Abstract
Background: Northern and Indigenous adolescents in the Northwest Territories (NWT), Canada, experience social and health disparities that elevate exposure to sexually transmitted infections (STI), including HIV. Safer-sex self-efficacy is an important marker of sexual agency and sexual wellbeing and associated with uptake of safer sex practices. Yet there are limited studies on how to nurture safer-sex self-efficacy (SSSE) among this population. To address this knowledge gap, we explored associations between social-ecological factors (intrapersonal level: resilience; organizational level: arts-based sexual health workshop participation) and SSSE among adolescents aged 13-18 in the NWT.
Methods: A Northern and Indigenous youth agency conducted pre-and post-test surveys alongside arts-based sexual health workshops that addressed HIV, STI, and healthy relationships, in secondary-schools with adolescents aged 13–17 in 17 NWT communities. Pre-test (baseline) surveys explored socio-demographic variables, resilience, and prior participation in the arts-based workshop. We conducted descriptive analyses of baseline data, followed by multiple linear regression analyses to estimate associations between resilience and prior workshop participation with SSSE. We conducted unadjusted analyses followed by analyses adjusted for age, and gender.
Results: Among the 296 participants (mean age: 23.5, standard deviation: SD: 1.4; cisgender men: n=161, 55.3 %; cisgender women: n=117, 40.2 %; transgender/non-binary: n=13, 4.5 %), three-quarters were Indigenous (n=211; 73.3%). Over one-third (n=126; 42.6%) had previously attended one of the arts-based sexual health workshops. Adjusted multiple linear regression analysis revealed that previous workshop attendance (β=0.09; 95% confidence interval [CI]: 0.03-0.16, p=0.007) and higher resilience scores (β=1.68; 95% CI: 0.12- 3.24, p=0.035), were associated with higher SSSE.
Conclusions: Findings demonstrate the role of multi-level factors, including resilience and arts-based sexual health workshops, in building SSSE. Findings suggest that arts-based intervention benefits may persist over time. Future research can focus on arts-based, resilience enhancing youth sexual health interventions to increase sexual agency.

Background: Ageism and ableism are increasingly acknowledged as impediments to an effective and inclusive HIV/HCV/STBBI response, but personnel in community-based HIV/HCV/STBBI organizations (CBHOs) often lack the data, resources, and the “know-how” to address these issues.

Methods: Realize conducted a multi-lingual survey of decision-makers and front-line staff in Canadian CBHOs to assess factors impacting their capacity to plan or implement policies and programs that respond to the sexual health education and HIV/HCV/STBBI prevention and support needs of older adults/seniors (OA/S), people living with disabilities and/or the d/Deaf community (PWD/D). The University of Toronto provided REB approval.

Results: Over 12 weeks in 2023, personalized invitations and reminders were sent to 179 individuals; 30 (17%) responded, including 11 decision-makers, and 19 front-line staff.

Most decision-makers indicated it was within their organization’s mandate to share information about sexuality, sexual health and/or STBBI prevention with individuals (n=8, 80%) and reported receiving such requests from OA (n=5, 62.5%), seniors (n=3, 37.5%) and PWD/D (n=4, 50%). Even so, most (n=6, 60%) had not recently provided staff training on how best to meet the needs of these populations.

Front-line staff rated their knowledge of clients’ disability-related issues as moderate (n=8, 50%) or good (n=7, 44%), and aging-related issues as good (n=11, 73%); however, comparatively fewer were aware of HIV/HCV/STBBI prevention resources tailored for PWD/D (n=5, 33%) or OA/S (n=7, 47%). Less than a third had received training on how best to meet the sexual and reproductive health or STBBI prevention information or resource needs of OA/S or PWD/D; the majority said receiving more (or any) training would help.

Conclusion: Findings indicate a need for education on the sexual and reproductive health and STBBI prevention and support needs of OA/S and PWD/D among CBHO staff to increase sexual health and reproductive justice. Realize is developing evidence-based curricula in response.

Background: Self-rated health (SRH) has been shown to be a strong predictor of morbidity, functional decline, and mortality outcomes. This paper investigates the association between sociodemographic variables (e.g., employment, education, sex) and SRH among Black Canadians.
Methods: We used cross-sectional survey data (n=1380) from the A/C Study of first and second-generation Black Canadians in Toronto and Ottawa. Participants were invited to complete an electronic survey questionnaire in English and French in 2018–2019. Generalized linear models analyses were used to evaluate the associations among sociodemographic factors and self-rated quality of health.
Results: A total of 1380 self-identified Black individuals completed the survey and were included in the analysis. The majority of participants were under the age of 60 (89.7%), females (63.4%), born outside of Canada (75.1%) and resided in Toronto, Ontario (61.9%). The strongest association with poor SRH was found for experiences of racism, substance misuse/disorder, and lack of social support following adjustment for age group, sex, other socioeconomic conditions, and lifestyle factors. Sociodemographic factors contributed a 6% criterion variance in SRH (F=3.086, p<.001, R2=0.057). In subsequent models, health-related dimension (e.g., health care access and access to basic needs) and perceived social support accounted for a 14% variance in SRH (F=4.031, p<.001, R2=0.148; F=3.906, p<.001, R2=0.145, respectively).
Conclusion: Our findings underscore the importance of improving the social determinants of health as a conduit to improving the general health status and the quality of life of Black Canadians. Access to health care and meeting basic needs were strong predictors of quality of self-rated health. Despite the multiple social, psychological, and health-related challenges and alarming inequalities that many minority groups experience in Canada, Black Canadians overall reported good SRH. Our findings revealed that Black Canadians may demonstrate high resilience levels in circumventing their current social circumstances and structural disadvantages to live the best quality of life. Understanding sociodemographic and socio-structural barriers that Black people face is essential to reducing vulnerabilities to poor outcomes (e.g., inequities in the HIV care cascade), and improving their health and well-being.

In 2021 / 2022 WHAI conducted consultations with 501 women* across Ontario who face systemic and structural risk factors related to HIV. Four consultation tools were used to ensure that communities had options for how they could share their experiences and feedback, and to foster de-colonial, trauma informed and participatory approaches to knowledge sharing. This work focussed primarily on amplifying the experiences and wisdom of cis, Trans, Non-Binary and 2-Spirited Femme people who are living with HIV, who identify as Black, Indigenous, newcomer, who use drugs or substances, have experienced violence and/or incarceration, and/or who sex work.

One of the six key themes that emerged through the consultation process was HIV Education, Prevention, Care & Support. In particular, women identified a need for increased awareness and access to HIV testing (including self-testing), HIV prevention tools such as PrEP, PEP and PIP, and increased awareness about U=U in the context of women's lives.

Moving forward, WHAI is working to strengthen our work across Ontario based on the wisdom shared by women. We are committed to facilitating community capacity building, knowledge exchange, and resource development about women's needs and rights to autonomy in HIV prevention tools, to cultivating spaces that amplify women's leadership and wisdom, and to working to strengthen accessible, supportive and thoughtful pathways to HIV prevention tools including HIV testing, PrEP, PEP and PIP, and what U=U means in the context of our priority populations.

In 2021 / 2022 WHAI embarked on a process of conducting accessible and inclusive consultations with women and community organizations across Ontario to inform our future work. Focussing on women who face structural barriers to health, our priority was cis, Trans, Non-Binary and 2-Spirit people who are living with HIV identify as Black, Indigenous, newcomer, who use drugs or substances, have experienced violence and/or incarceration, and/or who sex work.

The consultation process included 1) engagement with community knowledge holders to inform the development of accessible, creative and participatory consultation tools; 2) building team capacity to use the tools; 3) implementing the consultation process in 16 regions; and 4) collaboratively synthesizing findings into a key themes to inform our provincial work.

The consultations focussed on HIV, HIV prevention and more broadly, barriers and facilitators to wellness through a health equity lens. Throughout, it was imperative to centre the voices of those often excluded or marginalized, and this required careful thought around the tools developed. Four tools that applied storytelling techniques, art, one-on-one interaction and group discussions, were used to ensure flexibility towards public health restrictions, accessibility, cater to different styles of engagement, and center anti-racist, decolonial approaches for sharing knowledge and affecting community change.

In addition to 501 women engaged across Ontario, 317 workers from community organizations/networks were engaged to validate the knowledge / augment findings. This breadth of invaluable community sharing of stories, wisdom and expertise was synthesized into six key themes to inform future work at WHAI. Themes included HIV Education, Prevention, Care & Support; Community Connection, Economic Autonomy, Women Centred Harm Reduction, Safety, and Wholistic Care. Overall, these key themes demonstrate a strong, collaborative, community driven and participatory process which will be foundational for community led change.

Background: The Global Task Force for Chronic Pain in People with HIV (GTFCP+) is comprised of PLWH and/or chronic pain (CP+) and researchers. Drawing from living experiences, CP+ members identified stigma as a major barrier to healthcare services. This abstract examines survey results collected from attendees during the CAHR 2023 Ancillary Session on HIV and Chronic Pain.
Method: GTFCP+ created an interactive mixed-method in-person survey for the ancillary specifically for the session. Participants (n=27) provided responses to. Multiple choice and ranking questions and a word cloud activity through their phones. Questions focused on impacts of stigma on CP+, ranking of major gaps in treatment, care, and support facing CP+ in Canada, and a word that describes what CP+ need. Results were generated based on simple statistical and thematic analyses.
Findings: In the Word Cloud activity, the primary key term offered by participants on what they perceived CP+ need was “compassion”, followed by terms “understanding”, “support”, and “treatment” amongst others. Regarding stigma impacting CP+, over 85% (23/27) noted they were negatively impacted by stigma related to chronic pain and had been treated disrespectfully by healthcare providers. The top five gaps identified by CP+ (n=25) who responded included their perceived unmet needs for: 1) access to free non-medicinal treatment (92%); 2) mental health support at 88%); 3) access to specialized care (84%) ; training of healthcare providers (84%)); 4) access to specialized pain care at (84%), and 5) patient-centered care (76%).
Conclusion 1: Stigma facing CP+ was among the top major gaps in treatment, care, and support for CP+ in Canada. Results of the survey highlight the importance of person-centered, accessible, specialized chronic pain treatment and management be offered to CP+ through a holistic bio-psycho-social lens in Canada where healthcare professionals are trained and can offer stigma-free support.

BACKGROUND: The Global Task Force for Chronic Pain in People with HIV (GTFCP+) is comprised of people living with HIV (PLWH) and/or chronic pain as well as an international team of researchers and co-developed seven research priorities in 2023. The Canadian HIV/AIDS Chronic Pain Society composed of PLWH organized a CAHR2023 Ancillary Session on HIV and Chronic Pain.

