There is a robust body of research that has documented the representational politics of news media of HIV-positive people charged for HIV non-disclosure. News media representations of HIV-negative sex partners in cases of HIV non-disclosure have received far less scholarly attention. Adopting a social constructionist perspective, this poster identifies how "victims" of HIV non-disclosure are constructed in news media. It is based on a dataset consisting of 341 news articles on HIV non-disclosure from 14 English Canadian newspapers across the political spectrum. Victims of HIV non-disclosure were constructed as: i) suffering horribly, ii) morally pure and virtuous, iii) vengeful, and iv) agentic and responsible for their situation. We consider how such constructions have been enmeshed within contemporary arguments that establish or reject HIV non-disclosure as a social problem. We then discuss the ways these constructions and the assumptions upon which they are based reflect broader discussions on the severity of HIV, the responsibility for HIV risk and exposure, and the very nature of the social problem of HIV. Constructions of victims that uphold HIV criminalisation relied on assumptions of HIV as a deadly disease, but de-emphasised personal responsibility for HIV risk and infection. By contrast, constructions of victims that, in effect, oppose HIV criminalisation tended to minimise the harms of HIV and invoke personal responsibility for HIV risk. We suggest that both proponents and opponents of HIV criminalisation have engaged in the ideology of victimhood and thus participate in and reinforce what Best (1997) termed, the victim industry.

Psychosocial sexual problems are common among gay, bisexual, and other men who have sex with men (GBM) following an HIV diagnosis. However, these problems are often overlooked in care, where sexual risk reduction and biomedical aspects of sexual health dominate. We conducted a rapid scoping review to investigate how psychosocial sexual health problems of GBM with HIV are addressed. Literature from high-income countries published in English since 2010 was reviewed. Medline, Embase, PsycINFO, and Scopus databases were searched using a search strategy designed with two academic librarians. Sexual health problems were categorized according to the ten categories of Robinson’s (2002) model. “Safer sex” interventions were included only if they addressed at least one other sexual health dimension. Fifty-two documents were included, referring to 37 interventions. Most interventions took place in the United States (78%; n=29/37), were group-based (41%), and used counselling techniques (62%; e.g., motivational interviewing, cognitive-behavioural therapy). Their settings were mostly primary care (40%) or community-based (43%). The most commonly targeted sexual health dimension was “Safer Sex/Sexual Health Care” (70%), which concerned sexual risk reduction. “Challenges” (62%), the second most commonly addressed dimension, included substance use (19%), sexual compulsivity (16%), sexual abuse (16%), and intimate partner violence (IPV) (11%). Thirdly, were interventions targeting “Talking about Sex” (59%) which concerned HIV disclosure and communication/negotiation with sex partners, often combined with a focus on “Safer Sex”. About a third of interventions addressed “Culture/Sexual identity” (38%), Intimacy/Relationships (33%), and “Positive sexuality” (30%). Few interventions targeted “Body Image” (11%), Spirituality (8%), “Sexual functioning” (5%) or “Masturbation/Fantasy” (3%). Most interventions incorporated a focus on risk reduction. Given the high rates of IPV, erectile dysfunction, and body image dissatisfaction among GBM with HIV, these findings suggest more attention could be given to these issues both within clinical care and at the community level.

Psychosocial sexual problems among gay, bisexual, and other men who have sex with men (GBM) living with HIV are common after diagnosis. However, addressing these issues can be challenging. We conducted a rapid scoping review to identify the barriers and facilitators of interventions to address these among GBM living with HIV. Literature from high-income countries published in English since 2010 was used. Four databases (Medline, Embase, PsycINFO, Scopus) were searched using a search strategy designed with two academic librarians. Interventions were defined as treatments or procedures to improve health outcomes conducted in community-based or primary care settings. Barriers and facilitators were categorized according to the five domains of the Consolidated Framework for Implementation Research (CFIR): characteristics of the intervention and of the individuals involved, outer setting, inner setting, and the implementation process. Information was extracted from the retained documents with NVivo software for content analysis. Fifty-two documents were included in the synthesis, referring to 37 interventions. Forty-one mentioned barriers or facilitators. Among the characteristics of the interventions, facilitators (n=33;80%) were feasibility, acceptability, and cost-effectiveness in changing the target behaviour, while barriers (n=21;51%) were tied to cost, concerns about long-term effectiveness, and excessive duration. Facilitators (n=20;49%) related to the individuals were providers’ expertise, friendliness, and trustworthiness, while barriers (n=18;44%) were insufficient provider expertise, difficulty addressing sexuality-related topics, and participant concerns about misunderstandings or stigmatization. Barriers and facilitators tied to the other three CFIR dimensions were less commonly reported, namely, the inner setting (barriers n=8;20%; facilitators n=7;17%), the outer setting (barriers n=5;12%; facilitators n=5;12%), and the process of implementation (facilitators: n=2;5%; no barriers were mentioned). These findings highlight the importance of financially feasible, effective, efficient, and acceptable interventions that receive patients in a supportive, non-stigmatizing environment, where their needs can be met by providers who are adequately trained on sexual health-related topics.

At the onset of the COVID-19 pandemic, L’Actuel continued seeing patients in person. Medical staff were quickly struck by the gravity of psychosocial issues that were going unaddressed in a context where our systems, including local community organizations, were either overwhelmed or facing service interruptions.
Over the following years, L’Actuel put together a patchwork of small research projects to evaluate the needs of its patients with the clear intent of combining research and intervention. The clinic now boasts a psychosocial support team of five, with roughly half their caseload being people recovering from crystal meth addiction. Over the last year only, close to 500 patients have received support from the team.
This presentation will provide data highlights from the different projects that underpinned the development of the psychosocial support team. These include a project to assess the mental health of our older patients living with HIV through phone interviews (N=173); another to examine the potential connection between PnP (chemsex) and hepatitis C rates in our patient base (N=140); and a project to evaluate the impact of psychosocial support on mental health, sexual risk-taking, and sexual self-efficacy (N=125, ongoing). Close to75% of the patients indicate mental health issues; among those who practice PnP close to 50% are HIV+ and 26% of the HIV- ones take PrEP. Those are crucial information in terms of prevention and public health and converge towards the same observation: the importance of integrating a psychosocial dimension into patient care.
The presentation will also include an overview of the challenges and lessons learned from implementing an intervention team in the thick of a pandemic, along with the tools the team had to create to support their patients in a context where harm reduction as practised for more than 30 years is no longer adapted to these new realities.

In 2021 / 2022 WHAI embarked on a process of conducting accessible and inclusive consultations with women and community organizations across Ontario to inform our future work. Focussing on women who face structural barriers to health, our priority was cis, Trans, Non-Binary and 2-Spirited Femme people who are living with HIV identify as Black, Indigenous, newcomer, who use drugs or substances, have experienced violence and/or incarceration, and/or who sex work.

While adapting to ever-changing COVID-19 public health restrictions, the consultation process included 1) engagement with community knowledge holders to inform the development of accessible, creative and participatory consultation tools; 2) building team capacity to use the tools; 3) implementing the consultation process in 16 regions; and 4) collaboratively synthesizing findings into a key themes to inform our provincial work.

The consultations focussed on HIV, HIV prevention and more broadly, barriers and facilitators to wellness. Throughout, it was imperative to center the voices of those often excluded or marginalized, and this required careful thought around the tools developed. Four tools that applied storytelling techniques, art, one-on-one interaction and group discussions, were used to ensure flexibility towards public health restrictions, accessibility, cater to different styles of engagement, and center anti-racist, decolonial approaches for sharing knowledge and affecting community change.

In addition to 501 women engaged across Ontario, 317 workers from community organizations/networks were engaged to validate the knowledge / augment findings. This breadth of invaluable community sharing of stories, wisdom and expertise was synthesized into six key themes to inform future work at WHAI. Themes included HIV Education, Prevention, Care & Support; Community Connection, Economic Autonomy, Women Centred Harm Reduction, Safety, and Wholistic Care. Overall, these key themes demonstrate a strong, collaborative, community driven and participatory process which will be foundational for community led change.

During 2021/2022, WHAI undertook an in-depth, participatory consultation process across Ontario with 1) women living with and facing systemic risks related to HIV (501 women), and 2) community organizations and networks who work with these women (317 workers). In particular, this consultation process sought to centre and prioritize input from women who are often structurally excluded, including cis, Trans, Non-Binary and 2-Spirited women who identify as African, Caribbean, Black, Indigenous, newcomers, who use drugs/substances, have experienced violence and/or who are/have been incarcerated.

Participating networks and organizations included newcomer and immigration services, Black and Indigenous serving organizations, women’s drop-ins and shelters, harm reduction and overdose prevention programs, health care, and violence against women sectors. Consultation tools included arts-based, story telling, 1:1 and group based approaches rooted in accessible and culturally inclusive models. This process resulted in the identification of six key themes to inform WHAI’s future work.

