Background:
Two-Spirit, lesbian, gay, bisexual, transgender, queer, and questioning (2SLGBTQ+) youth are disproportionately affected by youth homelessness, comprising an estimated 20–40% of street-involved youth (SIY) in Canada. Structural inequities, housing instability, and barriers to affirming healthcare place 2SLGBTQ+ SIY at heightened risk for HIV and other sexually transmitted and blood-borne infections (STBBIs). Unstably housed youth are 2-10 times more likely to acquire HIV than their stably housed peers. Peer Navigator (PN) models show promise in improving access to HIV care; however, evidence on their effectiveness for 2SLGBTQ+ SIY remains limited. This study examines the adaptation and implementation of a PN intervention to increase engagement in HIV prevention and care among 2SLGBTQ+ SIY in three Canadian cities.

Methods:
A mixed-methods study was conducted with 2SLGBTQ+ SIY (N = 40) across Toronto, Vancouver, and London, Canada. Participants completed pre- and post-program surveys and in-depth, one-on-one interviews exploring HIV prevention, healthcare access, and experiences of homelessness. Descriptive analyses assessed changes in HIV care engagement and preventative behaviours following PN involvement. Qualitative data were analyzed using inductive thematic analysis to contextualize quantitative findings.

Results:
Following PN engagement, HIV testing increased from 77% to 90%, with fewer participants reporting unknown HIV status (27% to 10%). Among participants living with HIV (n=8), all were engaged in care and on antiretroviral therapy at baseline and follow-up, with recent viral load testing increasing (62% to 87%). Uptake of some preventative behaviours improved, including regular STI testing (50% to 70%). However, interviews highlighted persistent service gaps and described how survival priorities, housing precarity, and mental health needs often took precedence over sexual health.

Conclusion:
PN programs may enhance HIV prevention and care engagement among 2SLGBTQ+ SIY; however, sustained HIV and STBBI prevention requires integrated, low-barrier, and affirming services that address housing instability and mental health alongside sexual health.

Background
The Peel region is notably unique in its population (Statistics Canada) i which has meant gaps in sexual health awareness and uptake. In 2022, Moyo (the only AIDs service Organization in Peel) entered a collaboration with the PrEP clinic (Ontario’s first full-service PrEP Clinic) to provide a low-barrier clinic model providing near-free prevention services to predominantly racialized communities with intersecting gender and sexual identities in the region.

Methods
Clients were reached through a multi-channel outreach and engagement strategy i.e social media, in-person outreach activities with a community engaged care approach. This created a low-barrier, community-centered model for PrEP engagement that prioritized accessibility, trust-building, and continuity of care.

Data sources include clinic intake records, pharmacy dispensing data, appointment logs, and referral databases from clients aged 18+ who accessed the clinic from January 2022 to December 2025.

The clinic recorded 961 client visits (248 in the first year). The majority of visits were by racialized clients (75.2%), including ACB clients (7.7%). Women accounted for 4.0% of visits, with very limited representation of gender-diverse identities. 24.6% of visits were new clients, while 75.4% were repeat clients. Clients accessed a range of services including HIV testing (509 visits), PrEP bloodwork (294), STI testing/assessment (257), vaccinations (100), STI treatment (64).

Results
Significantly increased awareness of PrEP and improved access to HIV prevention services among priority populations in the Region. Preliminary observations indicate enhanced community knowledge of PrEP, increased inquiries about HIV prevention options, and greater uptake of PrEP referrals through Moyo’s programs, outreach activities, and HIV self-testing services.

Limitations
Not all individuals at risk for HIV in the Region are captured. Social stigma, fear of disclosure, and misinformation surrounding HIV and PrEP.

Conclusion
The model highlights the importance of partnerships, culturally responsive outreach, and geographically accessible services advancing HIV prevention goals.

Migrants living with HIV who possess precarious or lack immigration status encounter persistent barriers to health care, medication access, and social supports in Canada. These inequities arise primarily from structural exclusion embedded within health, immigration, and social service systems, rather than from individual behaviour. Drawing on Laura Bisaillon’s Screening Out, this abstract analyzes how systemic gatekeeping leads to fragmented care and delayed treatment for marginalized migrants living with HIV.

The implementation of an ecosystem-of-care model by the People With AIDS Foundation (PWA) in Toronto addresses these barriers through coordinated, cross-sector collaboration. This model integrates HIV clinicians, medication access programs, private laboratories, immigration legal supports, case workers, and peer navigators to deliver parallel and integrated services beyond traditional public coverage. Program data from 2023 to 2024 demonstrate the extent of unmet need and structural exclusion, with 581 individuals accessing immigration services, 1,130 receiving financial assistance, and 810 utilizing therapeutic care.

Rooted in people-centred, rights-based HIV programming, the ecosystem-of-care approach mitigates harm associated with fragmented systems by enhancing continuity of care and reducing treatment interruptions. Trust-based, trauma-informed, and peer-led practices are central to supporting engagement, particularly by addressing concerns regarding surveillance, disclosure, and institutional mistrust. Flexible funding mechanisms also facilitate timely responses to urgent and unmet needs.

This model provides a scalable and equitable framework for improving HIV outcomes among migrants and other marginalized populations. It holds clear relevance for the Canadian HIV response and broader discussions on health equity, implementation science, and structural determinants of care.

Background: The Dr. Peter Centre, an innovative HIV care facility in Vancouver, is undertaking a multi-methods study to examine how its integrated, person-centred model of care supports retention in HIV care and reduces experiences of stigma among LGBTQ+ Latino immigrants, migrants, and refugees living with HIV. Grounded in community-engaged research principles, the study centres lived and living experience while generating actionable insights for frontline practice, policy, and health-system change. This presentation describes the process of developing a community-based research study within a frontline clinical setting and reflects on key lessons learned during the research design phase.

Issue: A well-documented gap persists between the production of research knowledge and its integration into clinical and community practice. At the same time, community-based health and social service organizations often face barriers to having their priorities addressed through formal academic research. While these organizations are committed to evidence-informed care and possess deep frontline expertise and community trust, integrating research into non-profit clinical environments can be challenging due to resource constraints, competing mandates, and concerns about disrupting therapeutic relationships.

Lessons Learned: We share lessons from the study design phase, including: (1) developing research protocols within a clinical care setting without compromising trust or therapeutic relationships; (2) working within the operational realities of non-profit health organizations, including staffing capacity, funding limitations, and fidelity to organizational mandates; (3) the importance of strong, reciprocal relationships between academic and community partners, and ensuring appropriate representation in project governance; and (4) navigating funder expectations within the non-profit sector.

Conclusion: Lessons from this study highlight opportunities to strengthen collaboration between academic researchers and frontline organizations. Fostering mutual learning and shared accountability can support HIV research that is responsive to community contexts, enhances meaningful involvement of frontline providers, and improves the relevance and uptake of research in practice.

Introduction: Social inequities such as loneliness and discrimination due to sexual orientation (herein, discrimination) are prevalent across disabled people and Two-Spirit, Gay, Bisexual and Trans men, Queer and Non-Binary (2S/GBTQ+) communities. However, little is known about how loneliness and discrimination were experienced in Canada at the intersection of disability and 2S/GBTQ+ identity, especially before and during the COVID-19 pandemic.