METHODS: Participants (n=27) were asked to rank the seven GTFCP+ research priorities during the event (via Slido) and again in the post-event evaluation survey (19/27 response rate). This analysis is based on the post-event evaluation survey and stratifies participants into two groups. Results were stratified into two groups: 1) people living with HIV and/or chronic pain, and 2) ally stakeholders without lived experiences (researchers/healthcare providers/trainees).

FINDINGS: Both groups had similar rankings for the top four research priorities i) Establish best medical/non-medical approaches for HIV chronic pain (CP+) management; ii) Learn how CP+ can be prevented; iii) Determine the etiology of CP+ and if they differ from seronegative population; and iv) Understand how to individualize CP+ management. Differentiated rankings were observed for the following: v) Establish incidence of CP+; vi) Understand the most effective approaches to CP+ management; and vii) Learn how mental health and social factors impact the experience and management of CP+. PWH prioritized domains v), vii), vi) as the bottom three priorities, whereas ally stakeholders prioritized vii), v), and vi) as the lowest priorities.

CONCLUSION: 1: Given the ever-increasing competitive funding landscape and pressure on organizations to offer a multitude of services to support PLWH, the survey offered GTFCP+ its top four research priorities to focus on. Differentiated rankings for the lower three priorities revealed divergence between the two groups and the need for ally stakeholders to ensure research, programmatic and policy priorities follow the guidance of PLWH.

Background: People living with HIV often experience co-occurring chronic pain that exacerbates marginalization. However, social workers may lack knowledge and skills to address this complex interplay. There is a need to advance health equity through specialized educational initiatives aligned with community priorities.
Methods: The presenters detail the developmental process for a new 12-week advanced practice social work course on HIV and chronic pain at a Canadian university. The team conducted a needs assessment, reviewed texts/frameworks, and aligned objectives, topics, and assignments to core priorities in HIV care.
Relevance: This work builds on existing Canadian research and addresses current challenges in the HIV care continuum for key populations with complex co-occurring conditions. It informs training to enhance social work roles in community-based HIV care and support.
Results: The five learning objectives were carefully mapped to corresponding course topics and content. This intentional sequencing and alignment of learning objectives, units/topics, and curricular content with course assignments reinforces an integrated and comprehensive approach to building student skills in advancing health equity for those with HIV and chronic pain.
Conclusion: This case study provides a model for expanding social work education through specialized curriculum targeting knowledge and skills to equip students for ethical, anti-oppressive and anti-privilege practice to improve the HIV care and advance health justice for people living with HIV and co-occurring chronic pain.

Background: Mpox was identified in many non-endemic countries, including Canada, in of May 2022. In response to the increase in cases in Canada, and more specifically the province of Ontario, the vaccine Imvamune was rolled out. Eligibility was governed by provincial health authorities, and the response varied greatly by region. In addition, because of the nature of the language used to describe those eligible, there was potential for harm. The aim of this study was to explore the experiences of Mpox vaccine recipients.

Methods: As a part of routine care, a clinic in downtown Toronto, began hosting Mpox immunizations clinics between July of 2022 and March of 2023 with a standard set of clinical intake questions. Following this period, we conducted a retrospective chart review of 113 Imvamune vaccine recipients. Both descriptive quantitative data and thematic qualitative analysis was completed.

Results: 113 patients received one or two doses of Imvamune between July 2022 and March 2023. The average age was 49 (range 17-78). Through descriptive thematic analysis, this study found the following recurrent themes mentioned by patients in the data set: 1) eligibility and motivations, 2) rollout and access, 3) mis/information in the media, 4) stigma and community support.

Conclusions: There is little research in Canada on Mpox vaccine rollout beyond epidemiologic and cohort information. Understanding the difficulties and stigma that were faced by vaccine recipients is crucial to ensure that when a public health initiative is facilitated, that past traumas are not replicated. This study provides valuable patient perspectives in how to improve ongoing rollout, as well as how a campaign that includes a sexual health component may be more sensitively considered in the future.

Background
Stigma continues to represent a major and persistent barrier to the access of safe, supportive and inclusive services for HIV/STBBI prevention, testing and treatment. In 2022, the Canadian Public Health Association (CPHA) and Centre for Sexuality (C4S) began scoping efforts to inform updates to its 2017 Organizational Assessment Tool for Sexually Transmitted and Blood-borne infections (STBBIs) and Stigma (the Tool), to keep pace with evolving understandings of HIV/STBBI stigma, its intersections with other forms of oppression, and opportunities for intervention within health and social service (HSS) organizations in Canada.

Methods
Initial scoping efforts included: four virtual community conversations involving 29 people with lived experience of STBBI stigma (fall 2022); a literature scan on promising practices for addressing stigma at an organizational level (fall 2022); an online survey of 73 HSS professionals exploring current efforts, attitudes, and facilitators/barriers toward addressing stigma (winter 2023). Based on findings, a new draft of indicators and actions for the updated Tool were developed and shared for feedback with ten individuals with personal and/or professional experience of STBBI stigma (fall 2023).

Results
Significant improvements were made to the tool to reflect the following emergent themes: 1) creating more robust mechanisms for feedback, accountability, follow-through and transparency; 2) deepening opportunities for people with lived/living experience to occupy roles of influence and decision-making; 3) reinforcing the importance of structural level advocacy and intervention; and 4) viewing stigma reduction interventions as supportive of staff/volunteers alongside service users.

Conclusions
HIV/STBBI stigma reduction is a priority for many HSS organizations, but operationalizing, actioning and resourcing improvements is an ongoing challenge. With new insights from community members, professionals, and academic and grey literature, the updated Tool (anticipated fall 2025) will support HSS organizations in Canada to identify areas for improvement and tangible actions toward safer, more supportive and inclusive HIV/STBBI services.

Background: People in prison are disproportionately affected by HIV and other STBBIs. This is, in part, the result of the criminalization of those who are already disproportionately affected by STBBIs, such a people who inject drugs. This is also, however, the result of inadequate healthcare services in prisons, distinct from that provided in the community.
Description: In 2007, the Legal Network published 'Hard Time: HIV and Hepatitis C Prevention Programming for Prisoners in Canada', analyzing harm reduction measures in prisons across Canada. The present study explores how those measures have evolved since. Between January and October 2023, the research team conducted interviews with 27 key informants, including people who have been incarcerated, community organizations, and prison staff, and identified and analyzed relevant policies.
Lessons Learned: The study revealed harm reduction policies and programs across federal, provincial, and territorial prisons in Canada, that vary widely in practice. In some prisons, practices mirror promising community efforts. In others, significant gaps remain, which are particularly harmful to Indigenous and other communities that are overrepresented in Canada’s prisons. At the federal level, for instance, Correctional Services Canada has policies regarding Opioid Agonist Treatment (OAT), a Prison Needle Exchange Program, Overdose Prevention Services, naloxone, STBBI testing and treatment, safer sex materials, and Indigenous programming, with disparities in practice between institutions. At the provincial level, greater gaps and variations exist. Most provinces provide OAT, naloxone, STBBI testing and treatment, and Indigenous programming. In some provinces, such as Manitoba and Ontario, harm reduction practices are particularly limited.
Next Steps: The study revealed several promising practices to improve health outcomes, such as transferring the responsibility of healthcare in prison to provincial health ministries and offering timely STBBI testing to all upon entry into prison. These practices are key to providing comprehensive healthcare in prison, equivalent to the community.

Background: Violence against women (VAW) is the most pervasive health risk to women and gender-diverse people in Canada, particularly for certain communities, including Indigenous women and 2SLGBTQ+ individuals. Studies have repeatedly confirmed that those who experience violence are more likely to use drugs. Yet, in Canada, services for women and gender-diverse people fleeing violence are severely restricted for those who use drugs.
Description: The study examines policies and practices aimed at improving VAW shelter access to women and gender-diverse people who use drugs, based on desk research, community engagement, and a roundtable discussion. Specifically, in October 2023, the Legal Network conducted a roundtable with 22 representatives from 14 shelters across Canada. The shelters were selected based on their stated commitments to serving women and gender-diverse people who use drugs. The representatives included front-line staff, management, and people with experience living in shelters and/or using drugs.
Lessons Learned: An increasing number of VAW shelters have moved towards low-barrier, harm reduction models. Yet, gaps remain. Many provincial and territorial policies allow, or require, service refusal based on drug use. Even where women and gender-diverse people who use drugs are not denied access, several barriers restrict access. At the roundtable, participants identified the most pressing barriers as deeply entrenched stigma around drug use, shelter rules that punish drug use and related behaviours, harmful interactions with state authorities, and inconsistent and incomplete harm reduction measures.
Next Steps: The roundtable participants were united in calling for low-barrier VAW shelters centered on harm reduction. During the roundtable, participants shared their best and promising practices to enact low-barrier harm reduction models. Their practices centered on maintaining low-barrier admissions, creating flexible, participant-centered expectations (rather than rules), fostering a trusting environment, recognizing women’s intersectional identities, and providing comprehensive, non-judgmental harm reduction supports.

Background
Canada has been experiencing a relentless overdose crisis since 2016. One response is increased access to supervised consumption services (SCS). In 2019, the HIV Legal Network (LN) published a report on SCS in Canada and concluded that there was an urgent need to remove legal and political barriers that prevented their expansion. In 2023, the LN took stock of the progress made in the past four years and remaining challenges.

Methodology
Literature review supplemented by 11 interviews with key informants. An advisory committee of three Canadian experts in SCS reviewed the report.

Results
SCS have expanded rapidly in recent years, from 2 sites in 2016 to more than 80 supervised consumption and overdose prevention sites by 2023 in 9 provinces and territories. SCSs take many forms: permanent or temporary services, and dedicated sites or integrated services. The range of services offered at sites has also diversified with greater access to peer assisted injection and drug testing services, for example. But access to SCS remains limited to certain provinces and urban centers and does not meet the crying need for supervised inhalation services. While the expansion of SCSs has been facilitated by more flexibility at the federal level around exemptions, certain provincial policies and legislation and lack of funding threaten and even prevent their implementation.

Conclusions
While Canada has the most SCS in the world, access to harm reduction and harm reduction services remains largely dependent on the political context. Legislative and regulatory reforms and funding are needed at both federal and provincial levels to safeguard the gains made and meet the needs of people who use drugs

Background: HIV Pre-Exposure Prophylaxis (PrEP) is a highly effective intervention used to prevent HIV. Since 2018, the BC HIV Drug Treatment Program has provided HIV PrEP free-of-charge to people who meet clinical eligibility criteria. Despite this, many gay, bisexual, and other men who have sex with men (GBM) at high risk of acquiring HIV are not using PrEP. We examined why GBM who are eligible for PrEP are not taking PrEP.