Innovative participatory, community-based strategies were used to review and understand wisdom and stories shared. Sixteen WHAI Coordinators across Ontario worked individually and collectively across virtual platforms, using note-taking, coding, dialogue, reflection, journaling, whiteboard group work, and thematic and arts-based analysis. In parallel, a team of community knowledge holders provided a detailed provincial-level review and oversight. Theme identification involved review of feedback, sensemaking and establishment of provincial areas for meaningful and community identified future action. Fundamentally, this process was rooted in a collaboration between community members and partners, WHAI Coordinators and leadership.

Through these participatory processes, the team established six key themes, creatively represented through a visual demonstration of findings. Themes included HIV Education, Prevention, Care & Support; Community Connection, Economic Autonomy, Women Centred Harm Reduction, Safety, and Wholistic Care. These foundational themes will inform WHAI’s strategic and community-driven work for the coming years.

Background: Cultural safety is a key element in the accessibility of programs and services for Indigenous and African-Caribbean-Black community. The participation of these communities is perhaps the most important area of action to better support a respectful, inclusive, and equitable initiative. (Riecken, Scott and Tanaka (2006))
This project aims to address truth and reconciliation meaningfully and proactively, and cultural barriers to accessing skills development for PLHIV to help fight stigma.

Methodology:
Based on a post-program-only method, six persons from Indigenous communities and six persons from ACB communities interested in completing the core positive leadership training will be recruited through ASOs. These participants will also act as cultural safety peer reviewers for the evaluation by compiling observations in an evaluation manual. Qualitative data will be analyzed in a collective session with all participants.
Peer reviewers will receive a short training on cultural safety, how to use the evaluation manual and assess the content of the training activities. Our peer reviewers will be compensated for the evaluation portion of the work.

Expected Results:
The results of the formative evaluation will be compiled and analyzed, with suggestions and improvements to training content identified by our peer reviewers to ensure greater cultural safety for indigenous and ACB participants. Peer reviewers will develop skills in the evaluation of cultural safety.
We should better understand what can be done to assure a more inclusive and culturally safer environment for Indigenous and ACB communities during PLDIs’ training. We also expect to learn if the Indigenous four (4 Rs) ways of knowing is applicable for ACB community.

Conclusion:
The applied expected results will contribute to culturally safer and more inclusive HIV leadership training for indigenous and ACB participants.

Background:
Since Canada’s tainted blood tragedy, sexually active gbMSM have been excluded from blood donation. In late 2022, Héma-Québec implemented a gender-neutral qualification questionnaire allowing the inclusion of gbMSM as potential donors. New questions target at-risk sexual behaviours: having had more than one sexual partner OR a new sexual partner in the past 3 months, AND if so, having had anal sex. Our objective is to document the acceptability and feasibility of such a change among gbMSM, plasma product recipients and current donors.

Methods:
In 2021 and 2022, three waves of data collection took place at different times during the qualification change process: 1) qualitative interviews with gbMSM (N=28), 2) qualitative interviews with 18 plasma product recipients, and 3) an online questionnaire completed by 1788 current donors.

Results:
GbMSM perceived gender-neutral questions as more inclusive and equitable. Asking about anal sex was perceived as indirectly targeting gbMSM, therefore discriminating and stigmatizing. GbMSM regretted that protective behaviours were not considered and felt these new criteria would exclude many gbMSM and people in non-traditional relationship configurations. Plasma product recipients considered gender-neutral questions as more inclusive and safer because they exclude all people having risky behaviours, regardless of gender or sexual orientation. Recipients feared that the new criteria would lead to donor loss and were disappointed that questions did not include all at-risk sexual behaviours. On a scale of 1 to 7, current donors perceived gender-neutral questions as acceptable (6.1), legitimate (6.2) and safe (6.1), and were very comfortable answering them (6.3). However, they rated them as moderately embarrassing (3).

Conclusion:
The populations affected by this qualification change show high acceptance of gender-neutral questions, which they perceive as more inclusive. However, issues such as perception of discrimination, loss of donors, and embarrassment are raised and deserve to be addressed.

Background: Neurocognitive difficulties affect persons living with HIV (PHAs), especially those ageing with HIV. HEADS UP! 2 was a community-based research (CBR) study to understand the experiences of PHA when navigating care services for neurocognitive difficulties, and experiences of health care providers serving PHAs. Research shows that journaling may be a helpful tool for patient/peer participant engagement in research. We assessed this helpfulness with six (6) peer research associates (PRAs) who journaled for one year following prompts regarding their experience on this study.
Methods: Peer researchers and coordinators were invited to journal (written or audiovisual) about their experiences engaging in CBR and neurocognitive health. PRAs journaled individually and discussed their entries in ten in-person and online reflection meetings which included discussions about the phenomenology of remembering/forgetting, importance of physical rehabilitation, and ageing with HIV and social inclusion. PRAs also participated in seven capacity building workshops (e.g., use of dyadic interviews, coding, principles of knowledge mobilization). We reviewed our processes, discussions, and journals entries collaboratively to develop themes.
Results: Three key findings emerged: 1) COVID-19 delayed the study, including data gathering and analysis, and the PRA role as “data analysts” (contrasting with the seemingly more active role of “data gatherers”) caused frustration; 2) there was inconvenient access to the confidential storage of journal entries which created delays in participation in journaling; and 3) peers saw their lives reflected in the study participant interview transcripts; journaling provided a space for PRA voices and perspectives, but it was not until the team met in person that PRA felt safe to share these experiences and their journals entries.
Conclusion: Journaling is a potentially helpful tool for peer engagement but stirs up a great deal of lived experience. The role of peer coordinators became essential to navigate these challenges.

Background: The health and wellness of global self-identifying Indigenous Women populations (inclusive of feminine identifying non-binary people) living with, or impacted by, HIV or other STBBI, must be informed by evidence-based, culturally relevant Sexual and Reproductive Health and Rights (SRHR) metrics. Gender-based analysis further informs a robust response, including the roles and rights of Indigenous men and boys (inclusive of masculine identifying non-binary people) as advocates for change. Engaging Elders and People with living experience contribute to the value and relevance of research.

This research brings together Indigenous researchers from: Canada, New Zealand, Peru, Guatemala, Nigeria, Nepal and India. Each team is investigating culturally relevant SRHR metrics for Indigenous Women and girls at the local level and collaboratively working towards a shared global understanding.

Methods: This research uses Indigenous methodologies and celebrates the distinct Indigenous epistemologies of the global team. Each country is undertaking a scoping review which will inform a global collective statement. Focus group discussions will further explore key themes from the literature and a large-scale survey will gather diverse perspectives in each country.

Discussion: Project implementation began with representatives from each country (research coordinator, Person living with HIV and an Elder) meeting in Nepal in June 2022. While touring Nepal, team members shared their respective customs, ceremonies, community contexts and cultures. This land-based, cross-cultural sharing and relationship building created a foundation of respect and understanding for the research to proceed.

Next steps: By implementing multiple and collaboratively developed data gathering sources and sharing analysis, findings will address local and global SRHR contexts. The development of accessible, evidence-based and culturally relevant KT resources by and for Indigenous Peoples will respond to local and global community needs. This research will have far-reaching global impacts on understanding SRHR of Indigenous Women living with, or impacted by, HIV or other STBBI.

Background: HIV care decentralization is a national policy in Cameroon, but follow-up of people living with HIV (PLWH) is provider-driven, with little patient education and participation in clinical surveillance. The objective of this study was to assess the prevalence and predictors of ART non-adherence among PLWH in Cameroon.
Methods: Cross-sectional study of PLWH in HIV treatment centres was conducted. Data were collected using structured questionnaires and analyzed using STATA.
Results: There were 451 participants in this study, 33.48% were from the Southwest region. Their mean age was 43.42 years (SD: 10.42), majority (68.89%) were females. Overall proportion of ART non-adherence among participants was 37.78%, 35.88% missed taking ART twice a month. Reasons for missing ART included forgetfulness, business and traveling without drugs. Over half of participants (54.67%) know ART is life-long, 53.88% have missed ART service appointments, 7.32% disbelieve ART benefits, 28.60% think taking ART gives unwanted HIV Status reminder and 2.00% experienced discrimination seeking ART services. In multivariate analysis, odds of ART non-adherence in participants aged 41+ was 0.35 times (95%CI: 0.14, 0.85) that in participants aged 21-30, odds of ART non-adherence comparing participants who attained only primary education to those with higher than secondary education was 0.57 times (95%CI: 0.33, 0.97) and odds of ART non-adherence in participants who are non-alcohol consumers was 0.62 times (95%CI: 0.39, 0.98) that in alcohol consumers.
Conclusion: ART non-adherent was high and reasons for missing ART are masked in participants’ limited knowledge in taking ART, disbelief in ART benefits, feelings that ART gives unwanted HIV status reminder and experiencing discrimination when seeking ART services. These underscores need to improve staff attitudes, staff-patient-communication, and proper ART prior initiation counseling of patients. Future studies need to focus on assessing long-term ART non-adherence trends and predictors using larger samples in many treatment centres and regions.

Background
Héma-Québec has recently implemented a gender-neutral questionnaire for all types of blood donations, which allows gay, bisexual, and other men who have sex with men (gbMSM) to donate. This project assessed how this change may impact donor intentions to return.

