Introduction: Everyday Racial Discrimination–the indignities racial/ethnic minorities experience daily–can deleteriously affect health. The Everyday Discrimination Scale (EDS) is widely used in HIV research to measure racial discrimination and assess health impacts from this mistreatment. However, no studies have examined whether the EDS provides estimates of racial discrimination that are objectively comparable across race/ethnicity or HIV-status in Canada.

Methods: We analyzed EDS data from self-identifying women ≥16 years enrolled in the BCC3 study. We conducted Confirmatory Factor Analysis (CFA) by race (African/Caribbean/Black [ACB]; Indigenous; Other Racialized; White) and HIV-status to assess baseline model fit. Next, we ran multigroup-CFA (mCFA) assessing measurement invariance of the EDS across race/ethnicity and HIV-status to assess whether EDS measures the same construct by the same extent across groups.

Results: Of 504 participants, 62 were ACB, 152 Indigenous, 90 other racialized, and 200 white. 202 were living with HIV and 302 were not. CFA revealed adequate fit within race/ethnicity and HIV-status groups – all Cronbach’s alpha >0.9, factor loadings >0.6 and acceptable fit indices, except for Root Mean Square Error of Approximation. Residual correlations >0.4 suggested redundancy between some item pairs. In the mCFA, configural, metric and scalar equivalence was achieved across groups (Table 1).

Conclusion: In BCC3, the EDS provides racial discrimination estimates that are meaningfully comparable across race/ethnicity and HIV-status groups. Potential redundancy between item pairs warrants EDS refinement. Nonetheless, the EDS can be included in survey instruments that aim to examine and compare prevalence and impact of racial discrimination among diverse women in Canada.

Introduction: Nigeria must achieve effective HIV program coverage to reach its goal of ending the epidemic by 2030, but evidence suggests several gaps in service coverage and utilization across the country. The Effective Program Coverage (EPC) framework is a novel Program Science tool to examine coverage gaps through program-embedded research, learning, and monitoring. We apply the EPC framework using 2020 integrated biological and behavioural surveillance survey (IBBSS) data from Nigeria to examine inequities in coverage of condoms, HIV testing, PrEP, and needle and syringe programs (NSP) among female sex workers (FSW), men who have sex with men (MSM), people who inject drugs (PWID), and transgender people.

Methods: Weighted IBBSS data were used to generate coverage cascades that identify and quantify program coverage gaps and equiplots that illustrate inequalities in coverage across population groups and by key equity variables. Required coverage targets were aligned with Nigeria’s HIV/AIDS Strategic Framework. Availability-, contact-, and utilization coverage proxy indicators were defined using variables from IBBSS data collection tools.

Findings: All coverage targets were missed for HIV testing, PrEP, and NSP among all groups. Contact coverage is <40% for all groups—well below targets. Crude inequalities in utilization coverage between groups are stark: PrEP ranged from 2.7% (PWID) to 11.5% (MSM), HIV testing from 35.6% (PWID) to 77.3% (FSW), condoms from 25.1% (PWID) to 94.1% (FSW). Additional, ongoing analyses will be presented to disaggregate inequalities by key equity variables (age, geography, years identifying as key population, typology).

Conclusions: Our findings identify critical gaps, and meaningful inequalities in those gaps, in HIV prevention program coverage for criminalized populations in Nigeria. Innovative solutions to optimize coverage of prevention services are needed. Program-embedded research is required to better understand how criminalized populations in Nigeria access and use HIV prevention services to optimize programs, policies, and resource allocation decisions for effective program coverage, and achieve population-level impact.

Background: Substance use, violence, food insecurity, and mental health are positioned as syndemic factors as they interact synergistically to influence the health outcomes of women living with HIV (WLWH), including HIV treatment and care. Limited research has identified relationships between housing instability and syndemics factors, despite high prevalence of housing instability among WLWH. This study therefore examined associations between eviction, a severe form of housing instability, and syndemics outcomes among WLWH.

Methods: We drew on data from the Sexual Health & HIV/AIDS: Longitudinal Needs Assessment (SHAWNA), an ongoing longitudinal cohort study of WLWH in Metro Vancouver (2014-2022). We used bivariate and multivariable logistic regression, with generalized estimating equations (GEE) for repeated measures over time, to examine associations between eviction and syndemics outcomes: opioid and/or stimulant use frequency (none, less than daily, daily), sexual and/or physical violence by any perpetrator, food access insecurity and diagnosis, treatment, and/or counselling for depression, all self-reported in the last six months. Ordinal logistic regression was used for the ordered outcomes of substance use frequency. Adjusted odds ratios (AORs) and 95% confidence intervals were reported at the p<0.05 level.

Results: Overall, 2309 observations were recorded from 344 women. In adjusted multivariable logistic regression with GEE, eviction remained significantly associated with depression (AOR:2.00[1.09-3.68]). For women who were evicted, the AOR of using stimulant drugs daily was 3.18-times that of women who were not evicted[95%CI:1.60-6.34] and 2.39-times that for opioid use[95%CI:1.17-4.88]. Eviction was non-significantly associated with violence (AOR:1.71[0.81-3.59]) and food access insecurity(AOR:1.54[0.93-2.57].

Conclusions: Supportive, affordable, and low-barrier housing tailored to the needs of WLWH is needed to address eviction amongst WLWH. Policymakers should also focus on initiatives to keep WLWH in their homes, such as through increased housing stipends in social security allowances, laws preventing no-fault eviction, and low-barrier, free legal support for people who receive eviction notices.

