Background: Heterosexual Black men (HBM) are in communities facing disproportionate HIV risk in Canada; however, they have received limited attention in HIV prevention. The weSpeak study explored how HBM in Ontario navigate HIV risk, to inform population-specific, strengths-based HIV intervention. Resilience was explored as research suggests it is a useful concept for HIV prevention, although conventional resilience models may be misaligned with the values and realities of HBM.

Methods: In Toronto, 7 audio-taped focus group interviews lasting 60-150 minutes were conducted with 54 self-identified heterosexual Black men ranging in age from 16 to 71 years. Five focus groups were convened with men grouped by age range, one was convened for francophone men, and another for men living with HIV. The men identified their ethnoracial identities as African (n=25), Caribbean (n=21) and Black (n=8). Research team members applied thematic analysis to transcribed interview data to derive participant perspectives on connections between resilience and HIV.

Results: The participants described HIV as like other threats, including systemic racism, that HBM have navigated with resilience in past and present. The participants refused definitions of resilience associated with vulnerability in favour of models that emphasized multigenerational strength, determination and commitment to others that empowered HBM to overcome threats, protect themselves, and mobilize community resilience against HIV. All participants advocated for HBM-specific HIV prevention that foregrounded HBM-specific realities and resiliencies. They saw a role for HBM leadership in community-wide efforts to increase HIV literacy, but HIV-positive men identified stigma as a barrier to their full participation in these efforts.

Conclusions: Participants suggest that emphasizing the specific resiliencies HBM value and identify is key to engaging them more effectively in HIV prevention. Strengths-based prevention efforts would position HBM as consumers and collaborators in reducing the threat of HIV in Canada’s Black communities.

Background: Refugee claims based on sexual orientation and gender identity persecution make up 12% of the refugee cases in Canada, with queer African refugees constituting the most significant group within this category. Refugees are noted as being at a higher risk for HIV infection post-migration due to several compounding factors, including complex settlement challenges, pre-and post-migration trauma, limited employment opportunities, poverty, challenges accessing services, stigma, and racism. The refugee process inevitably increases stress levels, which reduces health prevention and health-seeking tendencies.

Method: Through the framework of queer phenomenology, qualitative in-depth interviews were conducted with 40 queer African refugee claimants navigating the Canadian refugee determination process. Study participants self-identified as male (20), female (16), transmen (2), and as transwomen (2). They arrived from 11 African countries of origin.

Results: While increased risk did not guarantee HIV infection, study findings noted that participants were forced to live precarious lives upon arrival in Canada and were in vulnerable positions due to lack of power in sexual negotiations, cultural differences in communication styles, the stigma associated with HIV and refugee status, and preoccupation with daily survival that did not lend itself to attention to healthcare needs.

Conclusion: A new model of HIV risk for queer African refugees has been created based on the social determinants of health, anti-Black racism, and Canadian homonational narratives of who deserves protection behind Canadian borders. This model highlights how HIV risk is elevated for queer African refugees during the refugee determination process not only due to the social determinants of health but also increased through the forced queer performance required in the Canadian refugee process as well as the forced heterosexual performance required in the countries of origin prior to migration. These factors constrained sexual health and HIV prevention choices, facilitating increased HIV risk for research participants.

Background
Mental health distress, social isolation, and coping challenges are the psychosocial sequelae of the COVID-19 pandemic. Racialized people living with HIV (PLHIV) are faced with additional hardships related to stigma, racism, and inequitable access to social determinants. CHAMPs-In-Action Alliance, which is made up of five AIDS service organization in Black, Asian and Latinx communities, surveyed their service users in May 2020 and found addressing mental health distress and stigma to be the priority. In response, the Alliance drew on local resources to convert their evidence-based in-person CHAMPs intervention into online modules to meet the identified needs.

Methods
The CHAMPs online intervention consists of six weekly self-directed learning modules accompanied by a 2-hour weekly online peer-facilitated group sessions. To prepare for community readiness, 19 Alliance staff and peer facilitators participated in the online pilot and three intensive train-the-trainer sessions. To date, the Alliance has engaged 75 participants in five cohorts of the CHAMPs intervention. Data collection includes socio-demographic questionnaires, pre-, immediate post-, and 3-month post- surveys of validated scales on HIV stigma, resilience and empowerment, and weekly online module responses.

Results
Preliminary data analysis of the surveys and module responses shows that the CHAMPs intervention is effective in reducing HIV stigma, promoting resilience and increasing engagement in HIV championship. Furthermore, we learned that pandemic public health rules brought both challenges and opportunities to implement community HIV programs. Compared to in-person sessions, online self-learning modules offered flexible participation in terms of scheduling and pace. However, the digital divide, a lack of private space, and the absence of in-person connection were also barriers for participation.

Conclusion
Racialized PLHIV experience increased social and health vulnerabilities during a pandemic. As Canadians continue to adjust to living the “new normal” of pandemic uncertainties, building community alliance and capacity is essential in reducing PLHIV health disparities.