Method
An online questionnaire was distributed to randomly selected donors who had donated blood or plasma ≤12 months. Participants were asked to rate, on a scale of 1 (“no intention at all”) to 7 (“strong intention”), their intention to return for a new donation amid the removal of the gbMSM deferral.

Results
In total, 1587 donors participated, including 738 plasma donors and 849 whole blood donors. Mean (± standard deviation) age was 49.4 (16.8) among plasma donors and 47.3 (16.1) among whole blood donors. Overall, 96.9% of plasma donors and 94.9% of whole blood donors were white. LGBTQ+ donors accounted for 10.3% of plasma donors and 11.0% of whole blood donors. A high proportion of plasma donors (89.3%) and whole blood donors (85.5%) rated as “strong” their intention to return amid recent changes in gbMSM eligibility; only 0.7% of plasma donors and 0.6% of whole blood donors reported having “no intention at all” to return. Using a univariable linear regression analysis adjusted for age, no personal characteristics or life experiences were associated with intention to return, except for cognitive (β=0.290) and affective (β=0.364) attitudes towards gbMSM, and knowing an LGBTQ+ person (β=0.364, all p<0.001).

Conclusion
The vast majority of active donors intend to continue donating blood amid the removal of the gbMSM deferral. Donor intentions did not seem to be influenced by personal characteristics or life experiences. However, cognitive and affective attitudes towards gbMSM, and knowing an LGBTQ+ person were associated with a stronger intention to return. These findings reinforce the importance of educating donors about blood product safety.

Background: Gay, bisexual, trans, and other men who have sex with men (GBTMSM) remain disproportionately affected by HIV/AIDS in Canada, including regionally in Southwestern Ontario. Canadian population-based studies suggest higher prevalence of adverse mental health outcomes among sexual orientation and gender identity/expression minority groups than in heterosexuals/cisgender ones. Previous literature has identified social support, and connection to 2-Spirit, lesbian, gay, bisexual, transgender, and queer (2SLGBTQ+) communities (including GBTMSM communities) as facilitating dissemination of information related to HIV-prevention, testing, and access to HIV care. These factors also mitigate impacts of stressors (i.e., stigma), improve and promote health, and influence additional health behaviors. These factors vary significantly across research conducted on broad geographic scales, necessitating exploration within heterogenous regions.
Methods: Between November 2021 and March 2022, semi-structured one-on-one online interviews were conducted with GBTMSM over 18 years old who resided in Southwestern Ontario, from within six AIDS Service Organization catchment areas. Interviews topics included participants’ connections and experiences in identifying with local 2SLGBTQ+ communities; where participants meet other GBTMSM; and how they received social support within their region. Interviews were transcribed verbatim, de-identified, anonymized, and thematically analyzed.
Results: Connectedness to broader 2SLGBTQ+/GBTMSM community were described by participants in two domains: online and/or in-person. Emergent themes included: difficulty to connect due to perceived fragmentation and continually changing community; abundance of online spaces, but a dearth of physical spaces to connect in; a desire for physical spaces that were characteristically communal (e.g., community centers); and feelings of unwelcome based on sociodemographic identities (e.g., racialization, age).
Conclusion: Findings highlight the composition and function of social support networks and community connections among GBTMSM in Southwestern Ontario for health promotion. Careful consideration of prevalence of supports and connections can help contribute to evidence-based HIV prevention, HIV incidence reduction, and connections to care.

Background: In addition to being an effective HIV prevention modality, pre-exposure prophylaxis (PrEP) has other advantages on the sexual lives of gay, bisexual, and queer men (GBQM), including reduced anxiety, enhanced sexual pleasure, and increased comfort with sex partners living with HIV. We examined the benefits of PrEP to GBQM and how PrEP affected perceptions of sexually transmitted infections (STIs) other than HIV.

Methods: We conducted annual qualitative interviews between 2020-2022 with 17 current and former PrEP users in Ontario as part of PRIMP, a mixed-methods implementation science study. 47 interviews were completed across three rounds, transcribed verbatim and coded in NVivo using reflexive thematic analysis.

Results: We found four interrelated themes across participant accounts over the three-year time period. First, participants consistently reported reduced anxieties related to HIV, contributing to their perception of greater sexual freedom and sexual pleasure. Second, although participants reported a rise in STI diagnoses over time due to increased condomless sex, they perceived STIs as less concerning. This decreased worry about STIs was linked to the increased sexual health screenings as part of PrEP care, and the availability of treatments and vaccinations for some STIs. Third, a few participants expressed anxiety about being stigmatized due to a positive STI diagnosis but dissipated as they encountered more STIs over time. Finally, other participants voiced concerns about non-PrEP users who were not getting tested as frequently as PrEP users, especially during the COVID-19 pandemic when STI testing were limited.

Conclusion: The added benefits of PrEP identified in this study will inform PrEP messaging to encourage greater uptake and adherence. However, PrEP presents challenges for STI prevention for both PrEP and non-PrEP users. Providers need to address the perceived stigma linked to STIs with tailored counselling programs. Frequent sexual health testing for non-PrEP users should also be promoted.

Background: Heterosexually identified men who have sex with men (H-MSM) experience discordance between their sexual identity and behaviours, and are at elevated risk for HIV transmission. Understanding and accepting H-MSM as they self-identify may be necessary to implement effective public health and psychosocial interventions. There is no known knowledge synthesis of H-MSM.

Methods: A scoping review synthesized primary studies about H-MSM identity development, attraction, and behaviour. Key search terms included ‘heterosexual MSM’, and ‘sexual identity-behaviour discordance’. Using Covidence software, 13 databases were searched and two independent reviewers screened 3,617 titles and abstracts and 269 full-texts to arrive at 164 articles meeting entry criteria. These 164 articles were then divided into papers that only reported the number or percentage of H-MSM in larger samples (n=34) and articles for full-team review (n=130) amongst 9 independent reviewers for thematic content analysis.

Results: H-MSM frequently either expressed sexual identity uncertainty, or justified maintaining heterosexual identity, often due to fear of discrimination and stigma and little or no social support. H-MSM compartmentalize sexual behaviors as isolated events unrepresentative of their sexual identity. H-MSM further minimized same-sex behaviors to infrequent, recreational/sport, or economic coincidences with little partner communication regarding HIV and sexual health. Many H-MSM would depersonalize male sex partners, deny same-sex attraction, and avoid gay-identified venues. Reviewed articles further reported H-MSM had negative emotional responses to sex with men (e.g., guilt, shame, disgust, unclean). Findings also suggest H-MSM are mislabelled in sexual health screening. The proportion of H-MSM in large, mixed samples supports estimates that H-MSM may comprise ~8% of North America’s sexually active male population.

Conclusion: H-MSM are unlike other heterosexual men and other MSM, and require unique considerations and approaches to sexual and mental health care. This presentation will discuss implications for Canadian HIV prevention research and practice with H-MSM.

Background: People living with HIV and people with disabilities face barriers to employment, health, social services, and community inclusion. Healthcare professionals who diagnose and treat HIV across Canada have few resources to support their care of people living with HIV who also live with disabilities.

Methods: Realize conducted the first national scan of HIV prevention, testing, treatment, and care resources, programs and/or services in Canada that support people living with HIV who also live with disabilities. A preliminary search identified community-based HIV organizations (CBHO) and disability service organizations (DSO) across Canada. Keyword searches were conducted and documented on each organization’s website (terms included: disabilit*, access*, HIV, AIDS, sex, sexual health) to identify programming or resources. Access points for people who are visually impaired and/or D/deaf or hard of hearing were also tracked. To augment the scan, ten key-informant interviews were conducted with stakeholders in HIV and disability communities, notes were taken.

Findings: 150 CBHO and 130 DSO were identified in a preliminary search. Based on inclusion criteria, the websites of 137 CBHO and 92 DSO were examined in more detail. Nearly three quarters (72.5%, n=99) of CBHO sites did not mention disability, 20% (n= 27) included accessibility information. Similarly, 75% (n=69) of DSO websites did not address HIV/AIDS or sexual/reproductive health. DSO focused on support for adults, or those with physical disabilities (13%, n=12) were more likely to include sexual health information. Key themes identified were: 1) linkage to HIV-related resources from the disability community is rare; 2) access to sexual/reproductive health information is limited, including on government websites where it is housed under 2SLGBTQIA+ programs, but not disability programs.

Recommendations: Meaningful, on-going consultation with HIV and Disability communities would increase access to comprehensive sexual education for people of all abilities, and builds the evidence base on HIV and disability.

Background. Culturally safe and racially inclusive primary care spaces (PCS) can be trusted sources of information on HIV prevention among heterosexual Black men (HBM). Yet in Ontario, HBM including the Black population accounts for 25% of new HIV cases annually. Hence, we estimated the effects of access to PCS on HIV vulnerability (HV) among HBM in Ontario.

