Background: The Canadian HIV Women’s Sexual and Reproductive Health Cohort Study – Prioritizing the Health Needs of Positive Aboriginal Women (CHIWOS-PAW) used Indigenous re-search methods to explore how Indigenous Women living with HIV on Coast Salish Territories understand their health and wellbeing through traditional medicines and ways of knowing. We describe our process of honouring ceremony and using water teachings to reflect on our re-search findings and co-create knowledge translation tools.

Methods: Under Indigenous leadership and conducting the work in a Good Way, our team of Indigenous and non-Indigenous re-searchers and Elder hosted a December 2021 gathering with the CHIWOS-PAW participants (known as ‘Wise Women’). Under the mentorship and guidance of Indigenous leaders, we shared and discussed the primary findings or streams of our re-search. We then worked together to translate the findings into teachings and create a series of educational posters for healthcare settings serving Indigenous Women living with HIV.

Results: The Wise Women shared many reflections on the research findings, emphasizing that they know what is needed to achieve their healing and wellbeing. As our Elder shared: “my body knows a thing or two about a thing or two about my body.” Teachings from the Wise Women included (1) understanding that health and wellbeing is a journey, not only a destination; (2) developing meaningful care relationships and partnerships is foundational to healing and health; (3) integrating traditional ways of knowing, including honouring culture and traditional medicines is essential; and (4) health and wellbeing is connected with nature. These messages were collaboratively incorporated into a visual poster series integrating water teachings and imagery.

Conclusion: Honouring ceremony and cultural humility, we co-created posters to translate research knowledge by, with, and for Indigenous Women living with HIV, that share how the Wise Women would love to vision their health and wellbeing.

Introduction: Saskatchewan has had the highest incidence of HIV nationally for over a decade. The burden of HIV began in urban centres and spread to rural and remote areas in Saskatchewan, leading to the emergence of unique rural care models to address gaps in services delivery. With the closest urban care centre over 90km away, an Indigenous-led in-community, nurse-based case-management model with clinical guidance from an urban Infectious Disease team was developed.
Methods: Existing documentation and key stakeholders engagement were used to describe the care model. Data was extracted from an electronic medical record system for clients accessing care between 01/01/2018-12/31/2020. Demographics and clinical outcomes were described, including the proportion of active clients on treatment and virally suppressed (defined as at least one ART prescription in the calendar year and the last viral load (VL) within the calendar year <200copies/mL, respectively).
Results: The HIV care model, initiated in 2011, includes harm reduction, STBBI testing, HIV phlebotomy, peer-support, and opioid-substitution therapy in community, as well as transportation for clinic days. Out of 110 HIV clients in care between 2018-2020, 83% were HCV co-infected, 55% were males and the average age was 41.9 (SE±0.9). The proportion of clients on treatment increased (79% in 2018 to 81% in 2019 and 87% in 2020). Of those on treatment, the proportion virally suppressed decreased from 87% to 78% from 2018 to 2020, while those with a VL >200copies/mL increased from 7% to 11%. The proportion with no VL increased from 6% to 10%.
Conclusion: The indigenous community-led model resulted in a high proportion of patients receiving ART with good levels of virologic suppression, highlighting the benefits of culturally responsive, safe and accessible rural HIV care. However, breaks in follow-up and lab testing as a result of COVID may have had impacts on maintaining viral suppression.

Historically, HIV/AIDS rates and outcomes have generated discussion and enactment of exceptionalism policy. This type of policy recognizes the exceptional needs of individuals living with HIV/AIDS and is primarily driven by stigma. HIV-specific policies are critical because HIV/AIDS is an exceptional health issue that warrants specific direction, as its transmissibility and impacts are unlike other diseases. However, in recent years there have been mounting calls to end exceptional HIV policies in ‘western developed countries’.
In Canada, the healthcare needs of many Indigenous Peoples fall under the jurisdiction of the Federal Government, be it through direct service provision or funding. The estimated HIV prevalence rate for Indigenous Peoples in Canada in 2016 was two times higher than the general population. Despite Indigenous Peoples making up only 4.9% of the population, Indigenous women accounted for 30.9% of new HIV cases in Canadian women, and Indigenous men accounted for 16.3% of new HIV cases in Canadian men. However, the federal and provincial governments in Canada lack any exceptional HIV/AIDS policy targeted towards Indigenous Peoples living with HIV/AIDS (IPLHA), and no specific policy directs care, services, or funds to Indigenous communities facing an HIV epidemic. We continue to see governments that refuse, or are reluctant, to solve the problem with an “exceptional” policy.
Using an Indigenous Knowledge Policy Framework, we critically analyze federal and provincial health policies gained through Freedom of Information Requests and argue that governments need to create policies that address the exceptional needs of IPLHA. We argue that there is a need for exceptional policies to address the issue of HIV/AIDS treatment and programming, as existing measures are not adequately dealing with the challenges IPLHA’s face, including issues of stigma, privacy, confidentiality, treatment, and autonomy that continue to disproportionately impact communities and the efforts to address the increase of new infections.

