INTRODUCTION: This CIHR-funded research project, spanning from April 2019 to March 2024, maps the care cascade system journey experienced by First Nations individuals living with HIV and the processes described by healthcare providers who serve them, highlighting barriers and facilitators. Not only does the study examine care itself, but it also maps the experience of living with HIV in Northern communities.

IMPORTANCE OF THE WORK: With escalating HIV rates among Indigenous populations in Manitoba and Saskatchewan, our study pioneers understanding the care journey of Northern First Nations people, emphasizing the pressing need for comprehensive insights and interventions.

METHODS: Our research followed a two-eyed seeing and ethical space approach, including guidance from a two-eyed seeing working group. We conducted in-depth, semi-structured interviews with 18 individuals living with HIV and 11 healthcare providers. Two lived-experience research associates enriched data collection and initial analysis. Rigorous qualitative analysis using MAXQDA software uncovered key insights on barriers, facilitators, and recommendations. To validate findings, we held a structured workshop with 50 stakeholders, including policymakers, researchers, community-based organizations, Indigenous entities, and individuals with lived experiences, from both Northern and Winnipeg contexts, yielding additional insights.

KEY FINDINGS: A key finding was that geographical location significantly shapes challenges in the HIV care cascade. This presentation will discuss key barriers, facilitators, and recommendations, emphasizing the role of geography. It will also discuss how the methodology itself generated rich data and fostered stakeholder engagement. We will finally outline plans for knowledge translation with the hope of transforming health and community systems for Northern First Nation people in Manitoba.

Background: Saskatchewan and Manitoba have the highest and second highest rates of HIV infections in Canada. The Gigii-Bapiimin study examined the impacts of services during the COVID-19 pandemic on First Nations, Inuit, and Métis people living with HIV in Manitoba and Saskatchewan.

Method: The study used decolonizing community-based research, using Indigenous principles, and a Two-Eyed Seeing approach. Eligibility criteria included being Indigenous and living with HIV in either Manitoba or Saskatchewan. The interviews explored the impacts of COVID-19 on healthcare access, HIV, and harm reduction services. The data was validated by a Community Guiding Circle of 13 Indigenous people living with HIV.

Results: The Gigii-Bapiimin study found decreased access to health services, HIV care and harm reduction during the COVID-19 pandemic. Participants shared stories that included stigma towards their HIV status and racism in the healthcare system. Finally, the pandemic interrupted vital harm reduction and support services, leaving many individuals without access to the resources they needed to stay healthy and safe. The impacts on access to HIV care were exacerbated by poverty, homelessness, and distress over inadvertent disclosure of HIV status. Participants mitigated these impacts by relying on Indigenous knowledges, ceremonies, and resilience within their communities.

Conclusion: Service providers need to improve access to healthcare, HIV treatment, harm reduction services and cultural ceremonies for Indigenous people living with HIV who are facing multiple access challenges. Reducing barriers to harm reduction and expanding the response to the toxic drug supply and the overdose crisis is urgently needed.

Sex Education by Theatre (SExT) is a trauma-informed and anti-racist approach to engaging youth in HIV/AIDS prevention through theatre. SExT addresses the need for culturally appropriate and trauma-informed pedagogical interventions, particularly for newcomer and Indigenous youth in Canada. Vulnerable youth populations face a disproportionate burden of sexual and other health issues due to a complex interplay of historical, social, economic and systemic factors.

Originating in Toronto's Thorncliffe/Flemingdon Park, SExT has evolved into a dynamic workshop program and touring performance—sketches, songs, raps, dances, and spoken word pieces by youth for youth—reaching over 10,000 young people in underserved communities nationwide. Research has found improved sexual health self-efficacy (condom use, STI/HIV testing, and sexual limit-setting) and personal/social development of peer educators and audiences.

In 2022, SExT received a SSHRC grant to explore program sustainability and community capacity-building by training current cast members in trauma-informed research and facilitation to become community researchers and peer mentors for a new cohort of youth from their home community.

Through Performative Inquiry and the DEPICT model of participatory qualitative health promotion research, arts-based data collection included scene creation, video, and comic-style field notes. 14 semi-structured interviews and one focus group were conducted with SExT Peer Mentors, and five focus groups were conducted with newly trained/mentored high-school-aged SExT Peer Educators. Peer Mentors were actively involved in all research, including design, facilitation, interviewing, field notes, analysis, and writing.

Collaborative analysis led to the conceptualization of the ‘STI’ Model of Peer Mentorship: establishing a ‘Secure’ base (meeting basic needs, foundation of relationship, peer vulnerability/modelling); adopting a ‘Trauma-Informed’ approach emphasizing choice, empowerment, and nervous system regulation; and prioritizing ‘Inclusivity’ by including mentors with shared and diverse culture, gender, community ties, and immigration status. This peer model may be applied in diverse youth HIV prevention contexts.