Methods. The analysis is based on quantitative datasets from a mixed methods study (2016 -2021). The effective sample size was 866 from four cities in Ontario: Ottawa (n=210), Toronto (n=343), London (n= 157), and Windsor (n=156). We calculated HV as aggregate scores (Maximum =90) from four sub-scales; i) HIV misconceptions (items =18, α = .69 ii) negative condom attitudes (items =9, α =.64), iii) lacked support (items=4, α = .93) iv) discrimination (items=5, α =.88). We measured PCS with linkage to a family doctor or a nurse practitioner/consultation visit in the previous year. We determined the association of HV with PCS in hierarchical linear regression model (Adjusted R2 =.20, F = 10.01, p<.001). We adjusted for sociodemographic and psychosocial variables selected by a stepwise and forward method.

Results. Mean HV was 55.89 (SD =10.6), and the difference in HV across the four cities HV was not significant. Access to Primary Care correlated with reduced HIV vulnerability (β= -4.6, p<.001, CI= -6, -3.2). Also, the following control variables correlated with reduced HV: born in Canada, 60 years of age or older, greater than elementary school education, and delayed sexual debut. Hegemonic masculinity HBM correlated with increased HV.

Conclusion. Access to primary care can reduce HIV vulnerabilities among HBM in Ontario. Interventions promoting Black men’s linkage to family physicians and nurse practitioners should be prioritized. Strengthening the cultural competence of primary care professionals would better serve the HIV care needs of HBM and their communities.

Objective: Deliver accredited STBBI continuing medical education to enhance the ability of healthcare providers (HCPs) to treat and prevent HIV, Hepatitis C (HCV), and syphilis in response to Saskatchewan leading the country with record high incidence rates.

Approach:
Between September and November 2022, the STBBI Treatment Education Program for Saskatchewan (STEPS) delivered a series of 7 live virtual presentations (1 HCV, 2 syphilis, 4 HIV). Presentations featured local medical experts who discussed clinical treatment, highlighted provincial resources, and provided an opportunity to ask questions. Recordings were provided to all registrants. Physicians and nurse practitioners who participated could request to be added as a Designated HIV and/or HCV Treatment Prescriber for Saskatchewan.

Methods: Registration data collected learners’ professions, locations, and number of patients seen in the last 12 months with the STBBI being discussed. Program data tracked live attendance and the number of presentations each learner registered for.

Results: In total, STEPS received 1454 registrations across 434 unique HCP learners with varying experience treating STBBIs. 98% (426/434) of registrants were from Saskatchewan, with the program reaching HCPs in over 56 communities across the province. On average, participants registered for 3 of the 7 presentations. The 687 live attendees across the 7 presentations showed engagement of 297 unique learners. Live participation for individual presentations ranged from 76% (136/179) to 34% (76/219). 24% (53/219) of the HIV series registrants attended all 4 HIV presentations live. STEPS enrolled 9 new HIV and 5 new HCV Designated Treatment Prescribers for Saskatchewan during this period.

Conclusion: There is a demand for live virtual STBBI Medical Education by HCPs in Saskatchewan. The range of communities and experience alongside the number of attending and returning learners suggests that this program is able to achieve access, reach and engagement towards meeting the STBBI educational needs of HCPs.

Background: Our academic-community partnership aims to reinvigorate current HIV prevention efforts by examining social structural determinants of health based on reflections, actions, and experiences of a diverse disprivileged community of sub-Saharan African women living with HIV in British Columbia, Canada. We describe the core process attributes we observed in our
community-based participatory photography project with this population.

Methods: Using a community-based approach, we engaged and recruited our photo-voice participants (11 cisgender women, 1 trans woman), who had a mean age of 49 years, had been living with HIV for an average of 14 years, and migrated from the sub-Saharan African region. Using a hybrid group-based setting employing cultural values of meal sharing, we explored participants' social structural determinants of health. During each of the six group discussions, the participants took and shared photographs. Our research team reflected on the process of conducting this study.

Results: Three core attributes stood out. First, the relational approach between researcher(s) and participants enhanced power equity through shared process control
during data collection. Our two community peer researchers were critical for recruitment
success, facilitation, and translation. Second, each phase in the data collection process allowed for flexible, individualized consent. This was necessary given participants’ numerous job and life obligations created challenge for scheduling and on-going participation challenging our research work. Third, the iterative nature of photo voice process, including multiple sessions of taking and sharing photos, strengthened and bridged the capacity of the participants and researchers, and created opportunity for participant self-determination and empowerment.

Conclusions: Culturally responsive arts-based photo-voice methodology reflects principles of community-based participatory research. Applying community-based research principles with participatory photographic visual methodologies provide an opportunity that promoted participants and researchers’ growth and change.

Objective: Despite high levels of mental health conditions and gendered social and systemic inequities among people living with HIV (PLWH), there is a notable scarcity of studies focusing on the barriers to mental health service access among PLWH, and even fewer with women living with HIV (WLWH). This study, therefore, examined the prevalence and social and structural factors associated with being unable to access mental healthcare services among WLWH in Metro Vancouver, Canada.

Methods: Data were drawn from the Sexual Health & HIV/AIDS: Longitudinal Women’s Needs Assessment (SHAWNA) study, an open longitudinal community-based research project with WLWH in Metro Vancouver (2014-present). Our primary outcome variable was unmet needs for mental health services (reporting “being unable to access mental healthcare when needing these services, in the last six months”). Bivariate and multivariable logistic regression using generalized estimation equations were used to examine the associations between social and structural factors and the unmet needs for mental health services. Adjusted odds ratios (AOR) and 95% confidence intervals (CI) were reported.

Results: Among the 281 WLWH included in the study sample, there were 1249 observations over 4 years (2015-2019). Of the study sample, 56.6% were Indigenous participants, 34.5% were White and 8.9% were African, Black, South Asian, or other racialized/women of colour, and 6.8% reported transgender identity. Gender-based physical and/or sexual violence (AOR=2.25; CI=1.46-3.45), HIV-related stigma (AOR=1.07, CI=1.04-1.10), and barriers to primary healthcare access (AOR=1.68, CI=1.11-2.55), all in the last six months, were significantly associated with unmet needs for mental health services.

Conclusion: Addressing intersecting mental health and HIV stigma in primary care could help support safe disclosures of mental health conditions and facilitate referrals to care. Long-term, sustainable strategies to address ongoing shortages of primary care and affordable, trauma-informed mental health care services among WLWH in BC and nationally are needed.

BACKGROUND: The APPROACH 2.0 study will implement testing for HIV, Hepatitis C and Syphilis in pharmacies in 3 provinces. The goal: to implement a sustainable, scalable Pharmacy-based STBBI Testing Model (PbSTM) to increase testing, find new diagnoses and link people with care.
Purpose: To describe our planning process for the implementation of the PbSTM.

METHODS: We used the Implementation Research Logic Model (IRLM) as an organizing tool to identify multi-faceted, complex and contextual connections influencing the PbSTM. Key determinants included characteristics of the intervention, inner setting (pharmacy) and outer setting (healthcare system and community), individual characteristics (pharmacist and patient), processes, and intervention features. Implementation outcomes were then defined for intervention, service and clinical outcomes; followed by stating Implementation strategies and related Mechanisms of change to counter barriers (-) and complement facilitators (+).

RESULTS: Figure 1 depicts the logic model describing the PbSTM. Implementation strategies were colour-coded to describe related determinants and intervention strategies. Mechanisms were postulated based on our intent for use of each strategy and will be examined further at the end of the study.

CONCLUSION: The PbSTM is a complex intervention that will bel integrated into existing healthcare and community systems. This planning process will facilitate examination of strategies to determine which were effective, critical, or unnecessary to inform how the PbSTM can be scaled elsewhere.

Background: Trans women with HIV often face barriers, such as stigma, discrimination, and providers’ lack of appropriate training, to accessing inclusive and comprehensive primary and HIV care. We aimed to: (1) describe differences in trans women’s disclosure of their trans identity to family physicians vs. HIV physicians, (2) compare trans women’s comfort discussing trans-specific health care needs with family physicians vs. HIV physicians, and (3) report prevalence of negative trans-specific experiences with HIV physicians.

Methods: Data of trans women with HIV in the Canadian HIV Women’s Sexual and Reproductive Health Cohort Study (CHIWOS) were analyzed across three waves (2013-2018). Descriptive statistics were used to explore disclosure of trans identity and comfort discussing trans-specific health care needs with family physicians vs. HIV physicians. The prevalence of reported negative experiences with HIV physicians was measured through the question: “Has your HIV doctor ever…?”, where participants could select from a list of potential experiences.

Results: At baseline, of 54 trans women, 39 (72.2%) had a primary HIV care physician, 94.9% of those had disclosed their trans identity, and 82.1% were comfortable discussing trans-specific health care needs with this physician. Of the 27 (50.0%) who reported having a regular family physician other than their HIV care provider, 92.6% had disclosed their trans identity and 88.9% were comfortable discussing trans-specific health care needs. The most common negative trans-specific experiences with HIV physicians at baseline were being told by the HIV physician that they did not know enough about trans-related care to provide care (12.8%) and that the HIV physician thought the gender listed on their ID/forms was a mistake (10.3%).

Conclusion: Our findings suggest trans women have similar comfort discussing trans-specific health care needs with their family and HIV physicians; however, reported negative experiences indicate the need for gender-affirming, trans-specific training for HIV care providers.

