Background: Structurally-based gender inequities undermine women’s wellbeing and care access. The Women-Centred HIV Care (WCHC) Model was designed to guide the provision of holistic care addressing these inequities. This study aimed to explore the healthcare desires and priorities of women with HIV in relation to the WCHC Model.

Methods: Women with HIV in Ontario were recruited from HIV organizations and health centres to participate in focus groups (FGs). Participants completed a demographic survey, watched a WCHC Model presentation or video, and engaged in one of four semi-structured FGs (3 in person, 1 virtual), which were recorded, transcribed, and analyzed using descriptive content analysis.

Results: Twenty-two women (aged 24 – 70, living with HIV for 4 – 31 years) participated in FGs of four to seven women each. All participants had a care provider, most of whom specialized in HIV. We constructed four themes through FG transcript analysis: 1) Promotion of social connections represented participants’ desire for support in building and maintaining healthy relationships – with friends, family, and peers – to enhance wellbeing and healthcare system navigation; 2) Sex, sexuality, and desirability underscored the need for person-centred sexual health care extending beyond reproductive health (e.g., sexual pleasure, changing medications to reduce undesirable physical side effects); 3) Aging, death, and dying emerged as stressors, prompting reflections on HIV in later-life and end-of-life contexts, along with family implications; and 4) Ideal patient-provider relationships were characterized by providers understanding women's circumstances, engaging them in decision-making, and advocating for their well-being.

Conclusions: The WCHC Model aligns with the healthcare desires and priorities of women with HIV. Emphasizing the significance of social support, sexuality, aging considerations, and patient-provider relationships, the findings underscore the necessity for integrating these insights into any WCHC Model rollout plans to enhance the overall health and well-being of women with HIV.

Objectives: 50% of people living with HIV and 20% of new infections in Canada are in people over 50 years old; 25-50% will develop neurocognitive impairments during their lifetime. To better understand experiences of people living with HIV when navigating healthcare services for neurocognitive concerns, the HEADSUP!2 study applied the candidacy framework to explore how people living with HIV appraise their eligibility for healthcare.

Methods: Using a community-based research approach and engaging a peer researcher team throughout the research process, people aging with HIV and experiencing neurocognitive concerns in Montreal, Vancouver, Calgary, and Toronto were recruited through community networks to participate in a qualitative interview. Potential participants were offered an opportunity to be interviewed by a peer interviewer and the option of being interviewed with a ”trusted other”. The team employed a participatory approach to analyze interview transcripts for themes related to candidacy for healthcare services including access and usage of services from identification of a need to receipt of treatment.

Results: 34 people living with HIV participated in qualitative interviews in French or English (8 Montreal, 9 Vancouver, 8 Calgary, and 9 Toronto). Participants self-reported an average age of ~58 years; 22 (64.7%) identified as male, 16 (47.1%) as straight; 7 (20.6%) participants attended with a trusted other. Findings suggest participants experienced barriers to healthcare services at each level of candidacy Themes included fear of cognitive diagnosis (e.g. dementia), concerns with overburdening professionals, dismissal of symptoms by professionals (e.g. “aging”, previous drug use), prioritizing co-existing health issues, professional lack of knowledge of treatment options, and lack of services for cognitive concerns.

Conclusion: This study identified barriers in every dimension of candidacy that limit care for people living with HIV who experience cognitive concerns. These findings can inform resources and healthcare services for people living with HIV and neurocognitive concerns.

Background: Within Manitoba and Saskatchewan, pre-existing health inequities amongst Indigenous groups were intensified during the COVID-19 pandemic. Service disruptions in the health and social service sector—combined with the effects of intersectional stigma—disproportionately impacted Indigenous peoples living with HIV (IPLH). IPLH experience structural violence and necropolitical exclusion through systemic forms of stigma situated within Canada’s expansive colonial history. Utilizing the theoretical foundations of structural violence and necropolitics, this qualitative study examines how the COVID-19 pandemic amplified preceding states of inequity for IPLH.

Methods: Semi-structured interviews were conducted with 60 participants. The sample comprised of those with lived experience (n=45) as well as those who provided services for IPLH (n=15). Indigenous Storywork guided the data collection and analysis process. Topics explored within each interview included access to health and social services, harm reduction, substance use, and experiences in providing services during COVID-19 pandemic. Thematic analysis was used to identify common themes throughout each story.

Results: Our results indicate that the COVID-19 pandemic exposed and amplified pre-existing forms of structural violence and necropolitical logics for IPLH within Manitoba and Saskatchewan. Specifically, we describe how structural violence and necropolitics are manifested via three main avenues— (i) restrictions and removal of care, (ii) bureaucracy and institutional care politics, and (iii) discrimination and systemic racism within the Canadian healthcare system.

Conclusion: The COVID-19 pandemic within Manitoba and Saskatchewan sparked massive changes in service provision within settler-colonial and neoliberal institutions of care. For those services that remained open to IPLH, masking requirements, questionnaire requirements, scheduling requirements, and a lack of in-person services acted as only some of the barriers described by community members as detrimental to care access. Increased experiences of discrimination in health care on the basis of substance use or HIV status further limited access to needed services.