Methods: From December 2022 – May 2023, we recruited HIV-negative participants from the Momentum II/Engage Study in Metro Vancouver whose survey responses indicated that they hadn’t been on PrEP in the last 6 months or had never used PrEP and met BC eligibility criteria for doing so. We conducted one-hour semi-structured interviews on topics such as sexual behaviour, perceptions of HIV and STI risk, healthcare access, and PrEP knowledge. Interview recordings were transcribed verbatim and analyzed using an inductive thematic approach by dual coders.

Results: Of the 18 interview participants, 89% identified as gay, 83% identified as Canadian or European, and 22% were below the age of 30. GBM with one sexual partner (45%) perceived their likelihood of acquiring HIV as low and choose not to be on PrEP because of their trust in their partner. 72% of participants reported having a family doctor, but out of those participants only 46% felt comfortable discussing their sexual health with their family doctors and the rest were hesitant due to stigma. Participants reported a lack of knowledge about PrEP among their family doctors as another barrier to PrEP.

Conclusions: Many PrEP-eligible GBM who were not using PrEP reported individual- and provider-level barriers affecting access. Enhancing HIV risk assessment tools and strengthening relationships between GBM patients and their healthcare providers can support informed decisions about HIV prevention and could increase PrEP uptake.

Background: Engaging heterosexual-identified men who have sex with men (H-MSM) is a priority for HIV research, especially as they may engage in behaviors that increase risk for HIV. H-MSM have the tendency to conceal their sexual encounters with other men and are difficult to identify and recruit for research and practice. This scoping review synthesized literature to offer recommendations for engaging with H-MSM in HIV research.

Methods: Articles published since 2000 were retrieved from 13 databases. Two reviewers screened 3,617 titles and abstracts along with the full texts of 269 articles that passed the title and abstract screening. Ultimately, 160 articles were included in this study. Thematic analysis was employed whereby five independent coders each reviewed a selection of articles, then met to achieve consensus on themes related to recruitment considerations for H-MSM.

Results: The samples from each study were examined to provide an estimate of the percentage of heterosexual men that are H-MSM and to describe common recruitment strategies. Approximately 0.1-5.0% of heterosexual men are H-MSM. The most common sampling strategies included social media-based recruitment, snowball sampling, and venue-based recruitment from HIV clinics, parks, and gay bars. Further analyses revealed three themes related to recruitment considerations: locations of sexual encounters; cultural backgrounds; and engagement with health services. H-MSM reported meeting sexual partners at bars, in bathhouses, online, and other venues. H-MSM typically aim to remain invisible, prefer discreet health services, and avoid gay-specific venues.

Conclusions: This presentation will highlight strategies to engage H-MSM in research and practice. Future researchers and practitioners, for instance, should consider recruiting and targeting H-MSM from multiple platforms and venues. They should offer heightened levels of privacy and avoid the use of stereotypical caricatures of gay and bisexual men in advertisements. These steps may facilitate H-MSM research engagement, leading to more knowledge of the population.

Background: Saskatchewan is in a dire health and socio-economic state, falling last in the country on numerous indicators of health, education, and public safety, while performing moderately in economy. Extant research has found that these indicators are social, structural, and systemic drivers of HIV. Rates of new HIV infections have been double the national average in Saskatchewan for over five years, and recently over five times the national average. While studies have reported provincial HIV epidemiology, no known study has examined the overarching state of the province, including drivers of HIV.

Methods: Informed by The Human Development Index and Statistics Canada’s Quality of Life Framework, secondary data analysis was conducted on publicly available data pertaining to categories of economy, education, health, and public safety in Saskatchewan. For each category, a mean score was calculated to summarize Saskatchewan’s state relative to Canada’s other nine provinces.

Results: Refer to figure 1 for study findings. Many indicators have been worse than triple national averages for multiple years. HIV-related indicators—number of physicians, opioid toxicity deaths, and intimate partner violence—are also in a sustained crisis state in Saskatchewan.

Conclusion: This study provides a startling perspective on the health and socio-economic state of Saskatchewan, presenting dire statistics on quality of life indicators. Understanding these indicators’ unique contexts may be critical to turning the tide on the HIV epidemic in Saskatchewan. This presentation will discuss how these indicators may be directly related to HIV in the province, with implications for intersectional and interdisciplinary research.

Background: Racialized 2SLGBTQIA+ individuals face minority stressors (e.g., racism, heterosexism, cissexism) that exacerbate risk for physical and mental health outcomes (e.g., HIV, anxiety, depression). During the COVID-19 pandemic, 2SLGBTQIA+ Asian individuals experienced unprecedented anti-Asian discrimination and syndemic mental and physical health challenges. Young adults were uniquely impacted. This study qualitatively explored minority stressors and protective resilience factors among East Asian bisexual young adults in Canada during COVID-19.

Methods: One-hour, online individual interviews discussed participants’ intersectional lived experiences, including challenges, coping strategies, and sources of resilience. Purposive sampling recruited young adults (18–29) self-identified as East Asian, bisexual, and residing in Canada. Two independent coders used constructivist grounded theory to analyze transcripts. Participant (n=10) demographics included age (M=25.50, SD=2.32), ethnicity (8 Chinese, 2 Mixed-Race), migration history (8 born in Canada, 2 immigrants), gender (7 women, 2 men, 1 nonbinary), and geography (8 Ontario, 1 Alberta, 1 BC/Ontario).

Results:
Ten interviews were conducted in December 2021. Participants discussed minority stressors that impacted well-being, particularly stigma-based stressors (e.g., sexual fetishization, bisexual erasure). These challenges shaped participants’ identities as East Asian bisexual youth. Coping strategies included personal actions (e.g., selective disclosure of identities) and support from social networks. They described interpersonal sources of stress and resilience (e.g., family of origin, friends, partners) and highlighted the importance of intersectional community spaces. Participants conveyed unique qualities (e.g., freedom of self-expression) engendering pride and resilience. A mid-level theory was created to illustrate factors shaping participants’ lived experiences and well-being.

Conclusion: Given the physical and mental health disparities faced by 2SLGBTQIA+ Asian young adults, particularly in syndemic conditions (e.g., COVID-19, HIV, identity-based stigma), public health interventions must address specific psychosocial factors that undermine versus promote well-being for this diverse population. Understanding these factors is critical for developing interventions (e.g., HIV prevention) that are culturally sensitive and community-based.

As Frontline Service Providers (FSPs), working with the people living with HIV (PLWHIV) in Northern British Columbia (BC), we observed the majority of PLWHIV are Indigenous women. The plight of these indicate that there is a need to address deficiencies in the delivery of supportive services and health care in rural and remote parts of Northern BC. The purpose of this qualitative study is to develop a greater understanding of the burdens, oppressions, and discriminations experienced by Indigenous women due to their HIV status and geographic locations. Based on our hypothesis, there is a lingering difference between the demography of women living with HIV (WLHIV) in urban/metropolitan and rural/northern localities. Indigenous women living with HIV can be disproportionately affected because of intersections of multiple forms of oppression, including racism, poverty and trauma. More adversely affected by mental health disorders are WLHIV who use substances due to the inadequate services in healthcare and support services. The methodology of this research will be mainly based on auto-ethnography, as a result of our self-reflections on our firsthand experiences as FSPs to PLWHIV in Northern BC. We also intend to use close-ended surveys involving WLHIV. All of the methods used in this research will be based on the feminist principals and methodologies. The findings are organized around four themes; stigma, oppression, poverty and inadequate services, which are reflected in the close-ended surveys and auto-ethnographic analysis. It is anticipated that the findings from the study will be used to inform provincial-level decision making regarding the development and delivery of appropriate, responsive, and accessible policies and programs that will support Indigenous women who are living with HIV/AIDS in Northern BC. This study also will be a platform for further research on WLHIV in rural and remote parts of Canada.

Background: The AIDS epidemic of the late 20th century represented a critical juncture in global public health, triggering unprecedented responses to infectious diseases. The multifaceted strategies developed during this period continue to inform public health approaches today. This research explored the valuable lessons learned from the AIDS epidemic and evaluated their potential application to address the contemporary challenges of the toxic drug crisis. While the nature of these crises differs, a comparative analysis reveals common principles and strategies that can enhance the effectiveness of responses to the toxic drug crisis.

Methods: A thorough study of the literature was conducted to identify important lessons learned from the AIDS epidemic. These lessons were then evaluated to determine their relevance and applicability to the current toxic drug crisis, creating a strong foundation for comparison. Through a comprehensive literature review, historical data, and case studies related to both public health crises, this comparative analysis used a qualitative approach to extract insights and parallels.

Results: Among potential solutions to address the complex challenges posed by the toxic drug crisis, the AIDS epidemic highlighted the importance of adopting wholistic and comprehensive approaches, harm reduction strategies, combating stigma, activism and community-driven responses, decriminalization, access to treatment, and public awareness campaigns. Harm reduction supplies and needle distribution sites, for example, proved successful in controlling HIV transmission and emerged as a crucial lesson applicable to mitigating the adverse impacts of the toxic drug crisis.

Conclusions: By utilizing the knowledge and experiences gained from the AIDS epidemic, people living with HIV/AIDS, clinicians, researchers, and service providers can work together to create more effective, empathetic, and person-centred strategies to better support people who use drugs. Incorporating this knowledge synthesis into current practices can lead to more resilient and adaptable systems that tackle the complex challenges posed by the toxic drug crisis.

This research addressed the widespread concern of Intimate Partner Violence (IPV), often labeled the silent pandemic, disproportionately impacting women and girls globally. This impact was magnified when intertwined with HIV, particularly for African, Caribbean, and Black (ACB) women. The study centered on ACB women in Ontario's Greater Toronto Area (GTA), delving into the profound repercussions of IPV and HIV within this specific demographic.

Informed by the Afrocentric approach and symbolically utilizing the Kente cloth, Kiondo (basket), and Water Carrier concepts deeply ingrained in African cultural symbolism, the research sought to illustrate the challenges confronted by ACB women. These symbols served as metaphors reflecting the challenges faced by ACB women and emphasized the empowerment derived from sisterhood. The primary objective of this abstract was to shed light on the specific challenges encountered by ACB women living with HIV within the context of IPV. Through synthesizing Afrocentric methodologies, Black Feminist Thought, and the Water Carrier concept, the research sought a comprehensive understanding of the intersections between IPV and HIV within Ontario's GTA, Canada. Utilizing Community-Based Research (CBR) qualitative analysis, the study incorporated perspectives from IPV survivors, Health Care Professionals (HCP), and social service providers to unveil nuanced insights. These insights served as the foundation for tailored interventions, policies, and support systems, empowering ACB women to navigate the intricacies of their experiences, fostering resilience, and promoting overall well-being in the face of the dual challenges posed by IPV and HIV.

