Introduction:
HIV pre-exposure prophylaxis (PrEP) is recommended for individuals with high ongoing risk of HIV infection. However, PrEP acceptance in Black communities is low. Previous research has failed to establish the reasons why Black Canadians accept or reject PrEP for HIV prevention. This study explores the facilitators and barriers to PrEP acceptance. Understanding these facilitators and barriers will enhance the development of targeted interventions to increase PrEP acceptance in Black communities in Canada.

Method:
PrEP-eligible clients were recruited from various PrEP providers in the Greater Toronto Area for key informant interviews. In partnership with the providers, we used purposive sampling to recruit three categories of PrEP-eligible clients based on their decision stage regarding PrEP: a) accepted to use or currently using PrEP, b) rejected PrEP, c) undecided about PrEP. Participants who enrolled in the study were interviewed by trained research staff using standardized key informant interview guide. Transcripts of the interviews were analyzed (content analysis) to identify emerging themes on facilitators and barriers to PrEP acceptance.

Result:
Twenty-nine patients participated in the key informant interview (accepted to use or currently using PrEP – 12; rejected PrEP - 7; undecided about PrEP -10). Emerging themes for facilitators of PrEP acceptance included: self-perceived HIV risk, adequate PrEP knowledge, discomfort with condoms, and supportive healthcare interaction. Barriers to PrEP acceptance included insufficient information about PrEP, concerns about side effects of PrEP, stigma surrounding medication for HIV prevention, burden of taking medication daily, cost of PrEP, and gaps in healthcare providers’ information.

Conclusion:
Factors influencing PrEP acceptance among eligible Black people are multi-dimensional; spanning across individual-level factors, provider-level factors and structural-level factors. Interventions that targets these multiple barriers will be required to increase PrEP acceptance in Black communities in Canada.

Issue: Canada’s Communicable Disease Report (2018) reflects that a sizeable proportion of HIV cases in Canada occur among individuals from Latin America, particularly among Latino men who have sex with men. Im/migrant Latinx folks are likely to experience inequitable access to health services in Canada. Including low testing and treatment rates influenced by violence, discrimination, lack of knowledge about their rights, status related to migration and documentation, and personal, cultural, and religious

beliefs. Tailored interventions and care for minorities with intersecting identities, with a focus on co-occurring stigmas, are crucial to ensure the well-being of diverse LGBTQIA+ Latinx people.

Description: The Dr. Peter Centre (DPC)’s integrated supports and services, including art therapy, have been successful in improving sustained management of HIV for Latino individuals, including retention in care and adherence to HIV medication. This presentation will share the DPC’s experiences using arts-based methods to highlight factors that contribute to resilient pathways among racialized minorities and other intersections among LGBTQIA+ populations.

Recommendations: Art therapy can play a vital role in helping immigrants and LGBTQIA+ individuals adapt to a new country, especially when facing challenges related to health, identity, and community integration. Art therapy can support this group by supporting expression beyond language barriers, building identity and self-acceptance, processing trauma and loss, fostering community and connection, offering empowerment and agency, encouraging healthy coping strategies to manage mental health, and supporting navigation of cultural identity in a new country. By providing a space for self-expression, community connection, and healing, art therapy offers essential support for immigrants and LGBTQIA+ individuals adjusting to life in a new country, helping them build resilience, confidence, and a positive sense of self.

Anti-stigma work led by people living with HIV has been developing internationally over the recent decades. Digital storytelling is a participatory process that engaged people living with HIV in exploring and expressing their lived experience in an impactfull way. The showing of the digital stories provides an opportunity to share their stories. Conversations regarding storytelling and HIV stigma will engage conference participants in a process of generating possible actions to reduce HIV stigma.
Eight peers participated in the digital storytelling project. The storytellers are a diverse group from a range of backgrounds. A selection of the stories that were completed will be presented. Following the showing a panel comprised of the development team will engage the audience in a generative process to identify possible next steps in a peer led HIV stigma reduction initiative.
The sharing of the digital stories and panel discussion will provide an opportunity for participants to experience the digital stories that have been created. Additionally, conference participants will be involved to offer suggestions for local actions. Actions that people living with HIV and HIV community organizations can engage in to continue to reduce HIV stigma. In this way building on the decades long work of HIV anti-stigma actions led by people living with HIV.
*** several peers have asked that their names not be included in the abstract

UVHA is a group of persons living with HIV in Alberta. We are grateful to have received funding from the Reach Nexus, Positive Actions Grants for our digital storytelling project. The poster describes the use of digital storytelling within the context of a provincial peer led HIV advocacy group (people living with HIV) and the groups plan to take action to reduce stigma.
Eight peers participated in the digital storytelling project. An experienced facilitator/trainer/researcher led the process. One of the goals of the process was to build capacity among peers in the area of digital storytelling and two peers completed the first level of training as digital storytelling facilitators. During the workshops 6 digital stories were completed and the workshops were evaluated.
The results of the evaluation are reported in terms of:
• The experience of participating in the digital storytelling process.
• The participants reflections on digital storytelling and stigma.
• The participants thoughts on the use of digital storytelling in an ongoing campaign to address HIV stigma.
• The participants experience and hopes for digital storytelling as a process to develop supportive community.
The evaluation of the project has been positive and has led to suggested activities to overcome stigma within local communities.

*** some participants asked that their name not be included in the abstract for confidentiality reasons

Objectives: Immigrants and visible minority populations are at higher risk of HIV infection in Canada. To understand the contributory role of these identities on HIV infection, our study examined how the intersection of racial identity and immigration status are associated with HIV risk behaviours among females and males in Canada.
Methods: We used a nationally representative data set from the 2015 - 2016 Canadian Community Health Survey (CCHS) and applied multivariate logistic regression analysis.
Results: Our findings revealed that compared to Visible minority immigrant men, White native-born (aOR = 0.43; p < 0.001), Visible minority native-born (aOR = 0.55; p < 0.001), and White immigrants (aOR = 0.65; p < 0.001), were less likely to have used a condom during their last sexual intercourse, while among women, only the White native-born (aOR = 0.53; p < 0.001) were less likely to have done so. Among men, only Visible minority native-born (aOR = 0.72; p < 0.05) were less likely to have ever tested for HIV relative to Visible minority immigrants. For women, the White native-born (aOR = 1.56; p < 0.001), and White immigrants (aOR = 1.44; p < 0.01) were more likely to have ever tested. Finally, while there were no observed differences between men, all other groups were more likely to report having more than one concurrent sexual partner among women.
Conclusion: Our findings suggest the need to address the structural determinants of health for those embodying both a visible minority and immigrant status while targeting the native-born population with awareness about HIV risk behaviours.

Street-connected and homeless youth (SCY) face significant barriers in accessing HIV prevention and treatment services. We implemented a peer navigator program for SCY aged 16-29 in Kenya and Canada from March 2021 to August 2024. Individuals with lived experience of homelessness and some living with HIV were hired as peer navigators (PN) at diverse sites: an adolescent medicine clinic (Eldoret, Kenya), comprehensive care clinics (Huruma and Kitale, Kenya), a public health unit (London, Canada), and a 2SLGBTQ+ youth transitional housing program (Toronto, Canada). The PN program was evaluated using surveys completed by SCY participants at all encounters with PNs. In Kenya, 343 SCY were recruited in Eldoret (50% cisgender women, median age 22, 14% living with HIV), 110 in Huruma (57% cisgender women, median age 23, 12% living with HIV), and 178 in Kitale (15% cisgender women, median age 19, 4% living with HIV). In Canada, 38 SCY were recruited in London and 11 in Toronto. Across both sites, the median age was 23, 14% were living with HIV, and 65% were cisgender women, with participants also reporting diverse sexual orientations (e.g., bisexual, pansexual) and gender identities (transgender and gender diverse). The PNs successfully linked SCY with HIV testing: the proportion of SCY knowing their HIV increased from 72% to 100% in Eldoret, 83% to 98% in Huruma, 30% to 78% in Kitale, and 76% to 82% in Canada. Among HIV-negative SCY, only 8 in Kenya and 1 in Canada reported PrEP use over follow-up. Among SCY living with HIV, 81% in Kenya and 71% in Canada reported an undetectable viral load while in the program. The PNs were effective at linking SCY with HIV testing services. Supports beyond improved access to healthcare are needed to improve PrEP uptake and viral suppression, such as housing, employment, and mental health services.

Background: Over 7.7 million Venezuelans have been displaced since 2014. Venezuelan migrant gay and bisexual men (GBM) in Latin America face significant gaps in HIV and STI prevention. Venezuelan GBM’s heightened vulnerabilities stem from the interplay of poverty, violence, and limited healthcare access. Lima, Peru is host to over 1 million Venezuelans and evidence is needed to develop strategies addressing compounding vulnerabilities and to optimize prevention efforts for migrant Venezuelan GBM.

Methods: Between June and October 2024, 307 Venezuelan GBM in Lima participated in a cross-sectional bio-behavioral survey and testing for HIV, syphilis, gonorrhea and chlamydia. We assessed HIV and STI positivity, HIV vulnerability, and PrEP uptake among participants who self-reported their HIV status as negative or unknown.
Results: Among 172 participants not living with HIV, the median age was 31 [IQR: 27-34] and 58% arrived in Lima ≥5 years ago. Only 59% reported formal employment, 55% earned ≤1500 Peruvian soles monthly and 35% had no health insurance. HIV and STI positivity was high, with 10% testing positive for HIV and 26% testing positive for ≥1 STI. Sexual behaviours such as condomless anal sex (54%) and substance use during sex (48%) were common. Additionally, 18% reported sex work, 29% reported intimate partner violence, and 10% reported police violence in the past year. While 84% of participants were aware of PrEP, only 24% were currently using PrEP. Among non-PrEP users, 66% were willing to use PrEP while 21% were unsure.

Discussion: These findings highlight significant health and social vulnerability among Venezuelan GBM in Lima, Peru, exacerbated by high rates of STIs combined with economic precarity. Despite widespread awareness and willingness to use PrEP, low utilization reflects systemic barriers to access. These results underscore the need for targeted public health interventions to address structural inequities and improve prevention services for this population.

Introduction:
Gendered HIV stigma persists despite scientific advancements to prevent and treat HIV. The 10-minute film “HIV Made Me Fabulous” aims to promote empathy and understanding by using embodied storytelling to present the complexities around Undetectable equals Untransmittable experienced by women living with HIV. We assessed the short-term impacts of the film on diverse viewers.

Methods:
Between February 2020 to March 2024, a mixed-methods survey was completed by viewers aged 16+ after watching the film. The survey was grounded in the Lafrenière and Cox (2013) framework to assess whether the film stimulated emotion, increased understanding of the presented issues, inspired further reflection, and moved viewers to share the film. We used descriptive statistics to examine impacts of the film (Agree/Strongly Agree versus Neutral/Disagree/Strongly Disagree responses) and compared this between viewer demographics.

Results:
The post-film survey was completed by 293 respondents. HIV status, role in community, sexual orientation and race/ ethnicity were not significant across responses. Overall, 85% Strongly Agreed/Agreed that they connected with the film emotionally. Respondents experienced both positive (e.g. empathy and empowerment) and negative emotions (e.g. frustration and sadness). Eighty-eight percent of respondents said that the film helped them gain a new perspective on U=U. Ninety-two percent of respondents said that the film helped them better understand the lived experiences and resiliency of women living with HIV. Eighty-four percent of women compared to 68% of men (p=0.03), and 89% those aged 30+ years compared to 76% of <30 years (p=0.02) were significantly more likely to recommend the film to others.

Conclusion:
The film had short-term impacts on viewers, including eliciting emotion and understanding. These effects were experienced by both viewers living with and without HIV from various roles, and with diverse sexual orientations and race/ ethnicity. Future research should assess investigate long-term impacts of arts-based knowledge translation initiatives.

Background:
The SHOP Project determined that older adults have limited access to sexual health education and information. With input from a global advisory committee, Realize developed two sexual health and sexuality toolkits dedicated to older adults, and front-line staff.

Methods/Process:
Realize conducted a comprehensive online global environmental scan to identify existing sexual health toolkits, specifically designed for older adults aged 50+. Our findings revealed a significant gap, with few resources currently available across the globe.

We launched a global online questionnaire to understand the sexual health education needs and desires for older adults. Twenty-eight older adults participated in the questionnaire. Of the 28 participants, 13 chose online resources as their preferred delivery of sexual health information. 46% said that the biggest barrier to sexual health information is the lack of available services in their area.

SHOP Toolkits were created with guidance from our Global Steering Committee which included older adults and PLWHIV from Chile, USA, Argentina, Africa, the Philippines, India, Nigeria, the UK, and Moldova. The toolkits are sex positive, and include information on pleasure, intimacy, optimizing sexual well-being, HIV/STBBI prevention, safer sex, and strategies to manage changes in sexual function. Efforts to create culturally relevant toolkits were important in the development; in doing so we ensured toolkit content was adapted to local audiences across the
globe, prior to being translated.

Conclusion:
The sexual health and sexuality of older people remains an under-serviced topic in healthcare
and social services. The SHOP Project works to address this gap by providing accessible, evidence-based resources that empower older adults and equip service providers to address
their unique sexual health needs.

Background: Venezuela’s humanitarian crisis has driven millions to migrate, with Colombia serving as the main host country. While much research has focused on access to sexual healthcare, including antiretroviral therapy (ART) access, the mental health needs of Venezuelan migrants living with HIV remain underexplored. Our study examined the mental health challenges and support needs of gay and bisexual Venezuelan migrant men living with HIV in Colombia.

Methods: Between October and December 2024, we conducted 28 semi-structured interviews with Venezuelan migrant gay and bisexual men living with HIV across Colombia. Participants ranged in age from 23 to 60 years (mean: 35).

Results: Participants reported significant unmet mental health needs, largely shaped by intersecting stigmas tied to their sexual orientation, migration status, and HIV diagnosis. Loneliness emerged as a pervasive theme, often accompanied by episodes of depression. Social connection was identified as a key factor in mitigating these challenges, with participants emphasizing the benefits of meeting other gay and bisexual Venezuelan migrants living with HIV, which not only improved mental health but also supported ART adherence. Despite having access to psychologists through health insurance for some, participants criticized the lack of specialized training among mental health professionals, particularly in addressing issues related to sexuality and HIV disclosure. For example, participants highlighted inadequate support in managing rejection after disclosing their HIV status to potential partners, revealing a substantial gap in culturally and contextually sensitive care.

Conclusion: Public health strategies must prioritize the development of safe and inclusive peer support networks to address the profound loneliness and stigma faced by Venezuelan migrant gay and bisexual men living with HIV. In parallel, mental health services must be strengthened through targeted training programs for psychologists and other providers to ensure culturally competent care that directly addresses the intersectional challenges of sexual orientation, migration status, and HIV.

This presentation will journey through the development of the Women and HIV / AIDS Initiative (WHAI)’s Landscape of Community Change resource.

