This presentation will provide an overview of the Women and HIV/AIDS Initiative (WHAI)’s Rupturing Anti-Black Racism: Planning and Facilitation Guide, developed in 2024.

WHAI is a community-based response to HIV amongst cis and Trans women, 2-Spirit and Non-Binary people in Ontario, working 16 communities across the province. WHAI aims to
-Reduce HIV risk for women disproportionately impacted
-Enhance local community capacity to address HIV
-Build safer environments to support women’s HIV related needs.

WHAI embarked on this work recognizing the harmful and debilitating impacts of white supremacy culture on AIDS service / community organizations and with an aim of strengthening our collective work to dismantle structural realities of white supremacy. With this foundation, WHAI committed to intentional, collective action that helps rupture these systems, with a belief that anti-Black racism (ABR) work in organizations must go beyond one-time training sessions or reactionary policies. Embedded in this work is an effort to recognize and dismantle practices contributing to Black fatigue, Black burnout, and to support allyship with white colleagues. The work must translate into sustainable and meaningful action that is ongoing and grounded in transparency, self-reflection and structural change work.

Building on Tema Okun’s work on white supremacy culture in the workplace and many other wisdom holders, this guide provides a road map outlining WHAI’s efforts to meaningfully recognize and rupture white supremacist structures that impact AIDS-service organizations and their respective communities. The guide provides an overview of WHAI’s journey to arrive at this work, key documents, session outlines and processes used to implement the work, as well as tips for adapting the work to local contexts. The resource also includes resources for continued learning and to build further capacity building within local and structural contexts.

Background: Barriers attending PrEP-related appointments impact users’ engagement in the HIV prevention cascade. We characterized access to PrEP care in the Ontario PrEP Cohort Study (ON-PrEP).

Methods: ON-PrEP recruited adults using any form of PrEP via ten clinics and community recruiters in six Ontario cities from 2018-2024. At baseline, participants completed questionnaires on sociodemographic factors and access to and quality of PrEP care. We computed descriptive statistics of care access variables, and performed non-parametric tests of differences comparing by race (White/non-White), gender (men/women & other genders), and income (above/below $60,000).

Results: White and higher-income participants were more likely to drive and less likely to take transit to appointments (p<0.001, p=0.013; Table). Higher-income transit users reported taking less transfers (p=0.002). White and higher-income participants reported shorter travel times to appointments (p<0.001, p=0.016). Higher-income participants were more likely to report other barriers (e.g. missing work) attending appointments (p=0.01). Non-White and lower-income participants reported greater difficulty traveling to (p=0.004, p=0.005) and finding time for (p=0.01, p=0.003) PrEP appointments. Most participants reported no other difficulties accessing appointments. Participants reported high trust overall in their PrEP provider (mean 9.25/10). non-men, non-White, and lower-income participants were more likely to report having ever experienced some form of discrimination in medical settings (p=0.01 for all), which they most-commonly attributed to their sexual orientation (47%).

Discussion: While many ON-PrEP participants reported satisfactory PrEP access, racialized, lower-income and gender-diverse groups face inequities. Targeted interventions including telehealth, subsidized transit and cultural competency training are essential to improve access and reduce barriers.

Background: Women living with HIV face gendered social and structural inequities that increase exposure to discrimination. While HIV-related stigma is well-studied, the role of Everyday Discrimination—mistreatment based on stigmatized identities—on healthcare access remains underexplored. This study investigated relationships between Everyday Discrimination and healthcare access, including antiretroviral therapy (ART) use and consistency among women with HIV in Vancouver, Canada.

Methods: Data were drawn from the Sexual Health and HIV/AIDS: Women’s Longitudinal Needs Assessment Project, a community-based study including 392 women with HIV in Metro Vancouver (2014-2025). Discrimination was measured using the validated Everyday Discrimination Scale (range:9-45). Healthcare access outcomes included: seeking healthcare, barriers to and unmet needs in healthcare over the last 6 months, ART use and consistency of use over the last 3-4 weeks. Associations between Everyday Discrimination and seven healthcare access outcomes were assessed through multivariable analysis with generalised linear mixed models, adjusting for confounders.

Results: The sample included 325 participants and 2442 observations between September/2015-March/2023. Among participants, 53.2%(n=137) were Indigenous, 35.4%(n=115) white, and 11.4%(n=37) other racialized women. 25.5%(n=83) reported minoritised sexual identities, and 8.0%(n=26) minoritised gender identities. The median Everyday Discrimination score was 16 (IQR:11-24). In multivariable analysis, higher per-point Everyday Discrimination scores were significantly associated with reporting healthcare barriers (Adjusted Odds Ratio(AOR):1.04[1.03-1.07]), unmet primary care needs (AOR:1.04[1.02-1.06]), and seeking care for any health concerns (AOR:1.02[1.01-1.04]). Everyday Discrimination was significantly associated with reduced likelihood of being on ART (AOR:0.96[0.92-0.99]) and sub-optimal ART use consistency thresholds (<95%: AOR:1.03[1.01-1.06];<90%: AOR:1.04[1.02-1,07];<80%: AOR:1.04[1.01-1.08]).