In collaboration with Women's Health in Women's Hands CHC and Roots Community Services, the research engaged in a partnership involving a community elder through the utilization of Talking Circles and one-on-one interviews. Embracing a postcolonial Indigenous worldview, where circles symbolized the equity of participants, the study embodied Afrocentric principles of ujamaa (familyhood), kujichagulia (self-determination), utulivu (patience), and Imani (faith), rooted in the spirit of ubuntu. This comprehensive approach aimed to centralize and amplify the voices of African, Caribbean, and Black (ACB) women, fostering awareness and cultural sensitivity in addressing the interconnected challenges of IPV and HIV in the Greater Toronto Area (GTA).

Background: The most impactful learnings of community-based research studies often lay within the undocumented processes surrounding community-academic collaborations. Our collaborative project aimed to understand the health-impacts of nonfatal overdoses. We conducted focus group discussions (FGD) with people who use drugs (PWUD) with and without HIV in Vancouver, British Columbia. We document key contributions of peer team members with lived/living experience in common with the study population – people with HIV and PWUD – and their project impact.
Community-Based Approach: In the project development phase, peers voiced support, informed key aspects of study design (e.g. establishing FGD for Indigenous-identifying PWUD), facilitated recruitment, and reviewed multiple iterations of the FGD guide. In the data collection phase, peer and academic team members collaboratively reflected on initial FGD to identify missing voices (e.g. women and gender-diverse individuals), gaps in discussions (e.g. HIV-specific issues), and address language issues. Recruitment methods, research design, and data collection tools were then revised. The analysis phase will entail peer guidance by team members through discussions of preliminary findings at community organizations.
Progress: We conducted 13 FGD comprising 74 PWUD across community organizations in Downtown Vancouver; each included a peer co-facilitator and peer support person. As a direct result of modifying recruitment methods, a significant number of women participated in women-only FGD, addressing an important knowledge gap.
Lessons learned: Our community-academic collaboration led to a project directly relevant and immediately responsive to community-identified issues. Identifying diverse expertise at community and research levels, and facilitating early, on-going, and respectful engagement between these groups was pivotal to all phases and enabled multi-directional co-learning. Involvement of allied academic and peer researchers facilitated meaningful relationships with targeted communities. Success hinged on an openness to a fluid research process, marked by iterative review of procedures and materials, and adapting accordingly to identified gaps.

Background:
Learning about sexual consent can be empowering, rights affirming and improve youth sexual health. Arts-based approaches have shown promise in sexual health programming with groups at higher risk of HIV acquisition, yet knowledge gaps exist among their applicability to sexual consent education, and with youth experiencing homelessness.

Method:
Focus group discussions (FDG) and in-depth, semi-structured interviews with precariously housed youth aged 18-24 in Toronto, Canada in 2021/2022 (n=13 youth; n=3 FGDs; n=5 interviews). FGD and in-depth, semi-structured interviews (n=10 participants; n=1 FGD; n=4 interviews) with youth workers with expertise in arts-based programming with precariously housed youth.

Participants provided feedback on two forms of art-based consent education: (1) poetry-based approaches; (2) comic scenarios: a visual tool designed as part of a sexual consent education programme for school-going youth. Both approaches were assessed for their likeability, relatability and applicability to the sexual consent education needs of precariously housed youth.

Findings and Discussion:
In discussing comic scenarios, youth participants stressed the importance of space and place in consent programming for precariously housed youth. While a comic depicting a house party was considered relevant and appropriate, participants further suggested other placed-based scenarios relevant to precariously housed youth to include cars and public spaces (e.g., under a bridge). Scenarios addressing digital technologies and consent (e.g., picture sharing, sexting) were considered highly applicable. Youth participants also suggested that alcohol, marijuana and illegal drugs were an oft-present feature of place-based sexual violence and should feature in sexual consent programming.

Second, poetry was considered an empowering and accessible medium by all participants, who suggested it focus not only on sexual consent education but also healing, survivorship and solidarity. Third, findings from youth workers highlight the need for dedicated programming for 2SLGBTQ+ precariously housed youth, given their exclusion from largely heterosexual- and cisgender- focused sexual consent programming.

In response to the COVID-19 Pandemic, the Public Health Agency of Canada’s (PHAC) National Microbiology Laboratory Branch (NMLB) made a significant capital investment in point-of-care testing (POCT) technologies. The objective was to bridge healthcare inequities by building capacity for POCT in northern, remote, and isolated (NRI) communities, thereby increasing access to diagnostic testing and linkage-to-care. Known as the “NRI Initiative”, this signified a paradigm shift in both approach to pandemic response and provision of diagnostic testing in which barriers to health services previously experienced by underserved populations were overcome through community-led, decentralized testing.

Working in full partnership with Indigenous leaders, community-led pandemic response teams, and in collaboration with all levels of F/P/T governance, POCT technologies were deployed to NRI communities across the country. NMLB provided a multi-faceted on-boarding process that included equipment and site verification, training test operators, biosafety guidance, ongoing technical support, and quality oversight through an external quality assessment program, QASI (Quality Assessment and Standardization of Indicators). This partnership has led to a transformed landscape of over 400 POCT sites across the country, where approximately 250 have GeneXpert instruments.

This POCT network can be used to support testing for HIV and other sexually transmitted blood borne infections (STBBI). A community led approach to HIV POCT services could reduce stigma and discrimination associated with HIV infections, the burden of travelling to major centers for testing, allowing for earlier detection of HIV infections, and ongoing monitoring of HIV antiretroviral therapy.

The success of community-led, decentralized testing provides an opportunity to leverage the existing POCT network for HIV testing and other infectious diseases affecting historically underserved populations.

Contexte:
Le sexe transactionnel en ligne (STL ; échange de services sexuels contre de l'argent, des biens ou des services en utilisant Internet pour trouver des clients) est de plus en plus présent parmi les hommes et les femmes trans. Cependant, ces populations restent sous-représentées dans les études et les interventions visant les populations clés. Cette analyse préliminaire vise à identifier les facteurs associés à l'utilisation non systématique des méthodes de prévention du VIH et des autres ITSS.

Méthodes:
L'étude ANRS SEXTRA, portée par Coalition PLUS et l’IpDH-Bolivie, est un projet communautaire et exploratoire visant à identifier les besoins en santé sexuelle des hommes cis et trans et des femmes trans impliqué·es dans le STL dans 8 pays. Au Canada, la collecte de données a eu lieu via un questionnaire en ligne (août 2021–mai 2022). Une régression logistique multivariée a été utilisée pour identifier les facteurs associés à l’utilisation systématique d’outils de prévention, c’est-à-dire les participants ayant déclaré utiliser toujours des condoms, la PrEP et/ou le TasP avec leurs client·es.

Résultats:
L’analyse a été menée auprès de 96 participants. Parmi eux, 57,3% ont déclaré une utilisation systématique des méthodes de prévention. L’analyse multivariée montre une utilisation moins fréquente parmi les personnes vivant avec le VIH (aOR[95%IC]: 0,19[0,04–0,85]), les personnes ayant eu besoin de soutien moral dans les 12 derniers mois (0,31[0,10–0,97]), et les personnes qui ne sont pas nées au Canada (0,19[0,04–0,94]).

Conclusion:
Cette étude contribue aux recherches limitées sur les besoins, pratiques et accès à la prévention et aux soins des hommes et les femmes trans impliquées dans le STL. Les résultats préliminaires montrent qu’une grande proportion de la population visée n’utilise pas de protection avec leurs client·es. Les facteurs associés au manque de protection mis en avant ici permettront d’adapter des campagnes de prévention pour cette population.

Objective: This study evaluated the impact of a 12-month online exercise program for HIV-positive adults. It combined live and recorded content with tele-coaching from Toronto Central YMCA, aiming to assess its effectiveness.
Methods: Using thematic analysis, the study investigated tele-coaching's influence on goal setting, mindset, and exercise adherence, considering COVID-19's impact. Participants included nine individuals (two cisgender females, one non-binary, six gay cisgender males) who were interviewed at start, mid-point, and 6-months after exercise intervention.
Results:
1. Goal-setting: Participants modified their initial exercise goals for greater realism and adaptability, with notable improvements in mindset, that is, showing a positive attitude shift towards physical activity, driven by personal challenges and motivations.
2. Accountability and Support: Consistent support from coaches and peers was essential for commitment and overcoming barriers like stigma and fatigue.
3. Technology and Convenience: While online resources and home-delivered equipment were appreciated, they didn't always increase usage.
4. Transitions and Intentions: Shifting from tele-coaching to independent exercise highlighted the need for self-motivation and coping with external factors.
6. Gender-specific Challenges: The program revealed extra hurdles for HIV-positive women, especially in balancing gender roles such as caring for others.
7. Complexities of Study Participation: The study's demands, like learning Fitbit usage and time management were challenging aspects of the intervention.
Conclusions and Recommendations: The study emphasizes the importance of mindset shifts and habit formation in exercise programs for HIV-positive people. Reducing stigma, both self-imposed and societal, and blending accessible exercise options with technology and flexible scheduling are key. This includes providing informative sessions to facilitate these changes.
Implications: Implications: The analysis revealing that people ageing with HIV encounter similar obstacles as older people with ongoing physical, cognitive, and stigmatized conditions underscores the need to adopt a comprehensive approach to disability and uphold disability justice in our physical intervention strategies.

Background:
Active participation by People Living with HIV (PLHIV) has been pivotal to HIV research historically; yet the recent surge of big data in HIV research often circumscribes PLHIV. Our Eng/aging team piloted a framework to authentically engage PLHIV (peer researchers) in administrative health data research.

Our Community-Based Approach:
Eng/aging is a community-led project including peer researchers, data scientists, clinicians and social scientists. Eng/aging involves two integrated elements: 1. Community-led administrative health data research using data from the "Comparative Outcomes and Service Utilization Trends (COAST) study” focused on aging and HIV; 2. Collective reflexive examination of our COAST research process to build a framework that engages peer researchers. To bridge capacity, we formed our diverse team and co-produced knowledge translation (KT) tools to collectively understand COAST/administrative health data, and research interests. We then used a peer-facilitated process to identify important COAST questions, and co-wrote and submitted a data analysis request complete with an analysis plan. We are currently co-analyzing results to inform our findings KT plan. Through the research process, we have collectively conducted participant observation and critical reflexive dialogue through “Gathering Wisdom” discussions.