Place: Peers4Wellness is a community based participatory action research (CBPAR) study. In British Columbia, the study is situated on the traditional unseeded lands of the Coast Salish people in the Metro Vancouver and Fraser Valley regions, with a particular focus on the Downtown Eastside (DTES) of Vancouver. Acadamically, the study is housed at Simon Fraser University and the University of Saskatchewan. The principal investigator is Dr. Alexandra King. Peers4Wellness launched in 2017 with catalyst-funding and is now funded by the CIHR (#401360).

Intention: The goal of Peers4Wellness is to support the wellness of Indigenous womxn with lived and living experiences of HIV and/or hepatitis C (HCV). The scope of Peers4Wellness involves a community needs assessment and community led programming. The objectives of the study are to introduce applied models for HIV/HCV wellness care and research that culturally responsive and peer led.

Protocols: Peers4Wellness applies an emerging Indigenous research framework that is grounded in Indigenous ceremony and shaped by etuaptmumk (Two-eyed-Seeing) theory. The study privileges Indigenous ways of knowing, being and doing as well as centering lived/living experiences and community wisdom. Peers4Wellness also weaves in relevant Western and academic knowledges and practices. The ensuing research methodology manifests through a collaborative leadership including an Indigenous Knowledge Holder, an Indigenous woman with lived and living communal and HIV/HCV experiences, community based organization(s), community representatives, academic allies and an Indigenous principal investigator.

Journey: This presentation will share some Peers4Wellness learnings. First, we will highlight some key findings from the needs assessment and how they informed the programing stage of the study. Then, we will introduce an innovative community designed wellness program for HIV/HCV that is Indigenous, peer led and community based in the DTES. Finally, we will showcase the Peers4Welness process Bundle, which guides the study’s engagement in culturally responsive and peer led CBPAR.

Background:
Modern antiretroviral therapy (ART) has significantly reduced morbidity and mortality among people living with HIV (PLWH). With recognition of the historical and ongoing impacts of colonization in Canada, Indigenous PLWH (IPLWH) face additional challenges which may impede their access to and initiation of ART. We designed a study to examine changes in time to ART initiation among IPLWH in British Columbia (BC).

Methods:
We used data from the STOP HIV/AIDS Program Evaluation (SHAPE) study and the BC HIV Drug Treatment Program (DTP) to examine factors associated with ART initiation among IPLWH. Analysis was limited to self-identified IPLWH in the SHAPE cohort who started ART in BC. We examined sociodemographic variables and measures of homelessness, substance use and mental health, and classified participants based on their year of HIV diagnosis. We conducted univariable and multivariable linear regression to model time-to-ART initiation.

Results:
Between January 2016-September 2018, we enrolled 644 PLWH in SHAPE, of whom, 138 (21%) self-identified as Indigenous. Overall, 54 met inclusion criteria for this analysis; 48% were female and 52% were diagnosed between the years 2000-2009. In univariable analyses, having a mental health diagnosis (Beta: 31.3, 95% CI= 4.5, 55.6) was associated with increased time to ART initiation. However, this association was not retained in the multivariable model, where only HIV diagnosis between 2000-2009 (Beta: -43.1; 95% CI= -69.2, -16.9), and 2010 or later (Beta: -86.3; 95% CI= -124.3, -48.3) were associated with a reduced time-to-ART initiation, compared to being diagnosed prior to the year 2000. We did not find any associations with gender, age, health authority, sexual orientation, education or history of drug use.

Conclusion:
Despite the socio-structural challenges faced by Indigenous PLWH, we found significant reductions in the time between diagnosis to ART initiation over time, emphasizing the improvements made in ART availability.

Background: Sexual health is comprised not only of HIV prevention and management, but also sexual and gender-based violence prevention. While the bidirectional linkages are well established between intimate partner violence (IPV) and HIV, less is known about approaches to fostering healthy relationships among adolescents in the Northwest Territories (NWT), Canada. As the NWT has among Canada's highest STI prevalence, alongside IPV rates 7-fold the national average, strengths-focused approaches to healthy relationships hold the potential for advancing sexual health and in turn HIV prevention with Northern and Indigenous adolescents.

Methods: A NWT-based Indigenous sexual health agency, Fostering Open eXpression among Youth (FOXY), and their counterpart Strength, Masculinities, and Sexual Health (SMASH), conduct annual Peer Leader Retreats at a fly-in lodge in the NWT for youth aged 12-17. Retreats include land-based learning, Indigenous teaching, and arts-based methods. We conducted thematic analyses on data collected from 24 focus groups conducted with participants between 2017-2019 with a focus on relational factors.

Results: There were 286 retreat participants (87% Indigenous, 69% young women) and of these, 158 participants (n=36 young men, n=122 young women) participated in post-retreat focus groups. Key themes included: a) learning to identify healthy/unhealthy relationships; b) reflecting on one’s role in perpetrating abusive practices in dating relationships alongside commitment to change; c) new insight of being in an unhealthy relationship together with options for leaving; d) communication skills; e) social and emotional support resources. Participants also discussed learning about healthy relationships from peer leader role modelling, including in intimate relationships and motherhood.

Discussion: Relationality is central to Indigenous ways of knowing and includes the interconnections between people, nature, and the land as well as connections between physical, mental, emotional, and spiritual wellbeing. Land-based learning holds the potential to foster sexual health and create enabling HIV prevention environments with Northern and Indigenous adolescents.