East Bay HIV/STI Case Management Manual

Author: Cameron Lincoln

Clear communication is a vital component of effective, trustworthy, and conscientious HIV case management. When people are able to express their health concerns, care plans, and personal goals, they feel empowered and actively involved in their healthcare. But what happens when language barriers get in the way?

Case managers must equip themselves with the necessary tools to bridge communication gaps. Without these tools, clients may not adhere to their medication, might distrust their medical care team, or may feel anxious about upcoming appointments. To address these challenges, we need to develop strategies that facilitate effective communication across languages. It’s reported that 54.2% of Alameda county is English monolingual; the remaining 45.8% of the population is bilingual, limited-bilingual, or “not at all comfortable” in English. Acknowledging the role of language––spoken, written, and body language––is crucial in navigating clients to access healthcare successfully. 

The language we use reflects important nuances through vocabulary, accent, pronouns, and tone of voice. These elements can convey key information about us, such as friendliness, shared identity, and level of formality. For example, clients might react differently when asked, “Do you have receptive/insertive anal sex with men?” versus “When you have sex, do you usually top, bottom, both, or neither—and with which genders?” This becomes more complicated when translating these concepts into other languages; asking a client their pronouns can be particularly challenging in Cantonese or Tagalog, but fairly straightforward in Spanish or French. As community-informed case managers, we can use our words to acknowledge, affirm, and advocate for our patients through language assistance.

Case managers come from diverse backgrounds, cultures, and communities, as evidenced by the languages we speak. Some of us may have learned a second language at home, formally at school, with friends, or from living in another country. For others, English may be the only language we speak. Pairing our clients with linguistically competent medical care teams, providers, and staff members (an approach known as “language concordance”) has been shown to close health gaps. However, simply matching clients and case managers by language is not enough. To go beyond basic language concordance, here are some strategies to ensure comprehensive and compassionate care:

• Match your client’s level of formality, vocabulary, and tone. When possible, try to mirror the language that your clients use. This helps build trust and rapport, making them feel more comfortable and understood. Maintain professionalism while adapting your communication style by observing their cues and asking about their preferences.
• Ask your client how they would like to be addressed. By asking how people would like to be addressed, we show that we are committed to providing respectful and personalized care. This can mean anything from confirming name pronunciation to asking about titles/honorifics (e.g., for English, Ms./Mrs./Mr./Mx./calling them by their first name/etc.). For gender diverse and queer clients, affirming their identity in their language can have a profoundly positive impact. This approach helps bridge cultural gaps and ensures better communication.
• Some clients may prefer English, a mixture of languages, or refuse interpretive services all together. Fluency is not always straightforward, and can change from situation to situation. For some multilingual individuals, they may feel confident explaining their symptoms in English. Other times, clients may be illiterate in their native language and prefer an English copy of forms for family to help translate at home. Some clients might decline using an interpreter all together out of fear they might be recognized by someone within their community. Especially for underrepresented languages/dialects, finding current and accurately translated materials can be difficult, and clients may feel that English or another language would be better. Regardless of their reasons, case managers should always center informed patient consent and offer interpretive services and translated documents as an option.
• Equip your client with additional resources in their language. Several websites, videos, and printouts about HIV can be found online through governmental and community-led organizations. This may require you to search for media in a different language online. Presenting information and materials in a client’s preferred language(s) is crucial; if they have any questions, you can always go through the resources together to ensure their understanding.
• Use your linguistic skills and community knowledge creatively. Not everything can be translated word-for-word. For example, while some communities have adapted U=U into their own languages (such as I=I and K=K), you may need to find alternative ways to communicate the concept of undetectable equals untransmittable. Working multilingually often requires creativity, whether it’s using different words that preserve the original meaning, finding new analogies, or rephrasing questions.
• Be transparent with your language limitations. Sometimes, there are words, medical procedures, or concepts we aren’t able to directly translate; we also might not have the vocabulary range, experience, or confidence discussing these concepts in the target language. It is always OK to ask clients to repeat themselves, to slow down, or even rephrase. This can be a learning opportunity to become more comfortable with new vocabulary, slang, or the expression of complex emotions.
• Know when to find an interpreter. In some circumstances, clients want to be 100% sure they are receiving correct, highly specific, information-dense material, such as complicated medical diagnoses, legal affairs, or financial and housing information. If you’re not entirely confident in your skills to accurately communicate this, it is crucial that you find an interpreter more familiar with the tools and vocabulary needed to handle these topics.
• Come up with a game plan if an interpreter isn’t available. There will be times when translation help is not immediately accessible, such as during a cold call from Social Services, a bill or insurance letter, or an off-site visit. Set up a plan B––consider doing a three-way call, asking the client to send a picture of the letter, rescheduling the visit, calling ahead to prepare for an onsite interpreter, or whatever best works for you and your client.
• Prepare your client for conversations they may have outside the clinic. Providing language assistance sometimes means familiarizing your client with key terms and phrases in English. Clients often desire to communicate their health information to loved ones directly––some of those people may only speak English. In the HIV field, this could include advocating for themselves at pharmacies, or with doctors, sexual partners, or strangers online. Encourage clients to use journals, their cellphones, or notes to track new words and phrases effectively.

Important links/resources

• Wiktionary:  Great to look up specific words and phrases across certain languages. Because it is community driven, though, some terms are being actively updated. Similarly, Wikipedia itself is a great option, especially if there’s a technical word that you might have trouble translating by yourself.

• Looking for information online in someone’s respective language is hard. Thankfully, I have been able to utilize my language skills to find websites and resources to refer to. For most things, I was able to look up “COUNTRY” + “HIV” + department of health/ministry of health/non-profit health organization, or any similar permutation. Here are a few examples for specific languages; please note that terms/vocab/spelling may vary from region to region, even if they share a language:

• Resources in Taiwanese Mandarin

• Resources in LATAM Spanish

• Resources in French

• Resources in Arabic, Indonesian, Khmer, Thai, Vietnamese, and Spanish

• Glossary of 20+ languages

• Resource for terms in various African languages

• The Taiwanese Tongzhi LGBTQ+ Hotline Association has been one of my biggest resources when trying to access information and flyers in Chinese that use LGBTQ+ centered language. They often work with other governmental organizations that talk about 2-1-1 PrEP, difference between PEP and PrEP, LAIs, and the Chinese equivalent of U=U.

• LGBTQIA+ multilingual terminology: This is an online library of glossaries offered in Arabic, Chinese (Traditional and Simplified), Korean, Spanish, Thai, and Vietnamese. It also explains key words in simple phrases, and includes words that may be relevant to peer-based case management. 

References:

• CDC. “HIV and TB Overview: Vietnam.” Global HIV and TB, 2024, www.cdc.gov/global-hiv-tb/php/where-we-work/vietnam.html.
• Chen, WT., Sun, W., Huang, F. et al. Lost in Translation: Impact of Language Barriers and Facilitators on the Health Care of Asian Americans Living with HIV. J. Racial and Ethnic Health Disparities (2023). https://doi.org/10.1007/s40615-023-01674-7
• Ribas-Roca, J., Eamranond, P. (2016). Using a Translator in Integrated Care Settings. In: Benuto, L., O’Donohue, W. (eds) Enhancing Behavioral Health in Latino Populations. Springer, Cham. https://doi.org/10.1007/978-3-319-42533-7_7