BACKGROUND: U=U is a public health strategy founded on solid scientific evidence that plays an important role in reducing HIV stigma. In 2019, Brazil's Ministry of Health declared that understandings about U=U impact HIV-related stigma, sexual and reproductive rights, linkage to health services, treatment adherence and HIV testing. Our study explored the implications and (mis)understandings of U=U on the health behavior and outcomes of gay and bisexual men living with HIV (GBMLWH) in southern Brazil.

METHODS: We analyzed data from in-depth, semi-structured interviews with 11 GBMLWH from May to September 2023 in two urban centers in southern Brazil. We conducted a thematic analysis to assess how knowledge and understandings of U=U impact their lives.

RESULTS: Our study identified three dominant themes in relation to U=U: physical and mental well-being, interpersonal relations with family and friends, and interpersonal relations with sexual and/or romantic partners. First, participants described how knowing they are undetectable cultivated feelings of tranquility and stability, which they contrasted to experiences of distress and anxiety before acquiring that knowledge. Secondly, while some participants described that people in general, and even themselves, were uncertain about HIV untransmissibility once one is living with the virus, some described how their interpersonal lives were positively impacted by U=U, including because these understandings had facilitated reconnections and disclosures about their serostatus to family and friends. Finally, many participants reported that their own knowledge about U=U opened new possibilities for having romantic and/or sexual relationships – experiences they contrasted with feelings of being “dirty” and "HIV vectors”.

CONCLUSION: U=U is pivotal to everyone living with or without HIV since it promotes HIV-stigma reduction and impact on PLWHA’s welfare. Our study highlights the importance of the awareness and comprehension of HIV non-transmissibility when people are on ART, which goes beyond the health target of becoming undetectable.

Introduction: For the sub-Saharan African women migrants living with HIV (SSAWMLH) in British Columbia, their knowledge of, and access to HIV prevention efforts, particularly Undetectable = Untransmittable (U=U) approaches are limited, impacting their daily life experiences, and generating inequities. Our objective was to explore the SSAWMLH’s experiences (knowledge and accessibility) of U=U.

Methods: This work relates to the findings generated from our larger community-based research study, Picturing Change, that explored social structural determinants of health of SSAWMLH in Canada. Applying an intersectionality lens, we used participant-generated photographic research methods of photovoice and photo-elicitation to carry out six photovoice focus group discussions and nine photo-elicitation semi-structured interviews over a seven-month period (December 2022 - June 2023). We analyzed participant images and verbatim transcripts using NVivo.

Results: With a mean age of 50 years (range 34-65 years), our 12 SSAWMLH participants are women (cis and transgender) members of a disprivileged community organization, Afro-Canadian Positive Network of BC. We identified five sub-themes concerning U=U. They include i) knowledge and awareness of U=U; ii) untruths about U=U; iii) immigration; iv) HIV non-disclosure laws; and v) impact of U=U on shame, stigma, pressure to take medications, pressure to maintain undetectable viral load, and mental health. We found that current U=U messaging, and other HIV prevention efforts, are primarily unknown and underutilized among this group.

Conclusion: For an optimal response to end HIV there is need to focus on culturally safe research programs and evidence-informed health promotion to equip these women’s individual agency regarding their health. Empowering these women will enable them to be community peer researchers and knowledge mobilizers within their community structures. While this may ameliorate the impacts of inequities, multilevel interventions are needed to address underlying issues of social structural determinants of health, particularly for new immigrants and hard to reach members.

In 2016, the Prevention Access Campaign launched the Undetectable equals Untransmittable (U=U) campaign to promote awareness of the scientific evidence that people maintaining an undetectable HIV viral load cannot pass on the virus. This study aims to describe the acceptance and uptake of the U=U message from a sample of people living with HIV from across Canada.

Participants (n=1016) were recruited from all provinces across Canada to complete the People Living with HIV Stigma Index – a global survey tool designed by and for people living with HIV to measure lived experiences of stigma. The survey contained questions assessing awareness and uptake of U=U. Chi-squared tests were used to examine if awareness of the message varied by gender, sexual orientation, and ethnicity.