Method: To address this knowledge gap, four cycles (2019, 2020, 2021, 2022) of cross-sectional, bilingual, community-based Sex Now survey data were used, which included 2S/GBTQ+ people aged 15 years or older and living in Canada. A total of 12,355 2S/GBTQ+ participants responded to loneliness outcomes, and 11,575 to discrimination outcomes. Among 2S/GBTQ+ participants living with disabilities, multivariable logistic regression models of each outcome identified temporal trends by survey year, and social determinants of health correlates.

Results: Compared with 2019 (before COVID-19), the odds of reporting loneliness were greater for 2S/GBTQ+ participants living with disabilities in 2020 and 2021 (but not 2022). 2S/GBTQ+ participants living with a disability who reported a racialized identity, financial strain, or a gender-expansive identity had greater odds of reporting loneliness. Compared with 2019 (before COVID-19), decreased odds of reporting discrimination were found in 2021 and 2022 (but not 2020). Generally, older 2S/GBTQ+ participants living with a disability were less likely to experience discrimination. 2S/GBTQ+ participants living with disabilities who were racialized, queer versus bisexual identified, and gender-expansive reported greater odds of discrimination.

Conclusions: These findings suggest that 2S/GBTQ+ people living with disabilities were impacted by greater loneliness and lesser discrimination during COVID-19. Equitable policy planning is needed to ensure that underserved yet deserving communities are not disproportionally affected by future pandemics and associated public health responses.

This poster will provide an overview of the participatory and community informed processes undertaken in this project, methods used, key findings and next steps.

Background: Cis and trans women in Ontario, particularly those who are Indigenous, African, Black, Caribbean, migrant, sex-working, using drugs, recently incarcerated or living with HIV, face persistent inequities in HIV/STBBI prevention and care. This CIHR-funded, implementation science–informed project aimed to identify multi-level barriers and facilitators and co-develop strategies for women-led, women-centred, nurse-facilitated models of care embedded in community settings.

Methods: Guided by community-based, intersectional, and trauma-informed principles, we conducted 23 focus groups with 88 individuals across Ontario (including cis and trans women, recently incarcerated women, sex workers, women who use drugs, recent migrants, women living with HIV, Indigenous women, African, Black and Caribbean women). Additional focus groups were held with NPs, RNs (primarily in rural/northern regions), AIDS Service Organisation (ASO) staff, and policy makers. A women-led governance structure, co-developed as a living document, ensured accountability to communities.

Process and engagement: Engagement strategies included talking circles, creative and storytelling-based activities, small- and large-group discussions, and one-to-one conversations to support safer participation and shared leadership. Focus group facilitation was co-designed with community partners to centre women’s priorities and expertise rather than treating them solely as “participants.”

Results and implications: Themes on structural and social barriers, existing strengths within communities and ASOs, and priority strategies to operationalise women-led, nurse-facilitated models of HIV/STBBI prevention and care were developed. We also outline our community report-back process and implications for policy, service planning, and future implementation research focused on women in Ontario.

This poster will provide an overview of the Women and HIV/AIDS Initiative (WHAI)’s tool “A Seat at the Picnic: Examining how social and structural determinants of health impact HIV risk and health outcomes”.

The goal of this resource is to raise awareness about how social and structural determinants of health impact particular populations more than others with a focus on HIV risk and health outcomes. It is intended to support community organizations to build strategies to work towards health equity. Using the picnic as a visual tool is meant to evoke feelings of collaboration and connection that come from planning and sharing a meal. Planning must be intentional and thoughtful to ensure the gathering runs smoothly. While social and structural determinants of health impact all aspects of health, we are focusing on HIV risk and health outcomes for this resource. Throughout WHAI work, we have drawn on creative measures for community capacity building. We use these methods to foster a range of learning and engagement styles. For this resource, we have selected to work with artist Jessica Campbell and use the analogy of a picnic to examine how social and structural determinants impact HIV risk and health outcomes for those living with HIV.

The resource includes
a facilitation guide,
an accompanying poster illustration of a picnic, and
key symbolic cut outs of items within the picnic image that can be used during facilitation as analogies to examine barriers, facilitators, tools, resources and needs.

This resource is for anyone who works with and supports women who may be living with HIV or who face social and structural risks related to HIV. This includes anyone who works at a community organization, in healthcare settings, harm reduction, shelters, prisons, settlement organizations, AIDS service organizations or in other related roles.

A critical challenge for youth living with HIV is the transition from pediatric to adult care, a shift often marked by fragmented services, reduced social support, increased responsibility, and heightened stigma. Many youth feel unprepared, leading to disengagement from care and poorer mental health. To address these gaps, the AIDS Committee of Durham Region (ACDR) developed the HIV & Youth Peer Engagement (HYPE) program. This study presents findings from a multi-year evaluation (2017–2022) examining the HYPE program’s impact on youth living with HIV in Ontario.

HYPE is a peer-led, Ontario-wide, youth-centered model designed to strengthen transition readiness, reduce social isolation, and improve communication between pediatric and adult care systems. Evaluation methods included pre-post surveys, focus groups, interviews, narrative reflections, and service-provider feedback. Quantitative data were analyzed descriptively, whereas qualitative information was summarized thematically.

Over five years, HYPE engaged 562 youth living with HIV and 407 service providers. Youth mostly identified as African, Caribbean, or Black (55%), gay, bisexual, or men who have sex with men (45%) and women (42%). Workshops increased youth capacity in communication, self-advocacy, and healthcare navigation by 52%, with 60% reporting improved health behaviours, including medication adherence and appointment attendance. The annual HYPE Summit strengthened social connectedness as 77% found it a meaningful opportunity to meet peers, and 91% reported greater confidence advocating for themselves in healthcare settings. Provider-focused activities improved confidence in youth-affirming and stigma-reducing practices by 13%. Qualitative findings reflected strong appreciation for HYPE activities, particularly opportunities for social connections, and noted the need for more youth-focused programming and sexual health education.

Findings highlight the value of peer-driven, community-based programming in supporting youth transitioning to adult HIV care. HYPE’s integrated model of mentorship, education, and provider engagement offers a scalable strategy to improve continuity of care and reduce stigma among youth living with HIV.

Introduction:

In 2017, the World Health Organization released global consolidated guidelines on the sexual and reproductive health and rights of women living with HIV. Since then, a Canadian community-academic partnership of women living with HIV, researchers, clinicians, and community service providers engaged in extensive consultation to take up the consolidated guidelines nationally, resulting in a national webinar series and two publications. In 2024, an advisory committee was established with representatives from this partnership to draft a comprehensive set of calls to action to advance the sexual and reproductive health and rights of women living with HIV in Canada. Here we share our knowledge mobilization strategy to co-create these calls to action.