Conclusion: Addressing Everyday Discrimination is critical to improving healthcare access and advancing health equity for women with HIV. Tailored interventions to address the systemic impact of Everyday Discrimination, including inclusive care pathways, accessible ART avenues and anti-discrimination practices at the policy and programming levels, are central to improving both HIV and broader health outcomes among women living with HIV.

Background:
Indigenous populations face disproportionate rates of HIV compared to non-Indigenous groups, driven by systemic, socio-economic, and cultural barriers exacerbated by colonial legacies. This review examines the intersection of these factors and their influence on the prevalence, prevention, and treatment of HIV within Canadian Indigenous communities.

Methods:
Electronic searches were conducted on MEDLINE, EMBASE, iPortal from inception to October 2024, supplemented with manual citation search. The search strategy included forward and backward citation tracking. Two reviewers independently and in duplicate assessed titles, abstracts, and full-text articles, with discrepancies resolved by a third member. Eligible studies consisted of randomized controlled trials (RCTs), cohort studies, cross-sectional research, and qualitative analyses. Data were extracted on key themes, including HIV prevalence, barriers to healthcare access, and cultural influences. Qualitative data were synthesized using thematic analysis.

Results:
Indigenous populations in Canada have HIV prevalence rates 3.6 times higher than non-Indigenous populations, with disproportionate impacts on women (45% of cases) and youth (12–36% HIV-positive). Systemic barriers, including healthcare inaccessibility and stigma, delay HIV diagnosis and treatment. Racism, stereotyping, and distrust in healthcare create significant obstacles. Socioeconomic factors such as poverty, housing instability, and unemployment restrict access to consistent care and drive high-risk behaviours, including substance use and unsafe sex practices. Cultural disconnection from traditional practices and intergenerational trauma stemming from colonial systems, such as residential schools, exacerbate vulnerabilities. Lack of culturally competent care further alienates Indigenous patients, perpetuating disparities and undermining health outcomes.

Conclusion
Findings highlight the urgent need for culturally competent, community-driven healthcare strategies to address the compounded impact of systemic inequities and socio-economic barriers. Congress attendees will gain insights into integrating Indigenous voices in healthcare planning and implementing tailored interventions to bridge these disparities. These strategies can inform global approaches to reducing HIV disparities among marginalized populations.

Background: African, Caribbean, and Black (ACB) migrants in Ontario face unique vulnerabilities to HIV acquisition post-migration. These vulnerabilities are shaped by the intersection of traumatic experiences, social disadvantage, and systemic inequities, which are often underexplored in research and intervention design. This study investigates how these factors influence HIV vulnerability among ACB migrants, contributing to tailored prevention and policy strategies.

Methods: This study utilized the qualitative component of the Msafiri Study, a mixed-methods investigation examining post-migration HIV vulnerability among African, Caribbean, and Black (ACB) migrants in Ontario, Canada. Data were derived from 44 in-depth semi-structured interviews conducted with ACB individuals living with HIV who acquired the infection post-migration. Participants were recruited from the Ontario HIV Treatment Network Cohort Study (OCS) between 2015 and 2017 through purposive sampling. Qualitative content analysis was employed to explore themes related to traumatic experiences, social disadvantage, and systemic inequities shaping HIV vulnerability.

Results: Traumatic experiences—such as intimate partner violence, anti-Black racism, and homophobia—emerged as critical determinants of HIV vulnerability, creating psychological distress and barriers to healthcare access. Social disadvantages, including poverty, precarious employment, and immigration-related challenges, exacerbated these vulnerabilities by limiting access to resources and increasing reliance on informal networks. Participants highlighted systemic inequities, such as racial discrimination within healthcare and housing systems, which further compounded their risks. These intersecting factors created cumulative disadvantages, impacting participants' ability to prioritize health-seeking behaviors, including consistent HIV testing and prevention strategies.

Conclusion: Addressing post-migration HIV vulnerability among ACB migrants requires a multi-level approach that tackles systemic inequities, provides trauma-informed care, and integrates culturally tailored support services. Policies should prioritize reducing structural barriers to healthcare access and economic security, while interventions must address the unique experiences of ACB migrants to enhance prevention efforts and mitigate HIV risks.

Background: Over 122 million people are currently displaced globally owing to conflict, persecution, and violence, 70% of whom are women and children. This study aimed to understand determining factors associated with adverse sexual health outcomes among cis and transgender women intending to seek asylum in the US.

