Background: Doxycycline as prophylaxis (doxy PrEP/PEP) may help ameliorate the impact of some bacterial sexually transmitted infections (STIs), including syphilis and chlamydia, that Two-Spirit, gay, bisexual, trans and queer men and non-binary (2S/GBTQ) people disproportionately face. In December 2023, British Columbia (BC) became the first province in Canada to introduce a public doxy PEP (i.e., post-exposure) program. We sought to understand 2S/GBTQ people’s experiences with and preferences for the implementation of doxy PrEP/PEP across BC.

Methods: We conducted semi-structured individual interviews with 2S/GBTQ community members (N=20) across BC from late 2024 to early 2025 to identify key preferences for delivery of doxy PrEP/PEP. We recruited participants through clinics, community-based organizations, and social media. We purposively selected participants to maximize diversity based on race, HIV status, and geography. We recorded, transcribed, and analyzed interviews using reflexive thematic analysis.

Results: Participants had primarily accessed doxy PEP through 2S/GBTQ-friendly sexual health clinics and community-based organizations where they had previously accessed other STI prevention, including HIV PrEP. Experiences were largely positive. Participants described few barriers to access and minimal side effects that were outweighed by the confidence provided by doxyPEP. Participants also reported confusion between doxy PrEP/PEP and HIV PrEP/PEP, concerns around antimicrobial resistance, and existing preference for other STI prevention methods (e.g., condoms, routine testing). Preferences for implementation included building doxy PrEP/PEP into existing online or telehealth HIV PrEP delivery services and ensuring doxy PrEP/PEP accessibility through pharmacies, particularly those in rural regions.

Conclusion: Overall, successful implementation of doxy PrEP/PEP requires tailored and culturally competent health promotion for 2S/GBTQ community members that situate doxy PrEP/PEP within the broader landscape of existing HIV/STI prevention. Key lessons from BC’s initial public program implementation, including the importance of leveraging existing 2S/GBTQ-friendly STI prevention and care infrastructure, can enhance rollout across Canada.

Background: As women living with HIV reach menopause, they face unique biopsychosocial challenges. Menopause affects multiple domains of life, yet research regarding available medical and personal support systems to aid in navigation during this transition is limited. To address this gap, we conducted a qualitative assessment of barriers and facilitators regarding menopause support for women living with HIV.
Methods: Seven semi-structured focus groups were conducted to explore women’s menopause experiences in Ontario and British Columbia (January-August 2023) in-person and virtually. Participants were women living with HIV who self-reported being perimenopausal or menopausal at the time of recruitment. Thematic analysis was conducted using NVivo.
Results: Forty women living with HIV with a median age of 52 years (IQR 47, 58) participated. Women highlighted four main barriers to accessing and receiving menopause support: 1) Intersecting stigmas: overlapping menopause, HIV, ageism, and sexism stigmas hindered menopause related health-seeking behaviour and peer support; 2) Knowledge void: Limited access to and understanding of menopause related information contributed to feelings of loss of control and difficulty attributing experienced symptoms to the menopause transition; 3) Negative healthcare experiences: Prior negative healthcare experiences led to reluctance in seeking medical consultation and treatments; 4) Competing priorities: Addressing basic social needs and other health concerns took precedence over menopause care. Two identified supportive care facilitators: 1) Women supporting women: Peers and providers with lived/living experience of menopause were highly valued; 2) Cultural integration: Acknowledgement that menopause experiences are deeply influenced cultural understandings, necessitating culturally competent menopause support.
Conclusion: This study underscores the need for holistic menopause support by, with, and for women living with HIV. Current supports are insufficient, emphasizing the importance of expanding educational resources for women and healthcare providers, adopting a person-centered approach that prioritizes fostering peer-led initiatives, and integrating culturally safe practices into menopause care.

Adolescents living with HIV in sub-Saharan Africa experience poorer health outcomes than adults across the HIV cascade of care. Frontline paediatric-adolescent HIV healthcare providers (HCP) have unique insights, but are often not consulted. The World Health Organization health systems building blocks (WHO BB) framework has been instrumental in strengthening health systems, and, catalysing achievement of global health targets such as the Sustainable Development Goals.

Participatory priority-setting and group discussions across twenty-four sites in twelve high HIV-burden African countries in 2022-2023 with 801 multi-occupational paediatric-adolescent HCP. Data were analysed inductively using thematic analysis, and themes mapped onto the six BB domains of service delivery; health workforce; information systems; essential medicines; health system financing and leadership/governance.

Gaps between BB provisions and health system realities included:
(1) Service delivery (BB1): inadequate space for confidential service delivery, inadequate disclosure support;
(2) Health workforce (BB2): Difficulties developing and maintaining paediatric-adolescent HIV skills, keeping up with changing guidelines; inadequate facility-level supports;
(3) Health Information Systems (BB3): Inadequate contact information for case-finding and follow-ups; limited access to integrated electronic health management systems
(4) Access to essential medicines (BB4): Inadequate availability of formulations of anti-retroviral therapy due to supply chain and funding issues;
(5) Health systems financing (BB5): inconsistent and/or inadequate remuneration;
(6) Leadership and governance (BB6): discriminatory age of consent, termination of pregnancy and homophobic laws and/policies.