WHAI is a community-based response to HIV amongst cis and Trans women, 2-Spirit and Non-Binary people in Ontario, working 16 communities across the province. WHAI aims to
-Reduce HIV risk for women disproportionately impacted
-Enhance local community capacity to address HIV
-Build safer environments to support women’s HIV related needs.

This resource seeks to ensure WHAI’s practices of community development and community change are rooted in disrupting systems that have been created and ingrained in colonial practices. Outlined within the report are examples from the Truth and Reconciliation Commission of Canada’s Calls to Action and the Reclaiming Power and Place: The Final Report of the National Inquiry into Missing and Murdered Indigenous Women and Girls Calls for Justice. The selected examples align with WHAI’s work and aim to draw attention to specific Calls to Action and Justice that strengthen our commitment to reconciliation work and identify steps towards accountability.

Developed in partnership with visual artist of Ojibwe and Ukrainian / other mixed settler heritage Stephanie Babij, this resource includes:
1) a guidebook that includes an overview of the resources, tips for facilitating this work locally with community groups, an overview of the Calls to Action and Justice that align with WHAI work, and tips for further learning;
2) a poster illustration of earth, water, sky, plants, and creatures which can be used as symbols and analogy for the Calls to Action and Justice; and
3) dialogue facilitation cards which can be used in community capacity building contexts to deepen participants’ understanding of reconciliation and foster personal and community strategies to strengthen reconciliation work.

Introduction: CAAN Communities, Alliances, and Networks (CAAN) has successfully led many community-based research projects focused on sexually transmitted and blood-borne infections (STBBIs), significantly enhancing the landscape of Indigenous health research. This initiative aims to mobilize STBBI research findings to develop and implement effective Indigenous knowledge translation (KT) strategies that not only disseminate research findings but also resonate with Indigenous communities. By incorporating the lived experiences and narratives of these communities into broader discussions, the initiative seeks to promote healing and advance reconciliation efforts.

Methods: CAAN is currently undertaking a comprehensive review of its prior projects to identify successful knowledge translation strategies and the challenges encountered in their execution. By analyzing various Indigenous KT methodologies across diverse cultural contexts, the initiative aims to deepen its understanding and enhance the practical application of these critical approaches. Valuable insights have been extracted and synthesized from previous research endeavours to illuminate health experiences related to HIV and STBBIs. Emphasizing the interconnectedness of mental, physical, and spiritual health, CAAN advocates for a holistic approach to well-being that empowers Indigenous Peoples in their pursuit of health and healing. An Indigenous-grounded data analysis process has been adopted that respects the contextual integrity of the narratives, ideas, and dialogues captured in CAAN's past research. The resulting findings will be disseminated in community-centric formats and peer-reviewed academic journals, reflecting CAAN's commitment to integrating both Indigenous and Western epistemologies.

Preliminary Results: Recent investigations have highlighted the critical role of social determinants of health and underscored the necessity for improved dissemination of research findings. CAAN’s mobilizing STBBI project emphasizes the integration of Indigenous methodologies by engaging community members, Elders, and individuals with lived experiences throughout the research process. This participatory approach ensures that the research remains culturally relevant and authentically reflects the perspectives and needs of Indigenous populations.

Human Immunodeficiency Virus (HIV) disproportionately affects women, particularly those experiencing intimate partner violence (IPV) and other forms of abuse, heightening their vulnerability. Pre-Exposure Prophylaxis (PrEP), a biomedical intervention for HIV prevention, offers abused women a vital tool to regain agency over their health and protect themselves in high-risk environments.

Women facing IPV encounter increased HIV risk due to forced unprotected sex, limited condom negotiation power, and heightened physiological susceptibility. Abuse is often intertwined with poverty, stigma, and restricted healthcare access, compounding the risk. PrEP, a daily oral medication combining tenofovir disoproxil fumarate (TDF) and emtricitabine (FTC), provides over 90% efficacy when consistently used. For abused women, PrEP offers discreet, autonomous protection, bypassing the need for partner consent or cooperation.

However, barriers to PrEP access and adherence remain significant. Fear of partner retaliation, stigma surrounding HIV prevention, and insufficient supportive healthcare services impede PrEP uptake. Adherence challenges, including instability, trauma, and lack of privacy, further complicate its use. Addressing these obstacles requires a trauma-informed, holistic approach that integrates PrEP into IPV survivor support services, such as shelters, counseling programs, and sexual health clinics.

Community-based education and outreach are essential to reduce stigma and raise awareness about PrEP’s empowering potential. Healthcare providers must be trained to identify IPV, offer nonjudgmental support, and incorporate PrEP into comprehensive care. Policies to enhance PrEP accessibility, coupled with robust social support systems, can bolster abused women’s ability to protect themselves.

This abstract highlights the urgency of targeted interventions to expand PrEP access for abused women. By bridging HIV prevention and violence prevention efforts, PrEP programs can empower survivors, mitigate risk, and advance gender equity while contributing to the broader goal of ending the HIV epidemic.

Keywords: HIV/AIDS, women, PrEP, intimate partner violence, trauma-informed care, health empowerment.

Background
More than 10 Ontarians die everyday from the tainted drug supply. Supervised consumption services (SCS) have reversed 22,000 overdoses in the province while reducing public drug use and discarded drug use equipment. SCS are also vital access points for HIV, HCV, and other STBBI screening and treatment — a critical service considering 11% of new HIV diagnoses in Ontario in 2020 were linked to injection drug use. Yet, the government announced legislation in August 2024 that would shutter SCS by prohibiting SCS from operating within 200 metres of a school or childcare centre and preventing municipalities and local boards from applying or supporting a request to the federal government to maintain or establish SCS. At least half of Ontario’s SCS will close because of the legislation.

Description
In response, advocates mobilized at all levels of government and in the media to denounce the preventable deaths and viral and bacterial infections that will result from SCS closures, especially within communities already facing marginalization and barriers to care. Researchers refuted the Ontario government’s unfounded claims that crime increased in neighbourhoods with SCS. Yet, Ontario hastily passed the Community Care and Recovery Act, 2024 (CCRA) in December 2024, with little debate or Committee review.

Lessons Learned
In response, The Neighbourhood Group Community Services, which operates an SCS in Toronto, and two individual applicants, commenced litigation against the CCRA, arguing that the law violates constitutional rights to life, liberty, and security of the person and to be free from discrimination and protections against cruel and unusual treatment, and further encroaches on Canada’s exclusive jurisdiction over criminal law. Advocates such as the HIV Legal Network continue to mobilize, including through a proposed intervention in the case outlining the enormous impacts on HIV prevention, treatment, and care. A hearing is scheduled for March 2025.

Background

Every year, tens of thousands of people enter prisons in Canada, who are more likely than the general population to be living with health conditions. In prison, the risk of HIV and other STBBI transmission and acquisition increases, as well as other harms to health, as people are barred from necessary healthcare services. People are instead forced to rely on healthcare in prison that is rarely equivalent to community standards. Thus, people regularly leave prison in worse conditions than when they entered.

Description

The present study explores how healthcare, including harm reduction, are provided to people in prison in Canada. A particular focus was placed on specific populations, who have distinct healthcare needs, including Indigenous individuals, racialized people, women, and gender-diverse people. In 2023 and 2024, the team identified and analyzed hundreds of relevant policies, and conducted dozens of interviews, including people who have been incarcerated, community organizations, and prison staff.

Lessons Learned

Federal, provincial, and territorial prisons across Canada are failing, to varying degrees, to provide adequate healthcare to people in prison. In most jurisdictions, healthcare continues to be provided by ministries responsible for prison administration, rather than ministries of health, and people in prison are not universally offered STBBI testing and/or education, HCV treatment, safer sex supplies, or sterile drug use equipment, among other critical services. The gaps are particularly stark for populations with distinct needs, who regularly lack access to culturally appropriate and/or gender-specific programs and services.

Next Steps

The study revealed several promising practices to improve health outcomes, including prioritizing decarcerating and alternatives to detention, providing consistent cultural- and gender-responsive services, and promoting cultural and gender sensitivity, through collaboration with community organizations. These practices are key to providing comprehensive healthcare in prison, equivalent to the community.

INTRODUCTION: The Organizational Stigma Assessment Cycle (OSAC) is a stigma reduction and capacity-building initiative led by PAN. This initiative was born out of a community-identified need to turn the tide against persistent HIV stigma and discrimination. Designed as a multi-step learning process, OSAC helps organizations identify where HIV/AIDS and other stigma and discrimination may inadvertently occur in their services and supports them in implementing changes for improvement. Organizations can complete the cycle once or revisit it as needed, depending on their capacity and goals. OSAC is rooted in intersectionality, acknowledging how overlapping identities—such as HIV status, race, gender, sexual identity, and substance use—shape individual experiences of stigma and discrimination. It recognizes that stigma is influenced by broader systems, including societal attitudes, policies, and economic structures.

METHODS: We piloted OSAC using a developmental evaluation approach at five sites from two community-based organizations across BC. There was a blend of in-person and virtual data collection through 58 surveys with people with lived/living experiences and 61 with staff. There were also five focus groups for people with lived/living experiences and three for staff. Peer reviewers, including people with lived experience and community workers, provided ongoing support to participating organizations through this pilot phase.

RESULTS: We learned what is working well and how to improve service delivery to reduce stigma in the areas of governance, programs and services, human resources, professional development, communication, finances and physical space. During the pilot, we also integrated adjustments to the process and ensured that people with lived/living experience were at the forefront of the work.

CONCLUSION: OSAC aims to foster more inclusive and equitable services across BC by equipping organizations with practical tools to address HIV/AIDS and other stigma at its roots. This innovative project represents a significant step toward creating stigma-reduced environments within community services.

This study focused on spirituality and healing in the context of Indigenous people living with HIV. Indigenous people living with HIV are confronted with various obstacles, such as cultural, spiritual, and systemic factors. The study aimed to understand the perception of spirituality for Indigenous people living with HIV by engaging and listening to their voices. This is an additional phase of a study that initially examined how health care providers viewed spirituality in the lives of Indigenous people living with HIV by engaging and listening to their voices. In this study, we adopted a qualitative narrative research design. However, the challenges of COVID-19 and its restrictions forced the researchers to move away from the planned narrative design to one that accommodated the restrictions of the pandemic. Lessons learned from this change in method will be presented.

Participants consisted of 14 people living with HIV in Prince Albert, Saskatchewan, area. These participants were selected using a combination of convenience and snowball sampling. Due to restrictions during the COVID-19 pandemic, in-person interviews were changed to telephone interviews that were conducted between February 2020 and January 2021. Data transcripts were analyzed by developing a coding framework and subsequently engaging in line-by-line coding.

The research revealed that spirituality was an important component in a person’s healing. Participants who had a solid foundation in spirituality reported dealing with their HIV diagnosis and treatment in more positive ways. In addition, not all participants shared the same level of spiritual beliefs due to their unique experiences of residential school and trauma. By understanding the importance of spirituality in the lived experiences of Indigenous people living with HIV, community and health care providers can better conceptualize how to include spirituality in their client care.

This study focused on spirituality and healing in the context of Indigenous people living with HIV. Indigenous people living with HIV are confronted with various obstacles, such as cultural, spiritual, and systemic factors. Healthcare practitioners who provide support to them often struggle with understanding or incorporating spirituality as part of holistic healing. The study aimed to understand the perception of healthcare providers on the role spirituality plays in the lives of Indigenous people living with HIV by engaging and listening to their voices. We adopted a qualitative narrative research design. Participants consisted of 15 healthcare providers who had previously or were at the time currently caring for Indigenous persons living with HIV in Prince Albert, Saskatchewan. These participants were selected using a combination of convenience and snowball sampling. Due to restrictions during the COVID-19 pandemic, telephone interviews were conducted between April 2020 and January 2021 to collect data. Data transcripts were analyzed by developing a coding framework and subsequently engaging in line-by-line coding. The data collected revealed that all 15 participants considered themselves spiritual people who engaged in different spiritual practices and incorporated spiritual activities in caring for Indigenous people living with HIV. Participants' perceptions underscored the importance of incorporating spirituality in client's healing as they recorded significant recovery amongst their clients through spirituality. It also highlighted a lack of access to Indigenous spiritual support (i.e., Elders) as a difficulty faced by healthcare providers. The results suggest that not all individuals living with HIV are spiritually well-positioned, but those that were more spiritual, were often more resilient and healed more holistically. The research helps healthcare providers and policy makers understand the importance of respecting and incorporating spirituality into the care of Indigenous people living with HIV. It is recommended that healthcare providers integrate concepts of spirituality in providing care.

An HIV self-test kit was licensed for use in Canada in November 2020. HIV self-testing offers an additional option for HIV testing, complementing existing methods such as and laboratory and point-of-care testing. By broadening the range of testing options, HIV self-testing can address the unique needs and preferences of the communities disproportionately affected by HIV.

To support the development and implementation of community-based HIV self-test kit distribution programs, a practice-based guidance document was created. This document draws on the guidance and expertise of representatives from 22 community-based organizations from across Canada who gathered in Toronto for a two-day in-person dialogue. These organizations were selected for their leadership in HIV self-test kit distribution, their regional representation and their service to the populations most affected by HIV. The dialogue consisted of facilitated discussions on effective distribution strategies and lessons learned. CATIE staff used discussions from the dialogue to develop the practice-based recommendations.

The practice-based guide provides practical recommendations for community organizations to support the uptake and integration of HIV self-testing into their services. Key areas covered include determining whether HIV self-test kit distribution is right for their organization; the meaningful engagement of people most impacted by HIV in the development and delivery of the program; policies and procedures related to distributing HIV self-test kits; education and training for staff; distribution of self-test kits in different settings (e.g., outreach, events-based, online); pre and post-test conversations; and linkage to care. By considering these practice-based recommendations, organizations can maximize the potential of HIV self-testing as a tool to reach the undiagnosed and to engage individuals (regardless of their status) in other relevant prevention and support services.

Introduction: Timely access to sexually transmitted and blood-borne infections (STBBI) testing and linkages to care are directly dependent on confirmed medical diagnosis. Access to STBBI testing was impacted by the COVID-19 pandemic in a variety of ways. This pandemic mobilized some public health innovations, reducing roadblocks in the STBBI cascade of care. Objective: To identify and map available peer-reviewed and open-access grey literature on public health and community-based innovations for testing, screening and diagnosis of STBBIs during the COVID-19 Pandemic, in Organisation for Economic Co-operation and Development (OECD) countries. Methods: MEDLINE (Ovid), CINAHL (EBSCO), Embase (Elsevier), Social Services Abstracts (ProQuest), and Sociological Abstracts (ProQuest), Google, https://clinicaltrials.gov/, and Canadian Agency for Drugs and Technologies in Health Grey Matters were searched September 2022, 2023. During this period, title and abstract screening were completed by three pairs of reviewers. Full text screening and data extraction was completed by two pairs of reviewers. Conflicts were resolved by the first and senior author. Community engagement was iterative. Results: A total of 7,108 peer-reviewed sources underwent title and abstract screening, and over 800 grey sources considered. 13 peer-reviewed and 43 grey sources, on public health and community-based innovations for testing, screening and diagnosis of STBBIs in OECD countries, were identified. Results confirmed STBBI resources were eliminated or redirected during the pandemic, while some were adapted, resulting in innovation and emphasizing the resourcefulness of those working in this service area. Discussion: The pandemic motivated public health and community-based innovation, including reimplementation of initiatives previously experiencing barriers to implementation. Many of these innovations shifted screening from clinical settings to community-based settings. It also highlighted a need for intervention continuity during significant events, and several concepts and innovations that can be explored further. Grey literature enriched the review, as it highlighted ongoing research and community-led research.

