Background: As people living with HIV (PLHIV) grow older, the need for home and community care (HCC) will increase. In British Columbia (BC), publicly-funded HCC includes home support, community nursing, community rehabilitation, assisted living, and long-term care. These services have been designed with consideration of the unique healthcare needs, and support structures of the populations most affected by BC’s HIV epidemic, including men who have sex with men; people who use drugs; and Indigenous individuals.

Approach: A team of Peer Research Associates (PRAs – i.e. PLHIV with experience in research and/or Peer Navigation), service providers, and researchers conducted a survey with 8 community-based organizations in Fraser Health Authority (FHA) to identify services accessed by Older Adults Living with HIV (OALHIV – i.e. those age ≥50), and consulted community experts to characterize the issues impacting OALHIV in FHA.

Findings:Transportation support and food support were the services most frequently used by OALHIV. Clients who had immigrated from more traditional cultures appeared to perceive the idea of HCC as alien. HCC promotional materials are mainly in English, and inaccessible to OALHIV whose first language is not English. Interpreter services used to access services often resulted in literal translation, missing cultural nuances. Some clients were hesitant about using interpreters, perhaps due to HIV-related stigma. Peer navigators avoided face-to-face translation services to improve confidentiality and took the extra time and effort to communicate in ways to protect clients’ privacy. Finally, many OALHIV live in FHA, yet receive HIV-related and other healthcare services in Vancouver, disrupting care continuity.

Conclusion:FHA encompasses diverse communities that experiences unique challenges and offer distinctive strengths and solutions in terms of accessing or augmenting supports for OALHIV. Through this client-provider-researcher partnership we will strive to translate our findings into changes in policy and programming to better support OALHIV in FHA and beyond.

Background:
AIDS Service Organizations (ASOs) provide essential services to vulnerable people living with HIV. However, the provision of services has been impacted by measures implemented to curb the COVID-19 pandemic. We examined access to basic needs support services (i.e., food bank, meal delivery, nutritional supplements, help with financial assistance, help with housing, and help getting medications) among people living with HIV.

Methods:
The OCS is a community-governed longitudinal study of people receiving HIV care in Ontario. Data for the current study come from OCS participants who completed annual questionnaires before (January 2019 – March 2020) and during (March 2020-October 2021) the COVID-19 pandemic.

Results:
A total of 3,181 participants provided data. Of these, 22.1% and 16.2% accessed basic needs services before and during the pandemic, respectively. The three most common services accessed (both pre and during the pandemic) were food bank, help with financial support, and nutritional supplements. Of these top three services, a larger drop (from 12% to 6.3%) was observed in accessing financial support services.

Before the pandemic, a higher percent of younger people (<40 years) than older people (≥40 years) (29.3% vs. 18.5%), women than men (35.1% vs. 28.3%), heterosexual than gay/lesbian/bisexual/queer (27.4% vs. 22.5%), and non-White than White (29.0% vs. 17.0%) participants accessed services. This pattern remained consistent during the pandemic with a higher percent of access among young, women, heterosexual, and non-White participants. However, a more prominent drop was observed in access to services among non-White participants than others.

Conclusions:
During the pandemic, 90% of people who needed basic support services have accessed them. Food bank, help with financial support, and nutritional supplements were the top three support services accessed. Further, younger, women, and non-White participants accessed basic needs services than others. Efforts can be targeted to enhance access to services to these specific groups.

Background

The Ontario HIV Epidemiology and Surveillance Initiative (OHESI) (Dec. 2021) pointed out the diverse barriers, disablers, and obstacles that individuals, and communities; may have experienced about HIV testing and treatment due to COVID effects. This might be particularly true with marginalized communities in Ontario.

Description

According to the OHESI (2019) estimates report, Latin individuals testing HIV+ were showing a steady increase for the past measured (2017-2019) years in the province of Ontario. Marginalized communities have traditionally been left behind when dealing with HIV testing in Canada. Many social determinants of health: e.g., immigration status, language barriers, poverty, lack of access to free/anonymity to/in health services, among other factors, have impacted Spanish-speaking communities' HIV prevention efforts, even before COVID hit. There is a lack of knowledge on how the current epidemic, vaccinations, and variables, would have affected HIV testing, treatment, and access to services at the core of different communities in the province.

Lessons Learned

COVID took by surprise nations around the world, the leadership of Ontario as a province that provides efficient health services has been up to question. Although global responses to COVID have moved faster (when compared to other pandemics, including HIV), it is necessary for an intersectional, multilevel lenses approach, to map out how COVID has added up sexual health challenges amongst Latinx individuals in Canada.

Conclusion/Next Steps

- There is paucity in supporting research, mental health services, and community education that is specialized in Spanish-speaking cultures, immigrants, language, and culturally sensitive Latinx minorities in Ontario.
- Policies supporting PrEP/U=U/condoms/self-test with access to Spanish-spoken regular care (acknowledging particularities of Latinx in Canada - such as (lack of) immigration status, language barriers, sexual orientation, and/or gender diverse individuals) is a must to effectively curve new HIV infections and meet Canada’s HIV infections present and future goals.

 
Background: Ontario's Gay Men's Sexual Health Alliance (GMSH) is a community-led provincial hub of learning, capacity building, and resource development for 2SGBTQ+ men's sexual health. The GMSH efforts align with the Ministry of Health priorities across the HIV prevention, treatment, and care cascade. 
 
Methods:  Research has demonstrated a link between 2SGBTQ men's sexualized drug use,.i.e., “party n play” (PnP) ,and an increased risk for HIV/STBBI transmission. 2SGBTQ+ PnP users have limited engagement with AIDS Service Organizations, and scant research exists about the needs of 2SGBTQ PnP users for accessing both substance use and HIV/STVBBI harm reduction information and supplies. The GMSH launched the Party n Play survey to collect data from 2SGBTQ PnP users on knowledge of harm reduction best practices, using harm reduction equipment, and exploring how these are currently being acquired in the community. The inclusion criteria were being 18+ years or older, an Ontario resident who used PnP within six months. The survey was promoted via PornHub, Grindr, and social media. There was a draw for a five $100 Visa gift cards as a small honorarium.

Results: Among the 417 respondents who completed the survey, 34% reported they accessed harm reduction supplies via their peers. 37.3% went to peers for harm reduction information, followed by 28% who got information from the internet. 81% of the 516 responses to a question about the topics respondents wanted more information on were substance only topics.

Conclusion: 2SGBTQ PnP users receive substantial HR information and supplies from peers, while indicating a need for safer substance use guidance. We conclude the following
1) Engage people with lived experience to create accessible programming and specifically, to improve access to harm reduction supplies for 2SGBTQ+ men who PnP.
2) Prioritize sharing PnP related harm reduction information to empower 2SGBTQ+ men to PnP safely.

Abstract (300-word max):  

Background: Ontario's Gay Men's Sexual Health Alliance (GMSH) is a community-led provincial hub of learning, capacity building, and resource development for 2SGBTQ+ men's sexual health. Its efforts align with the Ministry of Health priorities across the HIV prevention, treatment, and care cascade.

Methods: The evidence-based connection between 2SGBTQ+ men's party n' play (PnP), also known as ChemSex, and the increased risk for HIV/STBBI transmission has resulted in service providers needing to be informed of the context and relationship with PnP. The knowledge is crucial to reducing HIV-related harms and mental and physical health outcomes. GMSH's Party n Play campaign developed a framework to hold the complex needs and outcomes of 2SGBTQ+ men who PnP. The consultant and community members developed a framework model of the context and relationship of PnP. The model would look at the broader systemic intersections of oppressions and cultural factors contributing to PnP's trajectories.

Results: The Zones of PnP Engagement emerged as a new model after an extensive literature review and community consultation. Zones of PnP Engagement is a landscape of four distinct zones that guys navigate into, out of, and within throughout their PnP journey. The Zones do not re-stigmatize guys who PnP by overly emphasizing risk, danger, and problematic outcomes and shifts to a more neutral, sex-positive, and harm reduction focus that allows for self-discovery & exploration of self. The Zones opens new spaces for intervention for service providers to develop programs and services.

Conclusion: The Zones of PnP Engagement aims to develop tailored, non-abstinence-based responses that will "meet people where they are at". The Zones represent a key pivot in HIV sector's response to PnP. It will benefit multiple stakeholders and reduce PnP users' stigma and discrimination, focusing on strength-based client-centered care.

Background: Increasing access to HIV testing is important for gay, bisexual, Two-Spirit and other men who have sex with men (GB2M). This analysis sought to examine if comfort with discussing same-sex behaviour with healthcare providers (HCPs) was associated with HIV testing uptake among GB2M.

Methods: GB2M (n=910) were recruited through mobile apps to complete a survey about sexual health and activity. A subset of 79 participants completed a semi-structured interview. HIV-negative participants were queried on HIV testing (last three months), risky condomless anal sex (CAS; last three months), and comfort discussing sex with HCPs. Risky CAS was defined as CAS with HIV-negative partner not on PrEP, HIV-positive partner with detectable viral load, or unknown HIV status partners.

For quantitative data, multivariable logistic regression was used to assess the relationship between comfort discussing sex with HCP and HIV testing. For qualitative data, thematic analysis was used to identify themes associated with comfort discussing sex with HCPs.

Results: Of 910 participants, 206 HIV-negative GB2M who reported risky CAS in the past 3 months were included in analyses. Most were 18-29 years old (65.5 %), White (57.8%), gay (61.7%), single (67.0%), lived in urban centres (91.7%), had university education (51.5%), employed (72.8%), Canadian born (71.4%), and had annual incomes <$40,000 (63.7%). Most perceived themselves at high risk for HIV infection (87.9%) and half (50.5%) felt comfortable discussing sex with HCPs.

Regression analyses indicated GB2M who felt comfortable discussing sex with men with HCPs were more likely to be tested for HIV in the past three months (aOR=2.69; 95% CI: 1.06-6.87; p=0.038) than others. Qualitative data substantiated these findings.