Approach:

We undertook the following activities from 2024-2026:

-Established the advisory committee and developed the project framework.
-Drafted goals based on a comprehensive review of previous research and findings from the partnership team.
-Held a focused session with Indigenous women on relevant strategies and actions.
-Refined actions at in-person CAHR 2025 session. Invited individuals unable to attend CAHR for further review.
-Conducted a close final review of each goal with experts and women living with HIV.
-Launched calls to action with a webinar supported by CATIE.

Five over-arching goals were identified, to be achieved through 12 strategies and 41 actions.

Discussion:

Next steps include further knowledge mobilization activities to increase reach of the calls across the country as well as a 5-year evaluation plan to understand how the calls impact women living with HIV and others.

Introduction: Previous Cedar findings indicate that traditional language enhances participants wellness and supports strong HIV outcomes. A closer examination of what supports the resilience of young Indigenous people who use drugs is needed.

Methods: Cedar is a longitudinal Indigenous-governed cohort study that explores factors associated with health outcomes among young Indigenous people who use drugs in Vancouver and Prince George, BC. Between August 2020 and September 2025, 310 participants were enrolled and completed baseline interviews assessing their mental, emotional, spiritual, and physical health. Participants were tested for HIV via dry blood spot. The primary outcome was resilience measured by the 25-item Connor-Davidson Resilience Scale. Multivariable linear regression was used to examine factors associated with increased resilience scores. Results were adjusted for location, age, and sex.

Results: HIV prevalence was 14.6% (15.4% among women, 13.8% among men). The mean resilience score was 65.7 (95%CI: 63.7-67.8). Two themes emerged, cultural connection and housing significantly supported participants resilience. Feeding the birds weekly or daily was associated with a mean increase in resilience score of 6.94 (95%CI: 1.20-12.68), knowing how to speak their traditional language resulted in a mean increase of 7.22 (95%CI: 1.60-12.84), learning more about traditional culture was associated with a mean increase of 7.90 (95%CI: 1.57-14.24), and viewing laughter as medicine was associated with a 9.88 (95%CI: 0.67-19.08) increase. Living in the same place for the last six months was associated with a 10.68 (95%CI: 3.60-17.76) mean increase in resilience and feeling safe where they live resulted in a mean increase of 9.05 (95%CI: 4.26-13.83).

Conclusion: These findings underscore the importance of safe and reliable housing, and the power that land and culture has to keep our people strong. Wholistic programming that leverages cultural strengths in partnership with safe, stable, community living models is urgently needed.

ᐊbᐢᐟrᐊᐨᐟ Background:
People Living with HIV (PLWH) continue to experience treatment changes and side effects related to antiretroviral therapy (ART). Indigenous PLWH face intersecting impacts of colonialism, disconnection from land, and biomedical approaches that often overlook holistic wellness. Indigenous, land‑based, and arts‑guided methodologies offer strength‑based pathways for healing that honour Indigenous ways of knowing, being, and learning.

ᐅbjᐁᐨᑎvᐁᐢ Objectives:
This project explores land‑based learning and arts‑based practices that support healing, knowledge transmission, and self‑reflection related to ART side effects, guided by the lived experience of a Cree Woman Living with HIV as she returns to her homelands.

ᒣᐟᐦᐅdᐢ Methods:
Using an ethnographic, Indigenous, arts‑based approach, this work weaves together land‑based harvesting experiences, Elder‑led teachings, reflective journaling, and qualitative data from three previous community‑engaged projects involving 27 PLWH. These projects included visual art creation, storytelling, and video methods that centered community voices around ART side effects and holistic wellness. Ethical practices included relational consent, accessibility‑informed interviews, and Elder‑guided learning on the land.

rᐁᐢulᐟᐢ Results:
Land‑based harvesting of Sweetgrass, Horsetail Sage, and other medicines inspired my physical awareness, emotional grounding, and a spiritual connection. Hands‑on learning with Elders strengthened confidence, reduced bodily stress, and supported cultural reconnection. Across arts‑based projects, community described art as Power, Spirit, and Voice, contributing to feelings of empowerment, self‑discovery, and balance while navigating ART side effects.

ᒍᐣᐨluᓯᐅᐣᐢ Conclusions:
Indigenous land‑based and arts‑guided approaches offer culturally grounded, strength‑based pathways for addressing ART side effects among Indigenous People Living With HIV. This work demonstrates that healing emerges through relationships with land, Elders, art, and spirit—supporting whole‑being wellness beyond biomedical frameworks. These approaches have important implications for Indigenous‑led HIV care, research, and policy in Canada and beyond.

Background
Canada’s commitments to ending HIV — at home and internationally — include a United Nations target to ensure that 95% of people living with HIV in Canada know their status, 95% of people who are diagnosed access treatment, and 95% of people on treatment achieve an undetectable viral load. Reaching that target requires creating the conditions for effective, equitable, and sustainable access to prevention and treatment, and creating an enabling legal and policy environment that reduces barriers to services for people most at risk of HIV.

Method
On World AIDS Day 2025, the HIV Legal Network released an inaugural report on the state of the HIV response in Canada. It includes an assessment of the situation in each province and territory based on six metrics developed in consultation with community, research, laboratory, and clinician partners. Metrics consider access to prevention tools and treatment, legal and policy barriers to access, and reporting and evaluation to ensure the fullest picture is known.

Results
Canada has made considerable progress toward addressing HIV, but new infections are on the rise. No province or territory has met all the 95-95-95 targets — although British Columbia is closest. Major disparities exist between provinces and territories, with Manitoba and Saskatchewan leading by far in terms of new diagnoses. Punitive laws and policies undermine the HIV response and human rights, with instances of increased repression against key populations and new obstacles to harm reduction access, including in prison.

Conclusion
Our report presents a unique opportunity for renewed dialogue and action at all levels of government. Ending HIV as a public health threat in Canada is achievable with the right mix of political will and legal and policy change to ensure supports and services that respect the dignity and rights of people living with and affected by HIV.

Background: In Canada, Black communities are disproportionately impacted by HIV, yet access to racially and culturally appropriate services remains limited. Intensive case management (ICM) has been identified as a promising approach to supporting people living with HIV, however, evidence specific to Black populations in Canada remains largely absent.
Objectives: To identify and synthesize the empirical evidence on ICM approaches for Black populations living with HIV in Canada and the United States, to inform healthcare practices and treatment models for Black communities in Canada.
Methods: A systematic review was conducted in accordance with PRISMA guidelines. Comprehensive searches were completed in Embase, MEDLINE, Web of Science, CINAHL, PsycINFO, Social Service Abstracts/Sociological Abstracts, and Social Work Abstracts for studies published between 2000 and 2025. Eligible studies examined ICM interventions among Black communities in North America. Eight reviewers independently screened studies and extracted data. Findings were synthesized thematically.

Results: The search yielded 21,350 records, and 22 studies met inclusion criteria. Most studies were conducted in the United States, with a concentration in New York and southern states. Sample sizes ranged from 54 to 6,408 participants. Key themes across studies included the co-location of services, community-based and co-designed interventions, and the importance of wraparound supports to address intersecting complexities and social determinants of health such as housing, employment, and transportation. Common barriers included HIV-related stigma, complex healthcare system navigation, and challenges with outreach and treatment initiation.