Participants were mostly cis-male (61%), white (54%), and identified mostly as heterosexual (45%) or gay/lesbian (40%). Despite high levels of awareness of the message (73%), only 39% of participants had discussed U=U with their primary healthcare provider. Participants identifying as transgender, non-binary, or other genders (87%) were more likely to have heard about U=U than cis-women (67%) and cis-men (75%, p<0.01). Those identifying as gay/lesbian (84%) were more likely to have heard of the message compared to heterosexual (65%), bisexual (62%), or other sexual orientations (77%, p<0.01). Indigenous peoples had heard about the message the least (61%) compared to those identifying as African/Caribbean/Black (71%), White (76%), or other ethnicities (83%, p<0.01).

Our findings show that people living with HIV are mostly aware of and accept the U=U message although there is still a significant proportion still to be reached. Increasing awareness and uptake of the U=U message in healthcare providers and within the healthcare system may be a next key step to spreading the message and reducing stigma and fear around HIV.

Introduction:
Gay, bisexual and queer men (GBQ) living with HIV who are on treatment can have a long life expectancy and a healthy and active sex life without the risk of transmitting HIV to their sexual partners. GBQ men living with HIV in clinical care employ a range of biomedical and behavioural HIV and sexually transmitted infection (STI) transmission prevention strategies while engaging in sex.
Methods:
The OHTN Cohort Study (OCS) is a longitudinal cohort study at 15 clinics in Ontario. Between 2019 and 2022, 1,620 self-identified gay, bisexual and queer cis-men were interviewed using structured questions about number of sexual partners, types of sexual activities, partner HIV status, and condom use in the previous 3 months.
Results:
70% of respondents were sexually active and had a cis-male sexual partner in the previous 3 months. Among sexually active respondents, 77% had anal sex (insertive and receptive) and 94% engaged in other sexual activities including oral sex. Among those having anal sex, 96% reported having a suppressed viral load, with only 3% not knowing their viral load, and 52% of their partners were also living with HIV. They also reported that 26% of their partners were taking pre-exposure prophylaxis. Condom use with anal sex was 31%, but was higher when sexual partners were HIV negative and not on PrEP (42%).
Conclusion:
GBQ men living with HIV who are in care currently practice a variety of methods to prevent HIV and STI transmission. Including treatment as prevention as a strategy (U=U), they engage in sexual practices that protect their partners, from partner choice (choosing partners living with HIV or who are on PrEP) to barrier prevention methods.

Canada prides itself on the strength of its health and social systems, yet HIV stigma remains high, undermining HIV prevention and treatment efforts and negatively impacting health and wellbeing. Understanding how different types of stigma may have a different effect on overall health maybe be important for developing stigma reduction interventions.

A total of 1365 participants were recruited from all provinces across Canada between September 2018 to November 2023 to complete the People Living with HIV Stigma Index – a global survey tool developed by and for people with HIV to measure lived experiences of stigma. Health risks (alcohol and drug misuse, depression, low income, lack of basic needs, and unemployment) and protective factors (social support, self-efficacy, and resiliency) were assessed, and scores for health risk and protective factors were established for each person. Cross-sectional relationships between health risks and types of stigma were examined as well as the potential for protective factors to mitigate stigma.

Rates of stigma were high with 49% endorsing significant levels of internalized stigma, 62% with enacted stigma, and 83% with anticipated stigma. Internalized and enacted stigma were significantly associated with overall health (p<0.01), but anticipated stigma was not significantly related. With each additional health risk, rates increased for enacted (55% to 72%, p<0.01) and internalized stigma (44% to 59%, p<0.01), but not for anticipated stigma. Increasing levels of protective factors was linked with decreased enacted (81% to 56%, p<0.01), internalized (81% to 40%, p<0.01), and anticipated stigma (91% to 79%, p<0.01).

The burden of stigma is still high for people with HIV in Canada which may be exacerbated by socioeconomic and health-related risk factors. Interventions aiming to increase external support systems and internal resources may buffer against the negative impact of stigma and lead to improvements in health and wellbeing for people living with HIV.

HIV stigma remains a persistent barrier to good health and wellbeing for people living with HIV. Understanding how protective factors such as social support may reduce the negative impact of stigma on health is critical for designing stigma reduction interventions. This study aims to understand how different types of social support may moderate or change the nature of the relationship between stigma and mental health.