Discussion: HIV testing uptake may be influenced by comfort discussing sex with men with HCPs. The importance of queer competency among HCPs, and non-judgemental healthcare environments may increase GB2M comfortability in discussing sex with men.

Background / Objectives:
It is estimated that 10% of Ontario’s population uses substances in harmful ways. Currently, Ontario - like the rest of Canada - is living though an opioid-related crisis, which is compounded by the COVID-19 pandemic.
And yet data on substance use among African Caribbean and Black (ACB) communities is limited, leading to few culturally competent services for ACB communities. The African and Caribbean Council on HIV/AIDS in Ontario’s (ACCHO) Harm Reduction Resource for ACB Populations is filling this gap with a substantive resource that ensures harm reduction workers serving ACB communities are well-informed, well-equipped, and empowered to offer the necessary responses.
This resource is grounded in the following:
• ACB communities’ harm reduction needs are generally overlooked.
• intersecting aspects of identity (immigrant, LGBTQ+, etc.) impact ACB relationships to substance use in a unique way.
• social determinants of health including race and geographic location have been proven to contribute to ACB interactions with substance use.

Methods:
• Interviews and focus groups with expert harm reduction staff from leading ACB AIDS Service Organization provided:
-background,
-current situation analysis,
-culturally competent and up-to-date information on harm reduction services for ACB communities.

Results:
• Acknowledging racial and cultural biases, stereotypes and attitudes is fundamental in providing quality services.
• Stigma surrounding substance use in ACB communities deters people from seeking harm reduction services.
• ACB trans women, trans men and MSM are often left out of harm reduction responses.
• Digital equity is currently an important consideration, especially for ACB communities and other marginalized populations.

Conclusion:
ACCHO’s harm reduction resource is an innovative and responsive tool that will ensure that Ontario’s ACB populations are not left behind in harm reduction services, particularly at this critical point where harm reduction services are urgently needed to respond to Ontario’s overdose crisis.

Background: While the advent of safe and effective COVID-19 vaccines for the general population has led to mass vaccination roll-outs, certain populations may lack vaccine confidence. Our objective is to determine socio-behavioural, economic, cultural, and clinical correlates of COVID-19 vaccine confidence and uptake in people living with HIV (PLWH) in Canada. A secondary objective is to evaluate the level of COVID-19 and COVID-19 vaccine knowledge in PLWH.

Methods: With community members, we developed a study questionnaire with items from the validated National Advisory Committee on Immunization Acceptability Matrix including: a) perception of vaccine safety and efficacy; b) perception of disease susceptibility and severity; c) access to vaccination; and d) knowledge, attitudes, and trust. PLWH will be recruited via social media and through community-based organizations from January-April 2022 (target recruitment=250). Participants will include vulnerable populations and/or those at higher risk for COVID-19, e.g., men who have sex with men, people who inject drugs, women, persons of African, Caribbean or Black communities, persons from Indigenous communities and persons >65 years old. The primary endpoint will be total scores on the 5-item Likert scale of vaccine confidence. Secondary endpoint will be percentage of correct answers on questions related to COVID-19/COVID-19 vaccine knowledge.

Analysis: Descriptive statistics will be used to summarize results and compare responses between PLWH who have received vs those who have not received COVID-19 vaccine(s). For each participant, scores on the 5-point Likert scale will be added together (reversing for direction, as necessary). Logistic regression models will be used to identify factors associated with COVID-19 vaccine uptake such as age, sex, gender, and responses to the vaccine confidence questions. For knowledge items, score as a percentage of correct responses will be reported. Preliminary results will be presented during the conference.

Conclusions: Findings will guide educational interventions targeted towards specific sub-populations.

GOAL: We evaluated our experience establishing and sustaining HIV in MOTION (HIM), a Community of Practice (http://bit.ly/HIVinMOTIONsite) that applies a methodology of “Participatory and Integrated Knowledge Mobilization” (PiKMb) (Nguyen et al. 2020; Ungar et al. 2015) and embedded within a community based research program focused on HIV, rehabilitation and physical activity (CIHR CBR funded 2020 -2021 study on community-exercise; tele-coaching study funded by the OHTN 2021-2023).
EVALUATION: we used quantitative measures such as the number of synchronous online participants and analytics from links to our digital library/website; qualitative measures include attendees’ reports of “intent to use the material presented” and reflections from debrief sessions.
OUTPUTS: From October 2020 to September 2021, PiKMb activities included five (5) 2-hour online CoP webinars (each involving ≥8 hours of production), each crafted by 6 national “Ambassadors” and coordinators. Our online events highlight lived experience, research and practice in the area. To date, digital output includes 6 podcasts/edited videos and 2 digital community friendly eLearning tools (micro-learnings) on physical activity and HIV.
RESULTS: >200 diverse academic, fitness staff, and persons living with HIV from Canada, UK, US and have joined the synchronous online events. Of 44 respondents to all evaluations, 44 (100%) indicated intent to use the material and 33 (75%) indicated they would use the information to connect with each other regarding related matters.
CONCLUSION: Due to a dearth in this literature, we cannot formally compare our evaluation results to similar CoPs results; however, comparing/contrasting our results with existing PiKMb reports in the literature suggest that HIM helps build capacity and collaborations and mobilize knowledge regarding physical activity, HIV and rehabilitation; PiKMb benefits community based research but it is costly and energy-intensive; slow uptake of digital products by HIV educators, academics, leaders and clinicians suggest that PiKMb’ products might still be underrated and underused.

In June 2016, MLHU issued a public health alert related to rapidly increasing rates of HIV, hepatitis C, invasive Group A Streptococcal (iGAS) disease, and infective endocarditis among people who inject drugs (PWID). Prior to 2014, the Middlesex-London area identified an average of 25 new cases of HIV annually. However, by the end of 2016, the total number of new cases of HIV reported that year had climbed to 61—the highest number of new cases that Middlesex-London has seen in a single year.
In response, local stakeholders and more than fifty provincial and national experts were consulted and a local HIV Leadership Team was established to identify and implement strategies to address the outbreaks. As of December 31, 2018, the number of newly diagnosed cases reported had fallen to 30, representing a 49% decrease from the outbreak peak in 2016. As well, the number of cases reporting injection drug use as a risk factor has decreased from 74% of cases in 2016 to 52% of cases in 2018. Currently, there have been 19 cases reported in 2021.
The key initiatives believed to have contributed to this significant reduction in new cases include:
• enhanced collaboration in client support provided by the agencies involved in HIV care;
• implementation of HIV outreach programs, as well as use of assertive engagement models of care;
• establishment of the Temporary Overdose Prevention Site, now a Consumption and Treatment Services;
• increased access to harm reduction supplies, naloxone training and distribution and HIV testing;
• targeted public awareness campaigns promoting safer injection practices and;
• increasing HIV testing in Emergency Departments
The marked reduction in the annual number of new HIV cases over the past 5 years is a very positive trend and has demonstrated the value of collaboration, education, and evidence-based intervention.

Background: In Canada, HIV criminalization occurs under various offences of general application. Most prosecutions are for aggravated sexual assault, following Supreme Court of Canada decisions that HIV non-disclosure status before sex posing a “significant risk of serious bodily harm” (R v Cuerrier, 1998) – which means a “realistic possibility of HIV transmission” (R v Mabior, 2012) – can amount to “fraud” invalidating consent to sex, making it an assault in law. Prosecutors' and courts' interpretation of this legal test has led to wide application of the law and unjust prosecutions.

Description: In 2017, the Canadian Coalition to Reform HIV Criminalization (CCRHC) urged Parliament to legislate an end to sexual assault charges and limit any criminalization to the intentional transmission of HIV. This call is endorsed by 174 organizations/networks. In 2019, a Parliamentary committee recommended legislative reform. The CCRHC has explored different options for Criminal Code amendments, including adding interpretive provisions to limit the scope of existing general offences versus amendments precluding entirely the use of existing offences and replacing them with a new, narrowly-drafted offence specific to HIV transmission.

Lessons learned: There is no existing HIV-specific law in Canada to repeal or modernize; any amendments must address multiple aspects (both material and mental components) of multiple offences. Considerations include: the degree to which a given approach could limit the scope and severity of the laws (including sexual assault); whether a narrow, HIV-specific law is preferable to current very broad application of existing offences (de facto already singling out PLHIV); the feasibility of Parliament adopting particular reforms; the risk of limiting criminalization of HIV but expanding criminalization to other transmissible infections.

Conclusions/next steps: Advocates continue to press for Criminal Code amendments to limit HIV criminalization, guided by international recommendations and national community consensus to limit prosecutions to cases of intentional transmission.

Background. Anti-Black racism is recognised as a public health problem in Canada. An understanding of the many pathways through which racism impacts on health and healthcare needs of the Black Canadian population is necessary. This analysis focuses on the association of racism and health policy (i.e infant feeding guidelines) in the context of sociocultural expectations from HIV+ Black mothers.

Methods. This study is based on broader mixed-method community-based participatory research. Ethics approval was obtained from affiliated institutions’ REB. Quantitative data included Ottawa (n=89) and Miami-Fl (n= 201). Inclusion criterion was having a baby after being HIV+. By hierarchical binary logistic regression modelling (HBLM), we estimated the relationship between sociocultural factors (aligned to infant feeding guidelines) and racism experiences of the mothers. Effects of socioeconomic variables, HIV related factors, and city of residence were accounted for to reach final model (X2 = 26.01, p< .01, Accuracy =81.1%).

Results. Sociodemographic include age (Ottawa [M = 36.6 years, SD = 6.4], and Miami-FL [M = 32.4 years, SD = 5.8]; married (Ottawa [33.3%, n=29] and Miami [60.8%, n= 122]); completed university education (Ottawa [58.8%, n=50] and Miami [33.2%, n= 66]); employed (Ottawa [57.3%, n=51] and Miami [32.7%, n=62]); years since being HIV+ (Ottawa [M = 12.7 years, SD = 6.4] and Miami [M = 10.9 years, SD = 7.3]). Odds of racism is reduced when: i) cultural beliefs on infant feeding (OR = .06, p<.01, CI =.01, .38) align with policy, ii) family opinions on infant feeding (OR = .05, p<.01, CI =.01, .4) align with policy. Education, social supports, and vigilance independently reduced the odds of racism.

