Objectives: In 2017, the Canadian Coalition to Reform HIV Criminalization conducted its first national consultation, leading to a Community Consensus Statement. This statement is a shared and unified critique of Canada's approach to criminalizing HIV, which is one of the most severe in the world. It makes specific demands of the federal and provincial governments to limit the criminalization of HIV. To inform the next phase of its advocacy, the Coalition launched a second community consultation in 2021.

Materials and Methods: The consultation was conducted through an online survey and virtual meetings from August 2021 to early 2022. People living with HIV, affected communities, HIV service providers, advocates, researchers and activists were consulted on three proposed legislative reform options. The survey also asked respondents whether they thought the criminal law should apply in a variety of situations and whether the Coalition should continue its advocacy efforts to reform the Criminal Code. During the virtual meetings, participants were able to share their comments and concerns. Demographic data were voluntarily collected to ensure representation.

Results: The Coalition received 211 responses to the online survey. More than 100 people participated in seven virtual meetings. The majority of respondents (88%) supported the Coalition continuing its advocacy efforts to reform the Criminal Code. Only 3% of respondents supported maintaining the status quo (i.e., not advocating for reforms). In the specific factual situations posed (e.g., undetectable viral load, condom use, oral sex, coercion or fear), the majority of respondents consistently felt that prosecution was not warranted.

Conclusion: The consultation results will inform and strengthen the Coalition’s ongoing advocacy with the federal government for legislative reform. Meaningful involvement of people living with HIV and affected by HIV is fundamental to the reform process.

Conflicts of Interest: N/A

Keywords: Criminalization; Human rights; Criminal law; Consultation; Advocacy; Community; Survey

INTRODUCTION:
The Middle East and North Africa (MENA) region faces unique challenges in navigating HIV and sexually transmitted infections, where the spread of HIV is hastened by conflicts and economic upheavals. With growing immigration of MENA communities in Canada and Ontario, supporting youth wellbeing is crucial. YSMENA community-based research study identified key determinants driving how MENA diaspora youth living in Ontario access sexual health and interventions.

METHOD:
Using a mix-method design, data was collected using a quantitative socio-demographic survey and qualitative focus groups with 56 MENA youth, ages 16-29 years in Ontario. Fourteen (14) sequential critical dialogical focus groups were held with youth sub-groups including, gay and bisexual cis men, heterosexual cis men, heterosexual cis women, lesbian and queer cis women, and trans women. Each group participated in two focus group sessions to understand: 1) youth sexual health behaviours and cultural identity and 2) participant recommendations for interventions. An additional focus group, focused solely on interventions was conducted, with representation from all sub-groups. Sessions were transcribed and coded using NVIVO for thematic analysis.

RESULTS:
Youth provided recommendations for behavioural, structural and biomedical interventions that reflected the needs of their communities. Intervention suggestions common to all groups included culturally-relevant and language-specific educational programs, online interactive resources leveraging social media, mentorship programs to facilitate community connection, and health navigation tools to strengthen sexual health access and service use. Sub-groups identified specific interventions that would meet their unique needs; for example, trans women newcomers recommended anti-transphobia training with language interpreters; and gay and bisexual men participants recommended cost-free PrEP access.

CONCLUSION:
Youth-driven interventions identified by participants pose significant promise in strengthening the HIV and sexual health response among MENA youth and community in general. The knowledge generated and informed by youth would be especially relevant for community-based health organizations, healthcare practitioners and policymakers.

Background: The global U=U campaign aims to encourage the initiation of, and support for adherence to antiretroviral therapy (ART), reduce HIV stigma, and improve access to care for all key populations. While similar studies have examined the uptake of the U=U message among different populations, few studies have done so in the Canadian context. We aimed to quantitatively investigate the impact of U=U on lived experiences with HIV, how the message impacted HIV stigma, and understanding patient-provider health communication.