The Aging with Wisdom project aimed to develop a culturally and gender-responsive approach with Indigenous women to support their ability to age well with HIV, while taking up their traditional roles as leaders in their families and communities. The six participants in our study identified as women, cis or trans, with one identifying as a Two Spirit, gender-fluid, trans woman. Three identified as Cree, one as Coast Salish, one as Métis and one as “urban Indigenous.” They had been living with HIV for 10 to 30 years. The participants attended four research and wellness days at Tsleil-Waututh Nation (Vancouver). These days featured cultural and craft activities, ceremony, lunch and research as a distinct activity. Our First Nation Elder guided four sequential research sharing circles with the same participants in each circle which allowed an in-depth exploration of aging and HIV. The participants spoke about how HIV affected them in every part of the medicine wheel: physically, emotionally, mentally and spiritually. We concluded that (1) A small group of participants in a series of meetings with cultural activities and ceremony can provide incredibly rich data on a complex health issue. (2) The group setting provided meaningful supports to participants; they called it a sisterhood. (3) Culture is healing. Our Elder led ceremonies and gave cultural teachings throughout which helped women reconnect or connect more deeply with their culture. The title of our paper, “Indigenous Women living with HIV and Aging with Wisdom: Unfinished,” refers to these women having been left on their own to deal with the non-clinical aspects of HIV; that more could and should be done; that services could be added or adjusted; that our social safety net has holes; and that our work isn’t done.

Background: The 9Genders project aims to promote cultural reclamation and land reconnection for Gender-Diverse Indigenous people in Canada. The project has developed a unique decolonized research methodology that centers Indigenous protocols and ethics as the framework for guiding respectful gathering of gender-diverse narratives and experiences relevant to the HIV care continuum. Indigenous research methodologies emphasize community-led protocols, contrasting with procedural ethics oversight like institutional review boards (IRBs) which take a Western approach.

Methods: A developmental team gathering was held in Elsipogtog First Nation, Mi’kma’ki (New Brunswick, Canada). The purpose of the meeting was to develop appropriate protocols for ethically collecting data about Indigenous Gender Diverse experiences within ceremony. The team gathered in ceremony over seven days including; circles, sweats, sacred fires, drumming, and traditional basket making facilitated by Indigenous Elders and Knowledge Holders.

Results: Drawing on the team dialogue, we identified key considerations including: centering Indigenous protocols; ensuring voluntary informed consent and self-determined participation; providing holistic care and safety through community; protecting traditional knowledge; and reconciling flexibility of land-based ceremonies with institutional demands for details. Dialogue excerpts demonstrate commitments to voluntary participation and continuity of consent, determined by individual comfort levels rather than rigid protocols. Recommendations were drawn from the dialogues to assist the team in strategically planning for ethics submission to an institutional review board.

Conclusion: Positioning Indigenous oversight as the primary ethical review enables research grounded in reciprocal care and self-determination. We encourage creative translation aligned with the values of reciprocity and transparency, open spaces in regulatory systems to conduct research in ethical partnership rather than opposition with Indigenous communities. Recommendations uphold Indigenous ethical frameworks while translating core protections to align with IRB priorities like review of risk and benefits. This negotiation illustrates pathways for conducting human subjects research in academic institutions in ethical partnership with Indigenous communities.

Introduction
Achieving equitable access to diagnostic testing, especially in Northern, Remote, and Isolated (NRI) communities in Canada, has long been a challenge, particularly for Indigenous populations. The Health Equity, Access, and Response (HEAR) program, formerly known as the NRI initiative, emerged during the COVID-19 pandemic to support community-led testing programs supporting Indigenous communities’ rights of self determination. Initially focused on COVID-19, HEAR has expanded its scope to include community-led testing for HIV and other Sexually Transmitted and Blood-Borne Infections, aiming to address the longstanding testing accessibility issues in NRI communities.
Methods
The HEAR program, based at the National Microbiology Laboratory Branch, validated commercially available molecular and rapid antigen HIV tests suitable for decentralized HIV testing. To facilitate community-based testing, HEAR collaborates closely with communities to identify their specific needs. This support involves shipping necessary supplies, providing training, and offering ongoing quality oversight through quality assurance programming.
Results
The HEAR network has supported community-led COVID-19 testing in 600 NRI sites across every province and territory. Since its expansion to include HIV testing in July 2022, the network has effectively deployed various HIV self-tests and multiplex tests for HIV and Syphilis. This effort has resulted in the establishment of community-based HIV testing sites in four provinces to date.
Discussion
Community-led testing is pivotal for improving public health outcomes, particularly for challenging cases like HIV, where identifying undiagnosed individuals remains a significant hurdle. Prioritizing decentralized testing for HIV ensures accessible diagnostic services at the community level, facilitating prompt infection identification and linkage-to-care. This approach plays a crucial role in safeguarding the health of all Canadians and addressing health disparities in NRI communities.