Issues:
Diverse groups of Ontario residents living with HIV, including international students, migrant workers, visitors and newcomers awaiting status approval, have precarious or no health insurance coverage, making them vulnerable to worse health outcomes due to treatment access barriers and intersectional challenges related to their social locations. In response, 11 agencies in Toronto set up the Blue Door Clinic (BDC) in 2019 to provide comprehensive health care to non-insured populations with HIV in the Greater Toronto Area. Since inception the clinic has served close to 300 clients.

Description:
Beyond Blue Door is an intervention study to evaluate the effectiveness of the Blue Door Clinic in improving HIV care linkage, adherence and retention for our target communities. We engaged 62 precariously insured PHAs and 56 service providers/policy makers through focus groups and individual interviews. We also collected quantitative client service data amongst 159 service users including demographics, intake and referral to long-term primary care, participants’ access to social determinants, and health outcome indicators such as CD4, viral load and comorbidities.

Results:
Quantitative data showed that BDC provided timely access to initiate treatment for the newly diagnosed clients and successfully prevented 100% service users from treatment interruption; 88% of service users attained undetectable viral load prior to discharge or referral to long-term primary care services. Qualitative data identified key wise practices of clinical effectiveness: (1) multi-disciplinary team provides holistic person-centered, affirming care in a one-step setting; (2) peer-driven linguistic and culturally relevant care promotes self-health management capacity and community connections; (3) clinical EMR tools and practice adaptations informed by service evaluation data enhance continuity of care; (4) extensive community partnerships address intersectionality and promote access to social determinants.

Implications:
BBD results demonstrated the positive impact of multi-sector collaborative care approach and identified wise practices transferrable to care of other marginalized populations.

In 2017, the World Health Organization published the Consolidated guideline on sexual and reproductive health and rights of women living with HIV, providing the foundation for national stakeholders to create locally tailored action plans. The guideline prioritizes addressing environmental and systemic barriers over individual behaviours. To guide Canadian-specific implementation, a team of women living with HIV, researchers, community advocates, global program managers and policymakers, clinicians, and social service providers developed five key recommendations for a national action plan to advance the sexual and reproductive health and rights of women living with HIV, published 2022.

To operationalize the national action plan, the team convened a community gathering in 2023. Goals of the event included to co-creating an implementation strategy and an accountability plan. An overarching theme in discussion emerged highlighting that meaningful engagement of women living with HIV (recommendation 1 of the national action plan) underpins implementation of each of the other recommendations. To facilitate the development of this implementation strategy, we defined the following principles as foundational tools for implementing meaningful engagement:
1. Acknowledge and actively dismantle power differentials,
2. Commit to meaningful engagement as an on-going, iterative process,
3. Learn about the epidemiology and socio-structural forces that create and sustain HIV risk among women in your setting,
4. Invest in creating supportive infrastructure, transparent policies, and leadership opportunities for meaningful engagement, and
5. Integrate Equity, Diversity, and Inclusion principles to ensure that diverse groups, voices, and priorities are called into the conversation.

Considerations for co-creating an accountability plan include calling more people into this work, establishing intentional check-in times for implementation progress, and identifying opportunities for accountability mechanisms at the policy and regulatory level. Next steps require ongoing outreach to promote the key recommendations among new groups and uptake into federal policies.

Chinyere Njeze, Patricia Ukoli, Rusty Souleymanov, Bolaji Akinyele-Akanbi

Background: This study investigated systemic and structural barriers to HIV testing and healthcare access among African, Caribbean, and Black (ACB) communities in Manitoba, Canada.

Methods: A total of 33 ACB participants (mean age: 34; 20 self-identified as women, 13 as men, 25 self-identified as heterosexual, and 8 as LGBTQIA+) were recruited through flyers, peer networks, and social media. One-hour individual, semi-structured interviews were conducted, focusing on participants' perspectives and experiences with HIV testing, including access challenges, to understand the factors that affect HIV testing utilization. Participants were compensated $40 for their time. Iterative inductive data analysis was applied to the data using MAXQDA.

Results: The analysis revealed that barriers to HIV testing extend beyond individual behavior or choice, highlighting systemic racism, economic disparities, healthcare infrastructure inadequacies, and limited testing opportunities as key obstacles. HIV stigma emerged as a significant barrier. Trust issues with healthcare providers were underscored by the historical exploitation of Black communities in medical research. Participants also stressed the importance of communal values such as interconnectedness and collective unity in combating HIV within ACB communities.

Conclusions: The study provides a nuanced understanding of the structural barriers to HIV testing, rooted in systemic racism and historical socio-structural inequities. It emphasizes the need for culturally safe HIV services and education tailored to ACB communities. These findings are pivotal in designing interventions that address the unique needs and experiences of ACB communities in Manitoba, advocating for a shift beyond individual-focused strategies to a more inclusive, community-centered approach to combating HIV.