Conclusions: This review highlights the potential of culturally responsive ICM approaches for Black populations living with HIV, while underscoring significant gaps in Canada-specific evaluations. Findings support the need for community-driven, integrated service models and further research to inform equitable responses to HIV care for Black populations in Canada.

Background
People living with HIV often face intersecting vulnerabilities, including hepatitis C, mental health challenges, and substance use, which can create barriers to accessing equitable health and social services. Indigenous peoples in BC are disproportionately affected by HIV, underscoring the need for culturally safer, community-led programs. Making It Work was a community-based research study which used an Indigenized, realist evaluation approach to program theory development to examine how, when, and for whom community-based HIV services are effective, particularly in case management and community development programs using Indigenous service delivery models and harm reduction approaches.

Methods
To translate the program theory into practical tools, a Guidebook was developed through a collaborative knowledge translation process. An advisory committee of people with lived and living experience and service providers guided content development and provided ongoing feedback. A research trainee contributed to iterative design, drafting, and feedback integration. Development occurred in three phases: preparatory engagement with the team to shape content; iterative drafting incorporating advisory committee input; and dissemination through hard copies at case study sites, a PAN Knowledge Connect webinar, and broader sharing via community networks.

Results
The Guidebook synthesizes complex research findings into accessible, actionable resources that integrates organizational assessments, reflective exercises, and practical guidance to support service delivery. It emphasizes culturally safer spaces, trust and relationship building, meeting clients where they are, and meaningful peer inclusion. Advisory committee feedback and trainee involvement ensured content reflected diverse perspectives and was applicable across community-based organizations.

Conclusion
The Making It Work Guidebook demonstrates the value of participatory, community-engaged approaches in translating research into practice. Equipping organizations with structured frameworks and tools, supports the implementation of culturally safer, harm reduction–oriented services and fosters improved accessibility and health outcomes for people living with HIV, hepatitis C, and co-occurring mental health and/or substance use challenges in BC.

Background
HIV-related stigma within harm reduction services represents a persistent barrier to HIV prevention, care engagement, and health equity, particularly in small, urban, rural, and remote (SURR) communities. Enacted, internalized, and structural forms of stigma intersect within service environments, shaping service delivery, trust, and health outcomes. This project aimed to develop, pilot, and evaluate a stigma-reduction workshop and accompanying online toolkit tailored for harm reduction services in SURR communities.

Methods
A community-based, participatory action approach was employed, guided by a steering committee comprising people living with HIV (PLHIV) and harm reduction leaders from SURR communities. Project activities included an environmental scan of existing stigma-reduction resources, iterative workshop content development, and pilot delivery of in-person and virtual workshops. A mixed-methods evaluation was conducted using a survey and project-specific questions to assess participants’ learning, satisfaction, and self-reported confidence in addressing HIV stigma within service organizations.

Results
Workshop participants demonstrated increased understanding of the mechanisms and impacts of HIV stigma within harm reduction services and identified context-specific strategies for stigma reduction. Steering committee members reported increased confidence in their capacity to reduce HIV stigma in their professional roles. Leadership from PLHIV was integral to project implementation, with peers leading project coordination, content development, and facilitation. Key findings emphasized the importance of adaptive implementation, tailoring stigma-reduction strategies to specific service contexts, and centring lived and living experience to enhance relevance, credibility, and engagement.

Conclusion
This initiative enhanced individual and organizational capacity to address HIV-related stigma within harm reduction services, particularly in SURR communities. By centring participatory, peer-led approaches and emphasizing flexible, context-responsive implementation, the project contributed practical tools and evidence-informed strategies to address HIV-related stigma. These findings highlight the importance of PLHIV leadership and community-engaged interventions in advancing equitable, stigma-free HIV prevention and care within harm reduction settings.

Background
Métis communities hold distinct cultural identities, histories, and ways of knowing, being, and doing that shape health and wellness. Despite this, Métis-specific perspectives are often overlooked, with interventions designed under a homogenized Indigenous framework.
This presentation will share lessons learned from the adaptation process, practical strategies for integrating cultural frameworks into HIV/STBBI programming, and implications for policy and practice. By centering Métis voices and knowledge systems, we offer a model for culturally responsive health interventions that honor identity, promote wellness, and strengthen resilience.

Methods
We partnered with DRUM & SASH (D&S), a CIHR-funded implementation science project, to develop a Métis cultural response to HIV, Hepatitis C (HCV), and related mental health and stigma. Central to this work was the creation of a Métis Assessment Tool grounded in a wholistic, strength-based, culturally safe approach. Métis consultations informed the original concept and language to align with Métis values. Our Métis Wellness Advisory Circle (MWAC), composed of six members with lived and living experience (PWLE) of HIV/HCV, provided ongoing guidance. Additional consultations included 20 PWLE in the justice system and 35 PWLE experiencing unstable housing, alongside feedback from Indigenous service providers in British Columbia and Alberta.

Results
Findings highlight the importance of Métis-specific tools that meet people where they are and resonate with personal wellness journeys. Incorporating Michif language and traditional icons into the tool and manual supported language revitalization and strengthened cultural connections. Relationship-building through this process fostered trust and increased willingness to access testing and treatment.

Conclusions
Culturally grounded, community-led approaches enhance engagement and outcomes in diverse settings. We will continue refining the tool to expand its application within a wholistic framework, ensuring Métis voices remain central in shaping health and wellness strategies.
Keywords: Métis, HIV, Hepatitis C, stigma, cultural safety, implementation science, language revitalization

Supervised consumption sites (SCS) are evidence-based harm reduction interventions intended to reduce overdose-related morbidity and mortality and to improve healthcare access for people who use drugs. In recent years, various SCS in Alberta have closed or experienced service reductions, raising concerns about the potential population-level impacts of decreased access to supervised consumption services. This study examines the association between SCS closures and opioid-related mortality and emergency department (ED) visits in Alberta.

We are conducting a retrospective, population-level observational study using available administrative health data. Opioid-related deaths and ED visits will be examined before and after SCS closures using interrupted time-series and comparative trend analyses. Primary outcomes include monthly opioid-related mortality rates and associated outcomes. Analyses will explore temporal patterns associated with changes in supervised consumption service availability across affected regions.

This study aims to generate Canadian evidence on the health system and population impacts of SCS closures within the context of the ongoing overdose crisis. Findings will contribute to public health and policy discussions regarding harm reduction service accessibility and its role in preventing overdose-related deaths and reducing acute care utilization.

By examining changes in opioid-related mortality and ED visits following SCS closures, this research seeks to inform evidence-based decision-making related to harm reduction infrastructure, overdose prevention strategies, and health equity for people who use drugs in Alberta and across Canada.

Survival sex workers experience intersecting health and social inequities shaped by chronic pain, substance use, trauma, and criminalization. While survival sex work has been extensively examined in relation to infectious disease risk and social vulnerability, the co-occurrence and interaction of chronic pain and addiction remain under explored determinants of health within this population. This scoping review aims to map existing literature on chronic pain and addiction among survival sex workers in North America and to examine how structural factors influence healthcare access, care experiences, and health outcomes, with relevance to health equity-oriented care in Canada.