Discussion and Implication. Congruency of socio-cultural expectations with infant feeding policy reduced the odds of racism among HIV+ Black mothers. Considerations of socio-cultural contexts in health policies are important to address racism and health inequity.

Background
Gender, race, and class interactions influence health equity and access to health information including HIV knowledge. We explored the effects of the intersection of gender and class (education, employment); gender and other sociodemographic factors (age categories, language groups) on HIV knowledge among the African, Caribbean, and Black (ACB) populations in Ottawa and Toronto. The study will inform gender-specific HIV prevention programming.
Methods
Data were drawn from the 2018-2019 A/C Study survey on HIV transmission and prevention among ACB adults who self-identified as women (n=842) and men (n= 481). We estimated HIV Knowledge using an 18-item HIV Knowledge Questionnaire (scale =18). We used difference-in-difference estimation in hierarchical linear regression modelling to determine interaction effects of gender and class; gender and other sociodemographic factors on HIV Knowledge.
Results
HIV knowledge scores were not statically different (Mean difference = .28, p = .37, 95% CI = -.18, .73) in women and men. However, HIV Knowledge had a positive association with gender when moderated by language (non-English Speaking [β = 2.30, p<.05, 95% CI = .54, 4.05]). City (Toronto [β = 1.23, p<.001, 95% CI = .55, 1.92]), Higher education qualification (β = 1.12, p<.001, 95% CI = .72, 1.52), being employed (β = 0.58, p<.01, 95% CI = .17, .98) and Ever tested for HIV (β = .94, p<.05, 95% CI = .15, 1.73) independently increased HIV Knowledge.
Discussion and Conclusion
HIV prevention programming needs to bridge the knowledge of the non-English speaking populations, and those of ACB men. Tailoring HIV prevention to specific knowledge needs of transnational city residence, persons with lower education, and the unemployed are recommended. HIV testing programs should increase HIV knowledge through concurrent information sessions.

Background: The GIPA Homefire project brings together Indigenous People Living with HIV/AIDS (IPHAs), community and academic researchers to explore an Indigenous conceptualization of GIPA (Greater Involvement of People living with AIDS). This research team is led by 10 IPHAs and 5 Allies and co-coordinated by an additional IPHA team member and an ally. Our team values IPHA leadership in all aspects of responding to HIV, including when conducting rigorous and meaningful Community-Based Research (CBR). Before COVID-19, we intended to host an in-person, participatory research analysis meeting over several days. Like so many CBR projects, we were forced to change our plans and seek ways to engage virtually.

Methodology: The GIPA Homefire project applies a multi-pronged, mixed-method approach emphasizing Indigenous ways of knowing, decolonizing research methodologies, Two Eyed Seeing, and principles of CBR. Indigenous culture and ceremony play an important role in the success of our project. Finding ways to continue these practices virtually has been arduous, challenging us to find ways to adapt and move forward.

Findings: Many of our IPHA team members became disengaged due to impacts of the pandemic on their daily lives. We have reached out directly to check in with team members and share project updates to support ongoing engagement. To encourage team members to come back to the team as a collective and the important work of research analysis, we held a virtual pipe ceremony. We found that more team members joined online for ceremony and, even in a virtual setting, culture and connection can happen successfully.

Next Steps: Sustaining online engagement in research activities remains challenging. In this presentation, we will share the outcomes of our plans for a more personalized approach to engagement, including lessons learned about how to incorporate ceremony with technologically based approaches to support team contributions.

Background: Making it Work is an Indigenous-focused, community-based research project that utilizes a realist evaluation approach in British Columbia co-led by the AHA Centre at Communities, Alliances and Networks (CAAN) and PAN. With guidance from people with lived and living experience(s) on the research team, this study explores why community services work well for people, with a particular focus on case management and community development programs and services that use Indigenous service delivery models.

Methods: Building on our Realist Evaluation theory of change in October 2021, we held four focus groups by Zoom with 30 participants (service users and service providers) to learn more about how or why does this work, for whom and in what circumstances? We explored topics such as peer engagement and leadership in services, culture as harm reduction, and co-location of services and organizations. Study team members supported a primary mixed inductive-deductive analysis on the transcripts from the focus groups. Team members also held regular discussions regarding themes and areas to explore more deeply.

Results: We will present findings from our analysis of these focus groups linking major themes back to our initial theory of change model. Presenting the analysis through points of tension or disagreement will allow our study team and others to delve more deeply into why services work for different people living in different places across BC.

Discussion: These findings suggest that our focus groups unveiled points of tension and divergence that will help us to gain more depth in understanding the ‘full picture’ of our theory of change and by extension, our research questions. These findings also suggest that research teams can use an approach of focus groups and collaborative research teamwork to assess these points of divergence and utilize them in further stages of their research.

Background: People With Lived Experiences’ Strengths in the Face of Stigma is a qualitative study that explores people living with HIV’s personal strengths and resilience in combatting stigma, and learning more about what makes programs and services work well for people living with HIV. While research focused on stigma can be deficits-based, this study took an intentional strengths-based approach.

Methods: Between September 2020 and May 2021, we interviewed 20 people living with HIV across British Columbia. The interview was conducted by phone and asked questions on topics such as personal strengths, experiences of stigma, visions for the future and ideas for stigma reduction programs and services. We used a mixed inductive/deductive analysis approach to explore our core research questions and also capture the ‘roots’ of what underlay reported strengths and experiences of confronting stigma.

Results: Though we did not ask participants to share a life story directly, many participants responded to questions about their major strengths by framing them within life experiences – for example, strengths borne out of living through the AIDS epidemic and through their community involvement. While participants may have initially struggled to identify their own strengths, further questions that illuminated their history allowed them to identify their strengths readily. Some participants also noted that they appreciated the strengths-based approach and that it enriched their experience of the interview.

Discussion: These findings suggest that rather than viewing life history and strengths as two separate elements in an individual’s life, it is crucial to recognize how individuals may see their strengths as part of a greater picture. These findings also suggest that research teams could evaluate qualitative interview guides with an eye to a strengths-based approach as such an approach may enrich an interview experience for both the research team and the participant.

Background: The PrEP Cascade is a framework used for evaluating the implementation of HIV pre-exposure prophylaxis (PrEP) programs. The Cascade is a series of steps patients and providers take to get people on PrEP. In Canada, there has been limited qualitative research on gay, bisexual, and queer men’s (GBM) PrEP decision-making through the Cascade.

Methods: In 2020, we interviewed 37 PrEP users and 8 non-PrEP users living in Ontario and British Columbia about their decision-making through the Cascade. Participants were HIV-negative cis and trans GBM. The data were analyzed using thematic analysis.

Results: In addition to responding to COVID-19 lockdown measures, participants choose to start, stop, pause, and re-start PrEP due to various barriers and factors related to shifting pragmatic considerations (logistical effort and financial costs), biomedical considerations (efficacy, side effects, and sexually transmitted infections) and subjective considerations (identity, community politics, and changing sexual preferences). Symbolic and generational attachments to established versions of safer sex (condoms and serosorting) made some participants less likely to try PrEP, especially GBM born in the 80s and early 90s. Some GBM expressed increased social expectations to use PrEP and to have condomless sex and serodifferent sex. Some expressed how their concerns with side-effects were deterrents to them trying PrEP. Several discussed a shift from PrEP use being understood as rare and stigmatized, to becoming a normative expectation in GBM culture.

Discussion and Implications: PrEP has altered sexual practices in diverse ways. Healthcare providers must understand these shifts in order to help GBM make informed choices about PrEP, especially in relation to stopping or pausing PrEP. Our findings support offering PrEP at no-cost and providing individualized sexual health counselling to discuss PrEP use and changing sexual practices. More effective education is needed to communicate the manageability of PrEP side-effects.

In addition to the mental and physical health challenges the COVID-19 pandemic has directly introduced, a rise in misinformation related to COVID-19 has emerged, promoting increased expressions of stigma, discrimination, and racism against people of East Asian descent, an understudied group in mental health research. These negative social media messages have had tangible outcomes for these individuals including an increase in micro-aggressions, threats to safety, and verbal and physical assaults. From a total of over 600 million tweets gathered from Twitter repositories we randomly selected a total of 4,000 tweets using COVID-19 and stigma-related hashtags and systematically analyzed them using thematic coding to identify emergent themes. Five primary themes that emerged included: (1) blaming and assigning responsibility, (2) reactivated historical stereotypes, (3) criticism of China’s oppressive government, (4) political commentaries critical of the Chinese Communist Party, and (5) unspecified direct insults to East Asian community members. Substantial evidence was found for these tweets expressing both group labeling and responsibility: e.g., “Chinese virus” and “bat-eating Chinese”. In addition, we found examples of the communication of peril: “People are dropping like flies in Wuhan”. Misinformation towards this virus has the potential to directly interfere with public health policy responses targeted towards the pandemic such as hesitancy towards the vaccines but can also have indirect consequences towards stigmatized and marginalized populations such as individuals of East Asian Descent. Social media platforms can act as a venue for the widespread dissemination of stigma and stereotypes toward this marginalized group which can promote fear and online hate and intensifies negative stereotypes and discrimination which can translate into violence and hate crimes. Moreover, increased trauma-related distress and sequelae can emerge following these potentially traumatic events and influence a survivor’s sense of self. We discuss some preventative, culturally responsive, and trauma-informed interventions to respond to these outcomes.

Background:
Indigenous peoples in Canada experience higher HIV prevalence due to historic and continuing systemic inequities, and Indigenous adolescents are among those shouldering the impacts of colonialism and racism. Art-and-land-based HIV-prevention programming has demonstrated promise to be empowering and support wellbeing, yet further evidence is needed on the impact and efficacy of such approaches with Indigenous adolescents.