Background: Although up to 25-50% of people living with HIV will develop neurocognitive impairments during their lifetime and many people living with HIV are concerned about their neurocognitive wellbeing, there are limited resources, clinical or otherwise, for those with neurocognitive concerns who are living with HIV. HEADSUP!2 is a community-based research (CBR) study which aims to a) better understand the experiences of people living with HIV when navigating care services for neurocognitive difficulties/concerns, including HIV-Associated Neurological Disorders (HAND) and b) describe the professional experience of health care providers serving people living with HIV. In this analysis, we focus on the day-to-day experiences and service seeking/usage of people living with HIV and neurocognitive concerns.
Methods: Using a CBR approach with involvement of a peer team at all stages, people living with HIV and experiencing neurocognitive concerns in Vancouver, Montreal, and Toronto, were recruited through community networks to participate in a qualitative interview. Interview transcripts were analyzed using a team approach for themes related to their day-to-day experiences and experiences with health services.
Results: 20 diverse people living with HIV participated in qualitative interviews in French or English. Themes (and subthemes) included the impact of neurocognitive health concerns (social, occupational), self-management of neurocognitive impairments/symptoms (coping, cognitive strategies, occupational strategies), clinical presentation for health services (triaging of health issues, aging), and experiences of clinical management of neurocognitive impairments/concerns (clinical care, self-advocacy, accessibility).
Conclusion: This study highlights the challenges and resilience of people living with HIV who experience neurocognitive challenges in their daily life, as well as when considering and seeking health care and support services. These findings can be used to develop resources for people living with HIV and neurocognitive concerns, improve awareness among health care professionals about HIV neurocognitive issues and HAND, and improve neurocognitive services for people living with HIV.

Background: The effects of Covid-19 on health system services for northern First Nation people living with HIV have not been described. First Nation people in Manitoba, Canada with lived HIV experience have challenges for living well with HIV. We hypothesized that the Covid-19 public health orders would have unanticipated impacts for people with lived experience.

Methods: Health care providers and people with lived experience were recruited and enrolled with informed consent and interviewed virtually using a semi-structured questionnaire. Qualitative data were analyzed through thematic analysis.

Results: Three key overarching themes that emerged from analysis of the data: 1) disruptions to the health care (cascade of care) process; 2) disruption to overall well-being due to intersectional stigma; and 3) innovative ways to provide care.

Conclusions: A key finding was that the cancellation of in-person programs and services during the Covid-19 lockdown impacted important relationships established between health care providers and people with lived experience. Lessons learned from the Covid-19 pandemic can be used to improve the health system HIV cascade of care for First Nations people with lived experience and others living in rural and remote regions.

Sexually transmitted blood borne infections and HIV new infections are increasing as a consequence of syndemics driven by structural and social barriers. COVID pandemic public health precautions created additional barriers for HIV testing, care and for assessing existing HIV programs, interventions and knowledge sharing. It also brought opportunities for implementing change.

Community readiness assessment is a method of community change that integrates the community’s culture, resources and level of readiness to more effectively address an issue. It can bring the community together, build cooperation and increase the capacity for prevention, intervention and knowledge sharing. In northern Manitoba, First Nation communities identified the need for change with regards to HIV testing, linkage to care and for living with HIV. However, not all programs, interventions and/or knowledge sharing methods are appropriate for every First Nation community. The Canadian Aboriginal Aids Networks (formerly Canadian Aboriginal Alliances Networks) (CAAN) worked to create change in response to the rising rates of HIV with a community readiness assessment manual (2012). Our multidisciplinary, community-based research team piloted the manual with a Northern community and have now created a self-directed workbook building on the previous CAAN work.

Effective change needs to be culturally informed and respect First Nation communities’ own strengths and existing efforts for HIV testing, treatment and care. We created a step-by-step workbook that easy to follow and is available digitally and in hard copies for First Nation communities. An Indigenous graphic design company made it functional and visually appealing. They chose design elements including the wolf (qualities of teamwork/kinship, protection, endurance), scenes from northern Manitoba and stylized maps to represent the HIV journey in Manitoba. This presentation describes how the workbook can be used by small community groups to ask questions, gain insights and strategize next steps for responding to HIV.

HIV stigma is still pervasive in Canada, undermining HIV treatment and efforts as well as negatively impacting the health and wellbeing of people living with HIV. However, less is known about how social determinants of health drive levels of different types of stigma, especially in Atlantic Canada. This study aims to quantitatively examine how these social determinants impact rates of internalized, enacted, and anticipated stigma in a sample of people with HIV from across Atlantic Canada.

Peer research associates recruited 81 people living with HIV from across Atlantic Canada (mean age=40 years, 68%male) to complete the People Living with HIV Stigma Index – a global survey tool developed by and for people with HIV to measure nuanced changes in different forms of stigma. Bivariate binary logistics regression was used to examine the impact of social determinants of health (key population, gender, sexual orientation, ethnicity, education, employment, basic needs) on rates of internalized, enacted, and anticipated stigma.

Rates of significant stigma were high in our sample with internalized stigma at 58% and enacted and anticipated stigma at 84% and 85%, respectively. Bivariate binary logistic regression showed that the African/Caribbean/Black participants had significantly greater internalized stigma (OR=15.8, p<0.01) and anticipated stigma (OR=15.9, p=0.01) than the Caucasian reference group. Those who lacked basic needs had significantly greater enacted stigma (OR=21.5, p<0.01) and anticipated stigma (OR=8.1, p=0.01) than those whose basic needs were met.

There is a high rate and burden of HIV stigma experienced by people living with HIV in Atlantic Canada that significantly affects their health and wellbeing, particularly in those who identify as African, Caribbean, or Black, and those who have challenges with basic needs such as housing and food security. Targeted anti-stigma interventions are critically needed that consider the contexts of poverty and an anti-racism framework.

Digital health technologies can improve access to HIV testing; however, evidence on effectiveness and scalability in real-world settings is limited. This national study, the first of its kind in Canada, aims to assess the impact of I'm Ready, Test, a digital health app that provides access to free HIV self-test kits and care pathways, and examine the faciliators and barriers to HIV self-testing (HIVST) that participants encounter. A total of 7,221 active participants completed a pre-test survey via the I'm Ready, Test app between June 2021 to December 2022. Of these participants, 1,269 completed an optional post-test survey after uploading a test result to the app. These surveys were designed to collect participant demographics, the perceived benefits of the app, and the barriers to HIVST such as healthcare access and COVID-19 restrictions. Participants listed the greatest benefit of using the I'm Ready, Test app as its privacy (73%) and convenience (77%); however, the main drawback was a lack of knowledge of what to do with the HIV test result (11%). Despite the availability of the HIV self-tests, 34% of participants still reported feeling uncomfortable discussing HIV testing results with their healthcare providers. Many participants also reported not having access to a primary care provider (24%) or community health clinic (13%). Participants in rural areas reported a greater benefit from using the app due to difficulties in accessing healthcare services than those in urban areas (p<0.05). Additionally, 57% of participants who completed the pre-test survey reported reduced access to HIV testing due to the COVID-19 pandemic. These findings suggest that the I'm Ready, Test app is broadly acceptable, convenient and offers privacy in accessing HIV self-testing. Significant systemic barriers still exist in Canada for health care provider access and support when people test for HIV and their connections to care.

Context: Doing Indigenous re-search in a good way honours Indigenous Women living with HIV as more than just re-search participants or numbers.
Background: The Canadian HIV Women’s Sexual and Reproductive Health Cohort Study (CHIWOS) collected data from 1,422 women living with HIV/AIDS across Canada between 2013-2018 to better understand the role of Women-Centered HIV Care in the uptake of HIV services and care. Of the 1,422 women, 315 of them identified as Indigenous. As this re-search was grounded in the principles of Community-Based Research (CBR – participatory research that is driven by and equitably involves community members at all phases of the process and contributes to positive changes), Indigenous Community Researchers (ICRs) were responsible for collecting all data from the Indigenous Women who took part in CHIWOS. This re-search journey is not over…the ICRs have been working with the data for over a year to honour the wisdom and stories behind the numbers.
Discussion: Epidemiological research with Indigenous Peoples recognizes that behind (and within) each statistic and each number, there is a lived reality, a story to be shared.
Lessons Learned: This re-search journey of gathering Indigenous Women’s stories and wisdoms has been a long and enriching one. Grounded in Indigenous Ways of Knowing and Doing (IWKD), ICRs worked closely with allied researchers to analyze the Indigenous Women’s data from CHIWOS and story the data. Using quotes from Indigenous Women living with HIV/AIDS who contributed to CHIWOS, and linking these to the numbers, stories have emerged that are now being shared with the broader community through the ICRs. This is how re-search, and more specifically knowledge translation can truly honor the people who take part in re-search. When re-search data concerning Indigenous women is analyzed and shared from their perspective, we truly honour the stories and wisdoms within the numbers.