A comprehensive search of MEDLINE, Embase, and relevant grey literature was conducted for studies published between 2012 and 2025. Eligible sources included qualitative, quantitative, and mixed-methods studies examining chronic pain, substance use, healthcare access, or related social and structural determinants among survival sex workers in North America. Data were extracted and synthesized using thematic analysis.

Preliminary findings suggest that chronic pain and addiction frequently co-occur among survival sex workers and are shaped by overlapping experiences of violence, economic precarity, and structural exclusion. Both pain and substance use influence healthcare engagement, often in the context of stigma, criminalization, fragmented services, and limited access to longitudinal pain or addiction care. These barriers contribute to delayed care-seeking, reliance on emergency services, and disrupted continuity of care.

This review identifies critical gaps in research and service delivery related to the integrated management of chronic pain and addiction among survival sex workers in Canada. Findings underscore the need for trauma-informed, structurally competent, and community-driven healthcare models that address pain and addiction concurrently, with implications for advancing equitable care for structurally marginalized populations.

Background: Deeply rooted structural determinants of health (StDoH) continue to produce disproportionate health risks and inequities among Indigenous and racialized populations in Canada. These inequities call for analyses of how social, political, economic, and institutional systems and structures impact access to resources and opportunities for achieving health and wellbeing. This paper presents findings from an ongoing Critical Narrative Synthesis (CNS) that is 1) interrogating and contextualizing existing anti-racism and equity, diversity, and inclusion (EDI) literature and (2) exploring how anti-racism and EDI frameworks are framed, implemented, and operationalized in academic, health and governmental organization discourses.

Methods: CNS critically examines how knowledge is produced, attending to the power relations, inequalities, and ideological assumptions within the evidence. This synthesis is part of an Institutional Ethnography (IE) project that studies upstream strategies to address Indigenous and racialized populations' StDoH inequities. The analysis maps how the everyday work of anti-racism, Indigenous and EDI actors is organized through textually mediated practices. Through thematic mapping, we examined how researchers and institutions conceptualize Indigenous and racial health disparities, and what solutions are prioritized.

Results and analysis: Findings included interrelated analytic themes:1) Superficial and performative approaches to anti-racism: Although framed as structural commitments, many initiatives are surface-level, focusing on symbolic efforts such as one-off training, not systemic change; 2) Conflation of anti-racism with EDI discourses: Blending anti-racism with EDI dilutes its political intent, and replaces structural reform with procedural compliance; 3) Institutional barriers: Reluctance to name racism directly, inconsistent leadership buy-in, lack of sustained investment and structural integration hinder transformative intent.

Conclusion: Health equity initiatives frequently default to downstream, individualized interventions, eroding structural commitments. Effective anti-racism practice must stand as a distinct pillar, not subsumed under EDI. It also requires multi-level and long-term strategies anchored in explicit recognition of racism, power and resource distribution, and sustained community collaboration.

Background: Health data is central to identifying inequities in African, Caribbean, and Black (ACB) communities and informing research, policy, programs, and resource allocation. However, existing data governance systems are marked by structural racism and exclusionary practices, and consequently fail to prevent data misuse and impede the formulation of effective interventions. This scoping review maps determinants and best practices for equitable and community-centered ACB health data governance in high-income countries. This abstract shares the results.
Methods: The review was conducted by our ACB lab and ACB National Expert Working Group. The literature was searched through five electronic databases, targeting articles from inception until December 2024. Multiple reviewers handling screening and charting, then triangulated descriptive statistics with a qualitative thematic mapping approach to analyze the nature and extent of the literature on health data governance for ACB communities. From a total of 6, 784 electronic records, 15 met the inclusion criteria.
Results: Our analysis revealed key barriers and facilitators to equitable and community-driven data governance. The key barriers included structural racism, centralized institutional control, ACB exclusion from decision-making spaces, lack of disaggregated data, and widespread mistrust and distrust towards institutions. The key facilitators and recommendations to transform data governance were redistribution of power through co-governance models, sustained community engagement and oversight throughout the health data lifecycle, trust building, mandates for disaggregated data collection, and the establishment of transparent accountability measures.
Conclusions: Current data governance landscapes perpetuate the ongoing structural inequities faced by ACB communities. Institutions must empower ACB voices, and value their local, cultural, and experiential knowledge as expertise. Accordingly, data governance reforms require shifts from external control to community self-determination. Such transformation can deliver policy responses and programs that more effectively target and address health and social inequities in these communities.

Background: Suicidal thoughts and attempts are markers of extreme psychological distress and substantial unmet mental health needs. Key social-structural determinants of health, including stable housing, reliable food security, and broader systemic supports, are associated with mental health indicators and, in turn, improved HIV care outcomes. Given the relevance of social-structural factors for understanding psychological distress, we aimed to investigate associations between housing, food security, and engagement in HIV community-based organizations (CBOs) and suicide thoughts/attempts.
Methods: Data were drawn from the Sexual Health and HIV/AIDS: Women’s Longitudinal Needs Assessment Project, a longitudinal, community-based study among women living with HIV in Metro Vancouver (N= 389, 2014–2025), with interviews at baseline and at six-month intervals. The outcome was self-reported suicidal thoughts/attempts (last six months, yes vs no). Main social-structural factors measured in the last six months included housing (supportive housing only; independent housing[apartment/house] vs insecure[unsheltered/unstable]), food security (modified Radimer–Cornell Food Security Scale [scores 1-3]), and HIV CBO use (any vs. none). Generalized linear mixed models with random intercepts further controlled for age, race, sexual/gender identities, mental health histories, and COVID-19 period.
Results: The analysis included 366 women (2,924 observations) between September/2014-February/2024. At baseline, 12% women (n=42) reported suicide thoughts/attempts, 67% (n=244) housing insecurity, 75% (n=274) food insecurity, and 57% (n=210) HIV CBO use in the last 6 months. 33% (n=122) reported suicidal thoughts/attempts during follow-up. Higher average Food Security score (Adjusted Odds Ratio [AOR]=0.54; 95% Confidence Interval [CI]: 0.40-0.73) and supportive housing (AOR=0.63; 95% CI: 0.44-0.99, vs unstable/unsheltered housing) were associated with lower odds of suicidal thoughts/attempts. Independent housing and HIV CBO use were not statistically significant.
Conclusion: Structural supports are critical among women living with HIV, particularly food security and supportive housing, and should be included as part of broader, multi-level approaches to mental health and suicide prevention.

In Canada, services anchored in harm reduction principles are undergoing significant shifts due to political, legislative, and policy changes at both the federal, provincial, and municipal levels. These changes impact how frontline organizations operate and highlight the need for updated training materials that reflect the current realities of harm reduction service delivery.

Since 2018, the Dr. Peter Centre’s Frontline Solutions team has been building organizational capacity across Canada to establish and deliver services anchored in harm reduction principles that prioritize safety, site compliance, and responsiveness. During this session, we will share key strategies for integrating harm reduction, trauma-informed approaches, mental health support, housing stability and peer-led initiatives to create a seamless network of services. We will also discuss the impact of political determinants of health, considering strategies for fostering collaboration across organizations and sectors.

