, the RÉZO staff located in the booth outside the container are their first point of contact. These staff determine whether the person meets the eligibility criteria for the available clinic (e.g., whether the person has a RAMQ card). If the person is not eligible for testing on the day that they visit Zone Rose, staff will suggest that they return on another day.
For people who meet the clinic’s criteria, RÉZO staff have them fill out the clinic’s pre-testing form and accompany them into the container, one at a time. The container is a private, closed space with a medical exam table, a fridge for storing samples, a centrifuge and a printer. The nurse brings the necessary supplies for taking samples (e.g., syringes, tubes).
The nurse talks to the patient about their needs and risk factors to help determine which STBBIs to test for. The nurse then takes the necessary samples (e.g., blood draws).
RÉZO has included local business in this program. There are arrangements with local Village businesses to allow patients to use their bathrooms for urine samples and anal swabs when needed, as Zone Rose does not have a bathroom. A RÉZO staff member accompanies the person to the bathroom of one of the partner businesses and waits outside.
At the end of the day, the partner clinic nurse transports the samples to their clinic. The samples are then carried by a specialized transporter to the Centre hospitalier de l’Université de Montréal (CHUM) for analysis. Results are ready in one to two weeks.
Zone Rose also distributes HIV self-tests, allowing people to test when and where they want. If a person wishes, they can do the self-test in the presence of a staff member or nurse.
Providing results and linkage to care
The nurse who conducts the testing is responsible for follow-up: they ensure that people receive their results through a call, through an email or through an online clinic platform. In the case of a positive result, tailored follow-up and linkage to care is provided by the nurse or by a doctor in the nurse’s partner clinic. The type of follow-up and the way in which linkage to care happens vary depending on the results and the clinic.
Required resources
- Manager or director in charge of program supervision
- Frontline staff: two people present at all times while Zone Rose is open
- Partnership with one or more clinics to provide testing, follow-up and linkage to care
- A nurse from a partner clinic
- Volunteers
- Harm reduction supplies: naloxone and new drug use supplies (injection kits, Pyrex pipes, crystal pipes, GHB kits and snorting kits)
- Safer sex supplies (external and internal condoms, lubricants and dental dams)
- Resources on sexual health, STBBIs and harm reduction
- HIV self-test kits
- A closed and private space equipped with a sink, electricity and air conditioning
- A 10’ X 10’ tent for the outdoor booth
- A medical exam table, a fridge for storing samples, a centrifuge and a printer
Evaluation
The results presented here were gathered in the second year of Zone Rose’s operation from July 3 to October 5, 2024.
Support and education services
| Total support and education interactions* | 2,303 |
| Age group (rounded percentages) | |
Less than 20 years 20–29 years 30–39 years 40–49 years 50–59 years 60–69 years 70 years and up | 2% 31% 29% 15% 13% 7% 3% |
| Supply items distributed (with or without support) | 5,755 |
Resources Condoms Lubricant Condom package (2 condoms and 2 lubes) HIV self-test kits GHB kits Snorting kits Injection kits Crack pipes Crystal pipes Naloxone | 164 2,437 1,890 235 167 38 69 20 347 308 80
|
*The number of interactions represents the ones documented by the team but does not reflect the total number of contacts or the overall traffic around Zone Rose.
Testing services
| Number of tests completed | 427 |
| Positive test results | 68 |
HIV Gonorrhea Chlamydia Lymphogranuloma venereum (LGV) Syphilis | 2 36 20 0 10 |
| Follow-up after a visit to Zone Rose | 60 |
No. of people who started pre-exposure prophylaxis (PrEP) No. of people who have had PrEP follow up (e.g., renewals, blood test) No. of people who started post-exposure prophylaxis (PEP) Other
| 16 14 3 27
|
| No. of people who received a vaccination (HPV, hepatitis A and B, mpox) | 20 |
Overall, one or more STBBIs were detected in 15.9% of testing visits.
Challenges
- The dynamics with the partner clinics were sometimes challenging because of the diversity of approaches being used within a single space.
- Maintaining consistent testing services was a challenge given the nursing staff shortages across the healthcare system, which impacted the availability of nursing staff from the partner clinics.
- Some people were unable to receive testing because they did not meet the testing eligibility of either of the partner clinics. Other people had to return on another day to receive testing from a clinic whose eligibility criteria they met.
- Even though Zone Rose had established partnerships for bathroom use, the absence of bathrooms within the container occasionally posed challenges.
- The logistics of setting up the container took time, such as setting up access to electricity and obtaining a permit from the city to set up the container on Rue Sainte-Catherine Est.
- The dynamic on Rue Sainte-Catherine Est was less favourable for testing at night because people were in more of a party mood or under the influence of substances. Violence and crisis situations arose while Zone Rose was open, and RÉZO staff had to manage these as frontline staff.
- Interactions between the Zone Rose staff and police patrolling the Village to maintain safety sometimes affected the trust Zone Rose was building with people in the Village.
- Zone Rose aims to be an additional testing strategy that’s accessible to communities that are disproportionately affected by HIV and other STBBIs, including the community served by RÉZO, for which testing services are deficient in Montréal. However, given that Zone Rose is in the heart of the Village, people from other communities also visit this service, because they too have needs. The partner clinics, as well as the RÉZO support team, must then find a balance between carrying out Zone Rose’s primary mission and meeting the multiple needs of various communities.
Lessons learned
- Hiring internal (RÉZO) nursing staff to supplement the nursing services provided by partner clinics could be the key to providing a greater range of testing in an ongoing way with fewer eligibility criteria.
- Several months are needed to address start-up logistical issues.
- Testing during the day and early evening should be prioritized rather than testing late at night.
- Police patrols should be asked to avoid lingering near the site so as not to affect the trust built with community members.
- Before the start of each season, it is important to ensure that enough time is allocated to establishing partnerships, to planning and monitoring and to gathering supplies so that everything is ready to go and implementation goes smoothly when the service opens.
Program materials (in French)
Contact information
Alexandre Dumont Blais
Executive Director, RÉZO
207-2075 Rue Plessis
Montréal, Quebec H2L 2Y4
Canada
alexandre@rezosante.org