Background: Systemic gaps in HIV prevention, diagnosis, and care persist in British Columbia (BC) that result in ongoing HIV transmission, particularly among communities that experience intersectional social inequities. We sought to learn how HIV prevention, diagnosis, and care can be improved from the perspectives of those newly diagnosed with HIV.

Methods: Using a community-based approach and applying GIPA/MEPA principles, we conducted in-depth peer-led interviews with people in BC who were diagnosed with HIV between 2018-2023. Eligible participants were aged 18+ and were recruited using flyers (in-person and online) in partnership with local HIV service organizations and care providers. Interviews were conducted in-person or online in English (n=20) or Spanish (n=11), audio-recorded, transcribed, and thematically analyzed by peer researchers.

Results: Most participants (27/31) were Two-Spirit, gay, bisexual, and queer men or non-binary people, about a third were white (n=12) and another third Latinx (n=12), and ages ranged from 24-62. Participants highlighted barriers to HIV education, PrEP access, and testing services, which were amplified due to structural barriers (e.g., immigration status, limited English fluency), and emphasized the importance of trauma-informed diagnosis. Participants shared positive experiences with their HIV care providers but highlighted the need to address care across different regions of BC, HIV stigma, and access to peer support. Participants highlighted opportunities to enhance HIV care by better integrating STI prevention, including doxy PEP/PrEP, and improving the availability of long-acting treatment.

Discussion: Learning from people newly diagnosed with HIV in BC highlights how HIV responses must address structural drivers and inequities and how resultant gaps in HIV prevention, diagnosis, and care can be addressed. Potential enhancements to BC’s HIV care cascade should include multilingual HIV education, improved access to long-acting treatment, and services that are tailored to communities that are disproportionately impacted by HIV.

Background
Oral HIV pre-exposure prophylaxis (PrEP) has reduced HIV incidence among Two-Spirit, gay, bisexual, queer and other men who have sex with men (2SGBQM) in Canada, but some marginalized subgroups remain under-represented relative to need. Ahead of the regulatory approval of long-acting injectable cabotegravir (CAB-LA) in Canada, PrEP delivery models must be examined to minimize barriers to PrEP access and use.

Methods
‘The Future of PrEP is Now’ is a community-based research project examining CAB-LA access needs and preferences among Canadian 2SGBQM. We conducted 10 focus groups and 9 semi-structured interviews with 2SGBQM across Canada, prioritising participants meeting PrEP guideline indications and who are: Indigenous and Two-Spirit; African, Caribbean or Black; other persons of colour; transgender or non-binary; residents of remote/rural areas; and people who use substances. We analyzed qualitative data using reflexive thematic analysis to understand acceptability, community needs, and preferences related to CAB-LA.

Results
Participants (N=42; 76% with current/previous PrEP experience) were positive about CAB-LA, citing its ease of adherence compared to oral PrEP. However, many discussed the inconvenience of CAB-LA’s two-monthly injection cycle, requiring additional visits to healthcare providers annually on top of the quarterly monitoring visits currently recommended for oral PrEP. Also of concern was the cost of CAB-LA, especially in provinces without publicly-funded PrEP programs. Participants were interested in PrEP (oral and CAB-LA) delivery through an expanded range of providers, including sexual health clinics, community organisations, pharmacies, or primary care providers (PCPs), though complaints about PCPs’ unfamiliarity with PrEP were common. Finally, 2SGBQM described current PrEP access pathways as overly complicated, desiring more integrated approaches to PrEP consultations, delivery and monitoring.

Conclusion
Recommendations for improving access to CAB-LA include expanding the range of service providers able to administer PrEP, aligning monitoring frequency with CAB-LA administration, integrating monitoring within PrEP delivery, and expanding universal coverage.

Background: The criminalization of HIV non-disclosure is an ongoing concern for PLHIV. Under Canadian law, PLHIV face prosecution for serious criminal offences in circumstances where they did not disclose their HIV status to a partner before sex that poses a “realistic possibility of HIV transmission”. The overly broad interpretation of this legal standard by prosecutors and courts has created an enduring disconnect between scientific consensus regarding HIV transmission and Canadian criminal law.
Description: Such criminalization poses a number of challenges to human rights and public health, including perpetuating stigma, discrimination, and other harms against PLHIV. Incremental and piecemeal efforts to address this issue through prosecutorial policies and courtroom advocacy have had a modest but insufficient impact. A consensus has emerged at the community level that Criminal Code reform is required to align the law with the science and mitigate the harms of criminalization. Meanwhile, PLHIV face continued risk of criminal liability even in cases where no transmission occurred, where there was no intent to transmit, and even where reasonable precautions were taken to limit potential transmission.
Lessons learned: Criminal Code reform to limit HIV criminalization continues to be a key demand from community members and has been recognized as necessary by important governmental stakeholders.
Conclusions/next steps: It has been a year since the federal government concluded public consultations regarding Criminal Code reform. The Canadian Coalition to Reform HIV Criminalization (CCRHC) issued a widely-endorsed Community Consensus Statement in 2022 that outlines key elements for any proposed Criminal Code reform. Despite persistent advocacy efforts and collaboration offered by the CCRHC to assist the government in advancing law reform, a bill has yet to be introduced. Community advocacy will be essential if Parliament is ever to adopt reforms that significantly restrict HIV criminalization in line with science, human rights, and public health concerns.