Lessons learned:
Co-creating less technical, visually-based KT tools and presentations and having regular conversations was effective in achieving a project whereby peer researchers felt empowered to lead and develop a strengths-based research perspective. Involving peers with varying levels of experience was essential; this enabled community capacity to work through the complex analytic approach required of administrative data research. Full team commitment to community-based research principles is necessary. In-person time (e.g. a 3-day retreat) has been critical to our progress and requires coordinating complicated schedules.

Conclusion:
Community-led big data research is not only ethically sound but can also strengthen the veracity of big data HIV research by being human-centered—infused with lived/experiences and reflective of community priorities.

Introduction: There is paucity of research on social structural determinants of health (SSDoH) impacting sub-Saharan African women migrants living with HIV (SSAWMLH), a key population in Canada. Our research objective was to explore the SSDoH, including HIV-related stigma, and their influence on SSAMWLH in Canada, including participant’s viewpoints on how to improve their health outcomes and social concerns.

Methods: Between December 2022 and June 2023, we applied an intersectional framework and community-based research (CBR) approach to engage SSAMWLH across British Columbia in photographic methods. We employed mobile phone cameras from 12 participants to generate images (average 8 images per participant) using a hybrid-mode of discussions within videoconference-mediated technology for our focus group discussions (average length of 86 minutes). Then, 9 of 12 participants additionally agreed to complete our photo-elimination semi-structured interviews (average length of 53 minutes). Photos and verbatim transcripts were analyzed in NVivo.

Results: We had 11 cisgender women and one transgender woman participant (n=12), who have lived with HIV for an average of 14 years. Half of the women were landed immigrants, more than 50% have lived over 10 years in Canada, and more than 90% of participants lived in Metro Vancouver. We identified the following themes: i) negative and positive experiences while linked to health and social services; ii) gendered experiences; iii) stigmatizing and discriminatory experiences; and iv) barriers and facilitators to use of HIV prevention efforts, including U=U.

Conclusion: Culturally responsive participatory photographic methods can promote interactions with disprivileged women, help to interpret their experiences of social structural determinants of health and HIV-related stigma. Fostering CBR principles and intersectionality (re)commit researchers to health equity that can progressively respond to and result in social transformation. Further, new multi-level knowledge is co-constructed that can (re)produce and (re)design community-based interventions to help destigmatize HIV in this distinct important community.

Background: The Women-Centred HIV Care (WCHC) toolkits, designed to inform care delivery for women with HIV, have been well received since their launch in 2020. In response to community feedback, we aimed to create an innovative, interactive booklet based on the WCHC model to improve patient-provider communication and support women with HIV’s self-advocacy in healthcare settings.
Methods: We conducted one-on-one stakeholder consultations to gather ideas on desired format, content, evaluation, and implementation. Detailed notes were recorded during each interview, and content analysis was conducted. Preliminary content was developed and reviewed by four community members and the core interdisciplinary team.
Results: Stakeholder consultations were held with 25 experts in Ontario and British Columbia, including community members and various healthcare professionals. There was a preference for a user-friendly, colourful, and interactive pocket-sized paper booklet, that could potentially be translated into a mobile app. Priorities included practical features like appointment planning and sample phrases for self-advocacy. To assess the tool, stakeholders recommended evaluating user satisfaction with providers, communication, and overall experience, along with factors like autonomy, engagement, and potential clinical measures such as health-related quality of life. Implementation recommendations encompassed leveraging partnerships with existing HIV networks, developing a provider accompaniment, prioritizing urban and rural dissemination, and expanding translation to other languages. Using this input, we finalized content and collaborated with a graphic design company to create the WCHC Pocketbook prototype.
Conclusion: Integrating feedback from a broad range of stakeholders led to the creation of a relevant Pocketbook prototype, representing a novel resource in the field of women and HIV. The next phase of this project will involve conducting usability testing with women and providers to inform the final version. Subsequently, we hope to conduct an implementation study in care settings to assess the potential of the Pocketbook to impact real-world patient-provider interactions.

INTRODUCTION:
There is a dearth of research on unique challenges Middle Eastern and North African (MENA) youth face when accessing sexual health services in Canada. YSMENA is the first community-based research to identify effective interventions to reducing HIV vulnerabilities among MENA youth in Canada.

METHOD:
MENA youth, clinicians, researchers, and community leaders led survey development, with feedback from MENA HIV experts. MENA youth pilot-tested the survey, which was then administered online via Qualtrics from March-July, 2023. Survey had 80 questions covering socio-demographics, sexual health, stigma and discrimination, HIV/STI prevention interventions, mental health, and resilience.

RESULTS:
A large sample of MENA youth (N=239), ages 18-29 years (average=24.67, SD=3.39) from Ontario (78.8%) and British Columbia (22.2%) completed the survey. Sub-groups included: gay/bi/MSM (37.2%), heterosexual women (28%) and men (16.7%), trans-identifying youth (8.8%), and lesbian/bisexual/queer (LBQ) women (7.9%). Most participants were newcomers, with 70% having lived 9 years or less in Canada. About 67% had post-graduate or undergraduate education. Half of participants reported fair to extreme difficulty in meeting their monthly housing costs. Using DASS-21 scale, 11% reported mild to moderate stress levels, while almost half (46%) reported mild to extremely severe anxiety levels and one-third (33%) reported mild to severe depression levels. Gender-focused and culturally-relevant programs and creating safe spaces for gender and sexual minority youth were ranked first. Newcomer orientation on sexual health and sex-positive spaces were highlighted. Interventions, including improving medical access, training for health care workers, and media campaigns were ranked second. Interventions for enhancing accessibility for PrEP and testing were crucial for all groups, especially for trans youth (57.1%), heterosexual youth (31.8%), LBQ women (26.3%) and gay/bi/MSM (18.5%) to promote health-seeking behaviour.

CONCLUSION:
Knowledge gained addresses important gaps concerning this growing community in Canada and highlights youth-informed sexual health interventions that can guide policy and practical measures.

INTRODUCTION:
Research on sexual health practices of Middle Eastern and North African (MENA) youth in Canada is lacking, despite increased immigration. Gay, bisexual, cis men who have sex with men (MSM), and trans MENA youth bear disproportionate burden of STIs and HIV. YSMENA community-based research study aimed to determine meaningful HIV and STI prevention interventions for MENA youth in Canada.

METHOD:
A quantitative survey was administered to MENA youth, ages 18-29 years in Ontario and British Columbia (BC). The survey was developed by a community-based team, including MENA youth, clinicians, researchers, and community leaders with feedback from MENA HIV experts. The survey was pilot-tested with MENA youth and revised before administering online via Qualtrics. MENA Peer Research Associates helped recruit hard-to-reach participants.

RESULTS:
A total of 239 youth from Ontario (77.8%) and BC (22.2%) completed the survey, with no significant differences on background characteristics noted. Average age was 24.67 years (SD=3.39). Almost 50% identified as gay/bi/MSM (n=89, 37.2%,) or trans (n=21, 8.8%). Interestingly, 85% were newcomers, and most trans youth spent  3 years in Canada. Majority of gay/bi/MSM and trans youth (82%) were aware of PrEP, yet usage was low: 33.3% vs 18%, respectively. Concerns about side effects, stigma, and accessibility were reported. About 50% had limited knowledge of PEP, with a significant proportion reporting access uncertainty. Apprehension about HIV/STI testing was notable in gay/bi/MSM youth due to fear of positive results and stigmatization, whereas 60% of trans youth were uncertain about accessing HIV/STI testing. HIV Incidence Risk Index (HIRI) for HIV-negative participants indicates gay/bi/MSM (63%) and trans youth (28%) had HIRI scores of 10 or higher, denoting increased risk of acquiring HIV.

CONCLUSION:
There is a need for culturally-relevant, tailored HIV/STI prevention programming aimed at addressing barriers facing Gay/bi/MSM and trans MENA youth in accessing sexual health services.
 

Intimate partner violence (IPV) can have long lasting negative health impacts, and reducing IPV risk and experiences is critical for long-term physical, mental, and sexual wellbeing. This is particularly salient among refugee youth as experiences of IPV are more common compared with non-refugee counterparts and has been linked to depression and HIV risk. However, having higher sexual relationship power (SRP) may mitigate the risks of IPV among refugee youth. Yet, imbalances in SRP can influence sexual decision making and limit the ability for those with lesser power to negotiate engagement in safer sexual behaviours increasing the risk of HIV and IPV. Understanding how SRP affects IPV among refugee youth could influence interventions to reduce IPV, lower HIV risk, and promote mental and sexual health. To deepen this understanding, we explored the associations between IPV and depression and examined the mediation effects of SRP. Cross sectional data was collected from urban refugee youth in Kampala and structural equation modeling was used to test relationships between depression, IPV, and SRP. Results indicated that SRP, measured by the relationship control subscale mediated the relationship between IPV and depression. IPV was found to have direct effects on depression. These findings suggest that IPV both directly affects depression, as well as reducing sexual agency and relationship power that in turn also contributes to depression and increases HIV risk. It further underscores the urgent need for IPV prevention and gender-based violence prevention, as well as integrating of sexual relationship empowerment within larger programming for promoting healthy relationships and mental and sexual health.

Background: The Greater Toronto Area (GTA) is the epicenter of the ACB HIV epidemic in Ontario. The GTA alone accounted for 60% of the HIV diagnoses among ACB people. Despite this, we have limited access to culturally and racially effective HIV primary healthcare services to improve health and well-being and reduce HIV infections. Within this context, the Aya Circle of Care program located at TAIBU Community Health Centre is being created as the first intensive HIV case management primary healthcare program for ACB communities in the GTA.

Objective: To understand the strengths, challenges, and perceived impact of implementing an intensive HIV case management program within a primary healthcare clinic for ACB community members.

Method: We conducted a descriptive qualitative study using face-to-face semi-structured key informant interviews (N=20) with policymakers, researchers, service providers, and healthcare providers with expertise with HIV and ACB communities. A majority of the informants identified as living with HIV (55%). Data was analyzed using conventional content analysis.

Results: Informants proposed key themes for the foundation of the program. The program should centralize the social determinants of health and address health disparities experienced by ACB populations. The program should develop effective pathways to increase the timeliness of linking to primary healthcare, retention in care, adherence to treatment and maintaining viral suppression. The program should be geographically focused, grounded in Africentric principles, and focus on navigating the effects of structural anti-Black racism. Services should be led by Black providers within Black-focused organizations, address HIV stigma, provide services for family units and support those at risk for HIV.

Conclusion: Increasing access to intensive case management and primary healthcare services that are comprehensive and culturally, and racially appropriate is crucial for improving health and well-being among ACB populations living with HIV in Ontario.