We recruited 329 participants to complete the People Living with HIV Stigma Index at baseline (t1) between August 2018 and September 2019 and at follow-up (t2) between February 2021 and October 2021. Separate moderation models were created with different types of social support (emotional/informational, tangible, affectionate, positive social interaction) as moderators, baseline stigma (internalized, enacted, anticipated) as the antecedent, and mental health (t2) as the outcome.

Emotional/informational support was a significant moderator for the relationship between enacted (b = -2.12, 95% CI: -3.73, -0.51), internalized (b = -1.72, 95% CI: -3.24, -0.20), and anticipated (b = -2.59, 95% CI: -4.59, -0.60) stigma at t1 and mental health at t2. Tangible support was a significant moderator for internalized stigma and mental health (b = -1.54, 95% CI: -2.74, -0.35). Lastly, positive social interaction was a significant moderator for internalized (b = -1.38, 95% CI: -2.71, -0.04) and anticipated stigma (b = -2.14, 95% CI: -3.93, -0.36) and mental health.

We found that emotional/informational support, tangible support, and positive social interaction moderated the relationship between at least one type of stigma and mental health. In general, the relationship between social support and better mental health was stronger for participants with low stigma. These findings suggest that intervention strategies aimed at both stigma reduction and boosting a variety of social supports with different functions may be important for the good mental health of people living with HIV.

Background: Communities of people living with HIV across Canada have become increasingly concerned about ways that their biomaterial and personal information collected in clinical health care and research encounters is being shared and used for secondary purposes without consent by public health authorities to conduct surveillance.

Methods: This community-based research project, led by people living with HIV, legal experts, and researchers, uses Institutional Ethnography to map the pathway of biomaterial and information as it flows from clinical to public health settings. To do so, we conducted 26 qualitative interviews with clinicians and public health officials, and 17 qualitative interviews with people living with HIV who have had interactions with public health authorities, including those who have been under public health investigation or legal orders.

Results: Biomaterial and personal information travels through a range of information management systems across different jurisdictions to enable surveillance. Viral genotyping of biomaterial collected in Ontario is conducted in British Columbia, and HIV tests for Ontario are transferred to a lab in the prairies. In some regions, local provincial public health authorities directly access electronic medical records, including viral load and other diagnostics, via a range of diverse databases connected to the Ontario healthcare system. This information routinely used as part of public health investigations. People living with HIV have limited knowledge of the pathways of their blood and personal information and are distrustful of surveillance systems, organizing their lives in a defensive stance towards public health authorities. Clinicians may work with inconsistent understandings about how public health systems and investigations operate, despite being the focal points for procuring informed consent and clinical information.

Conclusions: Outcomes aim to speak back to top-down surveillance systems, and to articulate a new approach to public health, articulated from the ground-up, built on principles of trust, informed consent, and transparency.

Introduction:
Despite five decades of HIV/AIDS responses and advances in prevention, treatment and care, HIV related stigma continues to impede public health and community response. Racialized and immigrant communities in Canada bear disproportionate burden of HIV. However, access to culturally safe and inclusive HIV related services for racialized immigrants is limited. HIV related stigma contributes to community silence, impedes community responses, and perpetuates suffering.

Methods:
The Acceptance and Commitment to Empowerment (ACE) Study is a multi-phase project in Alberta and Ontario. The study aims to mobilize community leaders and service providers to reduce stigma in racialized immigrant communities. Phase One focuses on identifying HIV related stigma, community values that reduce or reinforce stigma, and reduction strategies applied in the local contexts. We used focus groups to engage 30 service providers/community leaders and 60 community members living with or affected by HIV related stigma. Collaborative partnerships were established to enhance outreach and recruitment.

Results:
In this presentation, we report on the observations, experiences and perspectives of service providers and community leaders. Service providers and leaders from diverse health and non-health sectors took part in the study. Key findings include: (1) the absence of HIV information in newcomer communities perpetuates silence and misconceptions of HIV; (2) service providers in settlement and non-health sectors feel unprepared to discuss HIV issues; (3) trends of increased conservatism in Canada and globally are barriers to youth sexual health education; and (4) innovative non-conventional HIV prevention education is needed.

Conclusion:
HIV vulnerabilities and HIV-related health disparities experienced by racialized and immigrant communities are complex and contextual. Effective HIV responses in racialized immigrant communities require engagement of stakeholders outside of the HIV sector. Phase One results of Project ACE will inform the refinement of our evidence informed online intervention to reduce HIV stigma and mobilize community HIV champions.