Healthcare empowerment refers to the process of being engaged, informed, committed, and resilient around one’s healthcare. Studies have linked healthcare empowerment to positive health outcomes; however, there is a lack of information around the role that healthcare empowerment plays in the relationship between HIV stigma and self-rated health. This study assessed the moderating effect of healthcare empowerment on the relationship between enacted, internalized, and anticipated stigma and self-rated health.

Participants (n=1318) were recruited from all provinces across Canada from September 2018 – October 2024 to complete the People Living with HIV Stigma Index. The survey contained externally validated quantitative scales measuring stigma, healthcare empowerment, and health. Moderation models were created for each type of stigma as the antecedent, healthcare empowerment as the moderator, and self-rated health as the outcome.

Healthcare empowerment was a significant moderator for the relationship between enacted (b = 0.11, 95% CI: 0.00, 0.23) and internalized (b = 0.23, 95% CI: 0.09, 0.37) stigma and self-rated health. Overall, for those with low levels of healthcare empowerment (-1 SD from the mean), greater enacted and internalized stigma resulted in worse self-rated health; however, high levels of healthcare empowerment (+1 SD from the mean) buffered the negative impact of stigma and participants had consistently high levels of self-rated health. The model with anticipated stigma was not significantly moderated (b = 0.14, 95% CI: -0.01, 0.29).

Stigma can negatively affect an individual’s self-rated health; however, these findings show the potential for healthcare empowerment to buffer or mitigate the negative effect of stigma. Understanding how to bolster levels of healthcare empowerment which is driven by a mixture of sociocultural factors, personal resources, and intrapersonal factors that act at different socioecological levels may be important for the development of interventions aiming to reduce the impact of stigma for people living with HIV.

Background: African, Caribbean, and Black (ACB) migrants in Canada face heightened vulnerability to HIV post-migration, shaped by intersecting experiences of stigma, emotional distress, and systemic disadvantage. This study seeks to explore how HIV stigma, emotional and psychological struggles, and coping mechanisms influence HIV vulnerability among ACB migrants living in Ontario, Canada.

Methods: This analysis utilized 44 semi-structured interview transcripts from the Msafiri Study, a mixed-methods investigation into post-migration HIV acquisition among ACB individuals conducted between 2015 and 2017. Participants were purposively sampled from the Ontario HIV Treatment Network Cohort Study (OCS) and included individuals living with HIV who acquired the infection post-migration. Qualitative content analysis identified recurring themes related to HIV stigma, emotional and psychological struggles, and coping.

Results: The results revealed three key themes. Firstly, HIV stigma emerged as a significant issue. Participants described pervasive stigma from family, friends, and community members, often internalizing these attitudes. However, some instances of positive coping were noted, particularly through empathy and support networks. Secondly, emotional and psychological struggles were prominent. They reported distress linked to traumatic experiences and systemic disadvantage, which manifested as depression, anxiety, and substance use. Emotional distress was exacerbated by the stigma surrounding their diagnosis, affecting self-perception and relationships. Lastly, participants highlighted coping mechanisms adopted to navigate challenges, including resilience-building, community reliance, and substance use. Together, these themes illustrate the complex interplay between stigma, psychological distress, and coping strategies within the lived experiences of individuals living with HIV.

Conclusions: Findings highlight the complex interplay of stigma, emotional struggles, and coping mechanisms in shaping HIV vulnerability among ACB migrants. Tailored interventions that address structural inequities, reduce stigma, and provide culturally appropriate mental health and social support are critical to mitigating post-migration HIV risk in this population.

Background: African, Caribbean and Black communities in Canada are disproportionately affected by HIV and the adverse health impacts of anti-Black racism, driven by systemic inequities and intersecting social determinants of health. This study explored experiences of HIV stigma, racism and discrimination in the healthcare system, and facilitators to accessing care, among im/migrant African, Caribbean and Black people living with HIV in British Columbia.

Methods: Qualitative data were drawn from the Drive for Change Project, a participatory action research project with im/migrant African, Caribbean and Black people living with HIV in British Columbia. Analysis drew on semi-structured interviews and focus groups (June/2023-April/2024) in English, Amharic and French with adult community experts with lived experience of HIV (n=27). The project drew on collaborative thematic analysis to describe how racism, HIV stigma and discrimination shape healthcare experiences.

Results: Narratives highlighted systemic barriers to health services, including HIV stigma, racism and discrimination, and reduced quality of care within healthcare settings. Negative experiences in healthcare settings, including involuntary disclosure of HIV status and interactions with healthcare personnel perceived as disrespectful or dehumanizing (e.g. denigrating comments, microaggressions, disinterested and differential treatment), were reported by nearly all community experts. They consequently described deeply felt impacts of negative encounters (e.g. feelings of humiliation and exclusion, internalized stigma, anticipated mistreatment and mistrust of the healthcare system), which in turn shaped future decisions about seeking care. Peer navigation services were identified as a key strategy to overcome barriers, build trust, and improve engagement with health services.

Conclusions: Addressing healthcare inequities requires systemic solutions, including culturally responsive peer navigation, and education for healthcare providers on anti-racism, HIV awareness, cultural humility and patient privacy. Sustained community engagement is essential to ensure accountability and foster inclusive, equitable healthcare services.
Keywords: Health services, ACB people living with HIV, im/migrants, HIV stigma, disclosure, racism.

