Background: The Covid-19 pandemic added an additional layer of stigmatization for African, Caribbean and Black women living with human immunodeficiency virus (HIV) (ACB WLWH) in British Columbia (BC). ACB WLWH experience HIV-stigma, racism, sexism, and potentially transphobia on an ongoing basis. The isolation and fear produced during the Covid-19 pandemic intensified the experience of stigmatization for many ACB WLWH.
Methods: We conducted a qualitative descriptive study utilizing in-depth interviews with participants who identified as ACB, are 16 years old, were living with HIV for at least 3 months prior to the beginning of the Covid-19 pandemic and reside in BC. Participants were recruited through purposive and snowballing sampling methods from relevant women’s health, HIV and/or ACB organizations in BC. To ensure the trustworthiness of the findings, a member checking event was conducted. Data was analyzed using thematic content analysis.
Results: A total of 18 ACB WLWH were interviewed for the study. 95% of the participants identify as cisgender. The participants displayed diverse perspectives ranging from age 21-71 and living with HIV for 4-26 years. In alignment with current literature, all ACB WLWH identified frequent experiences of stigmatization on the basis of HIV status, race, sex, gender or risk of Covid-19 transmission. One participant explained her experience as a self-identified transgender ACB WLWH as overwhelming and isolating, she described experiences of discrimination even within her community related to her sex, gender and HIV status.
Conclusion: ACB WLWH consistently identified support groups and a strong social support network as key resources in minimizing the effect of intersecting stigma on their quality of life. However, the availability of support groups was a limiting factor for participants in rural areas. More research is needed to explore how support groups can be developed further and what other interventions may be helpful for ACB WLWH.

Background: Many Black and Indigenous Two-Spirit, gay, bisexual, and people who have sex with men (2SGBTQ+) face structural barriers in STBBI testing spaces. Their negative experiences in testing centers, and issues with access, are informed by systemic racism. Our objective was to understand what role systemic racism plays in shaping the way Black and Indigenous 2SGBTQ+ service users experience testing spaces in Ontario.
 
Methods: Between June 2020 to December 2021, we conducted semi-structured focus groups and in-depth interviews with Black and Indigenous 2SGBTQ+ service users (n=10) regarding their previous experiences of STBBI testing in Ontario. The interviews were transcribed verbatim and analyzed following reflexive thematic analysis using Nvivo. Recruitment, data collection, and data analysis were conducted by 4 peer researchers in consultation with a community advisory board.  
 
Results: Narrative accounts revealed multiple, intersecting STBBI testing barriers experienced by Black and Indigenous participants. Across accounts, Black and Indigenous 2SGBTQ+ participants identified the following barriers to STBBI testing: 1) Experiencing judgment and discomfort due to racism (e.g. microaggressions from service providers, invasive and inappropriate questions); 2) Lacking cultural community in testing spaces (e.g. lack of cultural symbolism and visible community members in testing spaces; 3) Barriers accessing testing centers and services (e.g., geographic dislocation, displacement, and denial of Indigenous status cards).
 
Conclusion: The negative accounts identified by Black and Indigenous 2SGBTQ+ service users, signals a need for changes to testing spaces in Ontario and across Canada, to be more inclusive of Black and Indigenous testers. An online testing service could serve as a viable intervention here, however, a change within the system itself is still imperative.

Background: The quality of life (QOL) of African, Caribbean and Black Women Living with HIV (ACB WLWH) is adversely impacted by barriers to care services, and intersecting stigmatization and marginalization. There is limited evidence on QOL for ACB WLWH based on 4 major domains (physical health, psychological and spiritual wellbeing, social and economic factors, and family health) and related facilitators and barriers.
Methods: Qualitative, descriptive study using semi-structured interview guides
Results: We interviewed 18 ACB women, within the ages 21-71, living with HIV for 4-26 years. Two-thirds identified as non-Canadian citizens and average income was $1861.8CAD. Regarding physical health, participants identified perceived health status, HIV illness burden, access to HIV medication, and time for personal activities as facilitators. While the deterrents were low energy, pain, COVID-19 misinformation and impact, and poor access to care. The facilitators in the psychological and spiritual domain were peace of mind, gratitude, improvements, and ability to worship in their own language. Psychological deterrents were self-doubt, anxiety, depression, isolation, spiritual fatigue and loss of spiritual community. Having funding, education, employment, and a supportive environment were some social and economic facilitators. Conversely, job loss, inflation and the pandemic negatively affected QOL. In the family domain, one participant identified family support and time spent with family as facilitators while loss of family and inability to travel home were deterrents.
Conclusion: Our findings reveal ACB WLWH’s perceptions of QOL, and their experiences of various facilitators and deterrents to it, particularly, during the pandemic.
Implication: Given their vulnerability, there is need to reinforce and deploy innovative interventions to improve QOL for ACB WLWH beyond somatic HIV care services. Government advocacy aimed at improving the psychological, spiritual, economic and family domains of QOL are critical, especially, funding policies and programs that support diversity, inclusion, and health-equity of racialized, stigmatized groups.

