Background: The UNAIDS 95-95-95 goals cannot be reached without attention to key populations who experience intersecting oppressions, including trans women/transfeminine persons, who have a disproportionate prevalence of HIV and population-specific barriers (e.g., anti-trans stigma) and facilitators (e.g., access to gender-affirming hormone therapy [GAHT] and gender-affirming surgeries [GAS]) to uptake of HIV prevention/care. We sought to: a) characterize the prevalence of knowing vs. not knowing one’s HIV status; and, b) examine factors hypothesized to be associated with knowing one’s status, among this community.

Methods: Utilizing secondary cross-sectional survey data collected 2023 from a community sample of trans women/transfeminine persons aged 18+ across Canada taking GAHT for ≥3 months (n=213), we assessed the prevalence of knowing vs. not knowing one’s status then compared knowing vs. not knowing one’s status across sociodemographic (e.g., race), clinical (e.g., completed GAS), and psychosocial factors (e.g., depression) using bivariate and multivariate binary logistic regressions.

Results: Among this sample (mean age: 32.43 years, SD: 10.84; mean time on estradiol: 3.62 years, SD: 4.39), 33.80% reported not knowing their HIV status. In bivariable analyses, only clinical factors (having completed GAS, having planned GAS, and years since first taking estradiol) were significantly associated with HIV status knowledge (p<0.05). In a multivariable model including these three variables, both planned and completed GAS remained significantly associated with knowing one's HIV status (planned GAS adjusted odds ratio (aOR) 2.90, 95% confidence interval (CI): 1.49, 5.63; completed GAS aOR 2.32, 95% CI: 1.02, 5.27).

Conclusions/Implications: Over one-third of trans women/transfeminine persons did not know their HIV status, falling far below the UNAIDS 95-95-95 targets. Findings suggest that gender-affirming healthcare is a singularly important facilitator for HIV testing. Future research should explore this intersection and consider how integrated GAH and HIV testing may promote equitable access to sexual health for trans women/transfeminine persons in Canada.

Background: Group sex is associated with acquisition of bacterial sexually transmitted infections (B-STI) among gay, bisexual, and other men who have sex with men (GBM). However, whether this is driven by increased numbers of sexual partners alone or other factors is unclear. We compared B-STI diagnoses among GBM with group sex participation to non-group sex controls matched on partner number.

Methods: We recruited sexually-active GBM aged 16+ in Vancouver, Toronto, and Montreal through respondent-driven sampling from 02/2017-08/2019. Participants completed computer-assisted self-interviews and nurse-led B-STI tests (chlamydia, gonorrhea, syphilis) at enrolment and every 6-12 months through 08/2023. B-STI period prevalence included any diagnoses at study visits or self-reported in the previous six months (P6M). We created a matched control group with no group sex but similar P6M sexual partner number and other key characteristics (e.g., HIV status; substance use) using “nearest neighbour” propensity score matching (Rosenbaum & Rubin, 1985). We used generalized linear-mixed effects models to compare B-STIs among three groups of GBM: 1) any self-reported bareback/Party-and-Play (PnP) group sex, 2) other group sex, and 3) matched controls.

Results: We matched 767 group sex participants (median=10 P6M sex partners; 15.6% HIV+) to 767 controls (median=7 P6M sex partners; 12.7% HIV+). The proportion of GBM who had a B-STI in groups 1, 2, and 3 across all visits were: 76.4% (95% CI: 72.0-80.9), 45.1% (40.3-49.9), and 41.6% (38.1-45.1), respectively. P6M odds of B-STIs were higher among bareback/PnP group sex participants than controls, aOR=1.89 (95% CI: 1.51-2.37). Odds were similar among other group sex participants and controls, aOR=.97 (0.78–1.21).

Conclusions: Only bareback/PnP group sex participants had higher B-STIs independent of partner number, and should be supported with emerging/novel STI prevention. Future research should examine how norms facilitating condom use and limiting substance use may ameliorate the impacts of group sex on B-STI transmission.

Background: Cross-sectional differences in HIV-treatment attitudes (i.e., beliefs in whether treatment is effective at reducing transmission) and PrEP use are associated with differences in condomless anal sex (CAS) and STI acquisition. It is unclear, however, how these factors change within-persons over time, and whether these drive STI outcomes.

Methods: We analyzed longitudinal data from 2007 sexually-active HIV-negative GBM recruited using respondent-driven sampling from the Engage Cohort study (2017-2022) to examine the direct and indirect effects of PrEP use and HIV-treatment attitudes on CAS and acquisition of any bacterial STI (syphilis, gonorrhea, chlamydia) diagnoses (through self-report and lab-testing) between individuals and within individuals over time, using multilevel mediation (see Table 1).