Social and health organizations need to understand the shifting health risks and health service priorities in order to support their staff to provide the most effective services. We have found that certain materials, such as mentorship programs and trauma-informed practice, are more effective in in-person settings, where experiential learning and direct engagement are possible. Toolkits can be effectively delivered in virtual learning environments to increase accessibility. Training programs must be adaptable to local realities, cultural considerations, and specific service models to be truly effective.

Developing customized training modules that address an organization’s specific challenges—whether it be responding to ever-shifting toxic drug supply, engaging in cultural safety, navigating municipal restrictions or building relationships with law enforcement—will ensure that frontline workers are better equipped to provide responsive and effective care. By fostering flexibility and co-development in training approaches, organizations can enhance their capacity to meet the needs of the people they serve.

Background: African, Caribbean, and Black migrants living with HIV (ACB-LHIV) in Canada experience intersecting systemic, social, and psychosocial barriers that shape their engagement with healthcare. These include anti-Black racism, HIV-related stigma, immigration status-related issues, economic insecurity, and limited cultural responsiveness within healthcare settings. Existing research on ACB migrants, though limited in number, has largely focused on HIV acquisition, while overlooking their healthcare experiences post-HIV diagnosis (Etowa et al., 2022; Fante-Coleman et al., 2022; Logie et al., 2013; Tharao et al., 2025). Additionally, these studies are overrepresented in a single province – Ontario, limiting the understanding of how ACB-LHIV navigate healthcare across provinces and constraining the development of culturally-tailored interventions.

Objective: This phenomenological study, guided by an intersectionality framework, seeks to understand the experiences of ACB-LHIV when engaging with the healthcare system across different provinces in Canada by exploring how intersecting identities, such as race, immigration status, gender, and HIV status, shape access to care, perceptions of safety and trust, and healthcare-seeking behaviors.

Methods: This qualitative study will use purposive sampling to recruit up to 30 ACB-LHIV aged 18 years and older from Ontario, Quebec, and Alberta. Data will be collected through in-depth, semi-structured interviews conducted in English or French, either in person or virtually, based on participant preference. Interviews will explore healthcare access and engagement, interactions with providers, experiences of stigma and discrimination, and the meanings participants attribute to their healthcare experiences. Transcripts will be analyzed iteratively using interpretive phenomenological analysis, with attention to intersecting systems of power shaping participants’ experiences (Smith et al., 2009; Crenshaw, 1994).

Significance: Findings will generate in-depth, multi-provincial evidence on healthcare navigation among ACB-LHIV and inform the development of culturally responsive HIV care and support interventions for this population in Canada.

Keywords: ACB migrants living with HIV, Healthcare experiences, Intersectionality, Healthcare navigation

Background: Despite preventative efforts to minimize rates of sexually transmitted and bloodborne infections (STBBIs), Canada continues to have an alarming increase in these rates, where Black populations account for the highest rates of STBBIs/HIV in Canada. The overall objective of this research study was to understand the factors affiliated with the increase of STBBI rates by focusing on the reach of preventative measures in the Black populations of Canada.
Objective: The objective of this systematic review was to identify and analyze the barriers and facilitators to knowledge and awareness of STBBIs among Black populations in Canada. This review specifically focused on three key areas: general awareness of STBBIs, knowledge of STBBI prevention, and knowledge of STBBI testing.
Methods: A comprehensive search was conducted using five databases: OVID Embase, OVID Medline, CINAHL, and Scopus. A total of 1261 studies were initially identified, with 24 meeting the eligibility criteria, limited to studies published between 1990 and 2023. All eligible studies included in the review underwent quality assessment.
Synthesis: The review identified 57 barriers and 12 facilitators to STBBI knowledge. Key barriers included stigma, cultural norms, inadequate healthcare resources, lack of cultural competence among healthcare providers, and limited access to information and services. Facilitators included access to AIDS Service Organizations, culturally informed dissemination strategies, supportive family and community networks, and effective communication between parents and children. The Social Cognitive Theory (SCT) was used to interpret these findings, focusing on the role of observational learning, self-efficacy, and social support in knowledge acquisition and health-seeking behaviours, and to guide recommendations for future actions.
Conclusion: The findings highlight significant barriers and facilitators to STBBI knowledge among Black populations in Canada. Addressing these barriers and leveraging the identified facilitators, through interventions informed by the SCT, are recommended to improve STBBI knowledge and health outcomes among these communities.

Background: Disasters, including socio-political crises, extreme weather events, and pandemics, are increasing due to climate change and structural inequities. Strengthening disaster preparedness and response within the HIV sector is urgent. HIV community health workers (CHWs), long central to primary healthcare in South Africa, hold critical contextual knowledge, yet their role in disaster response remains underexplored.

Methods: This qualitative study (Western Cape, Nov 2024–Jan 2025) examined CHW priorities, experiences, and strategies related to disasters. We engaged 46 CHWs (ages 20–65) from urban Mitchell’s Plain and rural Morreesburg, Western Cape Province through two participatory workshops (n=24) and in-depth interviews (n=22).

Findings: CHWs identified floods, fires, and drought as key disasters. Maintaining HIV care during floods and fires was challenging due to displacement, property loss, and disrupted access to medicines and basic needs. People living with HIV and TB faced disclosure concerns and respiratory complications. Drought exacerbated ART adherence issues through water and food scarcity, which also increased diarrheal disease.

CHWs described acted as the "eyes" of their communities, linking clients to essential resources (food, blankets, documents) and leveraging networks for continuity of care. They also provided health education and used WhatsApp for early warnings.

While CHWs described floods and fires as frequent, seasonal occurrences, they lacked involvement in advance planning. Social issues like crime and poverty were also framed as disasters requiring urgent attention.

Discussion:
CHWs play a vital role in disaster response, mobilizing resources and sustaining care. They often act as frontline responders, emphasizing flexibility, improvisation and rapid adaptation to maintain HIV care during disasters. Yet proactive disaster planning among CHWs is limited. Furthermore, CHWs conceptualise crime and poverty as disasters. Together, these findings underscore the need for more inclusive, integrated and proactive approaches to disaster preparedness to ensure continuity of HIV care.

This environmental scan maps how Ontario’s HIV sector is integrating, or failing to integrate, the needs of trans and gender diverse (TGD) people across the HIV prevention and care continuum. The scan focuses on six regions (Toronto, Ottawa & Eastern, Northern, Central East, Central West, Southwest) and asks how HIV prevention, PrEP, testing, and harm reduction are connected to gender affirming care for TGD communities.

Using a mixed qualitative design, we combined narrative website and document analysis of 93 organizations with 40 semi structured and informal interviews with AIDS service organizations, community health centres, public health units, clinicians, peer navigators, and program staff. Data were coded for TGD visibility, TGD specific programming or referrals, mention of gender affirming care, and linkage between HIV prevention and trans health.