Background: Black women continue to be disproportionately impacted by the HIV epidemic in Canada. Public health research is beginning to implicate anti-black racism in such health disparities, particularly within the context of service access. The aim of this study was to understand how structural forms of racism influence Black women’s experiences of accessing HIV testing, antiretroviral therapy, and pre-exposure prophylaxis through services provided by hospitals, Toronto sexual health clinics, and private practices.

Method: In this qualitative study, recruitment and data collection took place between February 2021 - April 2022. Interviews were conducted with Black women who accessed services during the preceding 12 months (n=20,12 living with HIV). To construct a profile of structures, discourses, and knowledge systems organizing services, interviews with clinical, government, and community response leaders (n=10) were conducted alongside the collection of archival and policy documents (n=75). Interviews were transcribed verbatim and all texts were analyzed in NVivo software using a critical race narrative methodology.

Results: Four themes were identified: 1) Black women are at the periphery of HIV service infrastructure. Service networks are concentrated within downtown Toronto resulting in access disconnected from Black neighbourhoods and their social realities. 2) Standard constructs of HIV risk are racially stigmatizing. ‘HIV-endemic’ status characterizes Black women’s risk as natural and ‘foreign’, institutionalizing differential assessment and care. 3) Immigration status impacts service engagement. Connections to care via immigration pathways limited service awareness and treatment access for women living with HIV. 4) Preconceptions of Black women shaped the ‘clinical encounter’. Ignoring/minimizing treatment adherence difficulties and providers’ resistance to self-advocacy were experienced as racially motivated.

Conclusion: Structural racism impacts how Black women experience HIV services and their subsequent prevention and treatment decision-making. Critically thinking about the ways racism shapes Toronto’s service network can ensure Black women equitably access the interventions they want and need.

Background
Migrants living with HIV (MLWH) experience numerous barriers affecting their antiretroviral treatment initiation and time to viral undetectability. To improve these outcomes, rapid and cost-covered treatment upon linkage to care are recommended. However, quantitative evidence supporting such an approach to care is lacking. As such, we sought to examine the time-to-treatment and time-to-undetectability for MLWH enrolled in a program with free and rapid treatment initiation.

Methods
In January 2020, we initiated a 96-week prospective cohort study at a hospital-based clinic in Montreal, Canada. All patients received bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) free of charge and as soon as possible following care linkage. Median time to B/F/TAF initiation and viral undetectability from linkage to our clinic were calculated and compared between sub-groups via survival analysis (Kaplein-Meier and Cox regression with stratified bootstrapping).

Results
As of December 2022, data for 31/37 enrolled MLWH were available for analysis. Many participants are: men-who-have-sex-with-men (n=16, 52%); from Africa (n=14, 45%); and <39 years of age (n=17, 55%). Ten patients (32%) had insufficient health coverage (i.e., no health insurance or had insurance without coverage for HIV care and/or treatment). Median number of days to ART initiation was 0 (range: 0-42). Median number of days to viral undetectability was 60.5 (range: 0-379). Those with insufficient health coverage had a median of 30.5 days longer to reach undetectability (p=0.002).

Conclusion
Lack of health coverage was found to significantly delay time to viral undetectability. A potential reason for this is that those without coverage are not able to conduct blood tests at our clinic, and instead have to access other facilities that provide free tests. This process may have delayed time to receive results for non-covered patients, hindering efficient care management in our clinic. Thus, further research exploring the impact of administrative delays on reaching viral undetectability is necessary.

Background: Black Canadians are disproportionately affected by HIV infections and more likely to be aware of their seropositive status compared to other racialized groups. Low health and HIV literacy impact HIV prevention and treatment. This paper presents the result of a recent study which examined the HIV+ Black mothers' knowledge of vertical transmission (KVT) of HIV

Methods: We drew data from a mixed-method study of the sociocultural experiences of HIV+ Black mothers (aged 18-49years) in Ottawa-Canada (n=89), United States (n=201) and Nigeria (n=400) with sample size, N=690. We used response data from a set of survey questions assessing their KVT of HIV during: i) pregnancy; ii) delivery; and iii) breastfeeding. “Yes” response indicated knowledge while “No” or “Don’t Know” indicated misconceptions or no knowledge. Descriptive analysis and thematic analysis were used for the quantitative and qualitative data respectively.

Results: Majority (80 - 84%) of the mothers had KMCT but significant percentages did not think that HIV can be transmitted from mother to child during: i) pregnancy (Ottawa 38.7%, Miami 25.7%, and Port-Harcourt 12%); ii) childbirth (Ottawa 27.6%, Miami 32.3%, and Port-Harcourt 11.2%); and iii) breastfeeding (Ottawa 27.6%, Miami 19.6%, and Port-Harcourt 11.7%). Quotes from the IDIs indicates some levels of KMTCT: “.my children are safe because I did not breastfeed.”- Ottawa; “...I decided not to breastfeed because I didn’t want him to get the virus.”- Miami; and, “… you don't have to mix feed…, you have to strictly adhere to exclusive breastfeeding guidelines.”-Port Harcourt.
Conclusion: Although majority of the mothers had KVT, a significant percentage of them had misconceptions about modes of vertical transmission of HIV. Interventions are necessary to increase critical health literacy particularly among Black mothers in Canada and US where we found greater misconceptions about modes of vertical transmission of HIV.

Keywords: CHL, MTCT/vertical transmission, breast feeding