Background: The Covid-19 pandemic changed the method and delivery of HIV care services. Many care services switched to virtual or telephone format, and some support services disappeared altogether. African, Caribbean, and Black women living with HIV (ACB WLWH) face structural barriers to accessing, utilizing and affording HIV care services and the addition of virtual services further decreased the motivation to engage for many. 
Methods: Purposive and snowballing techniques were used to recruit participants from women’s health facilities, HIV and ACB organizations in British Columbia, who were 16 and older, identified as ACB WLWH, and diagnosed with HIV at least 3 months before the COVID-19 outbreak in January 2020. We conducted a descriptive, qualitative study using in-depth interviews. Data was analyzed using a thematic content analysis and validated by participants at a member checking event. 
Results: Barriers to accessing HIV care services primarily pertained to the alienated virtual delivery of care services. Barriers to utilization of HIV care services were reports
of feeling dismissed, and/or symptom stigmatization by providers. Facilitators of HIV care utilization were improved medication delivery systems. The affordability of HIV care
services was not impacted by the pandemic. However, the impact of inflation and increased cost of living negatively influenced participants and their ability to engage with
HIV services. Participants listed fear as the primary deterrent to their motivation to seek care. 
Conclusion: Participants indicated that access to care can be improved through increased funding and availability of support groups. Hybrid models of care were cited as improving utilization for those who preferred in-person care services. Affordability of
care services can be improved by providing extended coverage for supplements and related health expenses. Thus, improving the barriers to accessing, utilizing, and affording HIV care services will reasonably improve motivation to engage with HIV care services.

Background: Making It Work is an Indigenous-focused, community-based research project that utilizes an Indigenized ‘realist evaluation’ approach. The study aims to understand why, when, how, and for whom community-based services work well for people living with HIV, hepatitis C, and/or challenges with mental health and/or substance use, with a particular focus on case management and community development programs/services using Indigenous service delivery models. The study has used qualitative methods (interviews and virtual focus groups with service users and providers, and team discussions) to develop a program theory. The purpose of this component was to develop a survey to build and confirm our program theory.

Methods: The realist evaluation approach recommends using multi-method data collection. Thus, our study team decided to develop and use a survey instrument to more systematically ask service users and providers about service provision, while being mindful of Indigenous research methodologies. We explored the literature to determine if there were examples of similar realist evaluation survey design that engaged Indigenous methodologies, and worked as a team to develop a survey.

Results: The literature review indicated that we were working in new methodological territory. Our team discussed what needed to be included in the survey in relation to our program theory, drawing upon Indigenous ways of knowing. Through drafts, discussions of competing methods concerns, and pre-testing among team members, the final online survey tool included narrated stories and images for participants to reflect on. Survey results provide additional insights into the ways participants engaged with the survey tool.

Discussion: Our survey was designed to answer realist evaluation questions and work within an Indigenous way of Knowing and Doing. Tensions between survey methods and Indigenous methodologies were reconciled to some degree through incorporation of narrative and interactive elements.

Background: People living with HIV (PLWH) who use drugs in harmful amounts, types and/or modes of consumption experience barriers to accessing hospital healthcare services. A lack of equity experienced by PLWH who use drugs when admitted to hospital directly influences treatment engagement/retention. Hospital healthcare providers (HPs) can shape the experiences of PLWH who use drugs by virtue of direct practice. However, little discussion in the research literature articulates the self-reported experiences of PLWH who use drugs specific to their time spent in hospital. Methods: Semi-structured interviews were conducted with participants in Toronto and Ottawa, Canada, who: i) self-reported HIV ii) had a hospital admission in the past year; and iii) used drugs at time of admission. A structuration theory-guided thematic analysis was used to understand the beliefs and practices identified by participants that affect their hospital admission experience. Results: Participants (n=22) identified two sets of rules that influence their hospital admission; personal rules (“i.e., “my rules”) used for navigating the admission, and hospital rules (i.e., “their rules”). Participants indicated that the HPs’ use of a constructed difficult patient identity shaped their experiences while admitted to hospital and further reinforced their need to rely on personal rules to navigate their admission. Conclusion: Healthcare equity is not possible when all people are treated the same; social practices occurring during a hospital admission privilege some (e.g., HPs) and not others (e.g., PLWH who use drugs) and will continue to dictate the hospital admission experience of PLWH who use drugs. Hospitalized PLWH who use drugs are expected, by virtue of the experience of “their rules", to change their actions, but that change sits within a belief of abstinence on the part of HPs. Barriers experienced by PLWH who use drugs limit the degree to which they can implement self-identified positive changes while hospitalized.

PURPOSE:The Short-Form HIV Disability Questionnaire (SF-HDQ) measures the presence, severity and episodic nature of health challenges among adults living with HIV. Our aim was to assess the sensibility, utility and implementation considerations of the SF-HDQ in community-based settings.

METHODS:We conducted a mixed methods study with adults living with HIV and community health providers at seven community sites across Canada (5 community-based organizations and 2 community health centres). We electronically administered the 35-item SF-HDQ followed by a sensibility questionnaire (face and content validity, ease of usage, format) and conducted semi-structured interviews to explore potential utility and implementation in community settings. The SF-HDQ was considered sensible if median scores on the sensibility questionnaire were ≥5/7 for adults living with HIV and ≥4/7 for community health providers for ≥80% of the items. Interview data were analyzed using a team-based content analysis.

RESULTS:Median sensibility scores were ≥5 for adults living with HIV(n=44) for 95% of items (18/19 items) and ≥4 for community providers(n=10) for 100% of items. Interview data indicated that the SF-HDQ is comprehensive, represented the health-related challenges (disability) living with HIV; captured the episodic nature of disability; and was easy to complete. Community potential utility of the SF-HDQ included i) facilitating communication and fostering engagement with community; ii) taking a snap shot of disability and tracking changes over time; iii) guiding referrals to services and supports; and iv) informing community organization programs and planning. Implementation considerations included the importance of person-centered approaches for tailoring the mode of administration, offering flexibility for administration, mitigating burden of administration, the importance of community buy-in to utilize the tool, and communicating scores based on personal preferences among persons living with HIV and community providers.

CONCLUSION:The SF-HDQ possesses sensibility and utility for use in community-based settings with adults living with HIV and community health providers in Canada.

Background: In 2017, the World Health Organization released the Global Consolidated Guideline on Sexual and Reproductive Health and Rights (SRHR) of Women Living with HIV (WLWH), challenging countries to develop national action plans by centering women, gender equity, and human rights in evidence-based recommendations and best practice guidelines.

A Canadian community-academic partnership team (WLWH, researchers, service providers, policy-makers, clinicians) engaged in a four-year process identifying priorities for a national action plan to advance the SRHR of WLWH. Efforts included a national webinar series, World Café event at CAHR 2018, and online consultation, leading to a publication detailing five key recommendations with suggestions for implementation.

Here we share our co-creation and implementation of a Knowledge Mobilization (KM) strategy to support uptake of the recommendations into policy, programming, and research across Canada.

Methods: Key activities of the KM strategy through 2022 included:
● April-Nov: Developing a printable poster and implementation booklet to support organizations’ implementation.
● Jul-Dec: Compiling a nation-wide list of stakeholders in the SRHR of WLWH.
● Sept-Dec: Creating a website including a public endorsement of and commitment to the recommendations for stakeholders to sign.
● Dec 1-Ongoing: Launching an email/social media campaign sharing the recommendations and an invitation to sign the endorsement.

Results: In month one, 245 organizations were contacted through email, the website had 292 visits, and tweets had 1,662 views (9% engagement rate). Fifteen organizations and 24 individuals signed the endorsement, including leaders in HIV service, clinical provision, and research. Notably missing are government organizations, funders, and non-HIV-specialized service and clinical providers.

Discussion: Next steps include developing additional community-facing KM products, continued outreach to potential signees, and convening stakeholders at a CAHR 2023 ancillary event to co-create an accountability plan for signees. Ongoing action and commitment are needed to tangibly advance the SRHR of WLWH in Canada.

In the winter of 2022, we gathered a group of 9 Black women working in the health and social service sectors to create cellphilms that share what it has been like navigating the triple pandemics of HIV, COVID-19 and Racial Injustice. Cellphilms are short videos made on a mobile device in response to a research prompt. Following a participatory process, the participants’ cellphilms were edited into a composite video that highlighted the research process, findings and key recommendations. Using clips from the composite video and drawing on Activist Scholarship principles and Intersectionality theory, we share the key themes emerging from their work: Living through the Triple Pandemics as a Black person; Grief and Loss; Mental Health; Taking Care of others as you are struggling; Resistance and Self-Care. Finally, we examine the possibilities for transformational change that were afforded through the process of making our cellphilms, stitching them into a composite and sharing our work. We propose a framework of accountability, reflexivity and reciprocity throughout the process in order to build intentionality into knowledge mobilisation efforts. We conclude that cellphilm method is a highly impactful way to meaningfully engage Black women (and other groups experiencing oppression and marginalization) in community-based HIV research.