Methods: The Ontario HIV Stigma Index is a community-led, cross-sectional study about the determinants, social contexts and nuanced changes in HIV stigma. Trained peer researchers administered eight U=U questions to 240 adults living with HIV from September 2018-August 2019.

Results: A majority of participants were aware of the U=U message (96%) with 42% of those obtaining this information from their primary healthcare provider (HCP). Participants with higher enacted HIV stigma (experiences of discrimination due to HIV) were less likely to believe U=U can reduce HIV stigma (OR: 0.37; 95% CI: 0.16, 0.85). Participants with higher self-efficacy were more likely to believe U=U can reduce HIV stigma (OR: 4.86; 95% CI: 1.52, 15.54) and more likely to feel positively affected by U=U (OR: 4.21; 95% CI: 1.31, 13.57). Older adults, women, and gay/bisexual individuals were less likely to feel positively affected by U=U. Older adults were less likely to have U=U discussed with them from their primary HCP. Women were less likely to believe U=U can reduce HIV stigma.

Conclusions: Participants living with HIV who are older, women, gay/bisexual, have higher enacted HIV stigma, and higher self-efficacy possess varying levels of awareness, understanding, and perceptions of U=U. These results may help inform targeted HIV stigma reduction strategies such as workshops/guidelines on how HCPs disseminate U=U and the use of social messaging platforms.

Background:
Access to care and treatment is a structural driver of the HIV epidemic at the individual and population levels. Uninsured and precariously insured people living with HIV (UPI-PLHIV) experience complex challenges and significant gaps in care, resulting in health disparities and barriers to curbing the epidemic.
Methods:
Beyond Blue Door is a community-based participation study with mixed method design guided by a socioecological and population health promotion framework. The study aims to understand the service gaps, experiences, and needs of UPI-PLHIV; and to identify policy and practice changes to improve their linkage and retention to care. Using online focus groups and individual interviews, we engaged 30 UPI-PLHIV and 20 service providers working with UPI-PLHIV.
Results:
UPI-PLHIV represent a diverse group with intersecting social identities and immigration statuses in Canada, including migrant workers, students, visitors and newcomers with pending statuses. They are racialized and sexual minority people who have experienced trauma and discriminations both in their pre-migration countries and in Canada and face complex barriers in accessing many social determinants. Key access challenges to healthcare include: stigma, fear and distrust of health providers; lack of clear information on services and navigation pathways; language barriers; precarious employment and housing; gaps in healthcare coverage; and lack of health care providers willing to serve UPI-PLHIV. Service reduction and delayed immigration processing due to the COVID-19 Pandemic further compounded the hardship faced by this vulnerable population.
Conclusion:
To address the health inequities faced by UPI-PLHIV, both community-based interventions and systemic change are required. Community level strategies include: culturally and linguistically inclusive programs to support service navigation, linkage to HIV care and mental health support; and a centralized mechanism to coordinate treatment access. Systemically, universal access to treatment and healthcare coverage for all residents are critically needed to reduce health disparities and advance population health.

This paper provides information about the temporal and demographic patterns of HIV criminalization in Canada and the outcomes of HIV non-disclosure criminal cases from 1989 to 2020.

The authors reviewed information on criminal trials related to HIV non-disclosure compiled by the HIV Legal Network, media reports, and legal documents identified through LexisNexis, Quicklaw, and CanLII databases, and consulted with colleagues who are working to address HIV criminalization in Canada.

There have been at least 206 individuals prosecuted, in 224 different criminal cases, in Canada between 1989 and 2020. Two provinces – Ontario and Quebec – account for the majority of criminal prosecutions to date. Data shows that Black men are disproportionately represented in HIV criminalization prosecutions. Black people and Indigenous people appear to be convicted at a higher rate, acquitted at a lower rate, and are more likely to face prison sentences compared to White people who face similar charges.