Issue: The COVID-19 pandemic spurred a surge in virtual collaborative spaces within the HIV and harm reduction sector. The confluences of the pandemic, the drug toxicity crisis, grief, and loss within the sector, have contributed to a fragile system that may create challenging virtual spaces for participating communities.

Description: The Dr. Peter Centre (DPC) has a long history of hosting virtual communities of practice, training, and developing innovative digital knowledge translation products to build the capacity of health and social service providers to address emerging issues within the sector and promote the leadership of people with lived and living experience of drug use (PWLLE). The Urgent Public Health Needs Sites (UPHNS) HUB Community of Practice was created to address these issues during COVID-19.

Lessons Learned: When given the platform and safe space to widely share knowledge and expertise, innovation happens organically. This presentation will share lessons learned on leveraging digital tools and participatory design to lift the voices of PWLLE and facilitate equitable violence- and trauma-informed virtual spaces to inform policy and practice change. It will also highlight ways in which creative digital tools can bridge federal, provincial, municipal, and community responses towards putting an end to the toxic drug supply crisis and promoting stigma reduction efforts on HIV and substance use nationally.

Recommendations: This project underscores the transformative power of digital platforms in fostering equitable, informed, and collaborative spaces within the HIV and harm reduction sector. Harm reduction strategies embedded into the UPHNS HUB project are known HIV prevention strategies. Moving forward, what remains is to identify from a social science research lens to comprehensively understand the impact of virtual communities of practice. By examining the intersections between digital spaces, community engagement, and harm reduction strategies, we aim to outline pathways for more effective policy and practice change.

Introduction: The global HIV Community Council (HCC), a group of ten leaders of diverse, under-represented groups of people with HIV, prioritized stigma, and poor mental wellbeing as critical barriers to successfully living well with HIV. The HCC has developed a set of recommendations to address these critical barriers.

Description: The HCC achieved consensus on six global recommendations through offline and online meetings, a comprehensive literature review, and the sharing of examples of successful practical solutions to address stigma and poor mental wellbeing. The HCC selected the two recommendations that, based on their experience, would have the greatest impact, and provided guidance on their implementation.

Lessons learned: To address HIV-related stigma, the HCC recommended harnessing the ‘power of one’s own story’ using incubator programs, that provide access to mentorship and collaboration opportunities, to disseminate engaging, culturally appropriate, and relatable stories that challenge stigma across various settings, including social media. Supported by talent scouts to identify potential partners, build relationships, and facilitate collaborations between influencers and brands or organizations, these programs provide influencers with the resources and support to create and share accurate and culturally competent information about HIV across community-appropriate platforms. To address mental wellbeing, the HCC recommends partnering with expert organizations to equip leaders of peer-support groups with Mental Health First Aid training to enable staff of community organizations to identify and screen for mental health needs such as anxiety and depression and connect individuals with mental health services in crisis and non-crisis situations.

Recommendations: The HCC calls for action to implement community-endorsed, culturally appropriate, and practical solutions to tackle stigma and mental wellbeing and improve HIV care in a way that reflects the unique local lens of each community.

Background: Children and adolescents living with HIV in sub-Saharan Africa experience poor outcomes across the HIV cascade of care. Paediatric and adolescent-friendly HIV services are crucial to their wellbeing, and recent years have seen a call for urgent service improvements. While frontline health workers are responsible for delivering these services, less attention has been given to their contextual realities, challenges and what constitutes an enabling service delivery environment.

Method: Data were collected across 24 sites in 2022 at a convening of key service providers on the frontline of the paediatric-adolescent HIV response in twelve high HIV-burden African countries (eSwatini, Kenya, Malawi, Mozambique, South Africa, Tanzania, Uganda, Zambia, Cameroon, Ethiopia, Nigeria and Zimbabwe). Service providers included nurses, doctors, peers supporters, community health workers, and psychosocial support workers.

Results: Inadequate material and human resources were among the most commonly cited and prioritised difficulties. In discussing material challenges, participant described multi-level stressors related to patient health, their relationships with patients, and their own well-being. First, resource-related challenges were described as diminishing of efforts of children and adolescents living with HIV – and the frontline providers who support them – to adhere to HIV medicines and be retained in the HIV cascade of care. Second, resource-related challenges was described as stressful to frontline providers, who tried to buffer these structural and supply-chain barriers through resource prioritization, and in some cases, through supporting patients personally.Third, stock-outs and long wait times were reported as eroding patient trust in health products and services, as well as trust in frontline providers themselves. Frontline providers described this as difficult, stressful and demoralizing.

Conclusion: Findings suggest that the provision of frontline paediatric and adolescent HIV care – and the relational wellbeing of frontline providers themselves – is influenced by structural, institutional, relational and material contexts in which frontline providers work.

Background
People living with HIV have many competing concerns that prevent them from getting and using care. These issues are particularly pronounced in Black people living with HIV in Ontario. Case management is an approach to HIV care that considers all these issues, in addition to medical care. Black people living with HIV have different care needs, therefore their cases must be managed differently.

Objective
To develop and test a tool for identifying and categorising case management needs among Black people living with HIV in Ontario.

Methods
We employed a sequential exploratory mixed methods design to develop the HIV Case Management Acuity Assessment tool (HICMAAT). This is a two-phase design that begins with a qualitative phase followed by a quantitative phase. Using purposive sampling we recruited eligible participants who were asked about the relevance of 22 potential items in assessing the HIV case management acuity of a Black person living with HIV. We completed a thematic analysis of the interview transcripts and used those themes to generate variables for our quantitative phase.

Results
We conducted 27 qualitative interviews.The top 10 items reported by participants were: culture or language; mental health; support system; medication adherence; health insurance or medical care coverage; financial; experiences of racism and unfair treatment; experiences of HIV-related stigma, domestic violence or intimate partner violence and immigration. Participants identified family situation (e.g. family separation, dependents) and transitional care (whether the individual is transitioning from youth to adult care) as additional items.

Conclusions
Qualitative data suggests 24 items are relevant to the case management of Black people with HIV. These items will be ratified in the quantitative portion of this work and used to inform the development of HICMAAT.

Limitations
All interviews were conducted virtually due to COVID-19 which may have limited the participation of potential participants.

Background: For people living with and at risk for HIV, migration requires adjustment not only to a new culture and country, but also a rapid transition into needed healthcare. HIV outcomes are related to economic stability and social support, which can be challenging post-migration.
Methods: The OHTN Cohort Study (OCS) enrols people living with HIV (PLWH) receiving care in 15 clinics across Ontario. From 2020-2022, questions regarding experiences pre- and post-migration were included in the annual interviewer administered questionnaire. Individual responses were tracked to determine changes pre- and post-migration, and a sign test was used for significance testing. Positive (Pos) and negative (Neg) pre-post migration changes are reported.
Results: Among 329 respondents, 62% were diagnosed in another country, 36% in Ontario and 2% elsewhere in Canada. 52% were women, 37% gay bisexual men (GBMSM) and 11% heterosexual men. 48% came from an African country, 15% Caribbean, 14% Asia, 9% North America, 6% Europe and 9% South/Central America. 12% had been living in Canada 0-2 years, 49% 3-5 years, and 39% 6-10 years. Overall, participants experienced a positive change post migration for access to basic needs (food, clothing etc.) (Pos:47%,Neg:21%;p<0.001), feeling of safety (Pos:74%,Neg:3%;p<0.001), access to employment (Pos:61%, Neg:14%;p<0.001), access to lab testing (Pos:70%, Neg:3%;p<0.001), access to medical care (Pos:74%,Neg:4%;p<0.001) and improved mental health (Pos:50%,Neg:15%;p<0.001). Negative changes post migration were found for connection to friends (Pos:22%,Neg:35%; p=0.005) and connection to family (Pos:25%,Neg:33%; p=0.03). Mental health improved most for women (85.1% vs 76.5% heterosexual men and 69% GBMSM). Connection to HIV care improved over time with 83.3% improved 0-2 years post migration compared 98% after 3 years.
Conclusions: Overall PLHIV in Ontario showed positive experiences post migration, however, to support health for immigrants, additional supports are required to ensure that PLHIV have connections to community and social supports.

Background: People living with HIV are at highest risk for anal cancer. The International Anal Neoplasia Society (IANS) recently released the first-ever anal cancer screening guidelines. Yet, anal screening has not been adopted into HIV care, health system barriers may thus need to be overcome for widespread adoption.

Objectives: The ACCESS Study aims to gather evidence for implementation of equitable anal screening for people living with HIV in Ontario. Specific aims are to: 1) assess individual, healthcare provider, and system needs for adoption of anal screening; 2) co-create implementation strategies for screening that are feasible and acceptable to deliverers and recipients; and 3) evaluate strategies for reach, effectiveness, adoption, and implementation outcomes.

Methods: ACCESS will use a three-phase, mixed-methods design. The exploration phase includes focus groups and key informant interviews, informed by the Theoretical Domains Framework and the Consolidated Framework for Implementation Research. The preparation phase will assemble toolkits informed by the Expert Recommendations for Implementing Change. The implementation phase will use a quasi-experimental design using data from field notes, electronic medical records, and qualitative interviews to measure implementation outcomes, informed by the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, Maintenance).

Expected outcomes: Documentation of health system needs for implementation will support robust screening referral networks in which anal screening is equitable and cost-effective. Documentation of practice and clinic-level needs, preferences, and evaluation of early implementation efforts can help screening deliverers achieve competence and inform how to integrate this screening into routine HIV care. Learning recipient needs and preferences ensures that anal screening remains anchored in the experiences of people living with HIV for cancer prevention and improvement of quality of life.

KNOWLEDGE ACQUISITION, PERCEPTION, AND ENGAGEMENT LEVEL OF ISLAMIC RELIGIOUS LEADERS IN HIV/AIDS PREVENTION IN TORONTO, ONTARIO, CANADA
This qualitative descriptive study investigates perceptions, knowledge, and attitudes of 30 Muslim religious leaders (male, female, and youth) in Toronto regarding AIDS prevention and their views on people living with HIV/AIDS (PLWHA). Employing audio interviews, a content analysis approach was used for data analysis. Results indicate that these leaders don't consider AIDS a significant health issue within Toronto's Islamic community, attributing lowered risk behaviors to adherence to Islamic values.
While responses to PLWHA varied, there was consensus among leaders about their responsibility in preventing HIV/AIDS, emphasizing the role of sex education in fostering healthy behaviors and preventing HIV transmission. The study addresses a gap in existing research, which focuses on Christian leaders in Canada, neglecting the broader population and religious sites.