Method:
Fostering Open eXpression among Youth (FOXY)/Strength, Masculinities, and Sexual Health (SMASH) conduct Peer Leader Retreats as part of an action research program promoting healthy relationships, sexual and reproductive health (SRH), and HIV prevention among Northern and Indigenous adolescents in the NWT. Peer Leader Retreats, which include Indigenous teachings, arts-based methods (e.g., mask-making, beading), leadership skill development, and nature-based activities were held between 2017-2019.
We enrolled 286 participants (n=196 women [trans-inclusive], n=84 men [trans-inclusive], n=5 non-binary), aged 12-19 (mean 14.4, SD 1.3). The majority (n=235) were Indigenous. Participants completed a survey before and after the retreat. Focus group discussions (n=24) were conducted with 158 participants (n=69 boys, n=122 girls) post-retreat. We applied thematic analysis to explore retreat experiences described in focus groups, and Wilcoxon signed-rank tests to examine pre/post retreat changes in leadership, empowerment, and self-confidence.

Results:
Qualitatively, themes included: (1) improved leadership abilities and role-modelling; (2) social connectedness; and (3) increased feelings of empowerment/confidence. Quantitatively, leadership post-retreat scores were 3.5 points higher than pre-retreat (P<0.001). Self-confidence scores were 3 points higher post-retreat (P<0.001) Empowerment post-retreat scores were 4 points higher compared to pre-retreat scores (P<0.001).

Discussion:
Land-and-art-based programming supports the empowerment of Northern and Indigenous adolescents, improving confidence, leadership and social connectedness. Results provide insight into possible empowerment-related pathways to improved HIV and SRH outcomes. Integrated HIV prevention and empowerment programming can apply strengths-based, peer-led, gender-transformative approaches that attend to individual, relational and communal wellbeing and are grounded in Indigenous teachings.

Background: Ontario’s Gay Men’s Sexual Health Alliance (GMSH) is a community-led provincial hub of learning, capacity building, and resource development for 2SGBTQ+ men’s sexual health. The GMSH’s efforts align with Ministry of Health priorities across the HIV prevention, treatment, and care cascade. The Trans Interweaving Project (TIP) is a trans-led priority initiative. The goal of TIP is to examine and explore how the GMSH and Ontario’s HIV service organizations could better integrate trans and non-binary people in its programs and services while recognizing the fluidity and diversity of trans experience.

Methods: The TIP team includes a project lead, a three-person project team, and a Community Advisory Committee. Highly collaborative approaches and methodologies were designed and implemented. These included group conversations and sharing circles, informant interviews with cis and trans-HIV sector staff, trans people living with HIV, and a 2-day deliberative dialogue with sector leadership, management, and policymakers.

Results: TIP was a community-based participatory action research project that has produced inclusion indicators for specific segments of the trans community, including Two-Spirit/Indigenous, racialized, Francophone, migrants, and sex workers. Seventy-six individuals participated in groups and interviews, and 47 individuals completed a demographic survey. Participants describe in their own words a vision for participation and engagement in Ontario’s HIV sector as service users, staff, volunteers, and community leaders.

Conclusions: Project recommendations have far-reaching implications for the GMSH, community-based organizations in Ontario’s HIV sector, and critical stakeholders who serve trans and non-binary people. These include short, medium, and long-term actions to address structural barriers and challenges to participation in the HIV response, implement community mobilization interventions, and the production of HIV and sexual health-related resources, among others.

Objectives: We examined crystal methamphetamine (CM) use and diagnosed bacterial STIs among GBM. We also examined whether this association is mediated by negative attitudes toward condoms, escape motives, and sexual behaviours.
Methods: Sexually-active GBM, aged ≥16, were recruited through respondent-driven sampling from February 2017-August 2019. We fit a structural mediation model on the association between baseline CM use and bacterial STI diagnosis at 1-year study follow-up. We estimated indirect paths from CM use to bacterial STIs via: 1) escape motives, 2) negative attitudes toward condoms at baseline and 3) sexual behaviours at 1-year study follow-up (condomless anal sex [CAS], number of sex partners, and oral sex), adjusting for demographic variables (age, race, and HIV status).
Results: Among 2,449 GBM, analyses revealed a non-significant direct effect from baseline CM use to STIs at 1-year follow-up in the mediated model (β=.06; 95%CI, -0.06, 0.16; p=.35). There was one significant indirect path from CM use to STI: CM use to negative attitudes toward condoms to CAS to STIs (β=.02; 95%CI, .01, .04; p=.01). The model fit the data well (weighted root mean square residual=.032).
Discussion: CM use seems to predict subsequent bacterial STIs via negative attitudes toward condoms, which, in turn, is associated with CAS. Interventions to reduce STIs among CM-using GBM should attend to the association between CM use and negative attitudes toward condoms. There is a need to better integrate substance use services with STI/sexual health clinics for GBM.

Community-based research has been pivotal to the history of HIV/AIDS research and community experts living with HIV have fuelled community-based research to become mainstream in health research overall. Yet now, HIV researchers have turned toward big data largely at the exclusion of community experts. Our project works against this trend helping to lead the way for community-based big data research collaborations. Our aim is to foster an alternative to traditional big data HIV research whereby big data is reframed from a process of one-way extraction of numeric data to a multi-way dynamic of collaborative, richly textured analysis of the social lives of people within the big data.

Our project entails a collaboration of older adults living with HIV, administrative health data researchers, and physicians that is conducting research on aging and HIV using the Comparative Outcomes and Service Utilization Trends (COAST) Study, a robust population-based cohort study based on longitudinal clinical data linked with administrative health and demographic data in BC. Based on this work, we describe our team’s ongoing and iterative journey of critically reflecting on and reconceptualizing what it means to do big data research as led by community experts.

Community-based research holds that research embracing knowledge from lived experience produces higher value than expert-driven research alone and big data research is no exception. Community-led big data research is possible even if challenging, and is key to turning big data research from traditionally deficit-based into strength-based research, and to improving its veracity, ethicality, and relevance for people living with HIV.

Our project helps to ensure the historical contributions of HIV/AIDS community experts are not diminished by big data and that we do not go backwards in HIV/AIDS research by erasing PLHIV from the growing social force of big data research.

Despite sub-Saharan African women and girls accounting for 63% of new HIV infections globally, there is a dearth of research specific to these migrant women living with HIV in Canada. While Black females in British Columbia represent less than 1% of the general population, they represent 13.3% of new HIV diagnoses among females. From 2011 to 2016, the sub-Saharan African region constituted the highest source of Black immigrants to Canada. Yet, sub-Saharan African women are often aggregated with other Caribbean and Black women, which can conceal their contextual particularities and inequalities. For example, in British Columbia, most newly HIV-diagnosed immigrants were from HIV endemic countries. In this paper, we argue for more research involving sub-Saharan Africa women living with and affected by HIV/AIDS and suggest ways to meaningfully engage this community.

Employing a narrative approach, we present an analysis of nine qualitative, quantitative, or mixed methods community-based HIV studies involving African, Caribbean, and Black (ACB) populations in Canada between 2006 and 2019. Buttressing the need to disaggregate ACB data, we found just two studies specifically involving a sub-Saharan migrant population, while another included some East African countries. Our analysis also highlights the need to ensure and support culturally appropriate approaches to HIV research, particularly those intended to be community-led. We also offer insights to addressing challenges and enhancing opportunities in HIV research with sub-Saharan African women.

Meaningfully engaging sub-Saharan African women and their organizations in community-led research represents a critical opportunity to reduce complex health and social inequalities, support social justice and inform HIV policies and programs for this under-served population.

Background: Canada has been a hotspot of HIV criminalization, primarily via prosecutions for aggravated sexual assault. Prosecutors’ and courts’ interpretation of the legal requirement to disclose HIV+ status before sex posing a “realistic possibility” of transmission has produced wide application of the law and unjust prosecutions. The “overcriminalization of HIV” has been recognized by civil society, government representatives, international bodies and Parliamentarians.
Activities: Community advocates have campaigned for sound prosecutorial guidelines to limit HIV criminalization, supported by UNAIDS and the Global Commission on HIV and the Law. Canada’s substantive criminal law is federal, applicable nation-wide, but the federal prosecution service prosecutes crimes in 3 territories, while provincial Attorneys General and Crown counsel handle prosecutions in 10 provinces. Policy and practice vary significantly across jurisdictions. In 2019, a Parliamentary committee recommended a Canada-wide common prosecutorial directive reflecting important limitations on HIV criminalization urged by civil society and international bodies. In 2021, UNDP published a global Guidance for prosecutors on HIV-related criminal cases. In 2021-22, the HIV Legal Network developed a model policy for prosecutors in the Canadian legal context.
Outcomes: Drawing on the best available science, human rights standards, professional standards for prosecutors, and existing prosecutorial policies or recommendations, the model policy: sets out a general approach to such cases; identifies circumstances in which prosecution is unwarranted, including oral sex and vaginal or anal sex with a condom or when the HIV+ partner has a suppressed or low viral load; considerations regarding the degree of mental culpability that should be required; factors to consider in determining whether a prosecution is in the public interest; and considerations related to pre-trial detention, the conduct of a trial, and sentencing.
Conclusions: The model prosecutorial policy is a resource for further advocacy in the Canadian context to limit unjust prosecutions against people living with HIV.