Background: Systemic gaps in HIV prevention result in sub-optimal intervention uptake and ongoing HIV transmission, particularly among communities experiencing intersectional social inequities. This study explored how HIV prevention can be improved from the perspectives of people newly diagnosed with HIV (PLHIV) in British Columbia (BC), Canada, where a publicly funded PrEP (pre-exposure prophylaxis) program has been available since 2018.
Methods: Guided by Greater Involvement/Meaningful Engagement of PLHIV and community-based research principles, all project aspects were led by PLHIV. Recruitment was conducted through HIV service organizations and care providers. Semi-structured peer-led interviews were conducted in English (n=20) and Spanish (n=11) with PLHIV diagnosed between 2018-2023, residing in BC, and aged 18+.
Results: Most participants (n=27/31) were Two-Spirit/Gay, Bisexual, Trans, Queer Men and non-binary individuals, while four were straight women; one-third were Latinx (n=12/31), and ages ranged from 24-62. Social determinants of health such as housing, financial security, and immigration status influenced participants' access to HIV prevention and testing services. HIV knowledge varied across social locations and was shaped by persistent stigma and misconceptions about HIV risk. Testing access was often limited by geographic proximity to urban, affirming health services. Barriers to PrEP uptake included low awareness, difficulty perceiving oneself as a PrEP candidate, complexity in navigating health systems, and adherence challenges linked to mental health and substance use.
Conclusion: Effective HIV prevention in BC must address structural drivers of health and inequities. Prevention efforts can improve through tailored education for key populations, adaptations to PrEP services to reduce barriers, the promotion of accurate risk assessment tools, and upstream interventions targeting health inequities affecting priority populations, including newcomers. Systemic barriers must be tackled through structural interventions to enhance accessibility and equity in HIV prevention.

Background: Since British Columbia (BC), declared a public health emergency in 2016, drug toxicity and overdoses have continued to rise. People Living With HIV (PLWH) are disproportionately affected by both non-fatal and fatal overdoses. However, there is a limited understanding of whether and how HIV is associated with an increased risk for overdose. We explore perceptions of overdose risk and access to post-overdose care among PLWH who use drugs and the healthcare providers (HCPs) who support them.

Methods: Semi-structured focus groups and one-on-one interviews were conducted with 74 PWUD, including 38 People Living with HIV; and 19 HCPs representing diverse professional backgrounds. Participants were recruited from organizations and care centers in Vancouver that support PLWH and people who use drugs. Some focus groups were exclusive to PLWH to facilitate a safer space for discussion. Sessions were audio-recorded, transcribed verbatim and coded using NVivo 14.0.

Findings: Participants shared their perspectives on how HIV affects overdose risk and care, often reflecting on HIV as a protective factor, perceiving it as unrelated to overdose risk, and recognizing it as an added complexity. PLWH expressed that being HIV-positive allowed them to receive attentive healthcare and that their drug use was unrelated to their HIV status. HCPs shared similar understandings but noted that living with HIV increases vulnerability in any case due to stigma, mental health challenges, and compromised immunity.

Conclusion: These insights further our understanding of how PLWH and their HCPs recognize their risk for overdose, and the complex ways in which HIV intersects with overdose risk and care. Modern HIV care in BC fosters a sense of support among PLWH by ensuring they remain engaged in healthcare. Further, HIV may be considered more manageable than other comorbidities due to well-established testing and treatment protocols and de-stigmatizing campaigns.

This paper examines the complex intersections of HIV/AIDS policy, criminal justice, and marginalized populations in Canada, with a particular focus on Black men and gender/sexual minorities in prison settings. The analysis explores how existing legal frameworks, healthcare policies, and institutional practices disproportionately affect these communities, creating overlapping layers of vulnerability and discrimination.

The research investigates the structural barriers to HIV prevention and treatment within correctional facilities, highlighting the unique challenges faced by Black men and LGBTQ+ inmates. It critically analyzes current policies regarding HIV testing, treatment access, and confidentiality in prison environments, while examining how these intersect with issues of citizenship rights and social justice.

Drawing on public health data, legal scholarship, and sociological research, this study demonstrates how systemic inequities in the criminal justice system compound health disparities and social marginalization. The findings suggest that comprehensive policy reforms are needed to address the intersecting challenges of HIV prevention, treatment, and support services for incarcerated populations, particularly focusing on racial and gender equity.

This analysis contributes to broader discussions
about healthcare access, human rights, and social justice within the criminal justice system, while proposing evidence-based policy recommendations for improving health outcomes and reducing disparities among vulnerable prison populations.

Background The 2019 “Safety of Sperm and Ovum Regulations” aimed to protect reproductive rights in Canada by allowing medically assisted conception (MAC) services, including known (directed) donation and surrogacy, for individuals with HIV. However, a 2023 survey conducted by our study team revealed that access to MAC for people with HIV was limited, inconsistent, and regionally dependent. This work examines current laws, regulations, and policies that govern the provision of MAC for individuals with HIV and explores discrepancies between law and policymakers' intentions and the realities of clinical practice.

Methods Findings from a 2023 survey suggest significant disparities in access to MAC for people with HIV across Canada, prompting further investigation into underlying causes. A comprehensive review of legislation and policy documents related to MAC was undertaken, which identified ambiguous provisions that providers may use as rationales for denying care. To ensure a robust analysis, professors with expertise in health law and regulatory frameworks that govern MAC joined the study team, providing ongoing guidance and support.

Findings: Federal guidance documents state that “appropriate quality management measures should be taken” to prevent cross-contamination and disease transmission while preserving gamete quality. However, these policy documents provide no insight into what these measures should look like, leaving clinics free to determine how best to meet this requirement. Additionally, federal regulations exclude individuals with HIV from anonymous gamete donation, with exceptions made for directed donations at the medical director's discretion.

Conclusion: These findings underscore a critical gap between federal legislative intent-to allow individuals with HIV to access MAC-and clinical practice due to uncertainties arising from the regulations. People with HIV face significant and unwarranted barriers in building their families. Addressing this gap requires targeted education and policy reform to clarify clinics' legal obligations, ensure consistent practices and safeguard reproductive rights of people with HIV.

Background
Chronic pain affects approximately 60,000 people living with HIV/AIDS (PLHAs) in Canada, impacting their biological, psychological, and social well-being. As defined by the International Association for the Study of Pain (IASP), it is persistent pain lasting over three months, often resulting from HIV or antiretroviral therapy. This pain impacts sleep, mood, cognitive health, and social participation, with PLHAs using a mix of medical, alternative, and body-mind treatments to manage its physical and emotional effects.

Methodology
This study employs an exploratory sequential design mixed-methods approach, starting with a bilingual nationwide online survey, followed by national workshops using Q-sorting to prioritize statements based on participant agreement and relevance. Participants meeting the IASP definition of chronic pain were recruited via a broad network and received a stipend for completing a self-report questionnaire.

Results
The data are derived from a sample of 244 PLHAs, with an average age of 48 years and an average duration of living with HIV of 17 years. Most identified as English-speaking, male, and White, with smaller portions identifying as French-Canadian, female, Black, and Indigenous. Regarding gender identity, many identified as male, some as female, and a smaller group as gender non-conforming. A significant portion earned under $20,000 annually. Qualitative survey responses expressed gratitude for healthcare providers’ care but also frustration with judgment, delays, and lack of solutions. Respondents requested better pain management, more empathy, and improved accessibility, particularly regarding financial barriers and long wait times.

Conclusions
The data primarily originated from Ontario, Alberta, and Quebec, limiting its generalizability. Greater representation from other provinces, such as British Columbia and Manitoba, and more inclusion of women and French-Canadian populations, is needed. This sample of PLHAs was not passive; respondents engaged in complementary and alternative medicines, physical activities, hobbies, and other means, reflecting a group committed to managing their chronic pain.

People living with HIV (PLHIV) often face a range of social and emotional challenges that can significantly impact their well-being and quality of life. In New Brunswick, these challenges are compounded by social isolation, stigma, and geographic barriers to accessing support services. Additionally, the lack of HIV-specific programs, along with shifting priorities in AIDS organizations, has left gaps in resources and support networks. This project aimed to consult with PLHIV in New Brunswick to identify their socioemotional support needs and highlight barriers that hinder access to essential care and resources.

Methods:
From September 2023 to July 2024, we conducted consultations with PLHIV from various communities across New Brunswick, including both rural and urban, Anglophone and Francophone areas. The consultations included semi-structured interviews and focus groups to gather qualitative insights into the socioemotional and resource-related challenges faced by participants. Data was analyzed using thematic analysis to identify key themes related to emotional isolation, stigma, provider interactions, and the availability of support services.

Results:
Participants highlighted several significant social and emotional barriers to their well-being. Feelings of loneliness and a lack of emotional support were shared among every participant, often compounded by the fear of disclosing their HIV status and the stigma associated with it. Many reported difficulties in forming romantic relationships due to the fear of rejection, which further contributed to social isolation. Geographic distance from healthcare services and support networks also intensified these challenges, leaving many feeling disconnected. Furthermore, negative experiences with healthcare providers underscored the need for improved education and sensitivity among providers to better address the unique needs of PLHIV.
Resource gaps were a major concern. Participants noted a lack of HIV-specific programs and financial support, as many AIDS organizations had shifted their focus to needle exchange programs, leaving a gap in services tailored to PLHIV.

Background:
Access to harm reduction supplies, remains highly dependent on the political climate at both provincial and municipal levels. In regions where these resources are limited or politically contentious, underserved and rural communities face significant barriers to accessing harm reduction services. This study explored a community-centered, bottom-up approach to address these barriers and expand harm reduction services in rural and underserved areas, highlighting the role of local strengths in overcoming political and systemic challenges.

We aimed to explore how engaging communities in the development of harm reduction strategies can enhance service delivery and overcome political and logistical challenges that impede access to essential resources.

Methods:
Between March and December 2024, we implemented a bottom-up approach to harm reduction service expansion in several rural and underserved communities. The process involved direct consultation with local stakeholders, including people who use substances, community organizations, healthcare providers, and local policymakers. Community strengths were identified through participatory workshops and meetings, and these insights informed the development of customized harm reduction strategies for each community. Data were collected through quantitative and qualitative means, including data collection and community consultations.

Results:
The bottom-up approach resulted in the successful expansion of harm reduction services to several previously underserved communities. Communities were able to leverage local knowledge and resources to create solutions that were culturally relevant and practical. Key strategies included peer-led outreach, collaboration with local healthcare and social support providers, and mobilizing community-based organizations to advocate for harm reduction policies at the organizational, municipal and provincial levels. While political resistance at higher levels of government remained a challenge, local engagement significantly mitigated the impact of these barriers, leading to increased access to harm reduction supplies and improved community buy-in.

Background:
Little scholarship considers how academic researchers and people with lived/living experience (citizen scientists) encounter and collaboratively navigate the unique characteristics of administrative health data research, including underlying structures (e.g. classification and coding systems, billing structures), routine data collection procedures, and research methods and norms. Given the HIV community’s longstanding research leadership, a deeper understanding of administrative health data nuances through community-led or citizen science HIV research can provide lessons for health research generally.

Methods:
We based our research approach on existing ethnographies of citizen science. Our collaborative team of six citizen scientists, four epidemiologists, three social scientists, and two HIV clinicians used two qualitative methods: participant observation of our research process, and critical reflexive analysis through “Gathering Wisdom” dialogue. Research sessions and meetings were recorded through Zoom, audio device, and graphic and written fieldnotes. Recordings were transcribed and thematically analyzed.

Results:
Tensions experienced fell under two major themes. 1. Epistemological/ontological variation. Working with administrative health data meant situating ourselves within a positivist paradigm, which at times did not match team members’ worldviews or ways of knowing. 2. The social and institutional context of routinely collected health data and dealing with secondary use limitations (e.g., data codes may not fully reflect what occurred, important data are not captured). Tensions were opportunities to innovate and unsettle habits of thought; for example, we customized a definition of “primary care engagement” based on lived/living experiences of citizen scientists and HIV clinicians, and used a strengths-based approach to frame research questions around survival versus death.

Conclusion:
While administrative data research nuances were sometimes troubling to citizen scientists, this collaborative work showed how experiential knowledge enriches administrative health data research. Approaching tensions in collaborative research as productive sites for exploration can create innovations and new insights through synthesis helping to ensure co-production and collaborative equity.

Background: Online surveys are often used to evaluate digital sexually transmitted and bloodborne infections (STBBI) care services but risk selection bias towards respondents with better digital access and literacy. We compared awareness and use of GetCheckedOnline, BC’s online testing service, between participants recruited digitally vs. in-person.
Methods: Between June and September 2022, we recruited English-speaking, sexually active BC residents ( ≥16 years, ≥1 partner in the past year), using two modalities: (1) digitally mediated recruitment using social media ads and digital survey links at sexual health clinics and community sites, and (2) in-person paper surveys at community events/sites (e.g. Pride festivals, colleges), targeting populations facing STBBI testing barriers (e.g., low-income earners, gay men). We assessed awareness and use of GetCheckedOnline (Yes/No), recruitment modality (digital/in-person), socio-demographics, e-health literacy, digital access, and sexual health characteristics. Differences in awareness and use were analyzed using bivariable and multivariable logistic regression models, accounting for plausible confounders. Intersectionality theory informed testing and inclusion of significant interaction terms.
Results: Among 1,657 participants (mean age: 33.0 years, SD: 11.77), 52.5% (784) were women, 36.2% (600) were recruited digitally, and 35.8% (584) were aware of GetCheckedOnline, of whom 57.4% (324) had used it (Table 1). Digitally-recruited participants had higher odds of awareness (OR: 5.27, 95%CI: 4.23–6.57) and use (OR: 3.13, 95%CI: 2.20–4.45) compared with participants recruited in-person. Differences persisted after adjusting for socio-demographics, digital literacy and access, region, STBBI testing history and previous experience of testing barriers: awareness (aOR: 3.17, 95%CI: 2.18–4.60) and use (aOR: 2.47, 95%CI: 1.43–4.26). Covariate interactions were not significant.
Conclusion: Digitally recruited participants had greater awareness and use of GetCheckedOnline. Recruitment modalities strongly influence survey evaluations of awareness and use of digital STBBI services like GetCheckedOnline. Combined recruitment strategies are therefore essential for more inclusive and accurate evaluations of awareness and use of these services.