Examining the role of Islamic Religious Leaders (IRLs) in the Greater Toronto Area, the study reveals a mean age of 49 years, with 67% being male. Their primary source of information on HIV/AIDS was mass media (98%). While knowledge scores averaged 6.7%, 60% demonstrated good knowledge, and 56% could not correctly identify HIV as a cause of AIDS. Abstinence as a was strongly endorsed (98%), with 99.5% perceiving HIV/AIDS as a threat to social well-being.

Despite acknowledging the vulnerability of Muslims to HIV, 66.6% believed IRLs play crucial roles in prevention. However, limited training on HIV/AIDS was observed. Barriers to organizing educational programs included lack of knowledge (16.7%) and limited access to educational materials (12%). Most respondents (80%) expressed willingness for training on HIV.

In conclusion, the study underscores the fair knowledge of HIV/AIDS among IRLs but highlights their limited involvement in prevention programs. To address this, formal training, advocacy, and technical support are recommended, with an emphasis on capacity-building and materials.

This study examines the experiences of people living with HIV (PLWH) in relation to the closure of AIDS Service Organizations (ASOs) during the COVID-19 pandemic in Ontario, Canada. This study sought to understand the health and social implications of lockdown measures, and the adversities endured due to closures of services essential to maintaining positive health outcomes among PLWH.

Data were collected through semi-structured interviews. A total of eight service users from a Kingston, Ontario-based ASO were invited to participate and share their experiences of being HIV-positive and navigating service access throughout the pandemic. In addition to PLWH, eight ASOs from across the province of Ontario were included, with key informants interviewed to better understand the changes in operations that occurred to adhere to lockdown measures. Data were transcribed verbatim and coded utilizing thematic analysis in NVivo 12 software.

The results show that ASOs are integral to the health and well-being of PLWH, acting as resource centres for their social, physical, and financial needs. The inability of PLWH to access ASOs during the COVID-19 pandemic resulted in worsening health outcomes, increased feelings of isolation, disruption in medical care, and an increased inability to access resources. Service providers at ASOs felt that changes in their mode of service delivery and barriers to client management led to staff fatigue and moral distress.

The results from this study demonstrate the need for reimagining HIV/AIDS and other service provisions during pandemics to ensure that resources remain accessible for PLWH and other marginalized populations. Further, the results from this study will assist and inform future policy recommendations to ensure that the health and well-being of marginalized populations are at the forefront of public health policy decisions during pandemic situations.

Importance: In the USA and Canada women make up approximately 1/3 of people who inject drugs (PWID), but the clinical characteristics and outcomes of intravenous drug use complications in women are poorly described.

Objective: To identify clinical characteristics and outcomes of infective endocarditis (IE) in women who inject drugs (WWID).

Design: A retrospective cohort study of PWID with modified Dukes criteria definite IE admitted between April 5, 2007 and March 15 2018. Data was analyzed between June 1, 2023 and Sept 15, 2023. Descriptive analyses were conducted for baseline characteristics at time of first hospital admission and stratified by patient sex. Multivariable time-dependent Cox proportional hazards regression analyses were conducted for variables of clinical significance to evaluate one-year and five-year mortality. Fully conditional specification was used to handle missing data.

Setting: Five tertiary care hospitals in London, Ontario and Regina, Saskatchewan, Canada.

Measures: Difference in one-year and five-year survival probability between men and women PWID with IE.

Results: Women made up 51.2% (220/430) of PWID with IE and 30.4% (101/332) of non-PWID with IE. Women who inject drugs (WWID) with IE were younger than men (P<.001), and 5.0% were pregnant at admission. Women were also more likely to have right-sided IE (P<.001). WWID with IE living in urban areas had a significantly higher rate of five-year mortality than those in rural areas (P=.01). Addictions counselling was associated with lower mortality (P<.001), and mortality was lower in centres with inpatient addiction counselling when compared to those offering only post-discharge referrals (P<.001).

Conclusions and Relevance: Despite making up a minority of PWID, women are overrepresented amongst cohorts of PWID with IE. The reasons for women's increased susceptibility to IE needs further study. Inpatient addiction support services, reproductive counselling, and enhanced social support of WWID living in urban areas need to be prioritized.

Background
The experience of pain is a prevalent co-occurring condition, arising as a complex consequence of HIV infection itself and as a side effect of antiretroviral therapy among the 60,000 Canadian individuals living with HIV/AIDS (PLHAs), adversely affecting PLHAs' sleep, mood, cognition, emotional health, social and workplace participation, and overall quality of life. The International Association for the Study of Pain (IASP 2020) defines chronic pain as a distressful sensation linked to tissue harm, persisting for over three months. To cope with pain, PLHAs utilize a range of approaches, including standard medical care, alternative healing methods, and body-mind practices. The research protocol we plan to present at CAHR 2024 is the result of extensive participatory work involving peer researchers, clinicians, social behaviorists, and educators.

Objectives
1) Form, educate, and support a team of Peer Researchers (PRAs) to work alongside researchers and partners in all facets of the study; 2) Carry out a bilingual online survey with 500 PLHAs from a non-probabilistic sample to explore their chronic pain experiences, access, and impacts; 3) Apply the Q-sorting technique to prioritize survey results based on the most pressing needs of those enduring pain and HIV.

Study Design
This investigation adopts an Exploratory Sequential Design mixed-methods approach, beginning with a bilingual nationwide online survey and followed by a series of national workshops employing Q-sorting to categorize and prioritize statements based on participant agreement and relevance.

Participant Recruitment and Eligibility
Using our extensive combined network, we will recruit up to 500 diverse participants self-identifying with the IASP definition of chronic pain (i.e., pain > 3 months) and consenting to fill out a self-report questionnaire with a stipend offered.

Funding
The Canadian Institutes of Health Research and the HIV/AIDS and STBBI Community-Based Research Program [483727] fund this study, with approval from the University of Toronto REB.

Background: Gay, bisexual, and other men who have sex with men (GBM) are more likely to report loneliness, partly due to their experiences of heterosexist stigma. According to the Loneliness and Sexual Risk Model, loneliness among GBM is associated with engaging in behaviours that increase risk for sexually transmitted blood born infection (STBBI) transmission. We examined the association between internalized homonegativity, being open about one’s sexual identity (i.e., being out), loneliness, and the protective effects of social support. Lastly, we examined the association between loneliness and recent engagement in condomless anal sex (CAS).

Methods: Data were drawn from the third and fourth study visits of participants in Engage Cohort Study (n=1166) of GBM in Montreal, Toronto, and Vancouver. Using a moderated mediation analysis (Heys’ model 15), we examined whether outness mediated the relationship between internalized homonegativity and loneliness, and whether social support moderated these relationships. Separately, we used logistic regression to examine whether loneliness was associated with CAS in the past six months among participants who reported 2 or more sex partners and no primary relationship partner (n=489). Analyses controlled for age, education, financial strain, depression, and HIV status.

Results: Internalized homonegativity was positively associated with loneliness (beta=.240, p<.001) and outness (beta=.109, p=.005). Social support moderated the association between internalized stigma and loneliness, but outness was not a significant mediator. Among GBM who reported having two or more recent sex partners and no primary partner, loneliness was not significantly associated with recently engaging in CAS (p=.836).

Conclusion: Internalized stigma was associated with increased loneliness six months later, particularly among GBM who also reported less social support. However, as loneliness was not associated with recent condomless anal sex, it seems the potential association between loneliness and behaviours that increase STBBI risk among GBM is not as clear-cut as theory would suggest.

Non-prescribed Anabolic/Androgenic Steroid (AAS) use among 2-Spirit, gay, bisexual, queer and other men who have sex with men (2SGBQ+) is a common and complex practice influenced by social and cultural norms within and outside of queer men's communities. AAS use among 2SGBQ+ men has also been linked to a range of health risk factors and outcomes, including illicit substance use, sexual risk taking practices and increases in ST/BBIs, including HIV. This presentation will focus on results from a qualitative study that explored the world of AAS use among 2SGBQ+ men in Manitoba with a specific focus on the harm reduction opportunities and challenges embedded within the culture of AAS use for this population. Concrete recommendations to implement harm reduction strategies will be shared for public health and social service providers.

Community researchers living with HIV are central to the research process, yet often face precarious working conditions. During the COVID-19 pandemic, many research projects were put on hold, causing disruptions. The objective of this arts-based community-based research (CBR) project was to explore how COVID-19 impacted the employment experiences of community HIV researchers. We conducted 6 object-elicited focus groups with 25 community researchers living with HIV in Canada who worked during the COVID-19 pandemic, or whose work was interrupted by COVID-19. Focus groups included 10 Indigenous people, 3 people who were Black Canadian, Middle Eastern, or East Asian, 2 people who were Jewish, and 13 people who were white. The average age was 54.3 (range 32-69) with 13 women, 10 men, 3 Two-Spirit people, and 3 gender diverse people. The team used a collaborative approach to thematic analysis, double-coding each transcript. Community researchers identified technology and communication challenges that impacted their ability to work during the COVID-19 pandemic. While technology was a barrier for some, it facilitated access to employment for others. Many shared feeling they were “fumbling in the dark” due to lack of information about the status of research projects. Community researchers identified the following key recommendations for employers: 1) improve access to technology and equipment for work, communication, and team connection, 2) prioritize the health and well-being of team members, especially in relation to isolation and loss, 3) compensate community researchers for training and professional development, 4) involve community members as collaborators in research decision-making processes, 5) foster open, adaptable, and timely communication channels between community researchers, participants, and research teams, and 6) ensure equitable compensation including attention to cost of living and additional expenses (e.g. childcare, internet access). Attending to these suggestions will help to improve the working conditions of community researchers.

Background: New guidelines recommend anal cancer screening among people living with HIV, given their 20-90 times greater risk compared to the general population. We synthesized and characterized existing patient-/public-facing materials about anal cancer screening for potential use by people living with HIV.

Methods: We carried out PubMed searches to identify studies on patient perceptions, attitudes, and knowledge of anal cancer and/or anal cancer screening. Next, we contacted authors, supplemented with Internet searches, to gather publicly available materials used to promote anal cancer screening, diagnosis, and treatment. We thematically analysed the content of media, applying the Theoretical Domains Framework (TDF), and characterized their language, imagery, and formatting.

Results: As of 01/2024, we collected 23 materials from North America: pamphlets (7), videos (3), websites (3), posters (4), and social media posts and campaigns (5). Their intended purposes were education on anal cancer (7), screening (6), and diagnostic processes (4). Content included descriptions of anal cancer (11), screening methods (6), risk factors (2), and treatment options (1). Most targeted a general audience; few incorporated tailored messaging. While 6 materials mentioned specific groups at higher risk (e.g., men who have sex with men, people living with HIV), none incorporated aspects of gender, sexuality, or race/ethnicity in their messaging or imagery. Materials focused on overcoming knowledge barriers via information provision about cancer risks and the testing process. None addressed other potential barriers and facilitators according to the TDF (e.g., peer influences, emotions, or beliefs about capabilities or consequences).

