Background: Scant research has explored in-depth intersectional experiences of COVID-19 and HIV among PLWH during the pandemic. We sought to examine population-location-specific experiences of LGBTQ+ PLWH regarding COVID-19 knowledge, protective behaviours, psychological distress, and impacts on HIV care.

Methods: Using a mixed-methods study with convergent parallel design, we examined challenges faced by LGBTQ+ PLWH amid the COVID-19 pandemic in Toronto, Bangkok, and Mumbai. We used descriptive statistics and chi-squares to examine baseline data (03/21-12/21) from PLWH participants in a multisite clinical trial of an eHealth intervention to increase COVID-19 knowledge and protective behaviours, and reduce COVID-19-related psychological distress among LGBTQ+ individuals. We integrated content analysis of semi-structured post-intervention interviews (12/21-06/22).

Results: Participants (N=57; mean-age 27-years[IQR:9]) were from Toronto (n=9), Bangkok (n=23) and Mumbai (n=25), mostly (n=40) cisgender gay/bisexual-identified, 14 trans-identified, 3 cisgender lesbian/bisexual-identified. COVID-19 knowledge was significantly higher in Toronto vs. Bangkok/Mumbai. Cisgender-gay/bisexual- and cisgender-lesbian/bisexual-identified vs. trans-identified participants had significantly higher protective behaviour (masking/physical distancing) adherence across sites. High prevalence of clinically-relevant anxiety (32%) and depression (25%) symptoms were identified across sites and populations. Qualitative findings reveal lesser access to government/social-welfare/unemployment COVID-19 benefits among trans-people due to inability to change government-ID-card gender (India) and informal employment (“no proof”) (India/Thailand). Overall decreases were reported in ART access (22.8%), HIV-care visits (28.1%), and ART adherence (8.8%). Lengthy waits for HIV-medical care (check-ups/medication) were exacerbated by concerns about COVID-19 transmission in hospitals/clinics, worse COVID-19 outcomes due to HIV, and worse HIV outcomes if one contracted COVID-19.

Conclusions: HIV care disruptions, prevalent psychological distress, and HIV-specific health concerns during the COVID-19 pandemic indicate urgent need for service delivery innovations to facilitate HIV and mental health care among LGBTQ+ PLWH amid ongoing waves of COVID-19, and preparedness for future pandemics. Structural interventions to enable access to pandemic-related government social welfare are crucial for trans people.

INTRODUCTION
A highly under-researched community, Middle Eastern and North African (MENA) youth in Canada face unique challenges in navigating HIV and sexually transmitted infections, especially with increased immigration. Transgender MENA youth have been significantly immigrating to Ontario and identified as a key population. YSMENA community-based research study designed to determine HIV risk context and sexual health needs of MENA diaspora youth in Ontario.

METHODS
YSMENA Study employed mixed-methods data collection through quantitative socio-demographic surveys and qualitative focus groups engaging 56 MENA youth, 16-29 years in Ontario. Fifteen focus groups were held with youth sub-groups across the sexual and gender spectrum. Eight self-identifying transgender youth participated in a series of sequential critical dialogical focus group sessions in Arabic to increase access, then translated, transcribed and coded in NVIVO.

RESULTS
Seven youth identified as trans feminine and one as trans masculine; average age was 27 years (SD=2.67); about 90% moved to Canada in the last 10 years and 50% spoke only Arabic. Less than half (45%) have high school education and 75% were receiving social or disability assistance. All trans youth shared rent with a roommate and about 40% described their living arrangement as unstable and unsafe. Themes included layered experiences of exclusion and transphobia; shame, stigma and feelings of isolation from family; and discrimination while accessing health and HIV prevention interventions. Some discussed the precariousness and risks associated with sex work and lack of mental health care. Youth-informed interventions included training for healthcare workers on responding to service needs with respect and compassion. Training for language interpreters was also highly recommended. Overall, transgender youth demonstrated notable resilience and self-acceptance.

CONCLUSIONS
Experiences shared have important implications for strengthening provision of health care services. Bolstering community-based spaces to offer ethno-culturally relevant and non-judgmental service and increased holistic mental health services are recommended.

Background: Women living with HIV (WLWH) experience comorbidities more frequently and earlier than those living without HIV. Longitudinal data is needed to better understand changes over time. We examined and compared prevalence and incidence of comorbidities from participants’ most recent CARMA study visit among WLWH and HIV-negative control women enrolled in CARMA.

Methods: Prevalence and incidence of comorbidities were measured and compared between 207 WLWH and 59 HIV-negative cis-gender women, ≥19 years, enrolled in the CARMA cohort (2012-2017). Poisson regressions were used to compare total number of comorbidities and incidence, and Chi-square tests to compare prevalence of comorbidities by HIV status, adjusting for age in all models.

Results: Participant demographics and comorbidities are described in Table 1. WLWH were followed longer than controls (4.8 ±2.3 vs. 3.7 ±2.0 years). At most recent study visit, WLWH had a greater number of total comorbidities (3 ±2 vs 1.7 ±1.8; p=<0.0001). In age-adjusted analyses, WLWH had a greater incidence of mental health comorbidities compared to controls (incidence [95% CI] 65.7 [46, 94] vs 19.2 [6.2, 59.6] per 1000 person years; p=0.04). Furthermore, smoking and drug use were strong predictors of acquiring an age-related comorbidity (p=<0.001).