Background: Digital health literacy (DHL) influences access to digital STI testing services. Popular DHL tools, including the eHealth Literacy Scale (eHEALS), are often unidimensional and insufficient for guiding programs. This study examined how refined DHL measures based on eHEALS influence disparities in awareness and use of GetCheckedOnline, British Columbia’s publicly funded digital STI testing service.
Methods: We analyzed data from GetCheckedOnline’s 2022 community survey of English-speaking BC residents aged ≥16 years and sexually active in the past year. Outcomes were awareness and use of GetCheckedOnline (both yes/no). Latent DHL factors were identified using exploratory factor analyses from the eHEALS questionnaire, followed by confirmatory factor analysis using weighted least squares mean variance-adjusted models. Factor models were evaluated using standard indices. Structural equation modeling assessed associations between latent DHL factors, sociodemographic characteristics and main outcomes.
Results: Among 1,657 respondents (mean age: 33.0 years, SD: 11.77), 52.5% (784) were women. Three latent DHL factors were identified: Factors 1 (information navigation), two (resource appraisal) and three (confidence in use). Information navigation (β = 0.162, p<0.001 and β = 0.063, p=0.020) and confidence in use (β = 0.206, p=0.014 and β = 0.115, p=0.020) were positively associated with awareness and use of GetCheckedOnline. Resource appraisal was negatively associated with awareness and use of GetCheckedOnline (β = -0.263, p=0.006 and β = -0.150, p=0.010). DHL factors mediated the effect of age, income, education and digital access on awareness and use of GetCheckedOnline.
Conclusions: Findings suggest that users’ information vavigation and confidence in use DHLS are positively associated with awareness and use of GetCheckedOnline. In contrast, resource appraisal DHL may constrain awareness and use, potentially due to heightened criticality, skepticism, or concern about online stigma. Findings highlight the role of DHLs in existing inequities in uptake of digital STI testing. Future research should explore how DHLs interact with trust, stigma, and service design to influence use, particularly among populations marginalized populations.

Introduction
Electronic self-administered patient-reported outcome measures (PROs) have improved HIV care in some settings. We sought to understand the acceptability, usability, and impact of a PRO platform among women receiving HIV care in Toronto.

Methods
We invited clients from a health centre serving African, Black, Caribbean, Latin American and South Asian women, particularly immigrant, refugee and non-status women, to take a computer-based PRO assessment (MyPRO) prior to their care visit; this included measures of psychosocial and basic needs, health behaviors, and antiretroviral (ART) adherence and burden. Women completed MyPRO either remotely or on-site, with results delivered to providers ahead of their visit. We conducted semi-structured qualitative gender-concordant individual interviews, querying MyPRO usability, acceptability and impact on communication with providers including ART satisfaction, and acceptability as a tool for improving their care. We used Dedoose qualitative coding software to code transcribed interviews for thematic content. Two coders independently used a qualitative memoing process to summarize themes before meeting to reconcile interpretation differences.

Results
Women (n=15) reported that MyPRO was easy to use and improved recall of health needs to be discussed with the provider during their visit. By extension, this improved patients’ sense of preparedness for the appointment. MyPRO helped facilitate and legitimize discussion of sensitive topics including mental health and psychosocial needs, e.g. social support. By addressing previously undiscussed topics, it increased their sense of comprehensiveness of care. MyPRO also facilitated discussion of patients’ relationship with ART, increasing their confidence to initiate medication related conversations including adherence in the context of avoiding HIV disclosure. Some women reported that MyPRO led to discussion regarding medication side effects and suitability of injectable ART. These discussions, in some cases, led to a change in medication for the patient.

Conclusion
MyPRO was acceptable and facilitated more open discussion surrounding ART, psychosocial and other needs.

Background: Despite representing over 50% of women living with HIV globally, women of African descent are greatly underrepresented in HIV research, both as participants and among those leading the research. Within white-majority countries such as the UK and Canada, Black women are disproportionately impacted by HIV, but there is scant research on how it impacts their reproductive lives. Undetectable=Untransmittable does not apply to breast/chestfeeding; for this reason, the decision about infant-feeding options while living with HIV remains fraught with uncertainty. Based on a qualitative study conducted in the UK about infant-feeding decisions and practices (NOURISH-UK), we present our experience of co-producing research with Black mothers living with HIV. We focus on how our methodology enabled us to hear the silences faced by our socially marginalised study participants and respond in generative and empowering ways.

Methods: NOURISH-UK was a qualitative study that used semi-structured interviews. The study team and Patient Public and Involvement (PPI) group included academics, clinicians and women with lived experience of HIV and advocacy – including six Black women with HIV.

Results: We carefully assembled the study team and PPI panel, remained sensitive to power imbalances across social boundaries, arranged multiple meetings in formats that encouraged inclusivity and a diversity of perspectives, and employed creative dissemination routes for our findings. Our interdisciplinary co-produced approach led to (1) inclusive research design such that the majority of participants were from racially minoritised backgrounds (2) multiple co-produced lay and academic outputs (including a clinical guide); and (3) influencing the newly released UK national guidelines on HIV and infant feeding.

Conclusion: Epistemic practices are key to overcoming inequities in health research, and illuminate knowing among Black women with HIV. A shared commitment between academics, clinicians and academics key to achieving meaningful involvement within HIV research and maximising research impact.

Background: In 2022, Canadian policy on blood and plasma donor screening removed the historic time-based deferral for “men who have sex with men” (MSM) and replaced it with a new gender-neutral sexual behaviour-based screening policy. Now, all potential donors are asked if they had multiple sexual partners or a new sexual partner in the past three months, and, if so, whether they have had any anal sex with them; if so, they are deferred from donating. Many other HIV-related deferrals exist (e.g. ever diagnosed, past-year sex with someone living with HIV, PrEP use). We assessed the attitudes of the 2S/GBTQ+ community regarding current blood donor policies.
Methods: Our community-based online cross-sectional survey recruited participants from March-May 2024 via social media, community-based organizations, and advertisements on sociosexual websites/apps/media. Eligible participants included Indigenous Two-Spirit people; all gay, bisexual, queer, and non-heterosexual men (inclusive of trans men); and all nonbinary people (herein “2S/GBTQ+”). Participants also had to be aged 15+, live in Canada, and self-complete the questionnaire in English, French or Spanish.
Results: Of 2,227 eligible participants, 71.5% were gay-identified, 27.0% currently used PrEP, 21.8% were disabled-identified, 18.3% identified as racialized, 11.7% were living with HIV, and 10.5% were trans-identified. Most participants were aware of the historic MSM deferrals (91.3%) and lifetime bans for those living with HIV (89.4%). Only 27.2% knew current HIV-PrEP users were deferred. Two-thirds (64.2%) were aware of the new gender-neutral screening policy, was seen as justified by 50.9% of participants, discriminatory by 59.6%, and requiring further change by 72.1%. Most (84.9%) participants agreed that blood operators must do more to repair their relationships with 2S/LGBTQ+ communities.
Conclusions: Canada’s blood donation policies and HIV epidemic have important historic and contemporary relationships intertwined with other stigmas/discrimination (i.e. racism, xenophiba, cissexism, sex work), which shape public perceptions and social inclusion.

In 1981, the Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) became substantial global health concerns as this was unheard of across Turtle Island up until that point (Frideres, 2020). Today, Indigenous peoples (IP) (First Nations, Métis, or Inuit) living with HIV/AIDS (IPHA) in Canada have, on average, higher HIV rates compared to non-Indigenous Canadians. Thus, colonization has significantly impacted Indigenous life with foreign ideologies and left a legacy of oppression and marginalization, as IPs were never seen as equals (Hillier et al., 2020). Additionally, Indigenous communities experience the highest levels of social determinants of health due to historical trauma, as Dr. Duran refers to trauma as the “soul wound” (Duran, 2019, p.10), which in turn leads to higher instances of IPHA (Jongbloed, 2019).This interpretive qualitative study focuses on the prevalence and experience of stigma surrounding HIV/AIDS in the healthcare of Indigenous populations, particularly Indigenous heterosexual women.
My study is enriched with an autoethnographic focus on HIV/AIDS stigma in healthcare for IPs includes participant recruitment of five IPHA females who are heterosexual and over 19 years of age. As an IPH, I am the sixth participant, integrating my voice. The semi-structured interviews consist of twelve open-ended questions. My research focuses on the stigma surrounding HIV/AIDS in healthcare settings experienced by Indigenous Peoples. This dual role enriches my perspective on the challenges our community faces. I will analyze their responses using Thematic Analysis within an Indigenous Methodology, aiming to amplify the voices of these women, reduce stigma, and enhance healthcare outcomes. An Indigenous research methodology will honour participants' voices and narratives by approaching ‘research as a ceremony’ rather than merely as an academic clinical endeavour (Wilson, 2008). I aspire to inform healthcare practices that inadequately support Indigenous individuals affected by HIV/AIDS.

Background: Gay, bisexual, and other men who have sex with men (gbMSM) face unique challenges in accessing primary healthcare, including stigma, confidentiality concerns, and a lack of culturally competent care. This study examines these barriers and facilitators in Hamilton, Ontario, to inform equitable healthcare strategies.

Methods: A quantitative survey was distributed to gbMSM participants through community organizations and a PrEP/HIV clinic. The survey incorporated the validated Primary Care Assessment Tool (PCAT) alongside questions addressing healthcare access, barriers, facilitators, and satisfaction. Descriptive statistics were used to analyze the data.

Results: While all 21 participants reported having a primary healthcare provider, 38% experienced discrimination in healthcare settings. A large proportion of individuals stated they encountered barriers to 2SLGBTQ+ culturally-competent care (47.6%), and almost a quarter of individuals (23.8%) reported encountering stigma or discrimination when accessing primary care services. More than half of participants reported having supportive providers (61.9%) and 2SLGBTQ+-specific services (61.9%) as facilitators to accessing care. Most participants reported satisfaction in their primary care (61.9%), though it was lower among low-income (44.4%) and lower-education participants (55.6%). Additionally, 14% reported unmet healthcare needs in the past year, rising to 33.3% among low-income respondents.

Conclusions: Despite having good access to primary healthcare providers, gbMSM in Hamilton face systemic barriers to equitable care, particularly among low-income and lower-education groups. Enhancing provider competence in LGBTQ+ health, expanding telehealth options, and fostering inclusive care environments are essential steps to improve access and outcomes for gbMSM populations. These findings provide actionable insights to inform targeted healthcare policies and practices.

BACKGROUND
Correctional Services Canada (CSC) has implemented Prison-based Needle Exchange Programs (PNEPs) in 11 Institutions and an Overdose Prevention Service (OPS) in four. Objectives of each include reducing HCV and HIV transmission among people who use substances, mitigating overdose risk and increasing opportunities for health interventions.

Offenders participating in the PNEP provided with an exchangeable kit containing injection and drug-preparation equipment for use in their cell.
Offenders accessing the OPS in individual cell in Health Services issued injection- and snorting-related supplies for one-time use with personal drug supply. Health care staff provide emergency response and counselling.

METHODS
Convenience sampling in each Institution enhanced by purposeful sampling to obtain maximum variation in offender experience drove confidential anonymous interviews followed by thematic analysis.

RESULTS
Offender pressure to share PNEP equipment: “Guys are forced, muscled to give up their needles.” “It was putting too much heat on me. I can’t handle the pressure. I gave up my kit.” Whereas OPS participants reported, “I can use safely away from the unit and cleanly.”

Lack of counselling when accessing PNEP: “No follow-up when have been given a needle. That’s what’s needed here. Follow-up.” In contrast, the required post-injection OPS observation time experienced as an opportunity to engage with the supervising nurse, “Because of OPS now OK to admit that I have an addiction, not a secret anymore.

Safer snorting supplies: Straws available in OPS sites, but not component of PNEP kit.

Hours of operation: OPS only accessible during the day, i.e., during work or programming hours. “Doesn’t make sense. If they think I am high on my job, I’m gone.” Offender’s reported preferred time of evening substance use possible with PNEP-distributed equipment.

CONCLUSION
Responding to this evidence of program-specific personal and structural impacts, CSC is planning concurrent implementation of PNEPs and OPS at selected Institutions.

Introduction: Indigenous Peoples experience disproportionately higher incidences of HIV infection compared to settler Canadians. With higher rates of new HIV infections in Indigenous Peoples, PrEP is a plausible solution to decrease transmission. However, PrEP remains poorly adopted among Indigenous Peoples in Canada, and minimal research seeks to understand what Indigenous Peoples know, or do not know, about PrEP.

Methods: Indigenous methodologies were used to describe the experiences of PrEP in Indigenous Peoples in Toronto. A community-based advisory board consisting of a Two-Spirit Elder Advisor, HIV community champions, knowledge users, and the research team was established to help execute four Talking Circles alongside 2-Spirited People of the 1st Nations in Toronto. Talking Circles were audio recorded, transcribed, and analyzed using Indigenous Theorizing.

Results: Thirty people participated in the Talking Circles. No participant was currently on or had ever taken PrEP. Queer men and participants working for non-profit organizations had an in-depth understanding of PrEP, while women and straight men tended to have minimal to no understanding of PrEP. Considerations for taking PrEP included allergies, pregnancy compatibility, side effects, drug interactions, dosing frequency and cost. Patient-level facilitators to PrEP included mail delivery options, coverage through Non-Insured Health Benefits, and incorporation of cultural and Indigenous ways of understanding health in PrEP care delivery. Barriers included the near-exclusive promotion of PrEP to the gay community, bloodwork frequency and mistrust in healthcare systems, pharmaceutical industry and Western medicines. The patriarchy, racism and stigma were identified as determinants for the lack of PrEP awareness in Indigenous communities - especially womxn. Intramuscular PrEP was favored over oral. Suggestions to improve PrEP awareness included educating outreach workers, attending community events like Powwows, and education through First Nations high schools, Elders and social media.

Conclusion: Talking Circles were effective and culturally appropriate to understand Indigenous Peoples' conceptualization of PrEP.

HIV and hepatitis C (HCV) are contracted through similar routes, making co-infection a living/lived reality for 30% of people living with HIV worldwide. With injection drug use among the top risk factors for both in Canada, there are commonalities in prevention, engagement and harm reduction efforts.
To combat growing rates of HCV in Canada, CanHepC in 2019 launched the Blueprint to inform HCV elimination efforts, offering evidence-based strategies to help Canada meet the World Health Organization goal of eliminating HCV by 2030. Recognizing the unique jurisdictional healthcare structures in Canada, Journeys to Wellness: Prairie Hepatitis C Roadmap was developed to address specific and unique needs of Manitoba, Saskatchewan and Albert in eliminating HCV.