Findings suggest a need to expand BB2 to include supportive environments for HCP, inclusive of psychosocial support, and to add building blocks to (1) recognize the importance of conducive caregiver/family and community systems, inclusive of caregiver and client supports, community engagement and education; and (2) ensure rights-based services, addressing harmful beliefs.

WHO BBs provide a framework to identify and address paediatric-adolescent HIV health system challenges. Additional building blocks to create supportive family/community systems and environments for HCP merit further consideration.

Undetectable equals Untransmittable (U=U) is an important message to communicate the impact of HIV treatment, viral suppression, and to reduce HIV stigma. Discussing the U=U message with a primary HIV healthcare provider may be an effective way to learn about U=U. This study aimed to evaluate sociodemographic characteristics and protective factors that may be associated with discussing U=U with a healthcare provider.

Participants (n=1083) completed the People Living with HIV Stigma Index from all provinces across Canada between September 2018–October 2024. The survey contained validated measures capturing protective factors including resilience, social support, self-efficacy, and healthcare empowerment as well as a question assessing if participants had discussed U=U with a primary HIV healthcare provider. Multivariate binary logistic regression was used to determine sociodemographic characteristics and protective factors associated with having discussed U=U with an HIV healthcare provider.

Approximately half (51%) of the participants had discussed U=U with their healthcare provider. Participants aged 18-24 years were more likely to discuss U=U with a healthcare provider than those who were over 24 (OR: 3.94, 95% CI: 1.25, 12.46). Black participants (OR: 2.80, 95% CI: 1.72, 4.57) and transgender/non-binary individuals (OR: 2.61, 95% CI: 1.03, 6.62) were more likely to have discussed U=U than white and cis-men participants respectively. Greater healthcare empowerment (OR: 1.39, 95% CI: 1.04, 1.87) and social support (OR: 1.20, 95% CI: 1.00, 1.43) were associated with having discussions about U=U with a healthcare provider.

Younger individuals and people identifying as certain racial and gender minorities are more likely to discuss U=U with their HIV healthcare provider. Greater healthcare empowerment and increased social support may play a key role in facilitating these discussions. These findings highlight the need for intersectional approaches in healthcare communication, underscoring the importance of empowering patients and fostering supportive communities to promote informed U=U discussions.

Background:
Indigenous communities in Canada face disproportionately high rates of HIV, syphilis, and other STBBIs, exacerbated by systemic inequities and cultural barriers. While Pre-Exposure Prophylaxis (PrEP) is effective in HIV prevention, its uptake remains limited. This rapid review examines the impact of integrated biomedical interventions, PrEP, Post-Exposure Prophylaxis (PEP), and Doxycycline Post-Exposure Prophylaxis (DOXY-PEP), on awareness, uptake, adherence, clinical outcomes, and health equity in Indigenous communities.

Methods:
A rapid PRISMA-ScR review was conducted. Databases including PubMed, MEDLINE, Embase, CINAHL, and Indigenous repositories like iPortal were searched using the keywords “PrEP,” “PEP,” “DOXY-PEP,” “Indigenous communities,” and “HIV prevention.” Inclusion criteria targeted studies on Indigenous populations in Canada, focusing on barriers, facilitators, outcomes, and the role of Non-Insured Health Benefits (NIHB). The analysis examined how community-driven perspectives and Indigenous values shaped study designs, engagement, and outcomes, highlighting methodological integration.

Results:
The review identified key barriers such as limited awareness and knowledge among community members and healthcare providers, a lack of culturally tailored outreach, and inequities in NIHB coverage. Systemic discrimination fostered mistrust in healthcare systems, further impeding uptake. Facilitators included culturally competent care models integrating Indigenous knowledge systems, significantly improving trust and engagement. Community-led education initiatives enhanced awareness and adherence, while integrated healthcare delivery models co-managed HIV, syphilis, chlamydia, and gonorrhea, reducing incidence rates and promoting health equity. Embedding these interventions within community-driven frameworks emphasizing Indigenous leadership and intergenerational knowledge-sharing emerged as a promising strategy.

Conclusion:
This review highlights the urgent need for culturally responsive strategies to enhance awareness, uptake, and outcomes of PrEP, PEP, and DOXY-PEP in Indigenous communities. It provides actionable pathways to bridge sexual healthcare gaps and reduce STBBI burdens. The Feast Centre for Indigenous STBBI Research is committed to addressing these gaps through community-driven initiatives, tailored education programs, and collaboration with Indigenous leaders to improve outreach and engagement.

Background: The Kotawêw: HIV/STBBI Doula study explored the role of Indigenous (First Nations, Métis, Inuit) doulas in HIV and Sexually Transmitted and Blood Borne Infections (STBBI) care cascade for Indigenous women and Two-Spirit people in Manitoba.