Conclusion: At the most recent study visit, WLWH had more comorbidities at an earlier age and a greater incidence of mental health comorbidities compared to controls. Regular and earlier screening by health care providers for mental health disorders and other age-related comorbidities among WLWH is paramount. Furthermore, addressing social determinants of health is vital to improve health outcomes.

Background: Over the last six years, “Undetectable equals Untransmittable”, or U=U, has been incorporated into public health messaging, community position statements, and clinician communications with patients in Canada. Our objective was to understand what PrEP-experienced gay, bisexual, and queer men (GBQM) thought about the U=U message and how it informed their sexual decision-making over time.
Methods: We conducted annual longitudinal qualitative interviews with 17 participants who were current or former PrEP users as part of PRIMP, a mixed methods implementation science study (2020-2022). Over three years, 47 interviews were conducted with GBQM in Ontario, Canada. Interviews were transcribed verbatim and coded in NVivo following reflexive thematic analysis.
Results: All participants had heard of U=U at baseline. Participants’ sexual decision-making was largely attributed to their confidence in HIV prevention science and to the person taking medication (i.e., themselves using PrEP versus a real/imagined person living with HIV (PLHIV)). Longitudinal narratives of U=U clustered around four overarching themes (1) U=U confidence (i.e., increasing trust in U=U irrespective of their PrEP use); (2) PrEP confidence (i.e., PrEP as sufficient HIV protection making U=U less relevant); (3) combination confidence (i.e., trusting U=U and PrEP as a package); (4) partner confidence (i.e., potential ‘distrust’ of U=U due to uncertainties about partners’ medication adherence). Some participants noted their increased confidence in U=U was related to the normalization of U=U within HIV prevention discourses and growing awareness among queer communities. Overall, men described increased sex with PLHIV over time, including some participants who during earlier interviews said they would ‘never be comfortable’ with serodifferent sexual partners.
Conclusions: GBQM’s use of PrEP shaped how they thought about U=U and sex with PLHIV. To our knowledge, this is the first longitudinal qualitative analysis of U=U in Canada to examine GBQM’s shifting relationships to biomedical HIV prevention messages.

Background: Group chemsex (i.e., using drugs to enhance sex with multiple partners) is associated with increased condomless anal sex (CAS) and sexually transmitted and blood borne infections (STBBIs) among GBM. Sexual compulsivity and avoidant coping behaviours related to psychological distress are associated with chemsex and CAS. We report the effects of psychological distress on group chemsex engagement and CAS with Engage data.

Methods: We examined baseline data from 2,257 participants in Engage, a study of sexually active GBM aged 16+ years, recruited (02/2017-08/2019) using respondent-driven sampling (RDS) in Montreal, Toronto, and Vancouver. An RDS-II adjusted structural equation model was estimated examining sexual compulsivity, cognitive escape (i.e., using drugs to avoid thinking about sexual risks), and group chemsex in the past six months (P6M) as mediators between psychological distress and P6M CAS (i.e., >=1 instance). Analyses were adjusted for potential covariates (e.g., race/ethnicity, P6M PrEP use).

Results: 7.1% participants reported P6M group chemsex and 71.6% reported P6M CAS. The hypothesized model (see Figure) fit the data well (CFI=.95, RMSEA=.03). P6M group chemsex was associated with a greater likelihood of P6M CAS. Psychological distress, sexual compulsivity, and cognitive escape were all indirectly associated with P6M CAS via P6M group chemsex.

Conclusion: Psychological distress is associated with group chemsex via sexually compulsive behaviours and cognitive avoidance. The interrelation of these factors may increase the likelihood of CAS and ultimately STBBIs among GBM. Interventions to reduce chemsex harms could help GBM cope with psychological distress and incorporate other prevention strategies (PrEP use, STI testing).

Background: Within communities disproportionately impacted, HIV/AIDS is a historical experience of loss and resistance and an ongoing health inequity. We are quickly losing opportunities to gather first-hand experiences from the early days of the AIDS pandemic. Critical and intersectional oral history can preserve these essential community histories and centre the experiences of diverse people living with HIV, while also providing insights into how HIV prevention and care can be improved today.

Methods: “HIV In My Day” is an oral history project that collects, preserves, and mobilizes testimonies from the early years of British Columbia’s HIV/AIDS epidemic from survivors and caregivers. Thus far, our community-based team, including several peer researchers living with HIV, has conducted 118 interviews. Here we summarize and reflect on our multiprong community-based knowledge mobilization process.

Results: Activities included: the creation of an online, public oral history archive at the University of Victoria; three community town hall events to seek community input and share key findings; a multimedia display that presented at an arts-based event; an arts-based workshop and exhibition centring the voices and artistic creations of women living with HIV; multiple conference presentations and scholarly articles; a verbatim theatre production, which was part of the Cultch Theatre’s season in December 2022; and a community gathering associated with the play, including an exhibition of art and ephemera, held on December 4, 2022 in Vancouver, BC with 115 participants.

Conclusions: Our multipronged and arts-based approach demonstrates the importance of integrating community knowledge mobilization throughout research projects, from study conceptualization to completion, and also highlights the possibilities of arts-based approaches to engage diverse communities across generations about the histories and evolving meanings of HIV. Collectively, these activities have helped preserve cultural memory of the early AIDS epidemic, promoted cross-generational and cross-sector dialogue, and provided insights into HIV research and care.