Aims
• Assess current landscape of HCV prevention, diagnosis and treatment, identifying progress/existing gaps
• Uncover key barriers and enablers to effective HCV care and viral suppression
• Establish consensus on strategic priorities for improving HCV wellness across the Prairies

Methodology
• Community Guidance Circle (18) PLE, clinicians and thought leaders provided oversight and guidance
• Sharing circles in three provinces (18 PLE)
• Engaging 13 community-based organizations to understand stigma and barriers
• Hosted 20 consultations to add to messages of PLE
• PLE validated key messages that were also translated into graphic imagery

Emerging Themes
• HCV must move from a disease to a whole-person wellness lens
• Enhanced prevention and education are critical
• Person-centered care, which recognizes and addresses unique and overlapping challenges faced by many
• Stigma is a massive barrier to addressing HCV
• Access to HCV treatment in incarceration facilities must be improved significantly
• Provincial elimination strategies should be prioritized
• Advocacy and resources needed to increase community capacity

With 2030 only a few years away, identified provincial and collective opportunities for change are vital to galvanize our response.

Introduction: Women and gender-diverse individuals face barriers to equitable healthcare, particularly those from racialized and marginalized communities disproportionately affected by HIV. The Women-Centred HIV Care (WCHC) Model is an evidence-based approach integrating trauma- and violence-aware care, person-centred care, women's health, mental health, HIV care, and peer support. To expand its reach, the virtual WCHC Hub was established to implement a national knowledge mobilization (KM) strategy to improve health outcomes and reduce care disparities for women with HIV.

Methods: The Hub is guided by community-based research, intersectional feminism, cultural responsiveness, and anti-racism frameworks. This initiative operates through nine sub-hubs - six regional hubs (BC, AB, SK, MB, ON, QC) and three population-specific hubs (Black women, Indigenous women, and trans and gender-diverse individuals). From September 2023 to December 2024, the hubs organized events, including conferences, panel discussions, and presentations, to share the WCHC Model. Weekly talks addressed equity, mentorship, and clinical topics. Evaluations tracked attendees, presentation types, satisfaction, and perceived increases in knowledge.

Results: The WCHC Hub conducted 45 KM activities, including one conference with 120 attendees, two information sessions with 15 attendees each, and three panel discussions with 20–25 attendees each. A total of 12 presentations were delivered, with attendees ranging from 25 to 100. One publication and five newsletters were disseminated. Weekly talks included nine sessions on equity, three clinical-focused discussions, and nine mentoring sessions. A total of 12 evaluations were collected (n=88), with: 77% of participants reporting high satisfaction with the topics; 51% strongly agreeing that the sessions contributed to their understanding and skill development; and 55% strongly agreeing that the topics aligned with their goals and objectives for attending.

Conclusion: The WCHC Hub demonstrates the impact of a national KM strategy, leveraging regional and population-specific sub-hubs to promote evidence-based, person-centred care for women affected by HIV.

Background: Evidence suggests that peer navigation services are a critical strategy to address systemic and socio-structural barriers to health services and facilitate engagement in HIV care for people living with HIV. This community based study with im/migrant African, Caribbean and Black people living with HIV aimed to explore: (1) experiences with peer navigation services within the health system; and (2) how to tailor culturally responsive peer navigation support for the community.

Methods: This qualitative study was part of the Drive for Change Project, a community-based participatory action research study with im/migrant African, Caribbean and Black people living with HIV accessing health services in BC. Analysis drew on semi-structured interviews and focus groups in English and Amharic with community experts with lived experience of HIV (n=27, August/2024-December/2025) and peer navigators (n=6, January-February/2025). The project drew on collaborative thematic analysis to describe components of culturally responsive peer navigation support.

Results: Preliminary analysis highlighted that HIV stigma, migration experiences and cultural backgrounds shaped peer navigation service needs of community experts. Participants priorities for culturally responsive peer navigation services included: patient-centred/relational practice, culturally sensitive communication (e.g. respectfully addressing elders, appropriate terminology), service in preferred languages, integration of spiritual practices with HIV care, and support for migration-related concerns. Protection of confidentiality and self-disclosure of HIV status by peer navigators were critical for building trust with community experts. Narratives identified gaps in linkage to peer navigation services for recently arrived im/migrants and others linking to HIV care in BC.

Conclusions: Culturally responsive peer navigation services can facilitate engagement in care and empower African, Caribbean and Black im/migrants living with HIV in healthcare settings. Systemic solutions to scale up and ensure linkage to these services in the BC health system are urgently needed.
Keywords: Health services, peer navigation, African, Caribbean and Black people living with HIV, im/migrants.

Background: The Canadian HIV Cure Enterprise (CanCURE) is a collaborative research team focused on HIV persistence and strategies for sustainable HIV remission. Since its inception, CanCURE has engaged people with lived and living experience in project development and knowledge mobilization through its Community Advisory Board (CAB). To align CanCURE 3.0’s research agenda with community priorities, the CAB surveyed people living with HIV in Canada about their knowledge of HIV cure research and their research priorities. Here, we outline how community involvement contributed to creating a comprehensive survey and facilitated participant recruitment and retention.
Methods: In spring-summer 2024, the CAB co-developed a web-based survey through meetings and document review with a CanCURE researcher to champion community engagement.
. The 20 minute survey included 37 questions, focused on demographics, knowledge of HIV cure research and cure research priorities, Knowledge questions were multiple choice, while research priorities were ranked. Participants could also provide additional information in free text. Five CAB members formed a pilot group to provide feedback before the final survey was launched. Community organizations promoted the survey through email lists and closed social media groups, and community members assisted in recruitment and follow-up for incomplete responses.
Results:. Over two-thirds of respondents who provided consent completed the survey, though 15% did not follow up after receiving the link. Most of the 100 enrolled participants emphasized the importance of keeping community members informed about all aspects of HIV cure research.
Conclusion The survey was developed and executed in equitable partnership with community members and researchers, adhering to the GIPA Principles (Greater Involvement of People Living with HIV). Community involvement enhanced the survey's clarity and improved recruitment and completion rates Future efforts will focus on understanding reasons for incomplete surveys and increasing engagement in knowledge mobilization initiatives.

Background: Indigenous harm reduction (IHR) moves beyond conventional ideas and forms of harm reduction. This approach emphasizes Indigenous (First Nations, Inuit, Métis) Peoples as experts and leaders in their lived/living experiences, connection to culture and community, integration of Indigenous values, and collective accountability for community well-being. Importantly, this approach is rooted in culturally safe, and trauma-informed practices. Emerging literature and harm reduction resources have highlighted significant calls to further Indigenize harm reduction, toward improving equitable access to substance use treatment for Indigenous Peoples, aligned with community members’ unique values and needs.

Methods: This study is part of a mixed-methods study, aimed at alleviating overdose risk and adverse long-term health effects among people living with and without HIV, who were at risk of, or experienced an overdose, in Vancouver, British Columbia, within the COVID-19 context. Indigenous Elders, Indigenous Peer Researchers, and academic researchers co-conducted two focus group discussions (FGD) with a total of ten Indigenous community members from Vancouver’s Downtown Eastside. The FGDs were professionally transcribed, and coded and analyzed using NVivo 14.0.

Results: IHR principles were consistently reflected across the interview transcripts, demonstrating how community actively practiced and sought out IHR. Indigenous community members shared their experiences looking after their fellow Indigenous brothers and sisters during an overdose event, highlighting their imperative role as first responders. Community members stressed the significance and use of Indigenous community-based harm reduction programs, Indigenous-led peer supports, and the value of community connection in their harm reduction journey. Community voiced the need for hiring Indigenous healthcare providers with lived/living experience, and more wholistic and compassionate care.

Conclusions: Findings illustrate the critical role of IHR, reinforcing the need to Indigenize harm reduction. This is vital for reducing substance use-related harms and addressing the ongoing impacts of colonization on Indigenous Peoples, both living with and without HIV.

Background: Global control of HIV epidemic with advancements in antiretroviral therapies is hailed an important public health success. However, challenges remain owing to pre-existing health inequities in the context of Canada’s settler-colonial policies and practices. Along these lines, Indigenous Populations suffer from intergenerational trauma, structural racism, and ongoing health disparities, such as the disproportionate burdens of HIV and substance use. Herein, we analyzed HIV diagnosis rates in the context of per-capita Indigenous Populations across the Canadian provinces.

Methods: Using publicly available data, we conducted a correlational study of percentage of Indigenous Population (source: Canadian-Census) and the HIV diagnosis rate (Public Health Agency of Canada-2023) in the province. Pearson correlation test determined the statistical significance at 5%-α.

Results: The two parameters showed a strong and significant positive correlation with an r-value of 0.855 and a p-value of 0.002 (Figure-1). In simple terms this means that the diagnoses rate of HIV strongly correlates with the percentage of Indigenous Population in the province. Further assessment of outliers showed that Saskatchewan and Manitoba with the highest per-capita Indigenous Populations among the provinces (18.1% and 17.0% respectively) also happen to be the only two provinces with HIV diagnosis rates several times the national average (about 4 and 3 times, respectively).

Conclusions: Overall, by shedding light on such disparity in HIV burden in the Indigenous Canadian Populations, the current study highlights the opportunity for focused interventions to lessen the burden of HIV and to improve the health outcomes of the marginalized populations in an equitable way.

Objective: The Feast Centre for Indigenous STBBI Research supports Indigenous-led, community-driven research by fostering scholarship grounded in Indigenous knowledges, decolonizing approaches, and community-based methodologies. Through its Community Fellowship Program (CFP), the Feast Centre creates reciprocal learning spaces that center community wisdom, empowering Fellows to navigate academic frameworks while addressing community priorities. This presentation highlights the CFP as a successful model for bridging academic and community ways of knowing, demonstrating the transformative potential of culturally responsive frameworks in Indigenous STBBI research.

Methods: Designed as a self-directed model, the CFP employs an iterative process that engages Fellows, Feast Team-Investigators, Knowledge Users, Collaborators, and the Council of Elders. Fellowship applications undergo two rounds of review, with feedback provided to refine proposals and align them with cultural and methodological principles. Regular consultations with the Feast Team ensure projects remain culturally resonant and rooted in the 4 Rs of Indigenous research as a distinction-based approach to Indigenous STBBI research. Dynamic mentorship fosters reciprocal learning and co-creation throughout the research process.

Findings: The inaugural cohort demonstrated the transformative potential of the CFP’s collaborative model. Fellows reported growth in their ability to integrate community priorities with academic frameworks. Projects addressed critical gaps, such as creating culturally relevant harm reduction strategies, enhancing access to sexual health services for 2S/LGBTQIA+ Indigenous communities, and designing Elder-guided knowledge translation tools. Fellows highlighted iterative feedback and Elder-Knowledge Holder engagement as essential to refining their research and building capacity.

Implications/Discussion: By integrating iterative feedback, Elder guidance, and culturally responsive frameworks, the CFP fosters reciprocal learning and meaningful collaboration. This approach advances Indigenous STBBI research while empowering a new generation of Indigenous and allied scholars and leaders, ensuring sustainable, impactful outcomes. These findings demonstrate the value of culturally grounded, community-driven models in addressing complex health challenges.

Background: Policy responses to the COVID-19 pandemic have fuelled the toxic drug crisis and reshaped the illicit drug market. People Who Use Drugs (PWUD) have been especially vulnerable to COVID-19 mediated stressors and have experienced socioeconomic challenges; its impact on their health and wellbeing remains underexplored. This project aims to understand the impact of COVID-19 on the illicit drug market as a risk factor for Non-Fatal Overdoses (NFODs) and their long-term health impacts, and the ways in which PWUD with and without HIV in Vancouver navigated these changes.

Methods: Semi-structured focus groups and one-on-one interviews were conducted with 74 PWUD, including 38 (51.4%) People Living with HIV (PLWH); and 19 Healthcare Providers (HCPs) representing diverse professional backgrounds. Participants were recruited from organizations and care centers in Vancouver that support PLWH and PWUD. Certain focus groups were exclusive to PLWH to facilitate a safer space. Sessions were audio recorded, transcribed verbatim and coded using NVivo 14.0.

Results: The focus groups yielded rich data describing changes to the illicit drug landscape including increased drug prices, and uncertainty in the toxic drug supply with decreased drug potency and increased drug contamination. Participants also discussed the social, structural, and economic impacts of the pandemic, particularly how the Canada Emergency Response Benefit shaped people’s response to the changing drug landscape.

Conclusion: PWUD with and without HIV in Vancouver faced significant changes in the illicit drug market that impacted patterns of buying, selling, and drug use, increasing the risk of NFODs and associated health outcomes. Government responses during the pandemic further influenced how PWUD navigated the evolving drug landscape, compounding existing social challenges. Communities have demonstrated resilience in adapting to these challenges, yet there remains a need for comprehensive and supportive regulation in the illicit drug market, as well as sustainable interventions, rather than temporary solutions.

Introduction:
Research often excludes the experiences of EAL immigrant women living with HIV (WLWH) due to English-dominant study practices. Addressing these gaps is crucial for ensuring equitable representation of these communities within scientific literature. Our project aimed to develop and implement a community-engaged, culturally-sensitive translation process for the BCC3 study.

Methods:
EAL immigrant WLWH were consulted in identifying key languages for translation of study materials through collaboration with ACPNet. Participants identified 8 languages commonly spoken by EAL immigrant WLWH. We identified 6 top-performing artificial intelligence (AI) platforms through their ratings on the app store and forum recommendations (Lingvanex, OpenL, MerlinAI, QuillBot, ChatGPT and DeepL). To choose the most accurate AI tools, we translated drafts of study materials in the 8 languages using each AI. We engaged immigrant WLWH, fluent in both a target language and English, in a second community consultation to provide feedback on clarity and cultural appropriateness. We then hired 7 community members with lived experience and language expertise to refine translations, ensuring accuracy and cultural sensitivity. Completed materials were shared at a final community event.

Results:
Translations were completed in Gujarati, Hausa, Shona, Swahili, Zulu, Luganda, and French. The iterative process highlighted several linguistic nuances overlooked by AI, including gender perspectives and removal of stigmatizing terminology, underscoring the value of community input. The final translated materials were well-received by participants, who expressed appreciation for the culturally tailored approach. This process improved accessibility of research materials for less cost than traditional methods, provided paid work for community members, and fostered trust and engagement among participants.

Conclusions:
This project highlights the feasibility and value of combining AI tools with community-engagement to overcome language barriers in research. The BCC3 study plans to adopt this approach for the future, offering a replicable model for enhancing inclusivity and representation in research.

