Background
People living with HIV (PLWH) are at higher risk of developing certain cancers, underscoring the importance of timely screening. We examined cancer screening trends among people living with and without HIV in Ontario.
Methods
We conducted a retrospective longitudinal study using linked administrative health databases from April 2017 to October 2023. Outcomes were biannual proportions of screening-eligible adults who were up to date with colorectal (fecal test in the previous two years or a flexible sigmoidoscopy or colonoscopy in the previous ten years), breast (mammogram in the previous two years), and cervical (Papanicolaou test in the previous three years) screenings.
Results
PLWH were disproportionately represented in the lowest-income neighborhoods and urban areas, were immigrants, and had a high comorbidity burden. The proportions of women living with HIV and up to date with breast and colorectal cancer screening were consistently lower compared to women not living with HIV. Men living with HIV were consistently more up to date with colorectal cancer screening. Screening declined during COVID-19 pandemic lockdowns, with the largest drop in breast screening (April 2019 vs. April 2021: 12.6 and 9.6 percentage points for women not living with HIV and living with HIV). This was followed by a slow recovery, though cervical screening remained below pre-pandemic levels.
Conclusions
This study highlights persistent disparities in breast and colorectal cancer screening for women living with HIV and the significant disruption to screening programs due to the pandemic. These findings emphasize the need to address barriers to preventive care for PLWH.

Background: Since 2018, Manitoba has experienced unprecedented rates of HIV and other sexually transmitted and bloodborne infections (STBBI). As HIV/STBBI and COVID-19 share similar healthcare barriers, we investigated whether previous HIV/STBBI exposure was associated with COVID-19 vaccination.
Methods: Retrospective cohort analysis using linkable population-based healthcare databases. Cohorts of individuals alive on March 1st, 2020 and with a positive laboratory test for HIV, syphilis, or chlamydia/gonorrhea (CT/GC) in the 4 years prior to the pandemic were assembled. COVID-19 vaccination (up to March 31, 2022) was captured using Manitoba’s vaccine registry. Poisson regression estimated relative rates (RRs) and 95% confidence intervals (95% CIs) for vaccination by age-group, income quintile (IQ), and geography.
Results: 1,372 individuals testing positive for HIV, 4,527 for syphilis, and 24,414 for CT/GC. Proportion vaccinated with 2+ doses was 82%, 70%, and 76% in the HIV, syphilis, and CT/GC cohorts, respectively. Within the HIV cohort, 2+ doses uptake ranged from 81%-95% from lowest to highest urban IQs (RRhi_vs_loIQ: 1.17, 95% CI: 0.88-1.55). Those in the highest IQ were >20% more likely to have 2+ doses, relative to lowest IQs for syphilis (RRhi_vs_loIQ: 1.24, 95% CI: 1.01-1.54) and CT/GC (RRhi_vs_loIQ: 1.23, 95% CI: 1.15-1.32) cohorts. Vaccination in the HIV cohort was consistent across age-group and geography (Table 1) and similar to the rest of Manitoba.
Conclusion: Vaccination in the HIV cohort was high, and equitable across determinants. Reasons likely include Manitoba having a single provincial HIV program, and its ability to pivot and provide continuity of service during the pandemic.

Introduction: Gay, bisexual, and other men who have sex with men (GBM), especially those living with HIV, may face greater substance-related harms. We compared substance use disorder (SUD) diagnoses, SUD-related hospitalizations, and all-cause mortality between GBM and men from the general population in Vancouver. We also explored the association of HIV status and other factors with these outcomes among GBM.

Methods: We linked 798 consenting participants from two GBM cohorts (Momentum I and II) to administrative health data and matched them (1:5) on age, sex, and health region to 3,990 HIV-negative British Columbia residents. Healthcare practitioner billings and hospitalizations were used to ascertain SUD diagnoses. We used multivariable regression to compare incidence of SUD diagnoses, SUD-related hospitalizations, and all-cause mortality among GBM and their matches, from February 2012 to March 2020. We also examined factors associated with SUD diagnoses and SUD-related hospitalizations among GBM.

Results: Compared to men from the general population, GBM had higher rates of SUD diagnoses (incidence rate ratio [IRR]=2.73; 95% Confidence Interval [CI]=2.00-3.73) and SUD-related hospitalizations (IRR=1.97; 95% CI=1.21-3.20), but similar all-cause mortality (IRR=1.03; 95% CI=0.55-1.91). SUD-related deaths were rare (n=7; all in the control group). Among GBM, living with HIV (adjusted IRR [aIRR]=2.95; 95% CI=1.68-5.17), recent transactional sex (aIRR=3.71; 95% CI=1.88-7.33), and unstable housing (aIRR=2.41; 95% CI=1.09-5.32) were associated with higher rates of SUD diagnoses. Living with HIV (aIRR=3.10; 95% CI=1.46-6.56), recent tobacco use (aIRR=2.42; 95% CI=1.40-4.17), unemployment (aIRR=2.05; 95% CI=1.09-3.86), and unstable housing (aIRR=2.84; 95% CI=1.57-5.11) were linked to higher rates of SUD-related hospitalizations.

Conclusions: GBM experienced higher rates of SUD diagnoses and SUD-related hospitalizations compared with men from the general population. Rates were higher among GBM living with HIV and intersecting inequities. Public health and mental health interventions and policies should respond to this group's unique and overlapping challenges.