Background: With treatment, people living with HIV (PLWH) are living longer. PLWH may have additional needs while they age. We assessed how PLWH are planning financially, for health care and support as they age.
Methods: The OHTN Cohort Study (OCS) is a longitudinal cohort study. In 2020, questions were added to assess how participants were planning for old age. Financial, social and health care planning were described among participants 50 years or older and analyzed using multivariable logistic models, adjusting for combined gender/sexual orientation, time since HIV diagnosis, marital status, income, and age (50-64 vs 65+ years).
Results: 1153 participants responded, with mean age (standard deviation) 59.9 (7.1) years; 70.8% white, 13.5% Black; 16.2% heterosexual women, 14.4% heterosexual men, and 63.1% gay men. Of their future care, 14.7% thought about care preferences, 42.0% have planned for it, 37.4% shared their wishes about it with family/care providers, 41.4% have chosen a Power of Attorney; 28.9% will have enough money in older age; 24.4% can rely on support of family/friends, and 43.3% are concerned about discrimination at long-term care because of their HIV status. Multivariable models showed that participants aged 65+ were less likely to report having chosen a Power of Attorney (Odds Ratio (OR)(95% Confidence Interval (CI): 0.5(0.4,0.7)), having enough money (OR(95%CI): 0.3(0.2,0.4), but had greater concern for discrimination in long-term care due to HIV status (OR(95%CI):1.5(1.1,2.0)) compared with participants 50-64 years old. Gay men were less likely to report having enough money (OR(95%CI)=0.6(0.4,0.97) and relying on support of family/friends (OR(95%CI): 0.6(0.4,0.97) than heterosexual men, but they had greater concerns about discrimination in long-term care due to HIV (OR(95%CI):2.3(1.6,3.5) than heterosexual women.
Conclusion: Older adults living with HIV, especially gay men, can use additional supports for old age planning regarding support, finances, and long-term care.

Many community-based HIV research studies incorporate the principles of greater and meaningful engagement of people living with HIV (GIPA/MEPA) by training them as peer researchers. Unfortunately, there are still some aspects of research (e.g., quantitative data analysis and interpretation) where many projects fall short in realizing GIPA/MEPA principles. To address these gaps, we developed and evaluated an eight-week training course that aimed to build capacity around the understanding and interpretation of quantitative data and incorporating lived experience to increase the impact of the knowledge transfer and exchange phase of a research study.

Peer researchers (n=8) participated online from British Columbia, Alberta, and Ontario. Lessons learned were implemented throughout the dissemination of research findings from the People Living with HIV Stigma Index study. Focus groups were held with course facilitators and peer researchers to discuss their training experiences, and peer researchers answered a quantitative 16-item pre- and post-training self-assessment survey to evaluate the training. This work was created in collaboration with and includes the perspectives of both the peer researchers involved in the training and the course facilitators.

Peer researchers’ self-assessed knowledge and understanding of quantitative research and data storytelling significantly improved (Wilcoxon signed-rank tests; p<0.05). Through interactive activities and practice, they gained the confidence to deliver a research presentation which improved their understanding of research findings and helped with discussing results with community partners and study participants. The peer researchers also agreed that integrating lived experience with quantitative data has helped them to make research findings more relatable.

Our training curriculum provides a template for research teams to build capacity in research methods where peer researchers and community members are less often engaged. In doing so, we continue to uphold the principles of GIPA/MEPA and enhance the translation of research knowledge in communities most greatly affected.

Background : Spiritual needs are among an individual's essentiel needs in all places and time with physical and spiritual dimensions and mutual affect of these two dimensions , human has spiritual need as well. These needs are an intrinsic need throughout the life , threfore they will remain as a major element of holistic nursing care. One of the greatest challenges for nurses it to satisfy the patients spiritual need.

Methods: This is a qualitative study with data were collected 10 women's patients in internal HIV medication and 6 nurses in the perspective wards. Data were generated by open-ended interview and analyzed using rigorousness of findings was confirmed by use of this methode as well as team interpretation ,and referring to the text and participants.

Result: Final interpretation of the findings,totaly 6 sub-theme,three themes including formation of mutual relation with patient, encouraging the patient, and providing the neccessary conditions for patients connection with God, and one constitution patern, namerly spiritual need of hospitalized patients.

Conclusion : Spiritual need are those needs whose satisfaction cause the person's spiritual growth and mak the person a social, hopeful individual who always thanks God.. They include the need for communication with other, communication with God and being hopeful . In this study ,the three obtained themes are the spiritual needs whose satisfaction is possible in nursing systeme. Considering these spiritual aspect accelentes patients treatment.

Key Words: Spiritual need , communication patients phenomenology

Background / Objectives:
African, Caribbean, and Black (ACB) people make up 4.7% of Ontario’s population, yet account for over 25% of first-time HIV diagnoses. Close to 60% of all women newly diagnosed with HIV in Ontario are ACB. Additionally, ACB people are less likely to know their HIV status and to engage in treatment. This overrepresentation of ACB populations, particularly ACB women, highlights gaps in our public health system – gaps underpinned by the Social Determinants of Health, including anti-Black racism and social exclusion.
The Care Collective is a campaign that aims to encourage ACB women to know their HIV status by incorporating regular testing into their self-care practices. Positive Conversations is the latest initiative of The Care Collective, encouraging conversations around HIV to break down stigma – a major driver of HIV infection – and promote HIV testing.

Methods:
• Province-wide online survey for ACB women with about 150 participants.
• Questions focused on HIV awareness, familiarity with HIV, relevance, usage of services and resources.

Key results:
• There is little understanding about the prevalence of HIV among ACB communities, and HIV is not considered to be a top health concern by ACB women.
• HIV carries stigma. Top three words respondents associated with HIV are: disease, death and unprotected sex.
• There is lack of knowledge about living with HIV.
• 75% of respondents are more likely to get tested for HIV if they know someone who has.

Conclusion:
Positive Conversations is a ground-breaking initiative that is starting and supporting conversations by and for ACB women. It is building awareness of the rate of HIV among our communities, it encourages HIV testing and it is showing that people living with HIV can and do live long, healthy and beautiful lives – especially if they learn their status early.

Background: Public health responses to COVID-19, though especially important for reducing the risk of serious illness among older adults and those living with comorbidity, including many people living with HIV (PLWHIV), have worsened social isolation for these groups. Previously in-person events and services have been pushed into virtual arenas further exacerbating social isolation and loneliness among aging and older PLWHIV who already experience the same because of stigma, social circles compromised by loss, and financial insecurity.

Method/Process: In October 2021, Realize and the CIHR Canadian HIV Trials Network (CTN) Clinical Care Management Core team co-hosted the 3rd Canadian HIV and Aging symposium. PLWHIV were meaningfully engaged as members of the planning committee and represented more than half of the speaker line-up for the event. An UnConference, hosted in conjunction with the symposium, held space for older PLWHIV to meet and learn from peers through skills-building and self-care workshops. Participant evaluations were collected for both events.

Outcomes: A total of 142 unique participants joined the two events. 84 participant evaluations were completed and the majority of respondents identified as PLWHIV (80%) from Ontario, British Columbia and Alberta. Despite most respondents having living expertise related to HIV, there were modest changes in knowledge (% increase, as measured by a 7-point Likert scale) across the symposium themes: social priorities and service access issues (14%), biomedical and clinical needs (12%), experiences of diverse communities (22%), and the impact of gender (23%). UnConference participants appreciated informal networking activities, and stressed the need for more events that help strengthen community connections.

Conclusions: In the era of COVID, virtual events can still facilitate knowledge exchange, not just dissemination. By centering the lived experiences of PLWHIV, creating opportunities for interaction, and building in informal social activities, a research event increased knowledge and fostered community-building among older PLWHIV.

Background: Conversation about HIV policy goals beyond viral load suppression is increasing. The need to consider multi-level factors affecting the well-being of structurally marginalized communities, including people living with HIV (PLWHIV), has never been clearer than during the COVID-19 pandemic. This project asked: What does wellness mean to PLWHIV in Canada? 

Methods: When COVID-19 hit, Realize and the CAN LhIVE WELL team changed plans for an in-person national dialogue on living well with HIV, entitled Living Your Best Life (LYBL), taking it virtual. Recognizing the need for deliberate action to meaningfully engage PLWHIV virtually, six PLWHIV were hired to facilitate community consultations with specific populations of PLWHIV in advance of the multi-stakeholder dialogue. A semi-structured interview guide was used to explore participants’ views on the meaning of living well with HIV.

Notes from the consultations were analyzed thematically and informed the LYBL agenda, with summaries presented during the event. Purposive strategies, including moderated Q&A sessions, facilitated discussions, and synchronous online brainstorming, were also applied to engage LYBL participants on the topic of living well.

Results: COVID-19 was frequently referenced across LYBL, both for its direct impact on the health of PLWHIV and because the pandemic illustrated existing structural inequities that limit wellbeing for PLWHIV. Six themes emerged as central to wellbeing:
1. Culture is a contributor
3. Well-being is unique to everyone
4. Having one’s basic needs met is a pre-cursor
4. Conceptualize wellbeing broadly and wholistically
5. Community is an important contributor
6. Multi-level positive healthy actions are needed

Conclusions: COVID-19 has provided policy makers, health practitioners, and researchers with an opportunity to consider wellness more wholistically and engage PLWHIV to formulate responses at the individual, community, and structural levels. Stakeholders should heed the Calls to Action emerging from this successful dialogue, which was re-imagined for COVID-19 times.

Background: People living with HIV (PLHIV) have been combining antiretroviral therapy (ARV) with Integrative Medicine (IM) for improving their mental, emotional and physical health and well-being. IM is the coordinated use, intake of a wide range of supplements, herbs, vitamins, and practice of mind-body modalities and exercises with conventional medicine.
Methods:
A mixed-method research study describes participants' results (n=19) using IM and ARV. The qualitative questions covered comorbidities, barriers to access, side effects, the recommendation from PLHIV on disclosure and usage of IM.
Results: The finding revealed unique IM usage and practice characteristics amongst PLHIV. 17 PLHIV (89 %) disclosed IM use to physicians, but only 31% (n=6) consulted physicians on the type of IM to use. PLHIV consulted their peers 79% (n=15) on best practices of IM. Over 74% (n=14) took a multivitamin and supplements, 26% (n=5) took supplements only, and 53% (n=10) used herbs. IM practices highly utilized by PLHIV are massage therapy (84%), acupuncture (58%), and yoga (53%). PLHIV consulted staff at AIDS Service Organizations 58% (N=11) along with friends, family, and practitioners of IM. The research demonstrates the validation and impact of peer knowledge sharing among PLHIV (79%) on type of IM for maximum efficacy and managing side effects of ARV. 74% (N=14) strongly agree with the positive effect of IM on their health, quality of life, and having a positive outlook. Participants described IM as effective in decreasing stress and providing a sense of empowerment.
Conclusion: PLHIV utilizes and shares peer-based knowledge on IM with their peers on how to make informed decisions on the efficacy of IM over the long term. Further research is critically required to explore the role of IM in the lives of the PLHIV and the aging PLHIV.