How Social Media and Digital Platforms Can Promote Accurate Knowledge Mobilization to the Community: HIV Parenting Choices as a Case Study

V Esther Namalwa, Logan Kennedy, Jordan Hausman, Mona Loutfy

Background: Individuals living with HIV face barriers to parenthood, including stigma and lack of knowledge. The Canadian HIV Pregnancy Planning Guidelines provide essential information, but community dissemination has been inadequate. We examine the impact of digital and social media on mobilizing knowledge about parenting options for people with HIV in Canada and beyond.

Methods: A digital toolkit, launched as a website in December 2023, was co-created by a design firm and 11 community members across Canada, with support from VLK. Instagram and Facebook pages were launched in April 2024 (managed by a peer) to boost traffic, featuring weekly posts on advocacy, story-telling, and professional insights using relevant hashtags. Google Analytics data were used to analyze website traffic.

Findings: By April 1, 2024, 111 users accessed www.hivparentingchoices.ca, with 15% (22) returning more than once. Following the launch of the Instagram account, 263 new users have visited the website, with 15% (41) revisiting the site. This indicates a monthly increase of more than 10% in users. Website traffic spiked each Monday following the Instagram post, highlighting the connection between social media activity and user engagement on the website. 10% came directly from #HIVparentingchoices Instagram, 8% from other social media accounts, and 5% from an accompanying Facebook page. Between December 2023 -April 2024, the site had reached users in 4 countries. By the end of 2024, users from 10+ countries were accessing the site, with the majority from Canada, the US, the UK, Ireland, or the Netherlands.

Conclusion: Digital and social media platforms can disseminate research evidence and guidelines to community members. This approach supports informed choices for people with HIV.

Background: Gay, bisexual, and other men who have sex with men (GBMSM) who use crystal meth encounter significant barriers to accessing and staying engaged in social health programs. These challenges are compounded by the intersection of biological and social factors, including stigma, mental health challenges, and HIV. Systemic barriers impede equitable inclusion and retention in programs designed to support this population, highlighting the need for a comprehensive and coordinated approach to foster equity and inclusion.

Methods: Five focus groups were conducted with GBMSM who identified as crystal meth users, including individuals living with HIV. A semi-structured question guide facilitated discussions. Participants were recruited from HQ, a health clinic in Toronto, Canada, that specializes in serving the GBMSM community. Thematic analysis was used to examine participants’ lived experiences with program inclusion and retention.

Results: Participants (n=25) reported that discrimination associated with crystal meth use created substantial barriers to program inclusion, fostering feelings of judgment and exclusion. They emphasized the importance of safe, supportive environments with empathetic, non-judgmental staff and peers to encourage engagement. Key insights included the need for flexible program designs that address the unique and unpredictable nature of crystal meth use. Stigma from healthcare providers, a lack of tailored services, and rigid program structures were identified as significant barriers to retention. Participants highlighted the critical need for integrated mental health and HIV services that address the intersection of crystal meth use and sexual health.

Conclusions: This study highlights the urgent need for equity-informed, tailored social health programs that integrate mental health and HIV support while addressing the intersection of crystal meth use, sexual behavior, and broader social determinants. Such programs are essential for fostering trust, ensuring equitable access, and sustaining engagement among GBMSM who use crystal meth, aligning with the collective action themes of CAHR 2025.

By 2046, Canada is projected to have 2.5 million individuals aged 85 or older, with 23% of the population over 65. This demographic shift underscores the pressing need to address inequities faced by aging Canadians living with chronic health challenges, including poverty, mental health struggles, substance use, and HIV. These individuals, aging on the fringes of society, experience unique vulnerabilities that demand collective action and innovative solutions.

Our project, led by an Early Career Researcher with over 15 years of healthcare provision experience and funded by the CIHR Institute of Aging, adopts an intersectionality framework to explore and address the health inequities faced by marginalized aging populations. Two full-day focus groups were conducted with 51 participants representing older adults, racialized communities, Indigenous peoples, and professionals from social services, healthcare, and academia. This diverse group provided critical insights into the systemic and intersectional challenges faced by aging Canadians.

Project aims:
1. Develop a shared language and conceptual framework to unite stakeholders across disciplines and regions in addressing the health of marginalized older adults.
2. Equip stakeholders to critically examine and address the intersectional social inequalities impacting these populations.
3. Guide the development of research priorities and tailored strategies for prevention and intervention, particularly for those living with or at risk of HIV.

To address existing gaps, we advocate for a paradigm shift in the understanding of aging and HIV, emphasizing the interaction of biological and social determinants. Through interdisciplinary knowledge exchange sessions, capacity-building initiatives, and the formation of a Canada-wide multi-stakeholder research network - including individuals with lived/living experiences, researchers, policymakers, and service providers - we aim to sustain progress in health equity. This collaborative approach aligns with the collective action needed to meet the UNAIDS 95-95-95 targets and improve the lives of older adults who are aging on the fringes.

Background: Meaningful and equitable engagement of community collaborators is a cornerstone of successful efforts in mobilizing HIV champions. The Acceptance and Commitment to Empowerment (ACE) Project is a multi-phase project with the aim to reduce HIV stigma and related disparities through capacity building and community mobilization.
Description: In Phase Two of Project ACE, we aimed to recruit 48 service providers and community leaders to take part in the six-week ACE intervention that promotes readiness and committed action in stigma reduction and HIV championship. Existing evidence indicates that time demands on participants in intervention research poses challenges on recruitment and completion. Meaningful engagement and building trust with community collaborators are key to successful recruitment.
Lessons learned: Our team tapped into existing partnerships and built new relationships with new collaborators through community engagement and dialogue. We successfully engaged 20 community organizations, including 17 organizations that serve people living with HIV, two religious centers, and one cultural community group. A total of 55 participants were recruited into the project, and 41 participants successfully completed the ACE intervention. Key insights/lesson learned: (1) effective community mobilization requires trusting relationships built on transparency; (2) effective partnerships require equitable distribution of resources to community collaborators; (3) shared leadership promotes successful community mobilization; and (4) frequent open communication and flexibility in co-planning are essential to sustainable collaboration.
Next Steps: Meaningful and equitable engagement with community collaborators is proven to be critical to successful implementation of community-centred intervention and community mobilization. These relationships have the potential to extend beyond current activities to benefit future HIV initiatives and strengthen community networks. Project ACE team will continue to work closely with current partners and collaborators in Phase Three to engage 288 community members living with and/or affected by HIV to reduce stigma and become HIV champions.

Background: Gender-based violence increased during the COVID-19 pandemic and many services, including violence prevention and support (VPS) services, were disrupted. Women living with HIV experience high levels of violence and are a priority population in the gender-based violence response. We examined access to VPS services during the COVID-19 pandemic in British Columbia among women living with and without HIV.

Methods: Cis and trans women aged ≥16 years completed a survey regarding need to access VPS services from March 2020 - March 2022. Data were collected on age, ethnicity, gender identity, sexual orientation, education, relationship status, and household income. Participants reporting needing VPS services were asked whether they accessed services and if they experienced difficulty accessing services. Groups were compared using t-, chi-squared, or Fisher’s exact tests.

Results: Our sample consisted of 542 women with a median age of 47.7 years (Interquartile range = 37.4 - 57.2). Among them, 39 reported needing to access VPS services (5.2% of women living with HIV and 8.7% of women not living with HIV, p=0.152). Household income was significantly associated with need to access VPS services, as 12.4% of women with <$20,000 needed services compared to 4.1% of women with ≥$20,000 (p=0.002). Among those who needed VPS services, 29 reported accessing services (74.3%) and 12 reported difficulty accessing services (30.8%). HIV status was not significantly associated with needing VPS services, accessing services, nor difficulty accessing services (all p>0.10).

Conclusion: Our findings indicate that household income but not HIV status was associated with need to access VPS services, suggesting the importance of social determinants of health in needing VPS services. Furthermore, one-quarter of women needing VPS services did not access them, and nearly one-third experienced difficulty accessing services. Additional research should explore factors impacting VPS service accessibility during pandemic responses to inform future gender-based violence-related policy.

Background: COVID-19 and HIV disproportionately impact Black communities in Canada. The intersecting pandemics of COVID-19 and HIV/AIDS have further exposed and exacerbated systemic inequities, including racism, sexism, homophobia, and poverty, which heighten vulnerability and worsen health outcomes). These conditions have had a profound impact on Black women Living with HIV, who experience significant physical and mental health challenges, compounded by systemic barriers to timely and effective healthcare.
Methods: This doctoral research, led by a Black woman living with HIV and a Community Advisory Board of diverse Black women living with HIV centres Black women living with HIV, integrates activist scholarship ,critical theories, participatory of counter-storytelling and cellphilming to examine how lessons from the COVID-19 pandemic can reshape health and social policies to improve the intersectional well-being of Black women living with HIV in Canada.Forty-five participants were recruited to participate in 6–7-hour workshops that included technical training on mobile filmmaking, enabling participants to collaboratively learn and creating short cellphilms (2 minutes each), screening and group participatory analysis. A follow-up hour-long, semi-structured individual interviews were conducted with all the participants.Data from the interviews and cellphilms were analyzed thematically using NVivo, integrating insights to identify patterns and themes that address systemic inequities and inform individual, social and policy recommendations.
Results: Community-based research thrives on trust, flexibility, and reciprocity to empower community voices, address power imbalances, and enrich the process with essential perspectives that foster meaningful, equitable partnerships.
Conclusion: The findings demonstrate that when communities are meaningfully and equitably engaged in research, the benefits are profound. Initially aiming to recruit up to 30 participants, the study received an overwhelming response, resulting in 45 participants being included, with 100% attendance and full engagement throughout the workshops. Despite the six-hour workshop duration, participants remained actively involved, underscoring the value of creating inclusive, community-centered spaces.

Colonialist structures in Canadian healthcare systems encourage siloing of healthcare, however many throughout Canada are calling for wrap-around care. Siloing care, for example, HIV care only clinics, decreases health service access and increases stigma associated with specific diseases such as HIV and sexually transmitted and blood-borne infections (STBBI). This approach, although beneficial in accessing specialized resources, forces disclosure simply through presence. Indigenous populations have called for different approaches to reduce stigma experienced by over-researched “at-risk” populations such as Vancouver’s Downtown Eastside (DTES).
Stamsh Slhanay Llawat II/Warrior Women Healing II (SSL2) is a research project with members who are part of urban Indigenous communities within the DTES. Over the past year, research has been co-developed that nurtures urban Indigenous people’s connection with self and culture, leading towards improved wholistic wellness. This culture as intervention research explores physical and mental wellness but, critically, also spiritual and cultural wellness of participants - many of whom have lost their connection to kin, culture and spirit.
While data is an expected research outcome, we are not just looking for data. We are nurturing and celebrating the humanness of those participating. During the first two cycles of this project , stigma felt by participants as they are walking into a community - one that doesn’t ask your status, your history or other deficit-based questions – was reduced. A cohort of peers has been working together to look after their spiritual wellness, to strengthen ties to Indigenous cultures and co-create a community together with researchers. Methodologies used have been thoughtfully selected to center Indigenous ways of knowing and doing, focusing heavily on land –and culture-based activities while integrating the power of expressive therapy in wellness. Findings from this study will inform Indigenous wellness care and services planning with urban Indigenous populations across Canada and similar settler-colonial nations.

Background: Community-based organizations (CBOs) play a critical role in supporting older people living with HIV (OLPWH). Building trust between healthcare providers and CBOs is key to promoting comprehensive health for OPLWH. While there have been calls to strengthen connections between health systems and communities, research involving CBOs serving OPLWH remains limited. We address these gaps by leveraging lessons from CBOs to explore barriers to, and builders of, belonging in long-term care and assisted living (LTC/AL) for OPLWH.
Approach: From January to September 2024, we conducted 59 interviews with stakeholders, including LTC/AL physicians, administrators, care providers, residents and family caregivers; OPLWH; and CBO leaders. Our analysis focuses on interviews with CBO leaders serving the intersections of HIV/AIDS, queer advocacy, and housing support. Interviews were professionally transcribed. To enact thematic analysis, transcripts were divided amongst team members to identify meta-themes. Coded data were grouped based on themes collaboratively identified to ensure diverse perspectives informed findings.
Findings: CBO leaders identified three barriers preventing OPLWH from feeling they belong in LTC/AL: stigma within LTC/AL communities, misalignment between health system and community values, and negative experiences with the health system that create an expectation that LTC/AL will be harmful. Builders of belonging included: fostering trust with OPLWH through partnerships with CBOs and HIV peer navigators; care staff education on the lived HIV experience; and resident-driven initiatives that promote a shared sense of belonging. For OPLWH, belonging and a sense of home—key contributors to autonomy, security, and well-being—are often undermined by stigma and marginalization in care communities.
Conclusion: These findings underscore belonging as an affective experience vital to OPLWH's quality of life in LTC/AL, thus identifying a pathway to strengthen relationships between health systems and CBOs. Our next step is to propose specific tools and strategies to foster belonging for OPLWH within LTC/AL.

Introduction: The COVID-19 pandemic has significantly impacted the HIV care continuum (HCC), presenting challenges while also driving positive transformations globally. This study examines the impact of the COVID-19 pandemic on HCC in high-income countries, aiming to identify barriers and facilitators to care delivery amidst global health challenges.
Methods: This study employs JBI mixed-methods systematic review methodology. The search strategy included CINAHL, OVID-Medline, CAB Direct, and OVID-Embase databases and manual citation review. After systematic screening and data extraction, quality assessment was performed, and integrated findings were presented.
Results: The COVID-19 pandemic has disrupted various aspects of the HIV care continuum, posing challenges in testing, prevention, appointments, adherence, linkage to care, viral suppression, and treatment engagement. However, the pandemic has also spurred positive changes, notably through the widespread adoption of telemedicine, enhancing access to care and support services.
Conclusion: Efforts to mitigate structural barriers, enhance access to care, and promote ART adherence are essential to ensure continuity of care and mitigate long-term consequences. Tailored interventions for vulnerable populations and addressing disparities in care access are crucial for fostering equitable HIV care delivery.

Introduction: Older people living with HIV (PLWH) in Ontario face significant financial challenges, yet there is a lack of targeted financial empowerment initiatives to address their specific needs. This mixed methods study sought to explore service providers' knowledge and experiences in supporting older PLWH (50+) with income and benefit programs, as well as their access to financial education and empowerment services. The findings aim to inform the development of policy and programs tailored to this population's financial needs.

Methods: 19 service providers from HIV community service organizations across Ontario were recruited through email, leveraging existing stakeholder relationships. Participants took part in 90-minute facilitated focus group sessions conducted via Zoom, which were recorded and transcribed for analysis. A participatory data analysis approach was employed using the DEPICT model to enhance capacity building and engage community members throughout the process.

Key Themes:
Current Resources: urgent need for comprehensive financial planning resources that integrate the complexities of living with HIV and aging.
Financial Needs and Gaps: limited availability of tailored financial empowerment tools, contributes to financial insecurity among older PLWH
Navigating Government Pension and Benefit Programs: challenges in access government pensions and benefits, complex eligibility criteria, application barriers, and systemic delays that exacerbate financial vulnerability.
Increasing Awareness and Uptake: A critical need for more targeted education, enhanced collaboration, and proactive outreach to develop and increase the uptake of existing financial empowerment services, currently underutilized despite the pressing needs of this population.

