ᐊbᐢᐟrᐊᐨᐟ Background: Antiretroviral therapy (ART) has changed the course of HIV. Despite the advances, the treatment experiences of people with HIV taking ART must not be ignored, including regimen changes and side effects. This collective of work aimed to guide peer-led, Indigenous-based knowledge sharing about ART experiences through artistic expression. This presentation will share what I learned as the lead of these projects to highlight the impact of community collectiveness on healing and the return to spiritedness.

ᒣᐟᐦᐅdᐢ Methods: Our arts-based work used Indigenized approaches to knowledge sharing. People with HIV – Wisdom Speakers (WS) from across Canada were invited to join. We each completed a self-assessment before and after knowledge sharing. The Community at the HeART Framework and Powerful Positive Action Strengths-Based Messages were used by WS to share ART experiences with a focus on strengths-based messaging. The work culminated in a series of videos.

rᐁᐢulᐟᐢ Results: With a focus on collectiveness and healing, these are my own perspectives (CC), as well as those of the other WS. When the community gathered, we exemplified the community collectiveness where healing and return to spiritedness were present. Key moments included my questions of recurrent treatment changes and how side effects of ART are impacted by these changes. The videos captured the ART journeys of WS, including my own. My reflections highlighted the value of engaging with my community authentically about my ART journey. Lastly, I share of my connection to the community by honouring my spirit weekly.

ᒍᐣᐨluᓯᐅᐣ Conclusion: ART difficulties continue for people with HIV. Collectiveness through art and similar activities does have the power to heal ART difficulties. Continued research on reducing side effects – particularly among women – is essential for greater pathways to wholeness.

Background: Integrating trauma-informed and violence-aware care (TVAC) within HIV prevention is key for communities affected by structural violence, such as youth in the Northwest Territories (NWT) that experience disproportionate food insecurity, violence, and STIs. TVAC approaches centre: understanding the impacts of violence; creating safe environments; opportunities for connection; and capacity-building. This study explored experiences of TVAC among Northern and Indigenous youth participants in land-based and arts-based HIV prevention peer leader retreats (PLR) in the NWT.

Methods: A Northern and Indigenous sexual health program conducted week-long land and arts-based PLR in the NWT annually from 2022-2024 with adolescents aged 13-18 years. Following the retreats, we conducted focus groups with participants that were audio-recorded and transcribed verbatim. We conducted framework thematic analyses to explore participant retreat experiences in relation to TVAC.

Results: Among participants (n=185; mean age: 14.91, standard deviation: 1.55; gender: cisgender women: n=119, 64.3%; cisgender men: n=46, 24.9%; gender diverse: n=20, 10.8%; sexually diverse [lesbian, gay, bisexual, queer, or other]: n=87, 47.0%), most identified as Indigenous (n=150, 81.1%). Participant PLR reflections aligned with TVAC principles. Theme 1: Participants better understood the impacts of violence, including: 1a) Poly-violence (family violence, relationship violence, colonization) and 1b) Mental health coping strategies (trauma processing; grief circles; healing steps). Theme 2: The retreat environment was discussed as safe due to: 2a) Community-building (sense of community, coming home) and 2b) Traditional learning approaches (Elders, music, land, arts activities, Northern games). Theme 3: Participants discussed opportunities for interpersonal connection through increased: communication skills, non-violent conflict resolution, and boundary-setting. Theme 4: Capacity-building included growth and empowerment in: emotional regulation; leadership, self-care, confidence and self-efficacy, vulnerability, and openness.

Discussion: Findings highlight that adolescent peer leader HIV prevention experiences can advance TVAC approaches. Future adolescent HIV prevention programming can address social and structural drivers of HIV applying TVAC approaches.

Background: Concerning declines in adolescent sexual health outcomes, including condom use, have been recently reported in Canada. While the Northwest Territories (NWT), Canada faces social and health disparities that elevate HIV vulnerabilities, little is known of NWT adolescent sexual health trends over time. To address this gap, we examined longitudinal trends in sexual health and social disparities with Northern and Indigenous adolescents in the NWT.

Methods: This community-based study employed a repeated cross-sectional design with 6 waves of data (2018-2023) to examine HIV vulnerability trends among adolescents (aged 13–18) in 17 NWT communities. We assessed changes over time in sexual health outcomes (safer sex self-efficacy [SSSE], sexual activity) and social disparities (food insecurity, intimate partner violence [IPV]) using repeated cross-sectional analyses with mixed-effects models to assess fixed and random effects.

