Background: In Canada, someone can be convicted for HIV non-disclosure before sex posing a “realistic possibility of HIV transmission.” Some prosecutors and courts have accepted that a suppressed viral load precludes criminalization. However, with respect to condom use, the law and prosecutorial approaches are unsettled, despite Canadian and international scientific consensus that condom use means the possibility of transmission ranges from none (in case of “correct use”) to “negligible.”

Description: The first 1998 Supreme Court of Canada (SCC) decision on HIV criminalization, several subsequent lower-court rulings, and early prosecutorial policy (in BC), suggested condom use could suffice to avoid conviction. However, a 2012 SCC decision undermined this; court decisions and prosecutorial approaches now vary across the country. In 2016, a Nova Scotia court acquitted based on condom use. In 2018, Canada’s Attorney General directed federal prosecutors to “generally” not prosecute when condoms are used. In BC, 2019 policy states condom use “may weigh against prosecution.” However, in 2020 the Ontario Court of Appeal upheld a conviction despite consistent condom use (and no evidence of incorrect use or transmission).

Lessons learned: Prosecutors and courts invoke the risk of condoms breaking or slipping, but continued criminalization even in cases of condom use is also rooted in misrepresentations of the science regarding condoms’ effectiveness, judicial timidity, and, likely, fear and stigma regarding HIV and sex. Unless the SCC eventually accepts condom use can negate a realistic possibility of transmission, or Parliament legislates this limit, some prosecutions and convictions will continue in such cases.

Conclusions: Criminalizing people who take precautions and pose no to negligible risk of transmission is unfair and discriminatory, unscientific and contrary to international guidance. To limit “overcriminalization of HIV,” Parliament should amend the Criminal Code and Attorneys General should adopt policy clearly ruling out prosecution in cases of condom use.

HIV stigma can significantly affect the health and wellbeing of people living with HIV. This is especially true for marginalized populations who continue to be disproportionately affected by HIV. While studies have examined the contexts and impacts of ethnicity, gender, and sexual orientation on HIV stigma separately, there is less known about how these factors may intersect (and potentially exacerbate) the negative impacts of HIV stigma. This study aims to quantitatively examine and visualize how intersecting identities of ethnicity, gender, and sexual orientation may impact levels of internalized, enacted, and anticipated HIV stigma.

Participants were recruited in Ontario, Alberta, and Québec (n=1115) as part of the People Living with HIV Stigma Index study in Canada. Mutually exclusive groups were created from the intersections of race and ethnicity, gender, and sexual orientation (Caucasian men who have sex with men (MSM); Caucasian non-MSM; Caucasian women; African, Caribbean, and Black (ACB) MSM; ACB non-MSM; ACB women; Indigenous MSM; Indigenous non-MSM; Indigenous women). Heatmaps were used to visualize the intersectional levels of stigma across these demographics and characteristics.

High levels of stigma were present across the whole sample, with certain key populations having higher levels of certain stigmas compared to others. For internalized stigma, many groups had similar levels, except ACB women and Indigenous non-MSM groups who had the highest scores. All MSM had relatively lower levels of enacted stigma, with ACB women having the highest. The ACB population overall had the highest levels of anticipated stigma compared to the Caucasian and Indigenous groups, with ACB women again being the highest.

These heatmaps provide a useful tool to visualize how intersecting identities and personal characteristics may play a role in experiences of various dimensions of HIV stigma. More work is needed to validate these, and to develop and advance methods to quantify intersectionality factors.

INTRODUCTION:
Sex and sexual health practices of Middle Eastern and North African (MENA) youth in Canada are under-researched and require attention as the community continues to grow due to immigration. Gay and bisexual cis men who have sex with men (MSM) have been significantly immigrating to Ontario and identified as a key population. The YSMENA community-based research study aimed to understand barriers and resiliencies relating to sexual health access among MENA youth living in Ontario.

METHOD:
The study employed mixed-method data collection through a quantitative socio-demographic survey and qualitative focus groups engaging 56 MENA youth between 16-29 years in Ontario. Fifteen (15) sequential critical dialogical focus groups were held with youth sub-groups across the sexual and gender spectrum. Six focus groups were conducted with 22 gay and MSM youth representing the largest participant sample of the study. Focus group sessions were transcribed and coded using NVIVO to determine thematic patterns.

RESULTS:
Average age of the men was 26.9 years old (SD=2.59) and the majority spent less than nine years in Canada. The youth discussed dealing with systemic oppressions when accessing health care or employment, homophobia from cultural communities, strained familial relationships, while also grappling with fetishization and pressures to conform in mainstream gay spaces. The need for a sense of belonging, low self-esteem and lack of community connection were identified as factors contributing to condomless sex. While culturally relevant resources were lacking, many talked about journeys to self-acceptance and of building peer networks. Participants discussed strategies to strengthen their access to sexual health, especially PrEP, testing, and media-based educational interventions.