African, Caribbean and Black (ACB) communities continue to be disproportionately affected by HIV in Canada. Experiences of multiple dimensions of stigma and discrimination, compounded by the COVID-19 pandemic, have exacerbated this impact by reducing access to testing facilities and interrupting linkage to care. To facilitate increased uptake of testing, Women’s Health in Women’s Hands co-built with REACH Nexus and CBRC, the I’m Ready program to offer access to free HIV self-tests, HIV care pathways, with virtual support by trained peer navigators (www.readytoknow.ca).

Eligible participants were aged 18 or older and lived in Canada. Through the I'm Ready, Test mobile app, participants consent, create an anonymous profile, answer pre- and post-test surveys, order up to 3 free HIV self-tests for delivery or pick-up at 80 community sites across Canada, take the test, and upload results. Participants have opportunities to connect with peer navigator support before, during or after testing through the integrated I'm Ready, Talk telehealth platform. Participants could use self-tests for themselves and others.

In the first 6 months, 255 ACB people from across Canada participated: 49% were under 30 years of age; 42% identified as women, 53% as men, and 4% as gender diverse (Trans, non-binary, genderqueer); 54% identified as heterosexual and 44% as LBTQ+; 61% reported being born outside of Canada; overall health was “good” (36%), “very good” (26%) and “excellent” (17%); 20% reported symptoms of depression. Regarding access to care, 52% indicated that the COVID-19 pandemic negatively impacted access to HIV testing; 22% were first-time testers. Only 2% reported current PrEP use. Regarding sexual health, 31% disclosed prior STI diagnosis; 58% disclosed having condomless anal or vaginal sex in the last 3 months.

Opportunities remain to reach subsets underrepresented in this initial sample. This includes refugees and non-status individuals, gender diverse, and ACB communities in Western Canada.

Background: Doravirine is a recently licensed HIV non-nucleoside reverse transcriptase inhibitor with improved efficacy against viruses harboring resistance to efavirenz and nevirapine, showing limited cross-resistance to rilpivirine. In this in vitro study, resistance, and cross-resistance to doravirine was analyzed in a representative panel of clinical isolates harboring NRTI- and NNRTI-multidrug resistance.

Methods: Peripheral blood mononuclear cells infected with clinical viral isolates (n=8) harboring NRTI and NNRTI resistance mutations were passaged in rising concentrations of single and dual drugs treatments. Genotypic analysis monitored the acquisition and accumulation of drug resistance mutations at weeks 16 and 24 following selective drug pressure. Cell-based phenotypic assays assessed levels of resistance and cross-resistance of selected variants to NNRTIs.

Results: Doravirine showed potency on six viral variants harboring K65R or multiple thymidine analogue mutations (TAMs). Sustained pressure of viral variants with doravirine resulted in the acquisition of V108I (4/6), L234I (4/6), Y318F (2/6), V106A/I (2/6), F227 (1/6) and Y318F (1/6) mutations. The genetic barrier to doravirine was improved when paired with islatravir or lamivudine. One isolate escaped doravirine pressure, harboring TAMs, M184V and NNRTIs (K103N, Y181C and F318F) that retained rilpivirine susceptibility. The second variant harbored complex L74I, Y115F Q151M/M184V/G190A multidrug resistance with severe impaired replicative fitness precluding drug escalation. rilpivirine.

Discussion: Doravirine, paired with islatravir, shows favorable efficacy against viral variants harboring TAMs/M184VI/NNRTI multidrug resistance. The long intracellular half-life of Islatravir, suggest the opportunity for therapeutic options against resistant viruses that continue to arise in middle and low income settings.

Background: Genital inflammation (GI) defined by cytokines has been associated with increased HIV risk in women, with potential mechanisms that include increased density of HIV target cells and a more porous mucosal barrier. However, most genital target cell studies have been small and cross-sectional, and the factors that influence target cell density and predict HIV outcomes are poorly described.

Methods: We enrolled and prospectively followed 181 HIV-negative women, a subset of participants in the CAPRISA 008 study in KwaZulu-Natal, South Africa, with genital tract sampling at 824 biannual clinic visits. T cell phenotyping and enumeration was performed on endocervical cytobrushes using flow cytometry, and cytokines and barrier-associated matrix metalloproteinases (MMPs) quantified in cervicovaginal lavage. Associations between immune variables were measured using linear mixed models, and between immune variables and HIV acquisition using time-varying Cox regression; both were adjusted for potential confounders.

Results: Inflammatory cytokines and MMPs were associated with the abundance of activated endocervical HIV target cells; target cells were increased in particular at visits when GI was present. While GI was the strongest predictor of target cell abundance (adjusted beta=0.26, 95%: 0.10-0.42), target cells were increased in women with STIs and recent condomless sex and trended to decrease in women with Nugent-BV. A total of 24 women acquired HIV infection during follow-up. While genital CD4+ T cell abundance was not associated with HIV, the abundance of CD8+ T cells expressing HLA-DR was inversely associated with an 80% decreased risk of HIV acquisition in adjusted models (aHR=0.20, 95% CI: 0.05-0.79).

Conclusions: Genital inflammation and MMPs were associated with increased abundance of HIV target cells in the endocervix, in models adjusted for multiple covariates. However, endocervical CD4+ T cell abundance was not associated with HIV acquisition. Further studies of a protective role for HLA-DR+ CD8+ T cells should be further investigated.