In recent years, there has been a reduction in prosecutions, however, people living with HIV continued to be charged and convicted for HIV non-disclosure in cases in which their sexual activities pose a negligible risk of HIV transmission or no risk at all. A majority of prosecutions have been for cases that did not involve transmission of HIV. Prosecutions for ‘sexual assault’ based on alleged HIV non-disclosure have high rates of conviction compared to cases of sexual assault generally, and result in prison sentences that appear to be higher than in other cases of convictions for sexual assault involving forced or coerced sex.

The temporal trends, demographic patterns, and outcomes of HIV criminalization cases highlight the need for the criminal legal system to be better guided by science and by human rights principles in responding to HIV, and for government action to end the harms of HIV criminalization in Canada.

Background: Very little research is available on the sexual health of racialized immigrant and refugee populations in Canada. This community-based participatory study examined the sexual health of racialized migrant populations in Manitoba.

Methods: Participants (n = 34) from African, Caribbean, Black; Latin American/Latinx; South Asian; East and Southeast Asian migrant communities were recruited across Manitoba using printed flyers and through social media. Interviews with participants explored questions relating to sexual health, knowledge of HIV and other sexually transmitted and blood-borne infections (STBBI), and experiences with healthcare providers in Manitoba. Data were analyzed using thematic analysis.

Results: Four key themes emerged: (a) HIV/STBBI awareness, testing, and sexual risk practices; (b) sexual health information needs; (c) impacts of gender norms, culture, and religion on sexual health; (d) HIV stigma, social exclusion, and experiences of racism. Participants described differences in knowledge about HIV/STBBI testing. New migrants and those who were not yet linked to healthcare were more likely to reveal not having had an HIV/STBBI test in Canada, or even being aware where to get tested. The findings also show that HIV/STBBI risks were contextual; there was a spectrum of risk scenarios depending on the type of partnerships/relationships, and the type of sex individuals engaged in. Our result also highlighted the issue of access to sexual health information (in languages spoken by migrants), including the need to access this information at community-based agencies. Findings also reveal the impact of culture, religion, and gendered norms, as well as HIV stigma and racial discrimination in healthcare contexts, which negatively affected participants’ engagement with sexual health services.

Conclusions: Service providers, researchers, policy makers and funders should consider the impacts of these socio-ecological factors on the development of healthcare barriers, HIV/STBBI, and negative sexual health outcomes for racialized migrant communities in Canada.

Aim/Objective: Indigenous scholars, community leaders, and allies have imagined and constructed approaches to health research to inspire positive transformational change. Bringing Indigenous perspectives to research methods is one way of meaningfully involving Indigenous peoples in STBBI research across the four pillars of health research (basic, clinical, epidemiological, and social sciences). The goal of this rapid review was to examine how Indigenous knowledges have informed the creation of research methods, identify how Indigenous knowledges can assist to decolonize research, and observe how Indigenous knowledges and epistemologies construct research paradigms and teach beneficial ways to do research with Indigenous peoples.

Methods: This review adopted a rapid review protocol to gather relevant literature. Articles were identified in various databases. Those included in the final analysis contained an exclusive focus on Indigenous peoples, an exclusive focus on STBBI, and contained a discussion or description of how Indigenous perspectives have transformed the data collection process. Excerpts from the articles were charted and coded based on criterion provided from the Critical Appraisal Skills Programme [CASP] qualitative checklist. The sections were then collaboratively analyzed to identity emerging themes.

Findings: This review included 150 articles in the final analysis which were coded to identify common themes. Central themes included: (1) collaboratively building cultural safety; (2) engaging and involving community; (3) and integrating different elements of Indigenous epistemologies in the research design.

Implications/Discussion: Supported by the Feast Centre for Indigenous STBBI research, we are especially in how research methods change within an Indigenous and decolonizing perspective across the four pillars of health. Given the diverse populations of Indigenous peoples living in Canada, no standardized framework can be provided. However, common practices and translations of Indigenous worldviews have been compiled. The findings of this research will be used to support various projects funded by the Feast Centre.