Discussion: This work contributes to a resource library of patient education materials. Findings suggest potential needs for refinements to messaging, such as encouragement to seek screening and normalizing anal cancer screening. Materials will be used in future evaluation in focus groups with people living with HIV to support the eventual, broader implementation of anal cancer screening.

Background: HIV stigma is a barrier to testing, treatment, and an optimal life for people living with HIV (PLHIV). In order to better understand experiences of stigma for people living with HIV in Ontario and its relationship to health outcomes, we asked PLHIV about stigma and examined specific covariates in the OHTN Cohort Study (OCS).

Methods: The OCS is a cohort of PLHIV receiving care in 15 clinics across Ontario. Participants are administered an annual questionnaire, including a standardized HIV stigma tool (perceived and experienced). This sample includes 2,652 participants (from 2019-2022), and stigma was analyzed by demographics and HIV risk factors, and self-rated health. Stigma was categorized in very high, high, low, very low, and dichotomized (high vs low) in a multivariable logistic regression.

Results: The sample represented the cohort and key populations of PLHIV in Ontario; 5% Indigenous, 30% African, Caribbean and Black (ACB), 69% gay or bisexual men (GBMSM), 24% women, and 4.7% people who use injection drugs. Very low stigma scores were greater in the East (33.5%) and North (50%), as compared to Toronto (29.8%) and Southwest (26.1%). In a multivariable model, each year since HIV diagnosis decreased stigma (OR 0.98, 95% CI: 0.96, 0.99, p=0.009). Stigma was higher for ACB participants (OR 1.76, 95% CI: 1.22, 2.54, p=0.002) and women (OR 1.74, 95% CI: 1.15, 2.63, p=0.008). No association was found between high stigma score and age, immigration, employment, or for GBMSM. Very low stigma scores were more frequent among those with higher self-rated health (excellent/very good: 36% vs fair/poor 22.3%).

Conclusions: These results indicate that HIV stigma decreases the longer a person is living with HIV. Disparities exist, with women and ACB people experiencing greater stigma. Stigma is associated with health, and therefore must be addressed in order to ensure PLHIV experience optimal health.

Manitoba (MB) reported its highest increase in new HIV diagnoses in 2022. Marginalized groups, especially women and people who inject drugs, were overrepresented in new diagnoses, and are less likely to return for regular care upon diagnosis. We investigated the recommendations that People Living with HIV (PLHIV) have to improve HIV care.
Informed by people with lived experience (PLHIV, racialized, criminalized people), this mixed methods study draws upon semi-structured interviews and three questionnaires with 32 PLHIV in MB. Our findings focus on changes to HIV care and knowledge translation strategies for STBBIs.
Participants recommended two broad areas for improvement 1) meeting people ‘where they are at;’ and 2) education. Participants emphasized that PLHIV not engaged with HIV care face various challenges, which may include substance use, houselessness, and poverty. Accordingly, they suggested a dedicated street-based outreach HIV team to bring health services to the places marginalized PLHIV frequent (e.g., shelters). Participants also recommended more low-barrier social groups, transportation support, emergency housing and peer support for people newly diagnosed, and HIV care outside regular clinic hours. The other recommendation is for an education strategy focused on HIV prevention, treatment, and stigma reduction. Participants suggest posters and billboards in areas where social services are concentrated would make HIV information accessible for those experiencing houselessness and addictions. Participants also recommended 'open mic’ educational peer meetings where PLHIV can learn from each other, particularly for those newly diagnosed. Education in schools and social media was suggested to reach younger populations.
Many participants in this study had lived experiences of substance use dependence, houselessness and being in-and-out of HIV care. Incorporating their recommendations to create more person-centred HIV care and expand HIV education may improve HIV care for all and in particular reach those not linked to care and/or who face multiple forms of disadvantage.

Cis and trans female sex workers (FSW) face marginalization and struggle to access sexual and reproductive health and rights (SRHR) services. The COVID-19 pandemic worsened these disparities.
January-April 2023, we conducted stakeholder mapping (SM) with SRHR policies and programs decision-makers, implementers and users in Buenos Aires, Argentina. This strategy aims to identify, classify and categorize stakeholders based on the power and agreement level of SRHR policies and plans implemented during the pandemic. A qualitative study was conducted through focus groups with FSW and interviews with healthcare providers analyzed with the DEPICT model (methodology for collaborative data interpretation with the community) to investigate facilitators and barriers from their perspectives.
Considering the challenges in identifying the appropriate stakeholders, this approach became crucial. The landscape is dynamic, influenced by the sociopolitical context, and recent shifts in government. Following SM, we categorized 150 stakeholders Supporters (69%) and promoters (15%) outnumbered blockers (8%), observers (6%) and neutral (2%) in implementing new policies aimed at SRHR services for FSW. The qualitative interviews revealed barriers including the pervasive impact of intersectional stigma and discrimination, violence, failures in intersectoral articulation and coordination, and difficulties in scheduling of appointments for SRHR services. Facilitators identified improvements in transgender healthcare services in the last decade and the emergence of community assets as pivotal, particularly during the pandemic.
SM was invaluable for identifying and characterizing the priorities of key stakeholders for designing policies affecting SRHR services. The inclusion of community perspective, while challenging, enriched our understanding of barriers and facilitators while empowering the community to express their needs. Despite structural barriers and challenges posed by the pandemic, community organizations have displayed resilience, emerging as a vital support system for FSW. We highlight the importance of collaborative efforts and comprehensive approaches in addressing the unique needs of FSW in Argentina and similar contexts.

In 2018, British Columbia began providing HIV pre-exposure prophylaxis (PrEP) for those who meet clinical eligibility criteria at no direct cost to participants. Provincial clinical guidelines provide guidance on daily and on-demand dose schedules for gay, bisexual, queer and other men who have sex with men (GBQm). We sought to understand why GBQm defined as high risk for acquiring HIV, according to clinical guidelines, do not access PrEP.

Between January and March 2023, we conducted targeted recruitment of Momentum II/Engage Study participants (sexually active GBQm aged >16) in Vancouver who were clinically eligible for PrEP based on survey responses but reported never using PrEP. We conducted semi-structured interviews in English and focused on participants perspectives on PrEP, HIV risk, healthcare preferences, and their openness to different PrEP modalities. The data were coded and analyzed using thematic analysis.

We recruited 18 GBQm between the ages of 23 and 73 years old. Participants identified sexually as gay or queer and one gender identified as nonbinary. Participants identified ethnoracially as European, Canadian, or Asian. Most participants did not see their sexual behaviours as being high risk for acquiring HIV. Participants identified short time periods of risk which they weighed against their concerns about the perceived risk of long-term side effects of daily PrEP use. While some participants were aware of on demand dosing, many reported no knowledge about it. Once on demand dosing was explained during the interview, many felt it was a valuable strategy to prevent HIV acquisition during periods of higher risk.

Our research has identified a gap between clinical guidelines and the ways that GBQm understand HIV risk and prevention. This highlights the importance of multiple PrEP modalities within prescriber and health promotion practices to address the pragmatic ways that GBQm navigate sex and HIV in their lives.

In 2021, Ghana Health Service (GHS) devised a peer mentorship program to support adolescents and young adults living with HIV/AIDS with getting on to and adhering to anti-retroviral treatment (ART). Community adolescent treatment supporters (CATS) are adolescents living with HIV who have demonstrated exemplary behaviour in medication adherence, and connection and dedication to improving their communities. There are less than 15 CATS working in Kumasi, resulting in large caseloads. Partnering with GHS, this study sought to gain a more comprehensive understanding of the roles and experiences of the CATS working in Kumasi.

Data were collected through semi-structured interviews at three different HIV clinics in Kumasi. A total of five CATS were interviewed for this project, in addition to 15 peers who have direct interaction with a CATS. Aside from the peers and CATS, seven key informants working in the HIV clinics were interviewed to gain a better understanding of the CATS roles and overall treatment strategies for their clinics. Data were transcribed verbatim and coded using thematic analysis in NVivo 14 software.

The results demonstrate that the work of the CATS is integral to the well-being and maintenance of treatment amongst newly diagnosed adolescents and young adults. CATS work to facilitate appointment scheduling and treatment reminders, as well as providing psychosocial support and education to their peers. CATS expressed mostly positive experiences in their roles, resulting in increased confidence, community-building capacity, educational awareness, and better personal treatment outcomes.

Results from this study demonstrate the importance and need for increased enrollment of CATS. Acting as an extension of the work being done by staff at ART clinics, CATS serve as resources to adolescents and young adults living with HIV. Further work is needed to decrease the current workloads on the existing CATS, which will increase relationship building and ultimately treatment outcomes

Introduction:
Racialized immigrants and refugees in Canada bear a disproportionate burden of HIV. Over 45% of HIV cases in Canada with a known race/ethnicity were reported as visible minority. In addition to systemic social and economic inequities, HIV stigma and discrimination reinforces HIV vulnerability by creating unsafe environments that deter people from testing and disclosure, resulting in isolation, depression, delayed diagnosis and linkage to treatment and care, and poor health outcomes.

Methods:
The Acceptance and Commitment to Empowerment (ACE) Study is a multi-phase project being undertaken in six Canadian cities – Calgary, Edmonton, London, Niagara, Ottawa, and Toronto. Our study objectives are to examine the contextual determinants of HIV stigma in racialized immigrant communities, generate inclusive knowledge to inform accessible, effective and sustainable interventions; and mobilize leadership among community members living with and/or affected by HIV-stigma. Phase One focuses on identifying the different types of stigma and lived experiences 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.

Results:
In this presentation, we report on the perspectives and experiences of affected members in racialized immigrant and LGBTQ communities. Participants indicated that: (1) deep-rooted prejudices and misconceptions about HIV have persisted in their communities; (2) invisibility of people living with HIV reinforces silence and community denial; (3) gender-based violence heightened HIV vulnerabilities and stigma; (4) experiences of HIV stigma are intertwined with experience of racism and homophobia; and (5) HIV disclosure to trusted family, friends and health care providers as a strategy to resist stigma.

Conclusion:
Visible leadership of racialized people living with HIV is critical to stigma reduction. Effective HIV responses must integrated intersectional analysis of gender-based inequities, racism, homophobia and other systemic marginalization. Results will inform refinement of our Phase Two intervention.