Background: Northern and Indigenous youth in the Northwest Territories (NWT) experience socially and structurally produced vulnerabilities to sexually transmitted infections (STI), including HIV. Yet few studies with this population have examined how being at risk across multiple life domains may be linked with HIV vulnerabilities. In this study we examined associations between an Index of Vulnerability (IoV) comprised of social-ecological stressors with HIV prevention outcomes among Northern and Indigenous youth in the NWT.

Method: We conducted a cross-sectional survey with youth participants aged 12-19 in Fostering Open eXpression among Youth (FOXY) and Strengths, Masculinities, and Sexual Health (SMASH) arts-based sexual health workshops in schools in 17 NWT communities. The IoV included 5 domains that span structural (food insecurity), interpersonal (recent intimate partner violence [IPV]), and intrapersonal (alcohol misuse, HIV and STI awareness) levels. IoV indicators were summed to calculate an IoV score. To assess associations between IoV score and HIV prevention outcomes (safer sex self-efficacy [SSSE], HIV knowledge) we conducted adjusted and unadjusted multivariate linear regression analyses. We also conducted separate models to compare IoV and its constituent parts on the HIV prevention outcomes.

Results: Participants (n=296, mean age: 13.5 years, standard deviation [SD]=1.4; cisgender men: 55.3%; cisgender women: 40.2%; transgender/non-binary persons: 4.5%) included three-quarters Indigenous youth (73.3%). Cisgender women (1.77, SD=0.90) reported higher IoV scores compared with cisgender men (1.60, SD=1.00; p=0.0089). In adjusted analyses, higher IoV scores were associated with lower safer sex self-efficacy (aβ = -0.81, 95% CI: -1.45, -0.17, p=0.013) and lower STI/HIV knowledge (aβ =-0.79, 95% CI: -1.46, -0.12, p=0.021). The IoV scores accounted for more variance in both HIV prevention outcomes than any single indicator.

Conclusion: Future research and interventions can explore strategies to address food insecurity, IPV, and other social-ecological stressors to advance HIV prevention with Northern and Indigenous youth in the NWT.

Background: Antipsychotic medication is an essential part of treatment for psychosis among people living with HIV (PLWH), yet antipsychotic treatment uptake among this population is poorly understood. This study describes incident cases of psychosis-related disorder post-HIV diagnosis, as well as antipsychotic medication uptake among PLWH in British Columbia (BC), Canada.

Methods: We utilized data from the Seek and Treat for Optimal Prevention of HIV/AIDS (STOP HIV/AIDS) cohort of PLWH in BC. Our analytic sample included PLWH (aged ≥19) between April 1996 and March 2020 with at least one year of follow-up. Incident cases of psychosis-related disorder were identified by applying a case-finding algorithm and a 2-year lookback window prior to HIV baseline (defined as the latest of: April 1, 1996 or earliest HIV-related record) to exclude baseline prevalent cases.

Results: After excluding baseline prevalent cases and individuals with insufficient lookback time, we identified 644/6441 (10%) incident cases of psychosis-related disorder in our sample. Median age at diagnosis was 43 (Q1, Q3: 36, 51) and 273 (42.4%) of cases were diagnosed in hospital. 90.4% (n=582/644) of incident cases were people who use drugs (PWUD), 26.1% (n=168/644) were women, and 59.6% (n=384/644) were ever diagnosed with hepatitis C. 65.8% (n=424/644) of incident cases received an antipsychotic dispensation, a median of 26 days from diagnosis. 55.9% (n=237/424) received 2nd line antipsychotic therapy, 57.8% (n=137/237) 3rd line, and 57.7% (n=79/137) 4th line. <5 of the patients with a 3rd line antipsychotic therapy received Clozapine, recommended for treatment-resistant psychosis.

Conclusion: Our analysis revealed high incident rates of psychosis-related disorder among PLWH in BC, particularly among PWUD, women, and those ever diagnosed with hepatitis C. Multiple lines of treatment among some patients and few dispensations of Clozapine by 3rd and 4th line therapy suggest unmet treatment needs in this population.

Background: People living with HIV use cannabis for medicinal and recreational reasons at 2-3 times the rates of the general population. Cannabis legalization in Canada has evolved over phases with increasing access to legal cannabis since 2001 when cannabis became legal for medicinal purposes under the Marihuana Medical Access Regulations.

Objectives: To describe changes in cannabis use frequency and predictors among people with HIV across four major phases of legalization in Ontario.

Methods: In the Ontario HIV Treatment Network Cohort Study, a community-governed longitudinal HIV clinical cohort, we measured cannabis use frequency annually and conducted a segmented regression using Generalized Estimating Equations with logit link to assess the effect of three policy interventions: Marihuana for Medical Purposes Regulations (2014), Access to Cannabis for Medical Purposes Regulations (2016) and Recreational Legalization (2018).

Results: Of 4,736 participants, most identified as male (79%) and white (58%) with 15% using cannabis daily and 30% in the past month. From 2008 to 2021 and over 19,113 person-years of follow-up, there was an 80% increase in the odds of daily use (OR 1.80, SE=0.19; p<0.001; prevalence increased from 11% to 19%) and a 52% increase in the odds of past-month use (OR 1.52, SE=0.11; p=<0.001; prevalence increased from 27% to 34%). We observed a significant negative effect of recreational legalization on daily (OR 0.51, SE=0.05; p<0.001; prevalence dropped from 18% to 10%) and past-month use (OR 0.66, SE=0.06; p<0.001; prevalence dropped from 35% to 26%) but no significant changes in the other phases. No demographic variables moderated this effect.

Conclusions: Cannabis use increased significantly among people living with HIV over the study period. A drop in cannabis use at the time of recreational legalization was likely due to delays in the implementation of retail access when cannabis was legal but not yet commercialized.