Background/Objective: A trauma- and violence-informed care (TVIC) approach to HIV care has been proposed to improve HIV treatment outcomes but remains understudied, including among women living with HIV. This study examined the association between interpersonal violence and antiretroviral therapy (ART) consistency among women living with HIV in Metro Vancouver and assessed interactions between interpersonal violence and TVIC in HIV care on ART use consistency.
Methods: Data were drawn from the Sexual Health and HIV/AIDS: Women’s Longitudinal Needs Assessment (SHAWNA) Project, a longitudinal community-based study with women living with HIV in Metro Vancouver (September/2014-February/2025). Interpersonal violence was defined as any physical, verbal, or sexual violence in the past six months. Outcomes included ART consistency <95% (vs >=95%), and ART consistency <90% (vs >=90%), both in past 3-4 weeks. We considered 19 measures of TVIC in women’s main HIV clinic/provider (e.g., feeling safe at clinic) as effect modifiers separately. Multivariable generalized linear mixed models (GLMM) and marginal standardization were employed to estimate risk ratios (RR) of ART consistency, adjusting for key confounders. Interaction was assessed on additive (relative excess risk due to interaction) and multiplicative (ratio of RR) scales.
Results: The study sample included 357 women (2,008 observations) between September/14-August/2020. Multivariable GLMM found interpersonal violence was significantly associated with <95% ART consistency (RR:1.68[95%CI:1.27-2.08]) and <90% (RR:1.62 [95%CI:1.13-2.11]). Little evidence of additive or multiplicative interaction effects of interpersonal violence and TVIC on ART use consistency was found.
Conclusion: Interpersonal violence was associated with lower ART use consistency. While TVIC in HIV care did not moderate this relationship in our sample where TVIC prevalence is relatively high in HIV care, TVIC principles (e.g., safe environments, violence screening) remain critical to support women who experience violence in HIV and other healthcare. Anti-violence interventions, programming and policy at systemic, social and structural levels are key priorities.

Background: Gay, bisexual, and other men who have sex with men (GBM) report higher use of many psychoactive substances which may cause harmful health outcomes. We examined the rates and determinants of incident diagnoses of psychosis among two cohorts of GBM in Metro Vancouver, and compared their rates with matched controls from the general male population.

Methods: We linked consenting participants from the Momentum-I (2012-2019) and Momentum-II (2017-2023) GBM cohorts to administrative health data, and matched them (1:5) on age, sex, and health authority geography to a random HIV-negative sample. Up to March 2020, we calculated psychosis incidence rates based on International Classification of Diseases 9 and 10 codes associated with two physician visits within a year or any hospitalization. We compared incidence rate ratios (IRR) for GBM with their HIV-negative matched controls. Among GBM, we used Poisson regression to identify factors associated with incident psychosis diagnoses.

Results: 798 GBM (median age 35.0 years) were matched to 3990 controls from the general population. The incidence of psychosis was 1.74 per 100 PYRs (95% CI 1.33-2.28) for GBM and 0.64 per 100 PYRs (95% CI 0.53-0.78) for HIV negative controls for an IRR of 2.71 (95% CI 1.95-3.78). Among GBM, we found univariable associations with psychosis and past six-month use of amphetamines (p=0.005), sedatives (p=0.009), and opioids (<0.001). However, only opioid use was retained to minimize QIC in the multivariable model (adjusted rate ratio [aRR]=2.38; 95% CI 1.09-5.20), along with living with HIV (aRR=3.29; 95% CI 1.72-6.32), unstable housing (aRR=2.49: 1.21-5.09) and symptoms of moderate/severe anxiety (aRR=3.98; 95% CI 2.17-7.32).

Conclusions: The rate of psychosis diagnoses was higher for GBM, and was more common among those living with HIV and with recent opioid use. Culturally appropriate interventions to reduce psychoactive substance use among GBM could help prevent negative mental health outcomes.

Background: Cannabis use among people living with HIV is common. Our aim was to understand intersectional inequalities related to cannabis use frequency and daily use prevalence by gender, age, and race among Ontarians living with HIV.

Methods: We used cross-sectional data from 5,342 participants of the Ontario HIV Treatment Network Cohort Study, a clinical HIV cohort, to examine the additive interaction effects between gender, age, and race on the frequency of cannabis use per week and the prevalence of daily use in the past month. We included data from participants’ first visit between 2008 and 2023 and conducted a Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA) focusing on gender (man, woman, other), age (16-25, 26-50, 51+) and race (white, black, other) resulting in 27 intersecting strata.

Results: The majority of participants were men (76%), 26-50 years old (58%), and white (56%). We found that the 27 strata accounted for 7% and 17% of the inequality in cannabis use frequency and prevalence of daily use, respectively. Most of the explained inequalities are accounted for by the additive effects of gender, age, and race (85% for frequency of cannabis use and 88% for daily use). In other words, there was little evidence of interactions between these variables. Both cannabis use frequency and daily use tend to be higher for men, youth and whites. For example, for daily use: men (OR=1.66, 95%CI 1.10-2.52), age 31-50 (OR=0.51, 95%CI 0.32-0.81), age 51+ (OR=0.45, 95%CI 0.28-0.73), white (OR=1.71, 95%CI 1.10-2.65), black (OR=0.42, 95%CI 0.25-0.70).

Conclusion: The additive effects of gender, age and race on inequalities in cannabis use are predominant. Further research exploring the role of these and other intersecting identities (e.g., sexual orientation, immigration status) and their role in cannabis use prevalence/frequency may help direct interventions to promote healthy cannabis use.