Methods: A community-based approach was used to conduct 28 semi-structured interviews with cisgender (n=20) and transgender (n=8) women attempting to seek asylum in the US. Data were collected in-person in Tijuana, Mexico and online in Spanish or English between March and December 2024. Participants were of reproductive age (18-49), sexually active, and intending to petition for asylum in the US. Data were analyzed using reflexive thematic analysis and a lens of structural violence.

Results: Narratives detailed how structural violence associated with forced displacement (e.g., financial precarity, community disconnect, and a lack of legal protections) interacts with concurrent immigration policy, transphobia, and patriarchal norms to perpetuate gender-based violence and disrupt access to essential sexual health services, violating sexual and reproductive health rights. GBV was extremely prevalent, cited by some as the impetus for fleeing their home country. For others, violence was perpetrated by cartel members or state actors in immigration or policing roles along migration routes. Participants perceived transgender and Black women to be more severely targeted. The sexual health risk associated with GBV was amplified by disrupted contraception access. Participants described issues rooted in cost, sexual stigma, and difficulties navigating novel healthcare systems. Most participants were adamant about continuing to the US, despite enduring repeated traumas. Frequently cited survival strategies included seeking advice on social media, accessing free condoms at health facilities, and personal faith.

Conclusion: Adverse sexual health outcomes impacting asylum-seeking women were rooted in intersecting structural violence. Systemic reform is needed to ensure dignity and safety throughout the migration journey.

Black communities in Canada experience disproportionate rates of HIV, at times comprising 25.3% of reported cases while representing only 4.3% of the national population. This alarming disparity underscores the urgent need to design and implement more effective HIV care programs for Black community members, focusing on structural barriers created by the Social Determinants of Health (SDH). Our study investigates how SDH shapes healthcare experiences and outcomes for Black individuals living with HIV and identifies strategies for culturally appropriate service delivery models.

Objectives: (1) To understand how SDH shapes healthcare choices and experiences for Black community members living with HIV. (2) To develop more effective HIV service delivery models addressing the structural barriers caused by SDH.

Methods: We conducted a descriptive qualitative study, collecting data through 8 semi-structured focus groups (N=30) with a diverse group of Black community members aged 25 to 74 living with HIV in Ontario. The data was analyzed using conventional content analysis to uncover the intersection of systemic inequities and primary health care access.

Results: The findings reveal that participants prioritized multifaceted barriers, including HIV-related stigma, housing instability, reduced social capital, economic and social marginalization, anti-Black racism, insecure work conditions, and gender-based violence. These structural challenges significantly constrained health outcomes, underscoring the limitations of current health service delivery models. Participants emphasized the importance of integrated care approaches that equally combined primary HIV healthcare with interventions addressing SDH.

Conclusions: Implementing collaborative care models tailored to Black community members living with HIV should prioritize partnerships among healthcare providers, community organizations, policymakers, and researchers to address systemic inequities while simultaneously meeting primary healthcare needs. This research highlights the necessity of shifting beyond traditional clinical approaches to HIV care. Addressing SDH can drive equity-driven solutions, improving daily living and well-being for Black community members living with HIV in Canada.

Background: African, Caribbean, and Black (ACB) communities in Canada face disproportionately high HIV risk due to systemic inequities, stigma, and structural barriers that hinder access to prevention and care. Policy-driven interventions are critical to address these challenges and meet UNAIDS 95-95-95 targets. This study synthesizes policy recommendations from HIV prevention and PrEP research to identify actionable strategies for structural change.

Methods: A review of HIV prevention and PrEP studies among ACB populations in Ontario was conducted, drawing on findings from 12 studies published between 2007 and 2022. Key themes include systemic barriers, stigma, and policy gaps, with a focus on actionable policy recommendations to enhance healthcare access and equity.

Results:
Systemic Barriers: Racism, economic marginalization, and structural violence were common across studies, limiting access to HIV prevention resources and PrEP services. Policy changes to implement universal healthcare access and national pharmacare plans were identified as critical.

Stigma: Persistent internalized and external stigma exacerbated barriers to care. Recommendations included targeted campaigns addressing homophobia and community stigma, as well as the inclusion of culturally appropriate messaging.

Policy Gaps: Provider knowledge gaps and lack of cultural competency hindered effective service delivery. Policy recommendations emphasized mandatory training for healthcare providers in cultural humility, race-based data collection, and accountability for equitable care.

Facilitators: Community-driven initiatives, such as leveraging Black churches and ethno-specific organizations, were highlighted as effective mechanisms for outreach. Subsidized PrEP programs, tailored education, and participatory approaches were recommended to improve uptake.

Conclusion: Addressing systemic barriers and stigma requires a multi-level policy response, including implementing national pharmacare, integrating HIV prevention and PrEP services, and ensuring equitable healthcare access through cultural competency training. Policy reforms should prioritize inclusive healthcare strategies that engage ACB communities as stakeholders. These interventions are vital to advancing health equity and achieving UNAIDS 95-95-95 goals in Canada.