Recommendations: These findings highlight the urgent need to integrate financial empowerment resources into HIV care settings. Simplifying access to government benefits, enhancing financial literacy for both clients and providers, and fostering collaboration between service organizations are critical steps. These policy recommendations aim to address financial inequities, ensuring that older PLWH have access to the support needed to navigate their complex financial situations.

Introduction: Older people living with HIV (PLWH) in Ontario face considerable financial and social challenges. Tailored financial empowerment initiatives are limited, especially for communities with lower incomes. The Financial Empowerment study sought to understand the needs for financial information, services, and support of 180 diverse older PLWH (50+) in Ontario, to inform policy and program development.

Methods: An anonymized, online survey was conducted between May and November 2024 using Qualtrics software. PLWH (50+) in Ontario were recruited through existing networks and provided unique survey links after completion of pre-screening online or by phone. The online survey was chosen to increase accessibility for at risk and underrepresented communities, and to support gathering evidence on their financial empowerment needs. An honorarium was offered upon survey completion. Descriptive statistics were used to summarize participant demographics and quantitative data.

Results: Initial recruitment was limited, with fewer than 20 surveys completed in two months. Social media campaigns promoting the pre-screening survey resulted in almost 1000 responses, largely attributed to bot activity. Despite enhanced security measures, bot attacks were recurring, requiring ongoing screening and exclusion of illegitimate responses by study staff. 284 unique links were sent, and 97 survey responses were validated, based on documented criteria. This disruption limited the participation of PLWH, who already face increased digital, social, and economic barriers to research participation.

Considerations and Recommendations: Bot attacks significantly disrupted data collection, impacting data integrity and exacerbating existing barriers for PLWH. The planned data analysis was limited to reporting of results, given the likelihood of bot responses within the data set. These incidents highlight the challenges of relying on digital methodologies for engaging vulnerable populations. To support safe and equitable inclusion, hybrid approaches that combine online and offline methods, such as in-person interviews, community-based data collection, and partnerships with local organizations must be considered.

Background: In Canada, nearly 50,000 fatal overdoses have occurred since 2016, primarily driven by unregulated fentanyl. People who use fentanyl (PWUF) face heightened overdose and infectious disease risks. We explore how the volatile unregulated drug supply and structural inequities undermine HIV/HCV prevention and treatment access during the COVID-19 and fentanyl era.
Methods: Between November 2022 and August 2023, we conducted qualitative interviews with n=61 PWUF and n=19 safer opioid supply and/or opioid agonist treatment prescribers in Hamilton and Brantford. PWUF participants were asked about their overdose experiences, HIV/HCV testing and prevention practices, accessing treatment and health services, and drug supply changes. Prescribers were asked about the ways in which fentanyl and COVID-19 impacted their practice, the needs of PWUF clients, and challenges providing treatment. Thematic analysis was utilized.
Results: Many PWUF participants described shifting from injection drug use to smoking, though some reported reverting to injection in certain circumstances. While awareness was strong regarding HIV/HCV transmission risks and not sharing injection equipment, sharing smoking equipment was more common. Housing, economic and food insecurity emerged as destabilizing forces, with PWUFs describing how these experiences increased substance use and impeded healthcare engagement. Prescribers corroborated these challenges, reporting how structural inequities undermined their ability to maintain contact with patients and provide comprehensive care, creating potential challenges for integrating HIV/HCV care. Limited safer smoking services and stigma created additional barriers to care. These challenges intensified during COVID-19, with increased housing instability and reduced service accessibility reported by both groups.
Conclusions: Our findings reveal critical gaps in HIV/HCV prevention and care for PWUF in the fentanyl era, particularly around equipment sharing, structural vulnerabilities, and healthcare engagement. Results suggest urgent need for collective action across regions to develop integrated HIV/HCV care that addresses social determinants of health and expands harm reduction options especially in less-resourced communities.

In response to the COVID-19 pandemic, the Public Health Agency of Canada’s National Microbiology Laboratory Branch (NMLB) partnered with community-based organizations to establish a decentralized point-of-care testing (POCT) network. Designed to address health inequities in underserved populations, including Indigenous communities and other key populations, this initiative supported the establishment of over 400 POCT sites across Canada, with approximately 200 equipped with Cepheid GeneXpert® instruments. Originally developed for SARS-CoV-2 diagnostics, this network has been leveraged to address broader public health challenges.
Building on this infrastructure, the NMLB continues to collaborate with community-based organizations to expand its support for decentralized POCT to include sexually-transmitted and bloodborne infections (STBBIs), specifically HCV and HIV. This community-driven approach reduces barriers to healthcare for historically underserved populations by improving accessibility to testing, mitigating stigma, and minimizing the need for travel to centralized facilities.
Proof-of-concept was successfully demonstrated through a pilot initiative on-boarding the Xpert® HCV VL Fingerstick assay in three POCT sites. The same multifaceted on-boarding approach will be used to implement POCT for HIV using the Xpert® HIV-1 Qual XC assay. Proficiency testing material from an NMLB-established international external quality assessment program (EQAP) will be adopted as the quality control material for training and on-boarding POCT sites. This international EQAP will also serve as a model for the creation of a domestic EQAP program to provide ongoing technical support and quality oversight for newly established HIV-POCT sites.
The implementation of lab-quality POCT for HIV using this community-led model will improve our ability to reach the undiagnosed, enable early diagnosis and linkage-to-care, and overall improve health outcomes for historically underserved populations. This initiative underscores the power of partnerships with community-based organizations to address health inequities through locally driven solutions, fostering better outcomes for populations disproportionately affected by HIV and other STBBIs across Canada.

Introduction: People living with HIV can experience physical impairments (e.g. balance problems) and activity limitations (e.g. mobility difficulties), which can lead to participation restrictions (e.g. difficulty working), defined here as physical disability. These experiences can be further influenced by contextual factors, including extrinsic (e.g., stigma and social support) and intrinsic (e.g., living strategies and personal attributes) factors.
Objectives: The purpose of this study is to understand the experiences (presence and impact) of physical disability and the influence of extrinsic and intrinsic contextual factors on physical disability among adults living with HIV.
Methods: I will conduct a qualitative descriptive study involving online semi-structured interviews. I will recruit adults aged 18 years or older living in Nova Scotia, who self-identify as having a physical disability through social media, word of mouth, a peer researcher, and local HIV service organizations. The interview guide, developed using the Episodic Disability Framework and items from existing physical performance measures, will include questions about the experience of physical disability and the influence of extrinsic and intrinsic contextual factors. I will administer the World Health Organization Disability Assessment Schedule (WHODAS 2.0) questionnaire to describe general disability, and a demographic questionnaire to describe personal and HIV characteristics (e.g age, gender, race and time since HIV diagnosis). Data will be analyzed using hybrid inductive-deductive thematic analysis. Descriptive statistics will be calculated for the WHODAS 2.0 and demographic questionnaire responses.
Anticipated Results: This study aims to describe experiences of physical disability, the impact on daily life, and the contextual factors that shape these experiences among adults living with HIV in Nova Scotia.
Conclusion: Highlighting the lived experiences of physical disability and associated contextual factors may inform the development of effective rehabilitation strategies aimed at improving functional outcomes and enhancing health outcomes of adults living with HIV.

Background: For single and non-monogamous gay, bisexual, and other men who have sex with men (GBM), decisions to use condoms may be informed by HIV-PrEP use, and perceived HIV/STI risk (e.g., casual partners may be perceived as higher risk than romantic partners). We examined how PrEP use and relationship dynamics are associated with engaging in condomless anal sex (CAS) among GBM.

Methods: We analyzed longitudinal data (Engage Cohort Study; 2017-2023) on the sexual health and behaviours of sexually active single and non-monogamous GBM recruited using respondent-driven sampling in Vancouver, Toronto, and Montreal (n=2206). Participants completed study visits every 6-12 months, providing information on up to five sexual partners from the past 6 months. Using multilevel logistic regression, we examined how relationship dynamics (casual, close non-romantic, and romantic) and PrEP use were associated with engaging in CAS across partners and study visits.

Results: As summarized in Table 1, HIV-negative participants not using PrEP were more likely to engage in CAS with romantic versus close-non-romantic or casual partners (ORs>4.00, ps <.001)—however, we did not find this association among PrEP users. Participants living with HIV were more likely to engage in CAS with partners who were also living with HIV or on PrEP (ORs>2.00, ps < .05), regardless of their relationship dynamic.

Conclusion: Condom use behaviour among single and non-monogamous GBM varies across relationship dynamics, HIV status, and PrEP use. Sexually active single and non-monogamous HIV-negative GBM reporting CAS with romantic partners should still be encouraged to screen clinically for PrEP eligibility.

Introduction: Saskatchewan has faced the highest rates of HIV nationally for over a decade, with the epidemic significantly affecting rural and remote areas, including First Nations communities. To address gaps in care in these areas, Indigenous-led rural care models like “Know Your Status” (KYS) emerged. This study evaluates outcomes from the expansion of select KYS programs in Saskatchewan between 2018 and 2023.
Methods: Data from the Wellness Wheel Clinic’s electronic medical record system was analyzed, including clinic activity, healthcare personnel, and client care engagement for HIV and Hepatitis C (HCV) from 2018 to 2023. Key indicators included the proportion of HIV clients on antiretroviral therapy (ART), viral suppression rates (defined as a viral load <200 copies/mL) and the HCV treatment cascade of care for clients who initiated treatment during the study period.
Preliminary Results: Between 2018-2023, 158 unique clients living with HIV accessed care. Among these, 82% were HCV co-infected. An additional 142 clients were HCV mono-infected. The client population was 55% males and the average age was 40.3 years at the studies mid-point. ART coverage was consistently high, exceeding 87% annually, with viral suppression rates peaking at 85% in 2023 and dipping to 75% in 2020-2021, potentially due to COVID-19 disruptions. Of 271 HCV clients, 211 were RNA positive. Among these, 130 initiated treatment, 81% completed treated, and 75% achieved sustained virologic response (SVR 12).
Conclusion: The KYS model demonstrated strong outcomes, with high ART uptake and good viral suppression rates, underscoring the value of culturally responsive, accessible HIV care. Challenges, including disruptions during COVID-19, highlight the resilience of these programs.

Background
Indigenous people who use injection drugs (PWID) in Canada face significant structural and systemic barriers when seeking healthcare, rooted in the enduring legacies of coloniality and the pervasive stigma surrounding substance use. In Saskatchewan, the intersection of substance use and increasing HCV rates further underscores the urgency of addressing these inequities. This study aims to explore the barriers and enablers Indigenous PWID navigating complex life circumstances encounter when accessing healthcare services.

Methods
This qualitative study is a component of a larger multi-centre, multi-method study. Semi-structured interviews were conducted with 31 participants (Saskatoon, n=20; a northern rural and remote community, n=11) with injection drug use experience. Thematic analysis was conducted, and the findings were validated through feedback sessions involving community research associates with lived and living experiences.

Results
The findings reveal a deeply entrenched pattern of systemic racism, classism and stigma within the healthcare system, which contributes to substandard care delivery for Indigenous PWID. Participants reported significant barriers, including poverty, trauma and HIV- and IDU-related stigma, which compounded their sense of isolation and mistrust in healthcare providers. Logistical obstacles, such as transportation difficulties and prohibitive medication costs, further hindered access. Cultural safety was notably absent, as participants felt their beliefs and needs were routinely dismissed. Despite these challenges, participants identified pathways for improving access, including trauma-informed, empathetic care and peer support services. They also highlighted the value of proactive and patient-centered approaches that meet individuals "where they are" and prioritize respectful engagement.

Conclusion
This study underscores the pressing need for healthcare systems to address the structural inequities faced by Indigenous PWID. Interventions must prioritize cultural safety, trauma-informed practices and systemic reform to ensure equitable access to healthcare. These findings contribute critical insights into Saskatchewan-specific HCV-related health system utilization and advocate for transformative, justice-centered approaches to healthcare delivery.

Background: Peer mentorship is an evidence-based method to support people accessing treatment and care for substance use disorder and chronic illnesses such as HIV. The Cultural Care for Addictions project facilitated roundtables with care providers to discuss solutions to better support people to access care through peer mentors within acute hospitals, clinics, and community-based organization settings as a culturally responsive approach.

Methods: In spring 2023, two roundtable discussions were held with providers based in Saskatoon (n=6) and Regina (n=14). The discussion questions examined the options available to treat and support people with addiction, possible systemic challenges, and considerations for integrating peer mentors within the clinical circle of care.

Results: Providers shared the lack of inpatient addiction services in acute hospital care: "We have people having valves replaced in hospital for 6 to 8 weeks, walking out the door and then overdosing because nobody has treated their addiction."
Participants identified peer mentors' critical role in bridging social services gaps and retaining people in health care. However, rigorous metrics are required to evaluate the efficacy of peer programming. When discussing how outcomes from peer mentorship can be evaluated, participants advocated for patient-centred outcomes, as many patients simultaneously experience multiple health and social challenges. For example, "[patient-centred] outcome-based healthcare would look at 'did we house that person, were we [then] able to get them on ARVs, were we able to suppress their viral load?'"

Lessons Learned/Recommendations: When utilizing peer mentors' expertise, success can be measured by redefining patient-centred outcomes that facilitate patient retention in care. However, the function of a peer mentor cannot be generalized to fit under a single job description; just as there are various specialist physicians, there are various types of peers. Healthcare systems must provide flexibility and sustainability when integrating peer mentors.

Background: How HIV acquisition risk is communicated may affect perceptions of risk and interest in HIV pre-exposure prophylaxis (PrEP). This study assessed the impact of two risk communication strategies on PrEP engagement among non-PrEP users in Canada.

Methods: In 2022, adult gay, bisexual, and other men who have sex with men (MSM) in Ontario and British Columbia participated in an online survey. Participants were randomly assigned to receive HIV risk communication based on their HIV Incidence Risk Index (HIRI-MSM) scores and local prevalence, presented in either absolute terms (e.g.,“Your risk is approximately X%”) or relative terms (e.g.,“Your risk is approximately X times that of other MSM”). Participants compared this information with their self-assessed risk and reported its impact on interest and intent to use PrEP. Multiple logistic regression models were used to assess the effect of these strategies on interest and intent.

Results: Of 461 non-PrEP users, those in the ‘absolute’ group (244,53%) expressed slightly higher interest in PrEP (60%vs51%, p=0.071), though intent was similar across groups (43%vs45%, p=0.663). The ‘absolute’ group showed greater interest in PrEP (adjusted odds ratio, AOR: 1.53; 95%CI: 1.01-2.32), but no significant difference in intent (AOR: 1.06; 95%CI: 0.66-1.71). Former PrEP use, Perceived HIV risk, PrEP indication, PrEP-related stigma and province of residence were independent predictors of interest and intent.