CONCLUSION:
MENA gay and MSM youth experiences of migration layered with their sexual identities surfaced unique challenges and strengths. Participant recommendations of culturally relevant services, peer support and/or PrEP access have important implications for policy, programming and continued research.

Objectifs
Au Québec, l’histoire des premières années de la lutte contre le VIH/sida a peu été étudiée, y compris chez la population la plus touchée : les gais. Le projet de recherche sur lequel s’appuie cette présentation documente cette histoire à partir de la perspective de ses principaux acteurs, en s’interrogeant notamment sur un potentiel « retard ».

Méthodologie
Cette étude qualitative s’appuie sur une démarche socio-historique, d’où le recours à des sources documentaires, archivistiques et orales. En plus d’une revue de la littérature, des fonds des Archives gaies du Québec ont été examinés et des entrevues semi-dirigées ont été menées.

Résultats
La situation du Québec présente des points communs avec d’autres contextes, comme la mobilisation première de professionnels de la santé et de groupes communautaires. Notre recherche permet cependant de faire ressortir certaines particularités. D’abord, la mobilisation contre le sida au Québec s’inscrit dans un contexte sociopolitique de tensions avec le fédéral. Comme les deux paliers de gouvernement devaient collaborer dans la gestion de l’épidémie, ces tensions ont retardé la définition des politiques publiques. Ensuite, les communautés francophone et anglophone du Québec présentent des différences culturelles, avec des conceptions et des approches spécifiques. Ces divergences ont mené à la création de réseaux communautaires parallèles. Finalement, la reconnaissance de l’homosexualité est encore timide dans la société québécoise au moment où émerge l’épidémie. Cela a nui à la prévention chez les gais, en plus d’affecter les collaborations entre militants sida et groupes homosexuels.

Conclusion
Il est important de s’intéresser à la réponse au VIH/sida au Québec, car ce contexte jette un nouvel éclairage sur la notion de « retard » dans la lutte contre le VIH/sida, qui s’explique au Québec par des éléments spécifiques : tensions entre provincial et fédéral, divergences entre anglophones et francophones et reconnaissance timide de l’homosexualité.

Background:
2-Spirit, lesbian, gay, bisexual, transgender, queer, and questioning (2SLGBTQ+) youth are overrepresented among youth experiencing homelessness and constitute 20-40% of the homeless youth population. Street-involved youth (SIY), particularly 2SLGBTQ+ youth, are at greater risk of contracting HIV, sexually transmitted infections, and blood-borne infections, due to a variety of factors such as, age, socioeconomic status, housing status, and barriers accessing healthcare services. Unstably housed youth are 2-10 times more likely to contract HIV than their stably housed peers. This study focuses on adapting and scaling-up Peer Navigators (PN) to increase uptake and utilization of HIV care among SIY. We present findings on the unique barriers and facilitators to HIV health services among 2SLGBTQ+ SIY in Toronto and Montreal.

Methods: Utilizing an integrated mixed-methods approach, participants included 2SLGBTQ+ SIY, aged 16-29, healthcare providers, and community stakeholders in Toronto and Montreal. Semi-structured interviews, focus groups, and Theatre Testing workshops were conducted. Interviews and focus groups focused on the barriers and facilitators to accessing HIV health services. Data were analyzed using an iterative thematic content analysis approach.

Results: The main barriers to accessing HIV health services identified among 2SLGBTQ+ SIY included: inadequate 2SLGBTQ+ specialized services; lack of basic needs; and stigma. Participants reported systemic barriers, including widespread discrimination and stigma, and challenges accessing institutional settings, such as healthcare services. Facilitators to HIV health services were also identified and included: supportive relationships with friends and family and healthcare providers; accessible healthcare facilities; and 2SLGBTQ+ inclusive healthcare.

Conclusions: Although little is known about how to remove the extensive barriers to accessing HIV care experienced by 2SLGBTQ+ SIY, there are various types of interventions that show promise at targeting HIV risk behaviours and access to care among SIY, including PN interventions and inclusive and affirming population-based health services that target the needs of 2SLGBTQ+ SIY.

Background: COVID-19 has impacted sexual relationships and activities between gay, bisexual, queer, and other men who have sex with men (GBM) across Canada. Our objective was to explore how GBM actively consumed and evaluated both HIV and COVID-19 medical knowledge and technologies to reduce HIV and COVID-19 transmission when engaging in sexual behaviours during the COVID-19 pandemic.

Methods: Semi-structured interviews were conducted with 93 GBM as part of Engage-COVID-19: a mixed-methods study examining the impacts of COVID-19 on GBM living in Vancouver, Toronto, and Montreal. Two rounds of online interviews took place between November 2020-January 2021 and June-October 2021. Interviews were transcribed verbatim and thematically coded using NVivo. We evaluated how GBM adapted and interpreted medical knowledge, public health measures, and biomedical technologies related to HIV and COVID-19 when forging sexual safety practices during the COVID-19 pandemic.

