Background: Sexual compulsivity (SC; distress about one’s sexual behaviours or urges) is associated with internalized homonegativity (IH), depressive symptoms, and greater risk for sexually transmitted infections (STIs) among gay, bisexual, and other men who have sex with men (GBM). However, social support may mitigate the effects of minority stressors on sexual risk-taking. We examine the association between SC and recent bacterial STI diagnosis, exploring the protective effects of social support on IH and SC scores over time.

Methods: Sexually active GBM were recruited in Montreal, Toronto, and Vancouver (Engage cohort study). This analysis uses data from 1- and 2-year follow-ups (n=1492) to explore the association of SC with recent (past 6 months) bacterial STI diagnosis, depression scores, and IH using linear and logistic regressions. We also examined the moderating effect of social support on the association between IH and SC. Analyses controlled for age, education, HIV status, and financial strain.

Results: Higher IH scores predicted higher SC scores, both directly and indirectly via depression scores, one year later (B=0.15, p<.01, 95%CI:0.06,0.23). This effect was buffered by higher levels of social support (p=.04, 95%CI:-0.05,-0.01) and mediated by depressive symptoms (95%CI:0.01,0.02). There was a significant association between SC scores and recent bacterial STI diagnosis (OR=1.77, p<.001).

Conclusion: Our work shows the importance of recognizing minority stress and other psychosocial factors that increase the risk for STIs among GBM. Interventions should aim to foster social support as a source of resilience as this may mitigate the impact of IH on outcomes like SC, ultimately reducing occurrence of bacterial STIs.

Background: Prompted by the significant harmful impacts to people living with HIV of Canada’s criminal law on HIV non-disclosure, the HIV Legal Network, in collaboration with the Women & HIV/AIDS Initiative (WHAI) and Communities, Alliances & Networks (CAAN), hosted a roundtable about alternative justice responses to HIV criminalization in June 2022. The objective was to gather cross-sector perspectives about whether an alternative justice approach is warranted or appropriate in situations of non-disclosure.

Objectives: Given the interaction between HIV criminalization, disclosure, and gender, including the risks of gender-based violence and gendered power dynamics, gender-centred considerations grounded our discussion. We focused on community-based justice alternatives and how we can foster collaboration between the HIV sector, the sexual assault and gender-based violence sector, and alternative justice organizations in this work.

Discussion: Since most alternative justice responses focus on repairing the harm caused by an individual and include holding people accountable for their actions, our discussion necessarily raised questions around applying the notions of “harms” or “wrongdoing” to HIV non-disclosure: is HIV non-disclosure a wrong or harm in and of itself? Or does it depend on the circumstances and characteristics of the involved parties? Is there still a role for community-based interventions to support people living with HIV and/or their partners around non-disclosure and if so, what forms would such interventions take?

Conclusion: The current state of HIV criminalization is untenable and fails to promote “justice” for anyone involved. Instead, the law exacerbates harms faced by women and gender-diverse people. As such, urgent action is needed to prevent these harms, including through law reform, culturally appropriate resources to support people living with HIV that recognize the many risks associated with disclosure, community-based responses to HIV non-disclosure in appropriate situations, and peer-led support services for Indigenous and racialized communities.

Contexte:
La stigmatisation persiste toujours en tant que facteur de stress profond dans la vie des PVVIH affectant de nombreux aspects de leur vie. Pour mieux comprendre les déterminants sociaux de la stigmatisation liée au VIH au Québec, une équipe intersectorielle en collaboration avec ReachNexus, a réalisé l’index de la stigmatisation des PVVIH.

Méthodologie:
En 2019, un questionnaire a été administré en face-à-face auprès de 281 PVVIH. Ces entretiens étaient conduits par 9 pairs associés de recherche, dans 8 régions du Québec. Cette étude s’intéresse à l’échelle de stigmatisation anticipée des maladies chroniques d’Earnshaw, c’est-à-dire un score prenant en compte la conscience d’attitudes sociales négatives, la peur de la discrimination et les sentiments de honte. Le score de stigmatisation anticipée a été comparée selon des données socio-démographiques et d’autres mesures de stigmatisation.

Résultats:
Le score moyen enregistré est de 2,7 (pour un score variant de 1 à 5). Un score plus élevé est associé au fait de s’identifier comme femme (2,9 contre 2,5, p=0,001), à la présence de dépression (de légère à sévère) (2,8 contre 2,3, p<0,001), à un score plus élevé de stigmatisation intériorisée (corrélation: 0,24, p<0,001) ou institutionnelle (0,15, p=0,014), à une expérience de discrimination en milieu de santé dans les 12 derniers mois (0,21, p<0,001) et à un manque actuelle d’interactions sociales positives (-0,27, p<0,001).