Background: In 2020, Health Canada approved the INSTI HIV self-test using finger-prick blood. Wide adoption and distribution of novel HIV testing interventions, like self-testing technologies, will be essential in meeting the UN 95-95-95 goals through early detection and treatment. Our objective was to explore the acceptability of HIV self-testing among sexual health service providers and gay, bisexual, queer, and other men who have sex with men (GBQM) in Ontario, Canada.
Methods: Between June 2020-December 2021, we conducted virtual focus groups and interviews with service providers (n=18) and diverse GBQM (n=39) across Ontario. Data was transcribed verbatim and analysed using NVivo following thematic analysis. Four peer researchers conducted recruitment, data collection, and analysis in consultation with the research team and a Community Advisory Board.
Results: Providers and GBQM reported strong support for HIV self-testing. The two groups identified: increased testing accessibility and more privacy and control for sexual health clients as benefits. Providers also identified lower administrative burden for clinics and client empowerment as other perceived benefits. Meanwhile, GBQM emphasized increased time convenience as key factor influencing their decision to self-test for HIV. However, some GBQM also expressed hesitancy for self-testing due to concerns regarding accuracy and reliability of results and fear of needles/blood. Providers and GBQM recognized these concerns for self-testing: missed connections to counselling, resources, and treatment and potential for self-harm/suicide ideation when receiving a positive result. Both groups suggested that first-time testers may be better suited for clinic-based testing compared to experienced testers who may benefit from self-testing. Participants expressed that self-tests should be widely available for free, or for a modest fee around $20.
Conclusion: HIV self-testing is acceptable among service providers and GBQM, particularly when self-administered by experienced testers. Clinic-based testing options remain important for many people, including first-time testers and GBQM with concerns regarding self-testing.

Background: The Community, Aboriginal, Relationships, Experiences (CARE) study is a CIHR-funded project which aims to explore the pathways and obstacles to care being experienced by a diverse group of Indigenous People living with HIV in British Columbia. There is a unique opportunity to share learnings from the CARE study regarding the application of the OCAP® Principles and Indigenous methodologies in applied HIV research.

Approach: Key learnings and teachings on the operationalization of OCAP® principles included the formation of ethical research guidelines, data stewardship agreements, and prioritizing Indigenous methodologies and community-engaged approaches. From the start, the CARE Steering Committee, inclusive of Elders, researchers, community experts, and health authority representatives, have consulted and guided the research team as formal collaborators and partners. In order to follow the Principles of OCAP® to collect and use the data in a good way, it was determined that the Steering Committee would be best suited to act as the governing body and data stewards for the study. A data stewardship agreement was established between Steering Committee members and the research team, focusing on relational accountability and engagement in culturally appropriate and reciprocal work. The stewardship agreement places the members of the Steering Committee as stewards of the collected data, advocating for participant’s data rights and guiding how the data will be collected, used and shared.

Potential impact: This strategy and approach have set a path to engage in respectful and reciprocal research involving Indigenous People by applying the Principles of OCAP® in a unique way.

Background: The Indigenous HIV Doula study explored the role of Indigenous doulas in HIV care cascade and system navigation in Manitoba, with a particular focus on increasing engagement among Indigenous women and 2SLGBTQIA+ people who are living with or at risk of HIV in HIV prevention, care, and treatment.

Method: Data were drawn from community-based participatory research (conducted in 2022) that focused on the role of Indigenous doulas in HIV care continuum in Manitoba. Participants (n=9) were recruited using word of mouth, peer networks, and a community agency serving Indigenous people (Ka Ni Kanichihk Inc). Data were analyzed using thematic analyses.

Results: Four key themes have emerged: 1) the role and function of HIV doulas, 2) benefits of HIV doula work, 3) knowledge and skills necessary to perform HIV doula work, 4) integration of HIV doula work within existing agencies. Interviews revealed the important role of doulas in HIV prevention and care, sexual health management, reproductive health, pregnancy and childbirth, service navigation, and Indigenous cultural practices that are essential to revitalizing the strong cultural connection and spiritual path for Indigenous women and 2SLGBTQIA+ people. Additional benefits of HIV doulas work included lessening of stigma surrounding HIV and culturally appropriate outreach. Respondents pointed out the need for all doulas to be trained in HIV prevention and care, system navigation/linkage to care, trauma-informed care, as well as strong communication skills. Participants also discussed ways that an HIV doula position can be integrated within existing community-based organizations that serve Indigenous people in Manitoba.

Conclusion: The findings highlight how HIV doulas can be an integral component of healthcare teams and HIV care continuum for Indigenous women and 2SLGBTQIA+ people living with or at risk of HIV. Future service implementation initiatives can focus on ways to scale-up the Indigenous HIV doula program in Manitoba.

Background: The Gigii-Bapiimin study examined the impacts of the COVID-19 pandemic on the health and wellbeing of First Nations, Inuit, and Métis people living with HIV in Manitoba and Saskatchewan.

Method: Data were drawn from community-based participatory research (conducted in 2021-2022) which was grounded in an Indigenized ethical space and Two-Eyed Seeing. Participants were recruited across Manitoba (n=24) and Saskatchewan (n=21) using flyers, community agencies, peers, and social media. Interviews focused on pandemic’s impacts on health and access to services and ceremony. Data were analyzed using inductive thematic analysis.

Results: Four key themes emerged: a) negative impacts on physical, emotional, spiritual, and mental health and wellbeing; b) restricted access to health services, HIV care, and harm reduction supports; c) reduced access to Indigenous ceremonies, land-based activities, and medicines, d) coping and resilience. Participants identified how socio-physical distancing, isolation, and loss of social and community supports deleteriously impacted them. Issues related to mental health, substance use, homelessness, and intimate partner violence have intensified during the pandemic. Impacts were compounded by exacerbated poverty and economic stress, distress over inadvertent disclosure of HIV status and experiences of anti-Indigenous racism in health and social care contexts. Participants also spoke of the ways they mitigated the negative impacts of the pandemic by relying on Indigenous knowledges, ceremonies, and resilience within their communities.

Conclusion: Service providers must be prepared to respond to the unique impacts of COVID-19 on Indigenous people living with HIV, and their access to health services, HIV care, harm reduction, and ceremony. Interventions to improve access to economic and social resources may also be required to improve this community’s health and wellbeing. Our findings call for building a more just public health and social service safety net that meets the needs of Indigenous people living with HIV at the intersection of multiple vulnerabilities.

Non-prescribed Anabolic/Androgenic Steroid (AAS) use among 2-Spirit, gay, bisexual, queer and other men who have sex with men (2SGBQ+) is a common and complex practice influenced by social and cultural norms within and outside of queer men's communities. AAS use among 2SGBQ+ men has also been linked to a range of health risk factors and outcomes, including illicit substance use, sexual risk taking practices and increases in ST/BBIs, including HIV. This presentation will focus on results from a qualitative study that explored the world of AAS use among 2SGBQ+ men in Manitoba with a specific focus on the harm reduction opportunities and challenges embedded within the culture of AAS use for this population. Concrete recommendations to implement harm reduction strategies will be shared for public health and social service providers.

Background: Very little is known about the protective factors, strengths, resiliencies, and coping strategies that supported Indigenous people living with HIV (IPHA) in Manitoba and Saskatchewan in managing and responding to the COVID-19 pandemic.

Method: Data were drawn from a community-based study (conducted in 2022) which focused on the health of IPHA during the COVID-19 pandemic. Interviews focused on resiliencies, protective factors, strengths, and coping strategies supported IPHA during the COVID-19 pandemic.

Results: Five key themes emerged: a) the value of social support from family, friends, peers, and networks; b) the positive role of service systems that remained operating during COVID-19; c) the importance of ceremony and spirituality in resilience; d) coping within the context of health inequities; and e) coping and COVID-19 restrictions. Participants shared many challenges that were prevalent during the COVID-19 pandemic, and the ways they coped. Indigenous worldviews of social networks and relationality were a focus of their stories, as well as the importance of prayer, ceremony (personal and communal) and traditional practices. Participants demonstrate resilience through methods of adapting to COVID-19 restrictions, which were barriers to IPHA service provision during this time, as well as through communal gathering and ceremony. The importance of services remaining available during the pandemic, and methods of coping through substances, harm-reduction methods and medical support are discussed.

Conclusion: The findings from this study countered the Western medical model that often creates a pathologizing picture of Indigenous health and supplemented a gap in knowledge concerning resilience among Indigenous people living with HIV in two Canadian provinces. Service providers who work with Indigenous people must not focus solely on challenges but understand resilience and coping strategies employed by Indigenous IPHA’s to inform services and remove barriers that create further inequity.

Background: Women living with HIV in British Columbia, and across Canada, deeply feel the loss of women-centred spaces for connection, peer support, and meaningful knowledge translation and exchange (KTE). We therefore developed a series of arts-based KTE events for women to share information on healthy aging research.
Methods: KTE is integral to the BCC3 study. Our KTE team includes women living with HIV, a provincial HIV/AIDS Service Organization (AIDS Vancouver), Community Research Associates (CRAs), trainees, and researchers. Events consisted of a lay-language presentation by a CRA about actionable research findings, brainstorming sessions around managing health in relation to the theme, an art activity, a shared meal, and a gift bag containing health-promoting items customized to the theme. To gauge their value and efficacy, participants were asked to complete evaluation forms.
Results: Four events have been held thus far, three in Vancouver and one in Prince George, with 14-19 attendees/event. Event themes included cortisol and stress management, menopause, and chronic pain. Each event used a different art medium, including canvas painting, body mapping, and stencil drawing on t-shirts and pillowcases. Thirty feedback forms were received from three events (response rate = 30/48, 62.5%)(Table 1). Participants emphasized the accessibility of the research presentations, facilitated through CRA leadership.
Conclusion: The positive reception and high attendance at these events aligns with national calls to action by women living with HIV to create women-centred spaces. Our results emphasize the value of such events for connection, art, and learning by and with women living with HIV.