Methods: Community-based participatory research and Indigenous Storywork comprised the research design. An Indigenous Elder, a knowledge holder, and a guiding circle of 6 Indigenous women and Two-Spirit people living with HIV/STBBI guided the project. Using Indigenous storywork principles, stories were collected from people with lived experience of HIV/STBBI (n = 21), relatives of people living with HIV/STBBI (n = 7), Knowledge Holders [Elders (n = 1), kookums (n = 2), uncles (n = 1)], and service providers/helpers (n = 8) recruited through organizations, social media, and peers. Stories were thematically analyzed.

Results: Among people with lived experience, five key themes included: 1) foundational support and relational care, emphasizing trust-building and long-term relationships; 2) cultural practices and holistic healing, using Indigenous traditions like sweat lodges and storytelling to affirm identity and complement HIV/STBBI care; 3) practical support, system navigation, and harm reduction with tangible resources; 4) emotional support and advocacy, reducing isolation during diagnoses and navigating systemic barriers; and 5) combating stigma and colonial violence through education, trauma-informed care, and fostering community well-being. Knowledge holders emphasized cultural humility, spiritual guidance in support roles, and adapting harm reduction to cultural contexts. Relatives emphasized relational care, secondary stigma experiences, and the emotional labor of supporting someone living with HIV/STBBIs. Helpers/service providers highlighted systemic challenges and the importance of non-judgmental care, advocacy, and culturally safe, trauma-informed support.

Conclusion: The findings highlight policy implications on how HIV/STBBI doulas can be an integral component of health and social care teams and HIV/STBBI care continuum for Indigenous women and Two-Spirit people living with or at risk of HIV/STBBI.

Background: Youth in the Northwest Territories (NWT) experience social drivers of HIV, including higher STIs and sexual and gender-based violence exposure compared with national counterparts. Knowledge gaps remain regarding how HIV prevention approaches can advance the HIV prevention cascade with NWT adolescents. We explored experiences of participating in HIV prevention Peer Leader Retreats (PLR) in the NWT with Northern and Indigenous adolescents.

Methods: A Northern and Indigenous sexual health program conducted week-long land-based and arts-based PLR with youth aged 13-18 in the NWT. Youth learned leadership, HIV prevention, and sexual health skills with land-and arts-based approaches (e.g., drumming, Elder teachings). We conducted focus groups directly following the PLR and applied framework thematic analysis guided by HIV prevention cascade dimensions of motivation, access, and effective use.

Results: Most participants (N=185; mean age: 14.91, standard deviation: 1.55; gender: cisgender women: N=119, 64.3%; cisgender men: N=46, 24.9%; other: N=20, 10.8%; sexually diverse [lesbian, gay, bisexual, queer, or other]: N=87, 47.0%; Indigenous [Inuit, First Nations, Metis, or other]: N=150, 81.1%) attended the PLR for the first time (N=117, 63.2%), N=40, 21.6% attended once before, and N=28, 15.1% attended ≥ 2 times. Theme 1: Participants discussed how the PLR helped with HIV prevention motivation dimensions of increasing HIV and STI knowledge and risk perception, in turn reducing misconceptions and fear. Theme 2: HIV prevention access included a) PLR addressed gaps in school-based sexual health education, and b) PLR provided youth with confidence and self-efficacy to teach HIV prevention to peers, community, and family members. Theme 3: Effective HIV prevention use was shaped by learning a) practical safer sex skills (e.g. condom use), and b) intersectional stigma reduction.

Conclusions: Land-based and arts-based PLR approaches hold promise in advancing HIV prevention cascade domains of motivation, access, and effective use with Northern and Indigenous youth in the NWT.

Background: The Canadian HIV Cure Enterprise (CanCURE) is a pan-Canadian research collaboratory investigating approaches for achieving sustainable HIV remission. In preparation for the next funding cycle, CanCURE researchers and the Community Advisory Board (CAB) co-designed a web-based survey to identify HIV research priorities from the perspective of people living with HIV in Canada (PWLH). The current study examined gender-based differences in these priorities.

Methods: PWLH across Canada were recruited through community organizations and members between August and December 2024. Data was collected using REDCap electronic data capture tools hosted at The Research Institute of the McGill University Health Centre. The survey included 36 demographic questions and 21 questions ranking research priorities. Participant characteristics were summarized via descriptive statistics, and the research priorities were stratified according to gender.

Results: Of 119 participants, 47.9% self-identified as men, 46.2% as women, and 5.9% as two-spirit, non-binary, agender, or other. Men ranked preventing HIV transmission to partners as first priority, studying where the virus hides as second, and avoiding high comorbidity risks as third, while women prioritized not having to take daily pills as first priority and avoiding higher risks for comorbidities as second. Both genders equally valued expanding community involvement in HIV cure research. However, men focused more on integrating social and behavioural research, while women emphasized the need for diverse ethnic representation in research. Among the 84 participants with prior HIV research experience, women participated in interventional studies involving medication or medical procedures three times less than men (19.0% VS 61.1%, respectively).

Conclusion: While PWLH across Canada share some common priorities regarding HIV cure research, there are notable gender differences in their specific concerns. Furthermore, a significant gender gap in participation in interventional studies, essential for advancing HIV cure research, highlights the importance of aligning research priorities with concerns of all genders.