Introduction: Research indicates that peer navigators are highly effective in fighting HIV and improving life quality in diverse groups, especially in HIV prevention and treatment. However, there's limited knowledge about their impact in African, Caribbean, and Black (ACB) communities. This study investigates how peer navigators influence HIV testing within ACB communities, examining discourses surrounding peer navigation and the nuances of power dynamics in peer-to-peer interactions.

Methodology: The study adopted a community-based participatory research methodology. It involved conducting detailed interviews with 33 members of the African, Caribbean, and Black (ACB) communities in Manitoba, Canada. To ensure diversity among participants, the recruitment process involved community agencies, social media, and flyers and focused on including a range of ages, genders, and sexual orientations. For analyzing the data, the study used an iterative process of inductive thematic analysis and a critical Afrocentric feminist lens.

Results: Members of the African, Caribbean, and Black (ACB) community perceive HIV peer navigators as knowledgeable professionals who effectively engage with and advocate for their communities. Some argue that peer navigation, by shifting healthcare responsibilities onto communities, masks the health system's flaws and fails to tackle issues like marginalization and discrimination, hindering equitable HIV care access for ACB communities. Participants described peers as community leaders whose visible and accountable roles as insiders not only significantly enhance HIV service utilization by mobilizing communities but also serve as vital connectors between the community and various programs or research initiatives. Finally, cultural discourses on gender and age significantly impact peer navigation in the ACB communities.

Conclusions: To stem the increase of new HIV/STBBI infections in Manitoba's ACB communities, it is imperative for HIV service providers to tackle peer-to-peer power dynamics and develop culturally sensitive prevention strategies for ACB communities.

Truths

Peer navigation is a promising approach to supportive HIV and hepatitis C (HCV) care. Peer navigation can be underutilized by Indigenous women who have lived experiences of HIV and/or HCV (IWLE). This is attributed to Indigenous-specific racism in healthcare and the consequent (re)traumatization of peer navigators and IWLE. As a result, peer navigators burn out and IWLE quit accessing healthcare and disengage from peer navigation in the process. These truths call for reconciliation.

Reconciliation

Peer navigators and IWLE demanded healthcare system change. In response, this study addresses two questions: 1) what needs to change to stop Indigenous-specific racism in healthcare? and, 2) how can we achieve historic trauma safe healthcare?

Journey

Peers4Wellness is an Indigenous-led and community-driven study. This research unfolds in British Columbia. In 2017-2021, we consulted with 54 people (Peers4Wellness community) including peer navigators, IWLE, community organizations and Indigenous community researchers. Knowledge gathering and learning involved ceremony, which was grounded in Indigenous ways and supported by qualitative research methods. The journey culminated with a collective story about the community’s approach to reforming HIV/HCV care.

Story

The Peers4Wellness community introduces Healthcare CARES, a reconciliation-oriented relational model for HIV/HCV care. The model aims to decolonize the meaning and standing of peers (a group that includes peer navigators and IWLE) in healthcare. It also introduces Indigenous protocols for practicing historic trauma safe healthcare. These protocols Indigenize the principles of peer navigation and adapt them as standards for all HIV/HCV care. Healthcare CARES provide a foundation for transformative healthcare system change.

Presentation

We will share teachings from the Peers4Wellness story. These include the community’s approach to uprooting Indigenous-specific racism. The teachings also set relational standards (Healthcare CARES) for HIV/HCV care so that it is historic trauma safe, hence, supportive of peer navigators and IWLE.

Background: The Positive Leadership Development Institute (PLDI), funded by the Public Health Agency of Canada, launched an 18-month initiative to enhance cultural safety and inclusion within its HIV leadership training programs. The objective of the project is to build respectful relationships with Indigenous, and African, Caribbean, and Black (ACB) communities, expand PLDI's reach while reducing HIV-related stigma, improve health outcomes, contribute towards Truth and Reconciliation, and examine cultural safety and inclusivity of the leadership training program and delivery methods.

Methods: Adopting a mixed-method evaluation approach, the project utilized over 20 peer evaluators who brought a deep understanding of cultural context reflecting their community’s perspective to cultural safety evaluation. The peer evaluators evaluated various components of the training in both online and in-person settings in four provinces using the PLDI cultural safety evaluation manual and shared their perspectives in three different focus groups. Additionally, the PLDI training participants completed the post-training evaluation reflecting on their overall experience around cultural safety and inclusivity.

Results: Evaluation results highlighted that the online and core PLDI training had high inclusivity and good cultural representation. Meanwhile, the focus group discussion emphasized the need for ACB and Indigenous cultural representation in the trainer's pool, curriculum, duration, and delivery of the training components, incorporating various cultural teachings and community representation.

Discussion: The evaluation underscores the critical need for culturally safe approaches in HIV leadership training. With existing gaps in current literature and practices in community-based education, PLDI took steps to evaluate the inclusivity and cultural safety in HIV leadership training by leveraging insights from lived cultural experience. Work is underway to implement and evaluate the key recommendations from the project. Our team acknowledges that these efforts not only aim to improve training outcomes but also contribute significantly to broader health equity and community empowerment.