Despite growing HIV studies, scholarly investigations, and published data on HIV care and support among African, Caribbean, and Black (ACB) women living with HIV in Winnipeg, Manitoba continues to be scant and literally non-existent. HIV care and support remain seemingly important to meet the increasingly complex needs of people living with HIV and ensure they live long healthy, and independent lives.

This qualitative study informed by critical race theory and feminist methodological design —focused on exploring perspectives on HIV-care and support services for HIV-positive ACB women in Winnipeg, through in-depth semi-structured face-to-face, and telephone interviews with 11 HIV-positive ACB women and 12 service providers. Notably, it seeks to uncover knowledge, attitudes, beliefs, and feelings related to HIV-care and support services in Winnipeg as well as use and perceptions of these services.

An analysis of the interviews draws attention to various intersecting structural, systemic, and interpersonal forces implicated in ACB women’s access and experiences of HIV care and support. Key themes emerged related to issues of stigma and discrimination within and outside the ACB community, systemic neglect, limited awareness of HIV-program availability, and determination to achieve set personal goals.

The findings showcase unique experiences of ACB women as racial minorities and reveal underlying factors that impact ACB women’s use and experiences of HIV services. Issues of stigma and discrimination, including lack of knowledge on HIV services, can account for a significant decrease in uptake of HIV programs. However, conversely, the determination of ACB women to stay healthy, support their families and achieve set goals can impact HIV-care utilization and support women’s day-to-day experiences.

To promote access and health of HIV-positive ACB women, it becomes vital to increase HIV-care services information sharing with ACB women, engage with these women communities and organizations to ascertain major targets for social-structural interventions and policy advocacy.

Background: Discrimination is a driver of negative health outcomes. Through the lens of intersectionality, we recognize that people living with HIV have many identities that put them at risk for discrimination and HIV stigma. These experiences can drive transmission of HIV as well as negative outcomes for people living with HIV.

Methods: The OCS is a community-governed longitudinal study of people receiving HIV care at 15 clinics in Ontario. The Experiences of Discrimination tool (Williams et al, 2003) was adapted to include HIV status and for a Canadian context was included in the OCS questionnaire in 2020. Participants were asked about experiences of unfairness in work, healthcare, immigration/law enforcement, education, housing, and community settings. They were asked if they attribute those experiences to various aspects of their identity, including race and HIV status, reported here.

Results: 1,811 participants responded to the discrimination tool in the questionnaire. 44% of respondents reported that they had experienced some type of unfairness. 13% reported they were unfairly fired, with 9% attributing it to their race/ethnicity/ancestry and 14% to their HIV status. 14% were told to go back to where they came from, with 77% of attributing it to their race/ethnicity/ancestry. East/SE Asian (26%), South Asian (31%), Latin American (28%) and Black (18%) respondents reported being told to go back to where they came from due to their race/ethnicity/ancestry. 8% were unfairly refused healthcare, with 7% attributing it to their race/ethnicity/ancestry and 63% to their HIV status.

Conclusions:
People living with HIV may experience discrimination due to their race/ethnicity, immigration, sexual orientation, and their HIV status. We find that people living with HIV experience discrimination and unfairness including unfair firing and refusal of healthcare. Discrimination in healthcare due to HIV status was particularly evident, as well as community experiences of discrimination due to race/ethnicity/ancestry.

Context: Using an intersectional framework, this exploratory study aims at understanding the combinations of various social categories likely to produce health inequities among people living with HIV (PLHIV).

Methods: In 2019, under the Stigma index of people living with HIV in Quebec project, 281 PLHIV participated in face-to-face interviews conducted by 9 peer research associates in 8 regions of Quebec. A latent class analysis was performed based on several axes of oppression to identify unobserved subgroups of participants who shared similar social categories. These subgroups were then compared with regards to various psychosocial and health characteristics.

Results: Four classes were identified, each of them characterized by particular combinations of oppressed social categories: C1) people who belong to sexual minorities (43%); C2) women who predominantly belong to racialized minorities (30%); C3) poor people aged 50 and under who belong to sexual minorities and who predominantly engage in sex work (16%), and C4) poor people who predominantly belong to racialized minorities and use drugs (11%). Membership to C1 is associated with lower levels of stigma and higher levels of resilience scores, while membership to C3 and C4 is associated with more unfavourable psychological and social health profiles. Membership to C2 is associated with a lower level of disclosure and higher level of anticipated stigma from the family.

Conclusion: A better understanding of intersectional issues is essential for the implementation of interventions and services contributing to the reduction of health inequities for PLHIV. Despite the small sample size, latent class analysis seems to be a promising approach to identify subgroups based on the intersection of various axes of oppression and the health inequities they produce among PLHIV.

Background
The project aims to document the acceptability and feasibility of plasma donations intended for fractionation for gbMSM. The acceptability of implementation contexts was assessed, including A) adding admissibility questions only to gbMSM (having had more than one sexual partner OR a new sexual partner in the last 3 months), and B) using gender-neutral admissibility questions for all donors (based on FAIR model – having had more than one sexual partner OR a new sexual partner, AND anal sex in the last 3 months).

Method
One-on-one virtual interviews were conducted with 28 gbMSM. Participants were assigned to a group, where only one of the two qualification scenarios was presented to them using single blind. A short questionnaire preceded the interviews.

Results
Participants were aged between 21 and 62 (M=33) and 39% reported ever having donated blood. Acceptability of admissibility questions only for gbMSM was moderate (5,46/10). Although they may represent a small step forward allowing some gbMSM to give, they were seen as a source of discrimination, prejudice, and stigma towards gbMSM, since others are not held accountable for these behaviors. Donations felt partially opened to gbMSM, relieving blood donation agencies from external pressure. Acceptability of gender-neutral admissibility questions was slightly higher (6,40/10). They were seen as more inclusive and equitable. The question about anal sex was perceived as an indirect way of targeting gbMSM and a vector of discrimination and stigma. Participants questioned why the use of condoms isn’t considered. Both scenarios were considered poorly inclusive of non-traditional relationship configurations and would still result in the exclusion of many gbMSM. Participants felt frustrated and disappointed, as several wouldn’t be eligible to donate.

Conclusion
Despite being more acceptable, gender-neutral admissibility questions can be perceived as prejudicial depending on the behaviours evaluated and the efforts deployed in explaining such a change.

Background
Advances in HIV care and effective antiretroviral therapy (ART) have led to significant improvements in health and life-expectancy for people living with HIV (PLWH), however, treatment interruptions are common, limiting the full potential of ART. We conducted a strengths-based qualitative study to elucidate the approaches utilized by health care providers (HCP) to overcome barriers to treatment engagement among under-served populations in British Columbia (BC).

Methods
Participants were recruited through regional HIV programs and word of mouth. Purposive sampling ensured inclusion of a wide-range of HIV care providers. An academic and community researcher co-conducted semi-structured telephone interviews with HCPs, exploring approaches used to support PLWH who had experienced treatment disengagement. Participatory analysis and emergent coding, guided by interpretive description, were used to uncover themes.

Results
Across BC’s 5 regional Health Authorities, 19 HCPs were interviewed (November 2020-May 2021), inclusive of 8 public health nurses, 6 social-support staff, 2 peer navigators, and other HCPs working with PLWH. Narratives centered around forming connections and HIV care as a relational practice. Regional resource disparities and the continuation of HIV care as a specialized practice contributed to care fragmentation and increased barriers to services, necessitating ingenuity and creative approaches by HCPs to address care access gaps. Participants underscored the need to foster long-term, trusting relationships with clients, founded on respect, compassion, and non-judgemental approaches. Collaborative relationships with other providers, both formal multidisciplinary team-based care and informal HCP partnerships, emphasized holistic well-being and improved care continuity. Successful engagement approaches supported clients’ overall stability, and were contextually-tailored to address client priorities related to psychosocial and other intersecting health needs.

Conclusion
Preliminary findings identified relationship building, and collaborative care which addresses client priorities, as critical components of successful care engagement. Greater integration of specialized HIV services is needed to strengthen care continuity for PLWH in BC.

Safer Supply: Emerging Evidence

Safer supply has gained traction over the course of the past two years as one approach for addressing the drug poisoning crisis. Despite the increase in its uptake as a result of funding for safer supply programs by Health Canada and policy endorsement in BC, there is debate regarding its use, with detractors citing a 'lack of evidence' as their primary reason for their lack of support.

Safer supply involves the prescribing of pharmaceutical grade medications to people who use drugs who are at high risk of overdose. This provides a drug of known quality and potency as an alternative to the illegal drug supply. Safer supply is an innovative approach that is informed by the evidence on heroin-assisted treatment, opioid agonist treatment, and harm reduction. Since funding for programs began in 2020, numerous evaluation studies are underway and preliminary findings are emerging.

This paper presents the emerging evidence about safer supply, including preliminary findings related to health and social outcomes, engagement and retention, and in which direction the evidence is pointing regarding contentious issues such as unsupervised dosing and injection of tablets.

The National Safer Supply Community of Practice (NSS-CoP) is a knowledge exchange initiative tasked with supporting the scale up of medical models of safer supply programs across Canada. These programs provide a model of care for people who use drugs that incorporates harm reduction, primary care, HIV and HCV treatment, and support services that address the social determinants of health.

In this paper, the NSS-CoP team reflects on the processes of building a national interdisciplinary community of practice. We discuss the challenges of bringing together and engaging a diverse group of stakeholders (including pharmacists, clinicians, social care providers, policy makers, researchers, advocates, and people who use drugs) [PWUD]) from different contexts and communities across Canada. Our members experience different barriers and enablers to providing safer supply. They also have different ideas about how safer supply should be – or could be - implemented. We describe how the NSS-CoP has prioritized creating interdisciplinary spaces to nurture interactions between different kinds of expertise (i.e., clinical, social, lived experience) from different contexts (e.g., urban/rural). As an example, we look at how our informal weekly drop-in meeting has become a vital space for sharing lessons learned, providing different perspectives, offering support, and building relationships between PWUD and clinical and social care providers, and other NSS-CoP members. We illustrate the ways that in which these interactions are influencing how safer supply is being provided, and what advocacy is undertaken about the future directions of safer supply, e.g., the development of non-medical models, the expansion of pharmaceutical options, and the role of safer supply in transforming relationships between health care providers and PWUD.