Background: Project Acceptance and Commitment to Empowerment (ACE) is a multi-phase implementation research with the aim of reducing HIV stigma in racialized communities. Results of Phase One confirmed that HIV stigma intersects with racism, sexism, homophobia and other systemic barriers to impede HIV prevention efforts. Community-wide stigma reduction through capacity building is critical to addressing HIV disparities and eliminating preventable social suffering among people living with and/or affected by HIV.
Description: Phase Two of Project ACE focused on building capacity among service providers and community leaders to become champions of HIV stigma reduction. in six cities: Calgary, Edmonton, Greater Toronto Area, Niagara, London, Ottawa. We implemented the ACE intervention, which consists of six weekly online self-directed learning modules and six Zoom group sessions of collaborative learning and sharing. ACE promotes awareness of the impact of stigma, compassion, psychological flexibility, value-guided action, and collective empowerment.
Lessons Learned: Preliminary findings show that self-guided reflective learning and collective dialogue are effective in building community capacity in stigma reduction: (1) co-creating a safe space enables participants to share stories and experience vulnerability without fear of judgment; (2) integration of mindfulness practice facilitates psychological flexibility; (3) experiential exercises enable participants to connect with their values and formulate committed action; and (4) structured critical dialogue-and-reflection encourages aspiration for collective action toward stigma reduction and social justice. Furthermore, ACE facilitators identified the importance of debriefing after each group session to attend to their own emotional responses to challenging conversations and the emotional needs of the participants.
Conclusions: Implementing the ACE intervention with community leaders and service providers is a critical step in developing and implementing community-wide stigma reduction efforts. Increased collective capacity will facilitate sustainability of programs and services to address stigma and support HIV responses based on cultural needs and contexts of racialized communities in Canada.

Introduction: Acute care hospitals can be dangerous environments for patients who are dependent on criminalized drugs, due to stigma and written or unwritten abstinence-based substance use policies forcing patients into withdrawal and increasing risks of new bloodstream infections. Since 2018, a group of health care providers and community partners in Halifax have worked to implement harm reduction practices including oral and intravenous opioid agonist therapy, needle distribution, and naloxone kits. In this study, we sought to understand the experiences of hospital-based health care providers trying to implement harm reduction-oriented care without institutional policy support.

Methods: 10 semi-structured interviews were conducted between October 2024 and January 2025 with purposively selected health care workers at the QEII Hospital in Halifax. This project employed participatory action methods, as hospital staff and people with lived experience using drugs in hospital were engaged throughout the research process. Interview guides were informed by Normalization Process Theory, which considers interventions to be an assemblage of beliefs, behaviours, and practices contingent on context. Data was analyzed using thematic analysis.

Results: To date, we have identified themes related to context, mechanisms, and outcomes affecting implementation of harm reduction practices. Contextual factors included medical paternalism, fear of punishment, environment and resource barriers, and strong community harm reduction resources. Mechanisms included mentorship, provider groups collectively organizing to solve problems, leveraging existing tools, and task shifting to overcome restrictions. Implementation outcomes affecting ongoing practice change include improved awareness, local champions, culture change, and first-hand observation of improved patient outcomes.

Conclusions: We identified several factors that have impacted the partial implementation and normalisation of harm reduction practices in an acute care hospital. Grassroots groups of healthcare providers and community partners identified workaround mechanisms, reflecting contextual barriers and facilitators. Other institutions can learn from this model of enacting change while waiting for institutional support.

BACKGROUND
Gay, bisexual, trans, two-spirited and queer (“GBT2Q”) people have higher rates of substance use. One aspect of this public health concern is greater risk of acquiring and transmitting HIV and other STIs, particularly in the context of sexualized drug use (chemsex) among GBT2Q people who have sex with men. As a population, men who both have sex with men and use drugs face heightened risk of HIV, HCV, and other STBBIs, and other harms sometimes associated with substance use. Meanwhile, both GBT2Q people and people who use drugs face barriers to health care, including harm reduction services; GBT2Q people who use drugs have particular needs and face additional barriers. Until recently, this public health and human rights issue has received little attention in drug policy discussions or from 2SLGBTQ+ advocacy organizations.

DESCRIPTION
The HIV Legal Network undertook a literature review, key informant interviews, and a scan of services and (federal) strategies and funding in Canada. In 2024, it released *Connection, Care, Community: Strengthening Harm Reduction for GBT2Q People who Use Drugs in Canada*, two companion resources aimed at challenging stigma and protecting the health of GBT2Q people who use drugs.

FINDINGS
The first is a Summary Report reviewing the evidence about substance use — including problematic use — among GBT2Q people and includes insights from GBT2Q people working in harm reduction.

CONCLUSIONS
The second is an Agenda for Action with nearly 30 recommendations for action in multiple areas, including:

• improving data collection;
• challenging stigma through public education;
• making services more accessible, including through enhancing cultural competence of service providers;
• ensuring 2SLGBTQ+ communities are more inclusive and strengthen their advocacy for sensible drug policy;
• enhancing funding for the health of GBT2Q people who use drugs; and
• enacting key legal and policy reforms.