Across all regions, only 23 of 93 organizations had TGD specific programming or referral structures, and 42 showed some TGD or broader 2SLGBTQ+ visibility online. Twenty two organizations mentioned gender affirming care in strategic plans or reports, mainly in Toronto and Central East. Integration of HIV prevention and gender affirming care is still rare, concentrated in a few urban hubs, leaving many TGD people in Northern, Eastern, and smaller Central regions to travel or assemble fragmented services. Regional narratives highlight persistent policy and data gaps, uneven PrEP visibility, limited provider training, and rising impacts of anti trans rhetoric on patient and provider safety.

Findings show that TGD inclusion in Ontario’s HIV response remains ad hoc and project based. The scan calls for provincial standards on gender identity data collection, sustained investment in integrated HIV and gender affirming care models, and formal partnerships with TGD led and community-based organizations to make trans health central to HIV prevention policy and practice.

Keywords: trans and gender diverse, HIV prevention, PrEP, gender affirming care, Ontario, environmental scan

Background: Drug toxicity and overdose remain critical public health challenges in British Columbia (BC). The COVID-19 pandemic exacerbated these issues by disrupting drug markets and limiting access to care and harm reduction services, leading to increased overdose rates. These disruptions produced structural changes in systems of care that continue to shape overdose risk and access to support. This study examines perceptions of the lasting impacts of the pandemic among People Who Use Drugs (PWUD) in Vancouver, and explores community-identified priorities for changes and interventions aimed at reducing overdose risk.

Methods: Across 13 semi-structured, in-person focus groups, a total of 74 PWUD, including 38 individuals living with HIV, and 10 individuals who identify as Indigenous (First Nations, Inuit, and/or Métis) participated. Recruitment was facilitated in collaboration with community service and support organizations. Transcripts were coded using NVivo 14.0. We conducted an inductive thematic analysis of all transcripts.

Findings: Participants emphasized the importance of comprehensive support and training to strengthen overdose prevention and care (e.g., independent-living skill development, naloxone administration, and cultural sensitivity and anti-stigma training for healthcare providers). Priorities included food programs and housing initiatives; expanding harm reduction services with diverse modes of delivery (e.g., mobile health vans); increasing access to peer support and on-demand mental health and detox services; and creating gathering spaces that promote a sense of safety and community.

Conclusion: Insights from this study highlight gaps and opportunities for improving care for PWUD to better support overdose prevention and recovery. Participants’ recommendations point to the importance of culturally safe, trauma-informed, and peer-led programs during public health emergencies. These community-identified priorities can inform the development of more resilient, equitable, and responsive overdose prevention strategies in BC.

Gender-based violence (GBV) remains a significant driver of HIV vulnerability among women and girls, affecting autonomy, access to care, and risk reduction, especially amongst black communities. Despite recognition of this intersection, limited research explores women and girls’ lived experiences using peer-led methodologies, and comparative insights across studies remain scarce. This study employs a peer research approach to examine the relationship between GBV and HIV risk, situating findings within the broader landscape of peer-led research in urban communities.

This focuses on young girls and women 16-25, data on experiences of violence, HIV knowledge, prevention practices, and access to services, alongside qualitative data on safety, disclosure, and barriers to care. Comparative analysis was conducted alongside previous peer-led studies on GBV and HIV in similar urban contexts, enabling identification of shared patterns, unique local challenges, and effective peer-driven strategies.

Findings reveal that participants experiencing GBV reported increased HIV risk due to limited ability to negotiate safer sex, fear of disclosure, and reduced engagement with prevention services. Stigma, normalization of violence, and mistrust of institutions emerged as persistent barriers. Comparative analysis shows consistent patterns across peer-led studies: peer-led approaches increase trust, engagement, and disclosure, and highlight the importance of culturally responsive, community-driven interventions.

Recommendations include integrating GBV prevention into HIV programming, expanding peer-led education and support, improving confidential access to HIV services, and strengthening institutional responses to address violence and HIV risk simultaneously. The study underscores the value of peer-led, comparative research in generating actionable insights and guiding evidence-based interventions to reduce HIV vulnerability among women and girls affected by GBV.

In Canada, incarcerated individuals retain the fundamental human right to healthcare equivalent to that available in the community; however, empirical evidence indicates that this right is inadequately realized in the context of HIV prevention, testing, and treatment within federal and provincial correctional institutions. Epidemiological data drawn from peer-reviewed studies, Correctional Service canal surveillance reports, and provincial correctional health records demonstrate that HIV prevalence in Canadian prisons is several times higher than in the general population, with Black and Indigenous peoples disproportionately affected due to systemic racism, colonial legacies, and socio-economic marginalization. Despite prisons being recognized as high-risk environments for HIV transmission and are frequently based on voluntary or at risk-based models rather than routine opt-out screening, resulting in delayed diagnosis and missed opportunities for early intervention. Evidence further reveals interruption in antiretroviral therapy, limited confidentiality, and inadequate access to culturally safe healthcare, particularly for Indigenous incarcerated populations. Legal and policy analysis of federal of federal legislation, Correctional Service Canada directives, Charter of Rights and freedoms jurisprudence, and international human rights instruments highlights a persistent gap between Canada's formal obligations to provide community-equivalent healthcare and the realities of care delivery in carceral settings. The convergence of public health data and legal analytics underscores systemic failures within Canadian prisons healthcare that exacerbate HIV related inequalities and violate the recognized human rights and incarcerated individuals. Through surveys and peer reviewed research, the purpose of this analysis is to identify gaps between evidence-based public health practices and the legal protections to incarcerated people. Based on the findings, recommended reforms include the implementation of standardized, routine opt-out HIV testing across all correctional facilities, guaranteed continuity of antiretroviral therapy during incarceration and post-reals, expansion of harm reduction and culturally safe healthcare and strengthened legal accountability mechanisms to ensure compliance with constitutional and international human rights obligations.

Contexte :
Le nombre de nouveaux cas de VIH augmente au Québec, et le taux de dépistages tardifs (CD4<350) reste très élevé (50% des nouveaux cas en 2022). Le dépistage est un acte médical réservé au Québec et les intervenant·es communautaires ne peuvent que distribuer et expliquer l'utilisation des autotests. Des collaborations avec des ressources infirmières de la santé publique sont possibles, mais limitées.
L’objectif de ce projet était de sensibiliser le public à l’importance du dépistage et de démontrer le rôle que les organismes communautaires peuvent jouer pour le rendre plus accessible.

Methodes :
Huit organismes membres de la COCQ-SIDA ont participé au projet pendant deux périodes d’activités de dépistage: été/septembre et novembre. Chaque organisme a ciblé individuellement ses populations prioritaires et mobilisé ses partenaires locaux. Le financement du projet et des kits de dépistage a été assuré par Gilead avec un soutien de Biolytical.

Résultats :
Trois types d’activités ont été réalisés: (1) participation à des kiosques lors de grands événements organisés par d’autres structures, (2) organisation de foires de santé, (3) activités focus dépistage avec ou sans présence d’infirmier·es.
Les grandes activités publiques ont attiré un grand nombre de personnes, permettant une large diffusion de l’information et la distribution de nombreux autotests. Les activités plus restreintes ont permis des interventions plus approfondies avec un nombre plus réduit de personnes, avec un dépistage ou un accompagnement à l’autotest sur place.
Ces deux types d'activités ont permis d'établir un lien entre l’organisme et le dépistage, et d'augmenter le nombre de consultations en dehors de ces événements.