Title: Utilizing a practical, culturally responsive tool to support service providers to engage Black gay, bi, queer better, same gender loving (SGL) men to achieve improved health outcomes.

Authors: Eric Peters1, Adam Awad1, Max Mohenu1, Phillip Pike2

1. Gay Men’s Sexual Health Alliance, 2. Roaring River Films

 
Background: While overall HIV seroconversion rates are declining among white gay, bi MSM (gbMSM), rates are increasing among Black gbMSM in Ontario. GMSH, in partnership with Black-CAP and ACCHO, hosted two community dialogues with 40 Black gbMSM from academia, research, arts, culture, and the HIV sector, from which emerged recommendations. One was to develop a storytelling narrative to honor and acknowledge Black gbMSM community wisdom and lived experiences. One to support service providers better understand and respond to Black gbMSM HIV prevention needs in a culturally informed and responsive way.

Method: From the recommendations, GMSH produced Profile and Public Service Announcement (PSA) videos that featured three young Black gbMSM (30 – 37years). Participants were recruited from the community to speak on their shared experiences navigating healthcare systems.

Results: Storytelling is a powerful method to understand Black gbMSM’s lived experiences. It creates a medium that amplifies authentic community voices to reach broader audiences. The narratives inform engagement strategies, educate viewers on the intersectionalities of Black gbMSM’s identities, race, sexual orientation, and social location for improved service provision.

Conclusions: These PSAs were developed by and for Black gbMSM to bring context to the narrative of their lived experiences in navigating healthcare. The PSAs reveal cultural behaviors and attitudes towards HIV/STBBIs testing, PrEP, sex, sexuality, and navigating assimilation and settlement as a newcomer. Participants’ messages provide context and salient factors in Black gbMSM lives, giving background and awareness of how they want to be engaged for inclusive, affirming, and validating health care as Black gbMSM.

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Background: Weaving our Wisdoms (WoW) is a collaborative initiative that supports Indigenous People living with HIV and AIDS (IPHAs) by fostering connections to land-based teachings delivered by HIV Olders. WoW’s HIV Olders are Indigenous People living with HIV or AIDS long term who share their knowledge and wisdom with other IPHAs about living well with HIV. Grounded in an emergent on the land-with the land methodology, WoW focuses on optimizing wellness and “whole”-istic health among IPHAs.
Research Design: Guided by four complimentary approaches to research (community-based research, Indigenous Knowledge, Decolonizing Methods, and Two-Eyed Seeing), WoW employed on the land, with the land methodologies to explore IPHA wellness. Using this approach to explore how IPHAs perceive and understand their health has built the capacity of IPHAs to optimize their own “whole”istic wellness while reflecting on formal and informal mentorship roles of HIV Olders. This methodology included gathering to spend time together on the land while medicine picking, sharing tipi teachings, hosting sharing circles, engaging in ceremony and feasting. Verbal reflections on these experiences took place at the gathering, and 4-8 weeks after the gathering, where we sought to better understand the impact of on the land, with the land approaches, the role of HIV Olders, the role of peer-to-peer knowledge sharing, and the relevance of sex and gender within on the land, with the land research methodologies. Wisdom catchers took notes during the tipi teachings, sharing circles, and verbal reflections.
Results: Collaborative thematic analysis of the verbal reflections, tipi teachings and sharing circles revealed rich stories surrounding intersections of Indigeneity, Ways of Knowing and Sharing Knowledge, Sex, Sexuality, Gender, and Interconnectedness. WoW also revealed lessons for on the land/with the land approaches, including key considerations for other First Nations, Métis, and Inuit communities.

Background: The structural and social drivers of HIV-related stigma are a significant public health problem in Canada and globally. HIV stigma and discrimination bear heavily on people’s health, well-being, access to resources, and opportunities to flourish. The purpose of this project was to amplify the voices of people living with HIV about their experiences of HIV-related stigma and discrimination in Manitoba.
Methods: The project unfolded in two phases. During the first phase, adults living with HIV were recruited to participate in research informed by photovoice methodology. Participants attended an orientation session during which they were given information on the study purpose and processes as well as guidance on picture taking and journaling. Participants were asked to take pictures that represented experiences of stigma. Participants chose pictures as a catalyst for dialogue during follow-up individual interviews. Interview transcripts were analyzed qualitatively. During the second phase of the study, purposefully selected participants were invited to create a three minute digital story about HIV-related stigma.
Results: Eleven people living with HIV (64% women; mean age = 46 years; mean length of time since diagnosis = 14 years) participated in the photovoice phase of the study. Through pictures and dialogue, they expressed the emotional and social impacts of oppressive structural and interpersonal attitudes and behaviours toward people living with HIV compounded by intersections of additional forms of oppression including racism, sexism, and homophobia. They relayed stories of transitions toward confronting and resisting these oppressions through caring for themselves, people, and pets; reconfiguring social networks; and resisting and disrupting stigmas. A video digital story will be presented to illustrate one participant’s message to disrupt stigma.
Conclusion: Photovoice and digital storytelling elicited powerful stories of people’s experiences of stigma and discrimination and the ways they confronted stigma through caring, social networks, and resistance.

Background: Integrating harm reduction services (HRS) (e.g., supervised consumption services (SCS)) delivery across organizations serving people living with HIV/AIDS and people who use drugs can improve the HIV prevention and treatment cascade. HRS prevent overdose deaths, reduce drug-related harms, facilitate retention in HIV care and increase medication adherence. However, government support of HRS is inconsistent, requiring alternate sources of funding. Literature on fundraising for HIV and HRS is limited. Our study examines narratives used in fundraising for HRS at AIDS service, healthcare, and community organizations across Canada.

Methods: We conducted semi-structured qualitative interviews with fundraisers from organizations that provide SCS or support these services in the community. Interviews focused on the challenges and opportunities of fundraising for programming that addresses a stigmatized and criminalized behavior (drug use), strategies for fundraising, and opportunities for new donors. Data were analysed using thematic analysis.

Results: Participants (N=17) were recruited from Vancouver, Edmonton, Saskatoon, Toronto, Sudbury, and Halifax. When communicating to donors, some fundraisers positioned HRS as a primary client need (overt) whereas others used narratives that blended HRS with other services/client needs (integrated). Narratives varied depending on the size/type/culture of the organization, donor profile, fundraiser autonomy, and political environment. Stigma and criminalization of drug use layered additional challenges onto traditional fundraising issues, but also created new opportunities. Fundraising for a criminalized behaviour required balancing the ethical tensions in sharing client stories and connecting awareness, education, and advocacy with fundraising. Although there were fears of losing donors among a few fundraisers, this was not realized at the organizations that implemented HRS.

Conclusions: Our study demonstrates that although HRS creates some fundraising challenges for AIDS service, healthcare and community organizations, it creates opportunities for engaging new donors. Both integrated and overt fundraising narratives about the need for HRS, can benefit organizations needing supplemental funding.

Background: Limited data suggest that PrEP use in Indigenous communities is low although HIV incidence is significantly higher than in non-Indigenous peoples. We sought to identify research priorities related to PrEP and Indigenous peoples in Canada from the perspective of key stakeholders.

Methods: We conducted exploratory interviews with First Nation, Inuit and Métis community leaders identified through the FEAST Centre for Indigenous STBBI Research and its network of engaged community-based, clinical, academic, and policy-maker stakeholders. We used a semi-structured interview guide based on a theoretical framework regarding access to healthcare. Our work was intended as a research planning exercise to determine community priorities.

Results: Ten participants (7 male, 3 female) offered unique perspectives on PrEP from their lived experiences as Indigenous health researchers, cultural facilitators and healthcare providers in ON, BC, QC, MB and NS. Fourteen themes emerged from the interviews, in three groups. Seven themes involved areas of research that have previously been explored in other populations but not exclusively in Indigenous populations, including stigma affecting PrEP usage, optimal methods for knowledge translation about PrEP with Indigenous people, community awareness of HIV status/risk, optimal rollout strategies for PrEP, affordability, wariness of PrEP services, and risks to consider when promoting PrEP. Five themes were specifically associated with Indigenous populations, including community knowledge about PrEP/HIV, access to knowledgeable health care professionals in Indigenous communities, the role of Elders in PrEP-related work, Indigenous community champions for PrEP, and the importance of self-efficacy. Two themes related to topics for which relevant biomedical knowledge exists but may not have been adequately disseminated in Indigenous communities, including effectiveness of PrEP among women and people who inject drugs.

Conclusion: Research and knowledge translation on these themes may improve how PrEP usage can be increased in a culturally sensitive way to Indigenous peoples in Canada.

Prince Albert has a HIV rate of 56.4 people per 100,000 population this is 8.2x higher than the Canadian average. 67% of newly diagnosed individuals reported injecting drugs. Youth 19 and younger represent 2.7% of newly diagnosed cases in Saskatchewan. Substance use is a major driver for HIV infections in this region, where the rate of substance use among the youth is 11% higher than the national average for grade 10-12 students. This substance use is reported to start at a very young age which is thought to be due to diverse maladaptive mechanisms to life's stressors, such as poverty or homelessness, ease of availabilty of substances, response to trauma and living in an environement inodiated with substances. Early substance use prevention for youth in this region can prevent risks for illness such as HIV or delay detrimental effects of substance use on the health. Active youth involvement in substance use prevention is urgently needed to respond to youth alcohol and substance use. Young people must be engaged, empowered in all the phases of the research process including identification of the intervention. Arts-based interventions are ideal participatory action approaches that can empower young people to be agents in substance use and HIV prevention. Art-based interventions help to promote health, reduce harm, and change behaviors. This scoping review aims to explore various arts-based substance use prevention interventions for young people. Thematic analysis will be applied to appraise the articles included in the review. The scoping review will provide insight into interventions that can be considered among youth and the community of Prince Albert, Saskatchewan that improve population health and reduce the risk factors of substance use. The findings will be presented to community stakeholders and will inform the interventions that will be developed to respond to substance use among this population

BACKGROUND: Indigenous values of relational care and social connections are foundational to harm reduction programming and inform responses to the disproportionate impacts of HIV, the drug poisoning epidemic, and COVID-19 on Indigenous Peoples. Lockdowns, access restrictions and physical distancing requirements to limit the spread of COVID-19 have impeded access to culturally responsive Indigenous harm reduction (IHR) programming. These intersecting pandemics have created an urgent need for frontline organizations to adapt to provide culturally responsive IHR services.