Contexte : le chemsex est de plus en plus documenté parmi les hommes de la diversité sexuelle et de genre (HDSG), en particulier les motivations derrière cette pratique et ses conséquences potentielles. Les HDSG mettent en œuvre une série de stratégies informelles de réduction des méfaits. Cependant, on sait peu sur la manière dont ces stratégies sont utilisées pour développer des services adaptés.

Objectifs : 1) identifier les pratiques de réduction des méfaits, sur le plan sexuel comme sur celui de la consommation, mises en œuvre par les HDSG qui pratiquent le chemsex dans trois villes québécoises; 2) discuter de la manière dont ces stratégies pourraient être utilisées pour développer des services adaptés de réduction des méfaits.

Méthodologie : 64 personnes ont participé à des entretiens semi-structurés d'une durée moyenne de 90 minutes sur leurs expériences en matière de chemsex. Une analyse thématique a été effectuée.

Résultats : quatre thèmes ont été identifiés : 1) les stratégies pour réduire le risque de contracter le VIH ou d'autres ITSS, comme l'utilisation d'une PrEP; 2) la sécurité et la qualité des produits, souvent évaluée par la confiance accordée aux vendeurs; 3) l'apprentissage avec les pairs des techniques pour consommer efficacement et en toute sécurité ; 4) les stratégies pour gérer les effets secondaires de certaines substances, comme l'utilisation d'autres substances pour dormir ou manger après avoir pris des stimulants.

Discussion : les HDSG développent et partagent de manière informelle des stratégies de réduction des méfaits. Certaines fondées sur des connaissances scientifiques et d’autres non. L'utilisation de la PrEP et du dépistage pourrait être renforcée. Le rôle des pairs est crucial dans la transmission de ces stratégies. Il est nécessaire de renforcer les connaissances des HDSG et de mobiliser les réseaux des pairs pour mettre en place des services de réductions des méfaits.

Introduction: Estimating the number of gay, bisexual and other men who have sex with men (GBMSM) eligible for HIV pre-exposure prophylaxis (PrEP) provides insight into estimating projected uptake and potential costs of a fully publicly-funded PrEP program in Ontario.
Methods: We modeled the number of PrEP-eligible GBMSM in Ontario. Using 2022 aggregated dispensation-level data from commercially available pharmacy data, we estimated the number of males (GBMSM proxy) currently using PrEP in Ontario. We then applied two proportions from two Ontario GBMSM surveys, Sex Now (June-Sept 2022, n=944) and PRIMP (July-Dec 2022, n=872), to account for 1) individuals on PrEP but not PrEP-eligible and 2) individuals PrEP-eligible but not on PrEP. PrEP-eligibility criteria included having condomless anal sex AND EITHER a bacterial STI (chlamydia/gonorrhea/syphilis) OR a HIRI-MSM score >10. As British Columbia has a universal PrEP program, a sensitivity analysis applied the proportion of GBMSM using PrEP in BC to Ontario’s estimated GBMSM population.
Results: An estimated 9,826 GBMSM were using PrEP between Oct-Dec 2022. 11,957-15,281 GBMSM are estimated to be eligible for PrEP in Ontario (Figure 1); roughly 21.7%-55.5% more than estimated number of GBMSM currently on PrEP. Sensitivity analysis yielded PrEP-eligible estimates within the modeled range (12,317).
Conclusion: These estimates indicate moderate current PrEP uptake based on modeled PrEP-eligibility criteria and are essential for cost-analysis and uptake projections for universal PrEP in Ontario. Important to note this is a point in time and not all eligible will take PrEP and not all on PrEP meet the criteria stated above.

Introduction: Numerous studies have examined the effect of syndemics on HIV risk. However, there is no standard approach for identifying the syndemic factors most important in HIV risk. We aimed to (1) identify syndemic factors associated with HIV sexual risk behaviour among HIV-negative gay, bisexual and other men who have sex with men (GBM) and (2) apply syndemic theory to examine the syndemic factors’ influence on HIV sexual risk behaviour.
Methods: We used baseline data from Engage, which recruited sexually-active GBM through respondent-driven sampling in Montreal, Toronto and Vancouver. We defined HIV sexual risk behaviour as condomless anal sex with at least one of the last five partners where the partner was HIV-positive with detectable viral load or had unknown HIV status, and the participant was not using HIV pre-exposure prophylaxis. We explored pairwise associations between syndemic factors, sociodemographic characteristics and HIV sexual risk behaviour using Somers’ D statistics. We reduced the number of syndemic factors using a variable reduction method and conducted a mediation analysis using a path model.
Results: The final sample included 1458 GBM. Addressing objective 1, we identified childhood sexual abuse (CSA), intimate partner violence, transactional sex, polysubstance use and sexual compulsivity as syndemic factors associated with HIV sexual risk behaviour. Using these factors, we conducted the syndemic analysis (objective 2). We found a statistically significant direct effect for CSA (c' = 0.09, 95% CI 0.01– 0.17) and total effect (c = 0.14, 95% CI 0.06 – 0.21) of CSA on HIV sexual risk behaviour. The combined mediated effect of the other syndemic factors was 41% of the total effect of CSA on HIV sexual risk behaviour.
Conclusions: We identified the most influential syndemic factors associated with HIV sexual risk behaviour, which can help determine the primary focus of interventions to reduce HIV risk among GBM.