Women’s stories are important lenses to understanding life with HIV, both in popular culture and academia, but they are often missed or mired in social stigma. Nationally, women make up almost ¼ of the population infected with HIV and this percentage is higher in certain communities. In response, a collective of women living with HIV collaborated in an arts-based workshop and presented a public art installation, entitled Poz Women Show Off, on the traditional and unceded territories of the Songhees, Esquimalt, and WSÁNEĆ peoples (colonially known as Victoria, British Columbia). We use the term women broadly since we are a group that includes and welcomes cisgender women, Two-Spirit individuals, trans people, and non-binary folks. Co-led by HIV activist/artist, Peggy Frank, and arts-based researcher, Dr. Leah Tidey, participating women explored various art forms as methods of self-expression and knowledge sharing relating to the impact of HIV on their lives. Artistic pieces from each collaborator were then curated into an interactive art installation open to the public, both in-person and online.

The installation and workshop built upon 21 women’s oral histories from the “HIV In My Day” Archive, a collaboration between academic researchers and community partners that has produced a digital archive of 117 oral history interviews conducted in B.C. with long-term survivors of HIV and their caregivers.

We invite conference attendees to participate in an arts-based, interactive workshop that shares a 10-minute video of women’s stories and art, and a group poem entitled HIV Taught Me To Fly, created by Charlene, Dawn, Denise, Kath, Kecia, Levi, Penny, and Peggy. Using a reflective process, we will then engage participants in creating their own group poem. Finally, as a group we will reflect on how the use of arts-based practices in sharing HIV research resonates on both a cognitive and emotional level.

A Narrative Inquiry into the Experiences Related to Pre-Exposure Prophylaxis (PrEP) Access Among Young Men Who Have Sex with Men (YMSM) in Canada
Young men who have sex with men (YMSM) in Canada and globally are disproportionately impacted by human immunodeficiency virus (HIV). Pre-exposure prophylaxis (PrEP) is an effective strategy for reducing transmission and acquisition of HIV infection among high-risk populations, including YMSM. However, there is low uptake of PrEP among Canadian YMSM. The purpose of this narrative inquiry study was to explore and understand the experiences of YMSM in Canada in relation to their PrEP access. In this research, I worked collaboratively with three Canadian YMSM between the ages of 21 and 24 over six months. With relational ethics at the center, the participants and I engaged in multiple conversations in person and virtually and collected field text and stories (data) that reflect time, place, and social contexts. The intensive and long-term researcher-participant relationships allowed us to compose and co-compose narrative accounts that reflected the participants’ unique stories, especially those that shaped their overall PrEP access experiences. Through the continuous retelling of the participant’s stories and by reflecting on and laying their narrative accounts side by side, I identified resonant threads that highlighted their experiences of accessing PrEP in relation to and in the context of life-making and identity-making. These narrative threads also illuminated and helped understand the different social, structural, behavioral, and clinical factors that influenced their experiences. The findings from this research can inform stakeholders and decision-makers responsible for advancing and promoting the sexual health of YMSM in Canada. The findings from this research can also advance practice guidelines and health policies that will improve PrEP access and potentially decrease the rate of new HIV infections among YMSM in Canada.

Background: Sexual orientation disclosure is a barrier to gay, bisexual and other men who have sex with men (gbMSM) accessing primary care. Our aim was to ascertain the acceptability interventions that could support disclosure to providers.

Methods: We conducted a cross-sectional survey in 2021 among Ontario gbMSM. We recruited participants (18+ years) from sexual networking applications and community-based organizations. For each of 10 interventions, we asked participants why they found it acceptable or unacceptable in open-ended textboxes. Two authors coded responses independently and used content analysis to generate types of responses (positive opinions, negative opinions, suggestions for implementation and unrelated) and themes. We report themes from the three most acceptable interventions.

Results: Of 404 gbMSM included, most were White (59%), gay (82%), and the mean age was 39 (SD=12) years. 118 unique codes were generated from 486 responses for all three interventions. The three most acceptable interventions were: 1) a directory of LGBTQ2S+ friendly providers, 2) continuing professional development with LGBTQ2S+ specific curricula, and 3) a program that increases LGBTQ2S+ visibility in clinics. The intervention with the most positive opinions was the resource directory (n=170) because participants believed it a) could address prejudice (n=12), b) could have adverted previous bad experiences (n=9), or c) encourages open discussion of healthcare needs (n=6). Although it was acceptable, there were negative opinions regarding LGBTQ2S+ visibility (n=12) because participants a) believed it is performative (n=2), b) thought it could deter closeted people (n=2), or c) were skeptical of the provider’s LGBTQ2S+ friendliness (n=2). Common implementation suggestions were ensuring the directory checked for providers’ competency (n=6), mandating LGBTQ2S+ provider education (n=10), and ensuring providers promoting LGBTQ2S+ visibility have specific competency (e.g., PrEP knowledge, n=3).

Conclusion: Future implementation of these interventions should incorporate gbMSM’s lived experiences to overcome potential barriers in seeking care and coming out.

Background: Manitoba reported increased HIV diagnoses and newly-diagnosed people not linked to care, with an overrepresentation of Persons Living with HIV (PLHIV) experiencing houselessness, substance use, and mental health conditions disproportionately affecting young women. This study aims to understand experiences, barriers, and facilitators to HIV care for PLHIV in Manitoba diagnosed between 2018-2021.

Methods: Informed by participatory action research, health equity, and the expertise of people with lived experience, this qualitative study draws upon in-depth semi-structured face-to-face interviews. We interviewed PLHIV who are and are not engaged in care to explore their experiences with HIV services, life changes due to Covid-19, trauma, and substance use.

Results: Most participants highlighted how trusting and empathetic relationships with HIV frontline care providers and family members were key facilitators in connecting with and continuing care. New immigrants appreciated HIV care providers facilitating their transition into HIV care in Manitoba, especially navigating start of care and paying for medications. PLHIV noted the importance of HIV care providers offering more options and accommodating to needs in maintaining medical appointments and medication adherence during COVID-19 service disruptions. Participants discussed various barriers to care, noting uncomfortable experiences with some healthcare providers at diagnosis and perceived stigma and discrimination in home communities that have negatively affected their care. Some PLHIV reported feeling isolated in their home communities as they cannot share their status due to fear of discrimination from community members. Participants voiced a desire for satellite HIV-specific services, universal ART coverage, and opportunities for connection and support with other PLHIV.

Conclusions: This is the first study exploring what facilitates/hinders care for PLHIV in Manitoba. Our results highlight the need to work with communities towards eliminating HIV-related stigma and discrimination in community and health care settings as well as to educate/expand primary care HIV services into community health settings.

Environ 1 personne canadienne sur 8 (12 %) vit sous le seuil de la pauvreté. Dans les communautés de personnes vivant avec le VIH (PVVIH), cette proportion passe de 12% à 45-65%, soit environ 1 PVVIH sur 2 . On considère ainsi que la pauvreté au Canada représente à la fois un facteur de risque d’acquisition du VIH et une conséquence de l’infection .

Le Portail VIH-sida du Québec s’est donné pour objectif de «décrire, comprendre et analyser l’expérience de la précarité financière touchant les PVVIH au Québec». Un comité de recherche constitué de personnes concernées par le VIH s’est rencontré dans le but d’établir les priorités de la recherche. Un guide d’entretien qualitatif exploratoire a été co-construit avec le comité et les participant.es de la recherche; les entrevues ont ensuite été codées et analysées afin de dégager l’ensemble des thèmes soulevés pendant les entretiens. Les analyses ont été soumises à la révision de l’équipe de recherche et de la communauté.

Nos analyses permettent de mieux comprendre les effets du VIH sur les activités et sur la participation sociale des personnes. Ces effets varient en nombre et en intensité tout au long de la vie d’une PVVIH; les personnes rencontrées remarquent toutefois que leur expérience de vie leur permet de mettre en place des stratégies qui atténuent leurs impacts sur la santé. Ce cheminement peut être plus ou moins long, selon le contexte de vie et les caractéristiques individuelles d’une personne.

Cet aspect «épisodique» de l’incapacité liée au VIH n’est cependant pas reconnu par nos systèmes provinciaux. Les approches ‘tout au rien’ des définitions de l’invalidité des programmes et des milieux d’emploi ne permettent pas une conciliation santé-activités réaliste pour les personnes. Le système tel qu’il existe plonge et maintien en conséquence des personnes déjà souffrantes dans la pauvreté.