Conclusion :
Ces données mettent en lumière la relation existant entre l'anticipation d’un dévoilement du statut sérologique ayant des conséquences négatives avec notamment une faible estime de soi (stigmatisation intériorisée) et des symptômes de dépression. Cela réaffirme le besoin communautaire des PVVIH en termes de renforcement des capacités personnelles. De plus, l’appréhension de vivre de la discrimination ainsi que les discriminations avérées en milieu de santé mettent en évidence le besoin de formation du personnel de santé pour un accès plus inclusif.

Background
The practice of involving people living with HIV (PLWH) in care provision has gained increasing support, with Peer-roles beginning to be seen as a fundamental component of multi-disciplinary HIV care. We conducted a qualitative study (SHARE) to better understand the strategies which PLWH and their health care providers (HCPs) in British Columbia (BC) use to support care connection and address treatment disengagement.

Methods
PLWH who had experienced a recent HIV treatment interruption (≥3-months) were recruited through the STOP HIV/AIDS Program Evaluation (SHAPE) Study and through regional HIV programs. HCPs were recruited through regional HIV health programs. Academic and Peer Researchers co-conducted semi-structured phone interviews with HCPs and PLWH. The research team utilized participatory thematic analysis and emergent coding, guided by interpretive description.

Results
19 HCPs and 15 PLWH were interviewed between November 2020 to March 2022. Both cohorts emphasized the importance of Peer-engaged and community-rooted supports, which were seen as integral components of enhancing accessibility and creating supporting pathways to care. HCPs described Peers as the link that bridged the gap between the care system and the patient, with PLWH speaking to their importance in providing important community-rooted navigation supports. Participants touched on the value of Peers in relationship building and enriching cultural connections for individuals who had experienced treatment disengagement, in particular for those who were part of communities who experienced increased structural marginalization, such as newcomers, women, and Indigenous PLWH. Continuing challenges included community stigma, limiting some PLWH’s participation in Peer programs, and the lack of organizational support for Peer programs which contributed to the systematic under-valuation of their contributions.

Conclusion
Interviewees strongly affirmed the importance of Peers and community-rooted supports as critical components of successful care engagement. Greater involvement of PLWH in care connection and provision is needed to strengthen care continuity for PLWH in BC.

Disclosing an HIV-positive status during the course of interaction is not so straightforward and poses serious social and potentially legal consequences for those who are faced with the decision to disclose. Disclosing one’s HIV-positive status risks social exclusion, discrimination, and even physical violence. Alternatively, concealing one’s status, at the very least, threatens social solidarity and, at worst, risks criminalization for HIV non-disclosure. However, very little research has examined the specific interactional conditions wherein disclosure of one's HIV status (or its concealment) are occasioned and, equally, the role HIV-negative people play in creating those conditions.

This paper reports on findings from the HIV, Health, and Interaction Study, a qualitative study of mundane interactions recorded from approximately 65 everyday telephone calls and 20 minutes of face-to-face interactions involving people living with HIV. These interactions are unscripted and unprovoked by a researcher, and are instead reflections of the everyday interactions of people living with HIV.

This presentation reports on three main findings. First, one’s HIV positive or negative status can be made relevant (whether or not one discloses) in a host of mundane interactions. Second, HIV-negative people casually display their HIV-negative status, which is treated as taken-for-granted, during everyday conversations. Third, HIV-negative people inadvertently and perhaps unintentionally create social situations in which HIV-positive people must decide to disclose their HIV status. Such disclosures are often performed in such a way that mitigates the breach of normative assumptions about HIV but also reveals the experiences of oppression at the micro level of interaction.

This presentation takes up the call to understand the role that HIV-negative people play in creating the social conditions within which people living with HIV must live. Research should attend not only to the lived experiences of HIV-positive people, but also to the ways HIV-negative people shape those experiences.

In 2018, Canada was the first country that signed on to the global campaign for “Undetectable = Untransmittable” (U=U). Despite this, there has been limited research on U=U within a Canadian context and with key populations, such as racialized men who have sex with men. Thus, the current study’s objective was to identify significant factors impacting East and Southeast Asian men who have sex with men’s (AMSM) awareness and acceptance of U=U. Quantitative data was collected from May 2022 to July 2022 through an online survey that asked about sexual health and behaviour, perception of HIV risk, and knowledge and acceptance of U=U. Out of the 106 participants, 52.5% heard about U=U versus 47.5% who had not. Chi-square analysis revealed that AMSM who heard about U=U were more likely to have a family doctor and rated the effectiveness of PrEP and PEP more highly than AMSM who had not heard about U=U (p < .05). Similarly, U=U acceptance scores were significantly higher for AMSM who got tested for STIs more frequently within the last year and who rated PEP as highly effective compared to those who did not get tested for STIs and who rated PEP as not effective. Acceptance scores were also significantly higher for AMSM who pursued more information and were exposed to more information on U=U after initially hearing about it, and who identified as completely fluent in understanding English. These results suggest that accessibility to health services and sexual health information benefit in the awareness and acceptance of U=U, in addition to one's own self-driven research. Given that marginalized communities often face barriers to accessible services and information, future research should continue to explore U=U amongst other racialized groups and communities whose first language is not English.