Results: PrEP use was positively associated with any bacterial STI diagnosis between (β=0.174, p<0.001) and within (β=0.294, p<0.001) individuals over time. In contrast, HIV attitudes that were supportive of HIV treatment effectiveness were negatively associated with STIs within individuals (β=-0.256, p=0.001), but positively associated between individuals (β=0.093, p=0.008). CAS only predicted STI outcomes between individuals (β=0.209, p<0.001). Variation in STI outcomes was slightly more strongly accounted for by within-person rather than between-person effects (ICC=0.406).

Conclusions: Over four years, we found that variation in STI outcomes was accounted for by both within-person changes over time and between-person variance. PrEP use and CAS differences among participants predicted STIs, which underlines the importance of targeted treatment and prevention support for PrEP users.

Introduction:
Trans and gender diverse (TGD) people face inequities that heighten their risk of HIV/sexually transmitted and blood-borne infections (STBBIs), creating barriers to equitable care. Integrating gender-affirming healthcare (GAH) with HIV/STBBI prevention/care could enhance access and uptake of HIV/STBBI prevention/care. We conducted an environmental scan of the websites of sexual health and HIV/STBBI clinics in Ontario to determine indicators of TGD inclusion and what, if any, GAH services they provided.

Methods:
This environmental scan of HIV/STBBI clinic websites in Ontario, Canada was conducted between June-September 2024 following five steps developed by Turin and Shahid (2018): 1) identifying the purpose/objectives; 2) engaging relevant stakeholders; 3) refining the purpose/objectives; 4) data collection; and 5) dissemination. Websites were included if they were currently active and indicated a focus on HIV/STBBI prevention/care. Descriptive statistics were used to analyze the number of available services for TGD people and whether websites featured indicators signaling trans-inclusive environments.

Results:
Of the final 167 clinics, service descriptions were often ambiguous about HIV/STBBI care and few explicitly promoted services specifically for TGD people. One-quarter (25%) of clinics had visual or textual representations of TGD people on websites, and a smaller proportion (13.2%) of clinic websites explicitly mentioned providing any type of medical GAH. One-third of those clinics (31.8%) were in Toronto, with few integrated GAH and HIV/STBBI prevention/care available in other Ontario health regions, ranging from no clinics available (Central East) to four clinics available (Central West).

Conclusion:
We found significant gaps in availability of specific HIV/STBBI care for TGD people in Ontario and even fewer clinics integrated HIV/STBBI and GAH. Clinics offering GAH were concentrated in Toronto, leaving rural and suburban populations underserved. Findings underscore the importance of strengthening provincial capacity for integrated GAH and HIV/STBBI prevention/care and incorporating inclusivity indicators on websites to enhance TGD sexual health equity.

Introduction: In response to the HIV epidemic, Canadian blood operators developed blood donor policies which aimed to prevent HIV transmission through the national blood system. These policies, now widely regarded as discriminatory, prohibited men who have sex with men (MSM) from donating blood – and prevented many transgender and gender-diverse (TGD) individuals from donating. After years of advocacy by 2S/LGBTQ+ communities, these policies have been replaced by behaviour-based screening questions asked to all donors, regardless of sexual orientation or gender; however, the legacy of previous policies lingers, as has been well documented among MSM individuals and communities. These impacts on TGD individuals has yet to be examined, specifically in relation to their interest in donating blood or plasma under the updated criteria.

Methods: A diverse sample of 2S/LGBTQ+ participants were recruited across Canada using snowball sampling at a variety of 2S/LGBTQ+ community-based organizations. 15 participants met the inclusion criteria and participated in online semi-structured interviews. Each interview covered topics related to blood and plasma donations, recommendations for donor policies, and repair efforts required by blood operators. All responses were transcribed verbatim and analyzed by two researchers using a thematic analytic approach.

Results: Analysis focused on the 12 participants who identified as transgender (7 transgender men, 2 transgender women, and 3 non-binary/agender). These participants all identified as queer, gay or bisexual, and all but one participant was between aged 18-40. Key implications for blood operators included the need for greater dissemination of current donor policies; improved respect of and responsiveness to the experiences of TGD donors; and TGD-specific donor recruitment efforts.

Conclusions: Ongoing reparative efforts are required by blood operators to build trust with TGD communities. Specifically, improved efforts to include, respect, and recruit TGD donors are warranted at the national, community and individual levels for blood operator.