The Peer Navigator Project (PNP) is a mixed method collaborative implementation science research project that brings together researchers and community partners in Canada (London, Toronto, Vancouver) and Kenya (Eldoret, Huruma, Kitale) to explore and evaluate the use of peer navigators (PNs) for street-connected youths’ (SCY) access to HIV prevention, testing, and treatment. Five PNs are currently working in four of the study sites, and the project is using quantitative and qualitative data to monitor the PNs interactions with SCY, with a focus on the increased uptake of HIV testing and access to treatment for youth living with HIV.

The London site analyzed qualitative and meeting note data to better understand the complexities and nuances of implementing a PN in their respective site. Qualitative interview data which inquired about the PN role was collected from the PN at 6- and 18-months post implementation and at project completion. Interview data from SCY, healthcare providers, community stakeholders were collected at 6- and 18-months post project implementation. Documented notes from monthly meetings with the PN, Research Assistant (RA), and site Principal Investigator (PI) were reviewed by the RA and analysis involved theme co-creation and member checking with the PN and site PI.

Overall, the PN model has been an adaptable and well-received addition to the active project sites, and SCY has experienced improvements to social determinants of health and access to HIV care. In London, the PN is a positive role model that encourages and supports youth’s overall well-being. However, the PN must also navigate several structural, systemic, and interpersonal nuances and challenges based on their social location(s), place of employment, role description, and available support. Despite challenges, the PN role demonstrated a unique and life-saving support to SCY that merits being scaled up and sustained.

Intersectional stigma presents barriers to HIV research and cascade engagement. Graphic medicine, the use of images and text such as in comic books, has been employed to depict lived experiences to promote health, wellbeing, and education. Comic books provide a low-cost, youth-friendly approach to health promotion that is accessible to varying literacy levels. Limited research, however, has described the process of developing graphic medicine approaches for HIV prevention cascade interventions with youth experiencing marginalization in low and middle-income contexts. To address this knowledge gap, we developed the Qualitative Comic Book Mapping approach, whereby qualitative data alongside theoretical and empirical literature was used to inform scenarios that addressed intersectional stigma. Two case studies focused on youth aged 16-24 living in the Bidi Bidi refugee settlement, Uganda, include: 1) HIV prevention, with a focus on post-exposure prophylaxis (PEP), and 2) HIV testing. Steps included conducting focus groups and in-depth individual interviews with affected communities and key informants to explore lived experiences of intersecting stigma, coping, and recommendations to reduce stigma. The Qualitative Comic Book Mapping approach involved: thematic analysis of qualitative data and identification of overarching themes; aligning qualitative themes with theories of change for HIV cascade engagement and stigma reduction; and co-developing comic book scenarios with youth and community experts to integrate lived experiences alongside theoretical underpinnings. Youth were provided completed and blank versions of comics to complete themselves. Comics were well received by youth and service providers. Best practices include multi-lingual comics; integrating strengths-based and gender-transformative scenarios; and ensuring contextually relevant comic scenarios (e.g., trees, clothing, hairstyles). Case study 1 was associated with reduced sexual violence stigma and increased PEP knowledge and acceptance. Theoretically-informed comic books can be developed from qualitative data to inform HIV research and intervention approaches in community-based research with and for youth experiencing intersecting stigma.

Background: African, Caribbean, and Black (ACB) people in Canada are disproportionately impacted by HIV/AIDS. Statistics show that although ACB people only represent 3.5% of the Canadian population, they represent 21.9% of all new HIV infections (Etowa et al., 2022). A key factor has been attributed to multiple determinants of health that produce barriers to accessing culturally aware HIV services.
Peer support models have been utilized in various aspects of healthcare, as a tool to connect people to support and care. The ability for clients/patients to receive support from someone with lived experience has proven to be a valuable asset in reducing barriers to healthcare services. This paper will discuss the utilization of a peer-led model to increase access to HIV testing through peer-led outreach and distribution of the INSTI HIV self-test kit in community settings for ACB people.
Method: We pulled from several HIV testing peer-led interventions conducted to increase access to HIV testing for ACB women and community members in the Greater Toronto Area. Three ACB women were recruited and trained to distribute the INSTI HIV self-test kit in collaboration with Community Link, a community-driven initiative to distribute kits in community settings across Canada. The peers conducted weekly distribution through individual encounters, as well as community events.
Results: Preliminary findings between June 2023 and November 2023; the peers have distributed 2780 kits through individual encounters, and 1565 kits have been distributed at community events. This strategy has identified the peers as top distributors in Ontario by Community Link.
Conclusion: Through the utilization of peers who reflect the diversity within the ACB community, we have identified a strategy that aims to reduce barriers to access to HIV testing for ACB people. These preliminary findings show great promise in addressing the disproportionate impact on HIV/AIDS for ACB people in Canada.