Conclusion: Communicating personalized HIV risk in absolute terms may increase interest in PrEP but not intent to use it. Strategies to improve PrEP uptake should address prior PrEP experiences, stigma, and individual perceptions of risk.

SExT: Sex Education by Theatre addresses sexual and mental health inequities among newcomer and Indigenous youth in Canada. Launched in 2014 as a doctoral research initiative by Dr. Shira Taylor, SExT has reached over 11,000 youth nationwide and earned multiple awards for its innovative approach. By integrating participatory theatre methods with a trauma-informed peer education model, SExT empowers youth to explore critical health topics through creative expression. Youth participants co-create and perform scenes inspired by their lived experiences and infused with popular culture references. Structured discussions, role-play exercises, and iterative rehearsals ensure cultural relevance and adaptability to community contexts. Performances address essential issues such as HIV/STI prevention, mental health, consent, domestic violence, and gender/sexual diversity, engaging youth audiences through humour, music, dance, and storytelling in a way that is both impactful and relatable. Our previous research has shown that the program improves sexual health self-efficacy (condom use, HIV/STI testing, and sexual limit-setting) and personal and social development (personal growth, social inclusion, and social engagement) among audiences and performers alike.

Through self-study, interviews with peer mentors, reviewing scripts, videos and performances, and reflexive engagements with the show and the literature, we identify three pedagogical strategies that contribute to SExT’s success, including: (1) parody, (2) personification, and (3) embracing the outrageous. We present case studies of key scenes to illustrate these theatre techniques, including Let it Flow (a musical parody about puberty), Captain Condom (involving humorous personification of STIs), and Clinic Myths (a farcical exploration of healthcare stigma). These examples highlight the program’s ability to entertain, educate, and foster critical conversations. This study provides valuable insights for community-engaged facilitators seeking replicable methods and creative prompts to engage youth on sensitive health topics through participatory theatre.

Objectives
Using a novel community-based, participatory approach to digital storytelling embedded within a longitudinal survey-based cohort, this study aimed to explore experiences of trauma, resilience, and support in healthcare among women living with HIV, and make recommendations for improved care within health services.
Methods
The “My Story, My Way” project used the arts-based method of digital storytelling, aligned with objectives of the Sexual Health and HIV/AIDS: Women’s Longitudinal Needs Assessment(SHAWNA), a longitudinal, quantitative cohort study (2014-2025) in Metro Vancouver, Canada. Within a trauma-and violence-informed framework, in workshops over two years (October/22-October/24), community experts and researchers co-designed the project objectives and methodology, created digital stories, and explored narratives in qualitative art-elicitation interviews. Community experts produced audio-visual digital stories using a combination of voice-over audio, photographs, and images created by artificial intelligence-based written prompts. Researchers drew on grounded theory to identify emergent themes in transcripts, then refined them with community experts.
Results
The seven digital stories and interviews described experiences of inequitable power dynamics and lack of autonomy in interactions with providers and health care staff (e.g., clinic staff; researchers), uncovering dehumanization in healthcare settings. Community experts’ narratives emphasized the importance of consistent, trusting relationships with all healthcare staff. Community experts expressed their hopes for improved health services, highlighting the importance of training healthcare professionals in relationship-building. These narratives emphasized the need for programs that promote rights education and provide access to health advocates, including peer-based support.
Conclusion
Our community-based, participatory approach suggests that digital storytelling is a powerful tool for illuminating health inequities and engaging community experts who might otherwise not have opportunities to share stories. Narratives mapped recommendations to principles of trauma- and violence-informed, culturally safe care to create safer healthcare environments. Addressing biases and discrimination at all levels of care is essential to create safe access to healthcare.

Young men who have sex with men (YMSM) in Canada and globally are disproportionately impacted by human immunodeficiency virus (HIV). Pre-exposure prophylaxis (PrEP) is an effective strategy for reducing transmission and acquisition of HIV infection among high-risk populations, including YMSM. However, there is a limited number of studies exploring YMSM’s PrEP access experiences and the different social, structural, behavioural, and clinical factors that influence their PrEP access and use. The purpose of this narrative inquiry study was to explore and understand the experiences of Canadian YMSM in relation to their PrEP access. In this research, I worked collaboratively with three Canadian YMSM between the ages of 21 and 24 over 24 months. With relational ethics at the center, the participants and I engaged in multiple conversations in person and virtually and collected field texts that provided insights into their experiences across time, places, and social contexts. The intensive and long-term researcher-participant relationships allowed us to co-compose narrative accounts that reflected the participants’ unique experiences, especially those that shaped their overall PrEP access. Through the continuous telling and retelling of the participants’ stories and by reflecting on and laying their narrative accounts side by side, I identified resonant threads that highlighted their experiences of accessing PrEP in relation to and in the contexts of identity-making and social responsibility. This narrative inquiry research provided new understandings and knowledge of Canadian YMSM’s PrEP access experiences. The new knowledge from this research can be utilized to inform PrEP programs, research, education, policies, and practice guidelines that will improve PrEP access and help decrease the rate of new HIV infections among Canadian YMSM.

Introduction: Stigma can adversely affect the physical, mental, and emotional well-being of people living with HIV. This study explores demographic characteristics, experiences of stigma, health risks, and protective factors among people living with HIV in Saskatchewan.

Methods: We interviewed 71 people with HIV in Saskatchewan as part of the People Living with HIV Stigma Index 2.0 (survey created by and for people living with HIV) to measure stigma and health-related outcomes. Descriptive analyses were conducted to assess participant demographics, health risks (depression, low income (≤ 30k), substance use, unemployment, and unmet basic needs) and protective factors (social support, self-efficacy, and resilience). Individual scores were calculated to determine multiple health risks/protective factors.

Results: Participants: mean 44 years old and 13 years living with HIV, 69% were female, 75% identified as heterosexual, and 66% as Indigenous. Participants had elevated levels of stigma: internalized (44%), enacted (62%), and anticipated stigma (92%). Income was low for 87% of participants, 79% were unemployed, and 78% had unmet basic needs. Substance use was prevalent: 60% met threshold for significant alcohol use, 54% for substance use, and 51% for depression. Despite these challenges, 73% showed high levels of social support, 75% had high resilience, and 93% with self-efficacy. Overall, 44% had a health risk score of four or higher; 61% of participants had a protective factor score of four or higher.

Conclusion: This study highlights that people living with HIV in Saskatchewan have high levels of stigma along with several health risks and protective factors shaping their lives. While participants face significant challenges, including high levels of stigma, financial stress, and mental health concerns, there is also a presence of robust protective factors such as social support, resilience, and self-efficacy. Addressing these challenges will require interventions that go beyond medical care to tackle social and economic disparities.

The COVID-19 pandemic intensified sex and gender-based differences in health outcomes through high prevalence of essential work among women, differences in caregiving responsibilities and socioeconomic status. People living with HIV faced unique challenges during the pandemic, impacting their access care and adherence to treatment. However, there is lack of research comparing health outcomes between women and men living with HIV during the pandemic.

We conducted a cross-sectional systematic sampling study with people living with HIV, 18 years of age or older, receiving HIV care at the Toronto General Hospital in Toronto, Canada. Chi-square tests were used to evaluate differences in healthcare access and outcomes, according to sex. Multivariable logistic regression was used to estimate the association between sex and health outcomes, while accounting for age and racial background.

183 individuals participated in the survey (51% female), with a median age of 54 (IQR 45-63) years. During the COVID-19 pandemic, there was a trend towards worse access to HIV care among female participants (no viral load monitoring (14% vs. 9%), attending fewer or no appointments with their HIV care provider (44% vs. 32%), missing doses or stopping antiretroviral therapy (49% vs. 40%)). Interestingly, female participants were less likely to present to the emergency department (15% vs. 30%, p=0.019) or experience worsening of a preexisting condition (5% vs. 19%, p=0.006). After accounting for age and racial background, male sex was still associated with increased odds of emergency department presentation (OR=2.5, 95% CI 1.2-5.3, p=0.019) and deterioration of underlying comorbidities (OR=3.7, 95% CI 1.3-10.6, p=0.018). These associations persisted in sensitivity analyses accounting for differences in healthcare access.

We identified sex-based differences in health outcomes among people living with HIV in Canada during the COVID-19 pandemic. Pandemic preparedness efforts need to incorporate strategies that address sex-based determinants of health among people living with HIV.

Background: Engaging peer researchers (PRAs) in knowledge translation ensures research findings reach and resonate with the community. Five peer researchers from the Ontario Implementation of the Canadian HIV Stigma Index study collaborated with researchers to create accessible, plain language blogs based on peer-reviewed articles about HIV Stigma Index data. Published on the Positive Effect website (https://www.positiveeffect.org/blog), these blogs translated complex findings into community-centered content, amplifying the lived experiences of people living with HIV and bridging the gap between research and community understanding.

Methods: PRAs participated in every stage of the knowledge translation process. They reviewed the peer-reviewed articles addressing various aspects of HIV stigma, contributed to blog drafts and refined the content for clarity, relevance, and relatability. Their input ensured the blogs were accessible to diverse audiences. PRAs also identified practical resources to enhance the blogs' value to readers affected by HIV stigma.

Results: Between 2021 and 2024 Ontario Stigma Index data was analyzed and four publications were submitted to various journals. From this, four blogs were published on the Positive Effect website, garnering 304 page views. These blogs made research findings accessible to a broader audience and grounded the content in real-world perspectives, highlighting the daily impact of HIV stigma.

By translating peer-reviewed research into actionable content, the blogs extended the conversation on HIV stigma. This collaborative process provided PRAs with capacity-building opportunities, enabling them to critically engage with research and enhance their communication and knowledge translation skills. Additionally, participating in these activities increased peer researcher’s belief and confidence that they can affect meaningful change in their communities.

Conclusion: Co-creating knowledge translation outputs is an effective strategy to ensure research is relevant and impactful for communities affected by HIV stigma. This approach highlights the value of centering community voices in efforts to reduce stigma through accessible and relatable content.

Authors: Rusty Souleymanov, Melissa Morris, Skye Wikjord, Ann Favel, Laverne Gervais, Albert McLeod, Candace Neumann, and Tara Christianson.

Background:
This analysis explores the intersection of gender-based violence (GBV) and HIV/sexually transmitted and blood-borne infections (STBBI) among Indigenous (First Nations, Métis, and Inuit) women and Two-Spirit people in Manitoba.

Methods:
The Kotawêw: HIV/STBBI Doula Project incorporated visiting and storytelling as part of a community-based participatory Indigenous research approach. Stories were collected
from four groups: Indigenous women and Two-Spirit people with lived experience of HIV/STBBI (n = 21), family and loved ones of people living with HIV/STBBI (n = 7), knowledge holders with experience in HIV care (n = 4), and service providers/helpers (n = 8).Participants were recruited through community organizations, social media, and peer networks. The stories were thematically analyzed to examine how GBV contributed to
HIV/STBBI risk and impacted participants’ lives, with a focus on Indigenous pathways of healing and empowerment.

Findings:
The intersection of GBV and HIV/STBBI transmission was a recurring theme in participants' stories. Indigenous women and Two-Spirit people living with HIV shared personal accounts
of contracting HIV/STBBI as a direct result of GBV. Systemic, interpersonal, and structural forms of gender-based colonial violence were shown to shape HIV/STBBI transmission and
contribute to broader health inequities. Participants also described how GBV created significant barriers to accessing HIV/STBBI care. Despite these challenges, they highlighted
the importance of kinship, supportive relationships, advocacy, and ceremonial practices in fostering resilience and improving their health outcomes.

Discussion:
The findings highlight the ongoing impacts of colonialism, systemic neglect, and GBV on the health of Indigenous women and Two-Spirit people, reinforcing the importance of culturally safe, community-led care. Participants emphasized that Indigenous approaches to care, grounded in kinship, advocacy, and ceremony, are essential for healing, resilience, and empowerment.

Background:
Indigenous people in Saskatchewan have disproportionately been impacted by the HIV and syphilis syndemic, From 2019 to 2022, syphilis rates amongst Indigenous peoples surged by 900% contributing to an associated rise in HIV cases to 19.0 per 100,000 in 2023. A low-barrier syndemic approach is required that addresses the unique challenges Indigenous people face in accessing testing and treatment. Traditional healthcare models and jurisdictional barriers fail to meet their interconnected needs. Previous interventions have not identified an intervention in HIV, or syphilis that can be more broadly applied across diverse Indigenous communities and peoples. Wellness Wheel partnered with local organizations and First Nations to implement a flexible, community-centered point-of-care test-and-treat (POCTT) model in 29 underserved locations.
Methods:
A POCTT intervention for HIV and syphilis was developed. This integrated testing and treatment into trusted community spaces such as shelters, mobile health units, harm reduction programs, pharmacies, and Indigenous health centers. Community-driven site selection allowed for culturally safe implementation in high-need areas. POCTT was mobile and utilized clinic and multidisciplinary teams, including: medical professionals, outreach workers, and peer navigators. Collaboration with local leaders and service providers ensure alignment with community needs and values.
Results:
1760 participants were enrolled at 29 sites, 1478 (84%) self-identified as Indigenous. Demographics, risk factors and results in Table 1.0.
Conclusion:
The community-centered POCTT model across 29 communities identified a significant number of HIV and syphilis cases in underserved Indigenous people. Integrating testing and treatment for HIV and syphilis into a syndemic model simplified care. Engaging 1,478 Indigenous participants, including many first-time testers, demonstrated cultural relevance and broad applicability in First Nation communities and urban centers. Its flexible, low-barrier approach, grounded in community partnerships, highlights the potential for scalable, syndemic-focused solutions to address intersecting health challenges and improve healthcare across Indigenous communities.

This presentation will provide an overview of key elements within WHAI’s Living in the Asterisk (*): What does U=U mean for women booklet, a resource that seeks to reflect the voices, concerns and lived realities of cis and Trans women, 2-Spirit and Non-Binary people who face structural risks related to HIV and health outcomes.

While research around U=U has been transformative, WHAI has added an asterisk (*) to the U=U resource to represent important considerations and intersectional realities for women, such as access to care and treatment. The resource is intended to be used to support community conversations about HIV and the U=U messaging within the communities where WHAI works. Considerations explored include:
-What social and structural realities impact one’s ability to achieve an undetectable viral load and how does this impact U=U?
-Does U=U messaging create a hierarchy of who can achieve an undetectable viral load?
-What does U=U mean in the context of HIV criminalization?
-What does U=U mean when breast or chest feeding?
-How does U=U apply to people who use drugs?

These key considerations impact the women and gender diverse people WHAI works with and are important considerations for us to weave into community dialogues in order to create a culture of inclusion and supportiveness that doesn’t leave anyone behind.