OBJECTIVES: CAAN and the Dr. Peter AIDS Foundation have brought together decades of experience in community-based harm reduction and knowledge translation to identify: 1) how IHR programming for Indigenous Peoples has been impacted by COVID-19, 2) successful adaptations that Indigenous and non-Indigenous frontline organizations have made to provide culturally responsive IHR programming, and 3) resources to address service gaps that impact Indigenous Peoples. The resulting evidence base will support frontline organizations to implement culturally responsive IHR programming.

METHODOLOGY: A rigorous and innovative state-of-the-art literature review, combined with Indigenous Ways of Knowing and Doing, offers a Two-Eyed Seeing (Etuaptmumk) approach to knowledge synthesis. Sharing circles and interviews with key informants (service providers/users of frontline organizations) will further inform a Wise Practices Asset Map of culturally responsive IHR services. This environmental scan is national in scope, informed by sharing circles and interviews in each region (Pacific, Prairies, Central, Atlantic and Northwest Territories).

POTENTIAL IMPLICATIONS: IHR services that support connections to kin, community and culture are vital for meeting the needs of Indigenous people who use harm reduction services, particularly during COVID-19. The results of this ‘quick and nimble’ environmental scan offer a rapid turnaround of evidence-based wise practices to implement context-specific harm reduction adaptations for Indigenous people during COVID-19. Our project findings will facilitate the data-to-action trajectory of effective community pandemic responses.

Extensive public health resources have been directed to the COVID-19 pandemic. This focus has saved lives; it has also reduced attention paid to epidemics of sexually transmitted and blood-borne infections (STBBI) and the overdose crisis. Intersections between these crises and the pandemic have manifested as a syndemic, a clustering of health and social conditions that has worsened outcomes for people who use substances (PWUS).

The Manitoba Harm Reduction Network (MHRN) works towards equitable access to harm reduction supplies, reducing the transmission of STBBIs, and systemic social change. In summer 2021, a participatory evaluation of services was conducted with PWUS, MHRN staff, an Elder, and NCCID staff. The evaluation aimed to identify transferrable promising practices for harm reduction in the context of the pandemic.

The evaluation showed that the pandemic resulted in significant increases in houselessness, loss of income and disability/EI benefits, and serious negative mental health effects for PWUS. Shortages of preferred substances, and higher risk substance use, were common. All participants had been affected by overdoses during the pandemic. PWUS were disproportionately impacted by the shift to virtual and teleservices, the lack of walk-in appointments, and redeployment of STBBI nurses. Every participating PWUS reported challenges getting STBBI care; they also reported decreased access to harm reduction services and safe medical care for other conditions during the pandemic.

However, the evaluation also pointed to promising practices that can improve the lives of PWUS and reduce the transmission of STBBI. Incremental promising practices include: peer-led overdose prevention and response initiatives, locker programs for contact-free delivery of supplies, targeted provision of essentials, and provision of telephones to facilitate medical care. Other promising practices are structural in nature, including: increasing the surge capacity of the healthcare system, improving practitioner education about harm reduction, and facilitating the presence of advocates for PWUS.

Women’s stories are important lenses to understanding life with HIV, both in popular culture and academia, but they are often missed or mired in social stigma. In response, a collective of women living with HIV will “Show Off” in an arts-based workshop and public art installation in Victoria, British Columbia, January 2022. This community-based project adds women’s stories of living with HIV to existing and archived data from the “HIV In My Day” project. Co-led by HIV activist/artist, Peggy Frank, and arts-based researcher, Dr. Leah Tidey, participating women explore various art forms as methods of self-expression and knowledge sharing relating to the impact of HIV on their lives. During the facilitated workshop, approximately eight women will create through movement, painting, sound design, poetry, and/or theatre-based scene creation. Artistic pieces will then be curated into an engaging, interactive art installation open to the public. Both the installation and the workshop build on 21 women’s oral histories from the “HIV In My Day” Archive, a collaboration between academic researchers and community partners that has produced a digital archive of 117 oral history interviews conducted in British Columbia with long-term survivors of HIV and their caregivers. Hearing directly from women living with HIV is the event highlight, whether they share visual art, audio recordings, movement pieces, or a group poem. While our target for the one-day installation is thirty to sixty guests, both the workshop and installation will be video recorded to create an online installation that will be added to the HIV In My Day Archive. We anticipate learning more about strategies to address HIV stigma as well as the strengths and challenges of specific art forms and will create educational tools for women living with HIV that will be shared with stakeholders at conference presentations, online forums, and town hall meetings.

In 2017 the Community Outreach team was created at the Middlesex London Health Unit in response to a public health crisis related to increases in HIV, Hepatitis C, Invasive Group A Streptococcal disease and infective endocarditis in persons who inject drugs, in London, Ontario. The end goal of the team is to help decrease the spread of HIV and other infections associated with people who inject drugs (PWID) and support the client through their continuum of care. This presentation will include two case studies highlighting support provided for each client.
“Individuals’ experiences within health systems are influenced heavily by contextual factors, participant experience, and intricate relationships between different organizations and actors. Case study research is well suited for HSR [Health Services Research] because it can track and examine these complex relationships and systems as they evolve over time.” (Sibbald et al., 2021)
Each case study for this presentation has different factors impacting the client outcomes. One couple, whose diagnoses were in the grouping that led to the declaration of a health alert were supported by the Community Outreach team. A case overview of the client’s situation, the engagement strategies, and outcomes resulting from the team’s support will be discussed.
The second case review will be a client to colleague case review. One of the team members, our peer navigator, was once a client herself. This review will include a high-level overview of the journey from client to colleague, and how this experience has informed the work of the team since.
Finally, an overview of information about the team processes will be shared. Information about referral processes, client numbers and number of visits over a year will be discussed, including the team impact on outcomes reported for incidence of disease.

HIV Pre-exposure prophylaxis (PrEP) is an increasingly important biomedical tool in the prevention of HIV for HIV-negative individuals. However, given the recency of the medication, there is a lack of human rights-based research regarding access to PrEP for members of HIV-vulnerable populations. A significantly vulnerable population which could benefit from access to PrEP is female sex workers (FSW) in HIV-endemic or hyperendemic countries This research sought to examine the extent to which access to HIV preventive medicines such as PrEP are ensured under article 12.1: the right to the enjoyment of the highest attainable standard of physical and metal health, and article 15.1b: the right to enjoy the benefits of scientific progress and its applications, of the International Covenant on Economic, Social and Cultural Rights. This research utilised a case study approach to critically examine the rollout of PrEP for FSW in South Africa, drawing on the country’s Bill of Rights, national healthcare policies, and de facto PrEP implementation. While PrEP implementation for FSW in South Africa was guided by a human rights framework, this research found 1) PrEP rollout was largely physically and economically inaccessible for sex workers outside of select clinics or trial sites in urban centres; 2) dissemination of PrEP information for female sex workers was weak, reducing the medicine’s acceptability; 3) concerns about South Africa’s overburdened public healthcare system and continued criminalization of sex work contributed to a weak uptake of PrEP among sex workers. It is recommended that leaders in HIV-endemic countries implement legal instruments to increase free PrEP access for FSW in both urban and rural healthcare centres, expand PrEP training for healthcare providers, disseminate information through sex worker social networks, utilise generic PrEP alternatives to reduce costs, and take steps to address other social determinants of health such as decriminalizing sex work.

Indigenous people and communities in Saskatchewan (SK) and Manitoba (MB) experience marginalization due to ongoing colonization and systemic oppression. This marginalization is seen in health disparities including high rates of HIV, hepatitis C (HCV) and other sexually transmitted and blood-borne infections (STBBI). Systemic oppression continues to impact Indigenous people’s access to healthcare and representation in research. Waniska (a Cree word meaning ‘wake up, arise!’) is an Indigenous-led and -focused centre for HIV, HCV and STBBI research that reflects the action-oriented nature of Indigenous knowledges. The goal of waniska is to combat inequities found within HIV/HCV/STBBI research with Indigenous populations in SK and MB. Our work centres Indigenous ways of knowing, meaning-making and doing including etuaptmumk (Two-eyed Seeing) and ethical space through the lenses of trauma-informed and strengths-based approaches towards Indigenous health and wellness. Waniska is innovating research to centre community-based, land- and ceremonial-based approaches that promote wholistic wellness and healing that prioritizes the voices of community, gender diverse people and those with lived experience. Our research projects are shaped by Community Guiding Circles (CGC) composed of people with lived/living experience, those who are gender diverse, community researchers, Knowledge Holders and Elders. To support the capacity of CGC members, we are developing mâmâwihitowin, a curriculum of training opportunities around Indigenous research in the areas of HIV, HCV and STBBI. Led by waniska Community Coordinators, mâmâwihitowin will empower community researchers and CGC members to confidently engage in and guide research projects from inception to application. Through mâmâwihitowin, we aim to ensure that research and programs can access marginalized populations for HIV treatment to ensure equity for those experiencing marginalization in culturally-safe, trauma-informed ways. Mâmâwihitowin and the CGC will ensure that Indigenous communities’ priorities for HIV/HCV/STBBI research are actualized in meaningful ways with results that will positively impact their members.