Results: Among the sample (N=2,816; mean age: 13.71, standard deviation: 1.49), 45.45% (n=1,114) identified as cisgender girls, 50.47% (n=1,237) as cisgender boys, and 4.1% (n=100) as gender-diverse. Approximately one-fifth (18.91%; n=449) identified as sexually diverse (Two-Spirit, lesbian, gay, bisexual, queer, other [2SLGBQ+]). Nearly three-quarters identified as Indigenous (73.34%; n=1,735) and resided in rural communities outside of Yellowknife (73.19%; n=1,793).

Mixed-effects regression analyses revealed significant trends over time. SSSE declined (adjusted regression coefficient [Acoef]: -0.25 [-0.36, -0.15], p<0.001), with 2SLGBTQ+ and rural adolescents reporting lower SSSE. Sexual activity declined (Acoef: -0.02 [-0.02, -0.01], p<0.01), yet remained higher among 2SLGBTQ+ and rural adolescents. Food insecurity increased (Acoef: 0.02 [0.01, 0.03], p<0.01), disproportionately affecting girls, 2SLGBTQ+, and Indigenous adolescents. IPV remained constant overall (Acoef: -0.05 [-0.10, 0.01], p=0.07), but disproportionately affected rural adolescents.

Discussion: Findings signal the urgent need to address persisting social drivers of HIV (SSE, food insecurity, IPV) among Northern and Indigenous adolescents in the NWT, particularly affecting Indigenous, 2SLGBQ+, and rural youth, with multi-level, contextually tailored and social-equity informed approaches.

Background: Honouring stories shared from the Kotawêw: HIV/STBBI Doula Project, substance use, harm reduction, and service access among Indigenous (First Nations, Métis, Inuit) women and Two-Spirit people living with HIV/STBBIs in Manitoba was explored. Kotawêw, from the Cree language, translates to “making a fire” reflecting the warmth and light Indigenous HIV/STBBI doulas bring through culturally safe prevention and care.

Method: Utilizing a community-based participatory research design, grounded in the principles of Indigenous Storywork, an Indigenous Elder, cultural knowledge holder, and community guiding circle consisting of 6 Indigenous people living with HIV guided the project. Participants (N=40) were recruited using word of mouth, peer networks, and a community agency, Ka Ni Kanichihk; 29 identifying as First Nations/non-status, 7 as Métis, and 4 non-Indigenous service providers. Stories were analyzed using thematic analysis.

Results: Three key themes emerged: 1) Increased substance use upon initial diagnosis, 2) strong sense of community among those who use substances, 3) the role of culture and ceremony in individual healing journeys. Those who use substances sometimes take on supportive roles keeping one another safe and establishing a sense of community. Many respondents acknowledged culture and ceremony as significant for their healing, amplifying the need for access to cultural supports through harm reduction protocols as described by service providers and knowledge holders. The need for centering expertise of those with lived experience was identified throughout each group.

Conclusion: Findings underscore the need for integration of peer-based harm reduction, cultural safety, and ceremony as central components of care. Centering the knowledge of those with lived experience into services would more adequately meet the health and social care needs of Indigenous women and Two-Spirit people living with HIV/STBBIs who use substances. HIV/STBBI Indigenous doula programs can address gaps in care and mitigate drug-related harms perpetuated by colonial inequities in healthcare systems.

Background: The Kotawêw: Indigenous HIV/STBBI Doula Study explored the unique experiences of Indigenous women and birthing people navigating pregnancy while living with human immunodeficiency virus (HIV). This analysis focused on stories, relationships, and land-based cultural connections, recognizing their transformative power in improving health outcomes and wellbeing for pregnant Indigenous women and birthing people living with HIV.

Method: Data were drawn from community-based participatory research that focused on the unique ways that stories, kinship and land played a role in pregnancy and HIV care continuum in Manitoba. Recruited using word of mouth, peer networks, and a community agency serving Indigenous people (Ka Ni Kanichihk Inc), a total of 40 participants were interviewed, with 6 individuals who navigated pregnancy while living with HIV. Data were analyzed using Indigenous storywork and thematic analysis.
Results: The main themes focused on: 1) the importance of supportive, non-judgmental relationships in caring for pregnant Indigenous women living with HIV, 2) the need for HIV/STBBI specific pregnancy and parenting supports, 3) knowledge and skills necessary to perform HIV doula work, 4) importance of harm reduction principles and practices in HIV/STBBI pregnancy care. Considerations of the roles kinship, storytelling, and land, played in the pregnancy experiences were central. Interviews revealed the important role of doulas in HIV prevention and care, sexual health management, reproductive health, pregnancy and childbirth, and service navigation. Additional benefits of HIV doula work included lessening of stigma and isolation surrounding HIV and the ability to embed cultural space into systems of care.

Conclusion: The stories are powerful and provide invaluable insights into ways health and social care providers can support the needs of Indigenous women and birthing people living with HIV who are pregnant. These findings underscore the critical role of culturally grounded, relationship-centred care in improving health outcomes.