Results: Participants ranged in age from 24-64 years old. Our analysis produced four key themes. First, some participants reported creating “sex bubbles” with trusted and already known sex partners to ensure safety from COVID-19, HIV, and other sexually transmitted infections (STIs). Second, a few men have used masks to avoid physical contact and engaged in “socially distant” sex, such as voyeuristic masturbation. Third, several participants asked potential partners about their HIV, STI, and COVID-19 infection status, as well as COVID-19-related preventive behaviours, to assess their safety profile. Fourth, most participants reported increased sexual activities following double vaccinations and employed “vaccine sorting” as a safety precaution.

Conclusion: Our results demonstrate how GBM have actively evaluated, consumed, and adapted HIV and COVID-19 public health messaging to create preventive measures and reduce sexual risks during the COVID-19 pandemic. Future research should focus on how GBM manage numerous epidemics in creative ways to sustain safer sex and continue sexual behaviours in a constantly shifting COVID-19 context.

Background: Intimate partner violence (IPV) is associated with HIV risk among sexual minority men (SMM). Bidirectional (IPV), reporting both IPV victimization and perpetration, may further increase HIV risk. Syndemic theory suggests a constellation of risk factors compound IPV risk, but common approaches to syndemic analysis are unable to precisely inform IPV-related HIV interventions. This analysis examined associations between four syndemic factors (alcohol misuse, illegal drug use, childhood sexual assault [CSA], depressive symptomatology) and bidirectional IPV among SMM in three Canadian urban areas using novel analysis methods.

Method: Using baseline data from the Engage Cohort Study (N=2,449), we fit three logistic regression models with lifetime exposure to bidirectional IPV as the outcome and controlling for demographic factors. Model 1 examined syndemic factors individually, Model 2 employed a summative scale of syndemic exposure (i.e., reporting 0, 1, 2, or 3-4 syndemic factors), and Model 3 used marginal analysis to examine the relative excess risk of each syndemic combination.

Results: Thirty-one percent (N=762) of respondents reported bidirectional IPV. CSA (N=954, 39%), alcohol misuse (N=1361, 55.6%), illegal drug use (N=1356, 55.4%), and depressive symptomatology (N=463, 18.9%) were significantly associated with greater odds of bidirectional IPV. A dose-response relationship was found between number of syndemic factors and bidirectional IPV (1 factor: aOR=1.63, 95%CI [1.30, 2.04], 2 factors: aOR=3.11, 95%CI [2.49, 3.88], 3-4 factors: aOR=4.17, 95%CI [3.29, 5.28]). Respondents reporting alcohol misuse, depressive symptomatology, and CSA had a 57% higher risk of reporting bidirectional IPV than those reporting zero syndemic factors (0.57, 95%CI [0.21, 0.94], p=0.002).

Conclusion: Given the close association between IPV and HIV risk, pinpointing specific factors on which to intervene is critical to ending the HIV epidemic in Canada. Nuanced analysis methods can help disentangle factors associated with IPV and HIV in SMM, potentially leading to more efficacious interventions for specific SMM communities.

Background: Stigma continues to be a major stressor in the lives of PHAs. To better understand the social determinants of HIV-related stigma in Quebec, an intersectoral team conducted the PHA Stigma Index.
Methodology: In 2019, a questionnaire was administered face-to-face to 281 PHAs. These interviews were conducted by 9 peer research associates, in 8 regions of Quebec. The questionnaire explored different types of stigmas: institutional, effective, perceived, internalized, and intersectional.
Results: The mean score on the scale of reluctance to seek HIV care after diagnosis was relatively low, at 2.51 on a scale ranging from 1 to 9. A higher mean score on this scale was observed among those who reported speaking a language other than French, the presence of depressive symptoms, a HIGHER mean score on the scales of current internalized and anticipated stigma, lifetime institutional stigma, and discrimination experienced in HIV care in the past 12 months, and a LOWER mean score on the scales of social support received. Multivariate analysis indicated that a higher mean score on the reluctance to seek HIV care scale after diagnosis was associated with having a higher score on the anticipated stigma (ß: 0.46), internalized stigma (ß: 0.27), and discrimination experienced in HIV care in the past 12 months (ß: 0.37) scales (R2: 21.2%).
Conclusion: The sources of experienced stigma are numerous. The institutional stigma experienced throughout life, which may explain the delay in seeking care, seems to be reflected in the anticipated and internalized stigma experienced at the time of the survey. This underscores the importance for the health care professional to be sensitive to the initial encounters following a diagnosis. Increased institutional stigma may also reflect a lack of sensitivity on the part of health care professionals to intersectional issues that subsequently sustain internalized and anticipated stigma among PHAs.