Conclusion :
Le dépistage événementiel ne permet pas de trouver massivement les personnes vivant avec le VIH sans le savoir, mais il sert à démystifier le dépistage, à le promouvoir et à faire connaître les organismes communautaires VIH locaux.

The prevalence of sexually transmitted infections (STIs), specifically human immunodeficiency virus (HIV) is markedly higher among gay, bisexual, and men who have sex with men (GBM; Public Health Canada, 2024). Other biomedical interventions have shown promise, but understanding condom use remains an important component of STI/HIV prevention (Gandhi et al., 2023; US Preventive Services Task Force, 2019). Among heterosexual couples, relational power has been identified as a moderator in the negotiation of condom-use, however, this has not been well studied in GBM (VanderDrift et al., 2013). We conducted a survey of 210 Canadian GBM to examine how relational power impacted condom negotiations at their most recent sexual encounter. Condom negotiation was assessed via multiple measures of condom insistence/resistance strategies adapted for GBM (Davis et al., 2014; Noar et al., 2002), and were examined in relation to Anderson et al.’s (2012) interpersonal sense of power scale. Men who scored higher in relational power tended to be older than their sexual partner and also scored higher on self-perceived dating success. Men who reported greater femininity, self-identified as a top, Black, or living with HIV tended to score lower in relational power. Furthermore, we found those lower in power generally endorsed less assertive negotiation strategies, but were still likely to achieve their desired condom use outcome. These findings highlight the inequity of power and stigma present for certain GBM; and the importance of building self-advocacy skills, as engaging in any form of condom negotiation strategy was more effective than using none, regardless of the power dynamics in play.

Background:
People who use drugs (PWUD) continue to face disproportionate risk for HIV infection yet are often excluded from HIV prevention and education. We are a community-based team conducting implementation science research, housed at a needle exchange program in Regina, Saskatchewan. We hypothesized that knowledge of pre-exposure and post-exposure prophylaxis (PrEP and PEP) amongst PWUD in Regina is low and that pop-up educational events could improve PrEP and PEP knowledge amongst PWUD.
Methods:
Data was collected through 147 participants who identify as using injectable drugs in Regina, Saskatchewan. Participants completed adapted items from Shreshta et al’s (2017) PrEP/PEP Knowledge Subscale before and after a peer-led, pop-up education session. Items assessed general knowledge about PrEP/PEP (e.g., I know about PrEP, I know about PEP, I know where to access PrEP/PEP) and were rated on a 5-point, Likert-style scale ranging from 0 (strongly disagree) to 4 (strongly agree), with higher scales indicating higher knowledge of PrEP/PEP.
Results:
A paired-samples t-test examined changes in PrEP/PEP knowledge before and after the education session. Participants’ knowledge increased substantially following the session. Before the session, scores were relatively low (M = 0.52, SD = 0.79). After,scores were much higher (M = 2.03, SD = 0.44). This difference was statistically significant, t(146) = –21.11, p < .001. The mean increase of 1.50 points (95% CI [–1.64, –1.36]) reflects a very large effect (Cohen’s d = 1.74), indicating that the education sessions had a strong impact on PrEP/PEP knowledge.
Conclusion:
Embedding peer-based PrEP and PEP education into community-led HIV/STBBI prevention and harm reduction education sessions effectively increases awareness among populations facing systemic barriers. Person-centered care may strengthen PrEP and PEP knowledge. This presentation will discuss how to effectively provide PrEP and PEP education, and the forms of PrEP and PEP that may be most accessible to PWUD.

Introduction
HIV-related stigma remains a persistent barrier to equitable access, quality of care, and service engagement within community-based settings. While stigma reduction efforts often focus on individual attitudes or behaviours, organizational policies, practices, and environments play a critical role in shaping experiences of HIV-related stigma. The Organizational Stigma Assessment Cycle (OSAC) is a structured, capacity-building tool designed to support organizations in identifying and addressing organizational and structural drivers of HIV-related stigma. Grounded in an intersectional framework, OSAC recognizes the compounding effects of stigma alongside racism, colonialism, gender identity, sexual orientation, and/or substance use.

Methods
OSAC was implemented using a developmental evaluation approach to pilot the cycle across five sites within two CBO's in BC. A mixed-methods design was employed, using surveys and focus groups completed by staff and people with lived/living experience of HIV-related stigma, with one organization conducting the cycle twice. Peer reviewers with community practice expertise supported organizations throughout implementation, contributing to iterative refinement of the tool and its application.

Results
Implementation findings identified organizational strengths and areas for improvement related to HIV-related stigma across key domains including: governance, programs and services, human resources, professional development, communication, finances, and physical space. OSAC supported organizations in increasing awareness of how HIV-related stigma operates structurally and developing context-specific strategies for stigma reduction. Meaningful involvement of people with lived/living experience highlighted nuances that may have otherwise been overlooked, while enhancing the relevance, acceptability, and uptake of stigma-reduction actions.

Conclusion
Findings demonstrate that OSAC is a feasible and acceptable organizational tool for HIV-related stigma reduction in community-based settings. By supporting structured reflection, intersectional analysis, and participatory engagement, OSAC facilitates movement from stigma identification to action. This work contributes to the growing evidence base of organizational-level HIV stigma interventions and informs future implementation and scale-up opportunities in community organizations and other diverse contexts.

Introduction: Chronic pain remains an under-recognized aspect of living with HIV in Canada. Community
accounts point to significant impacts on daily functioning, mental health, and social participation,
alongside limited access to coordinated pain care. This study sought to centre lived experience in
understanding how people living with HIV navigate and make meaning of chronic pain.

Methodology: Using 248 bilingual survey responses, peer researchers and community partners refined 24
resonant statements capturing pain experiences, management strategies, communication barriers, and
structural determinants. Seventy-one participants across Canada engaged in an adapted, hands-on Q-
sorting activity, ranking statements from “most like me” to “least like me.” Sessions were photographed,
accompanied by brief reflections, and followed by facilitated group discussion. Seven hours of audio
were analyzed collaboratively using biopsychosocial and identity-based theories of pain, the social
politics of discomfort, and candidacy theory.

Results: Participants described chronic pain as diffuse and difficult to articulate, exacerbated by limited
inquiry from providers and the absence of guidance around medication complexity, substance use, and
self-directed microdosing. Medical distrust and reliance on diverse, community-rooted self-management
strategies were prominent. Pain care was often negotiated as a question of legitimacy.

Conclusions: Findings highlight the need for realistic, culturally grounded knowledge mobilization; provider training responsive to community realities; and low-cost, community-led supports. Equitable
pain care requires centering experiential knowledge and strengthening partnerships among PLHIV,
providers, and community organizations

People living with HIV who are structurally excluded from provincial health insurance experience persistent barriers to timely and continuous care. In New Brunswick, individuals without a valid Medicare card (including newcomers and people with precarious residency or documentation) often face delays in HIV testing, specialist referral, ART initiation, and access to supportive services. These barriers contribute to poorer health outcomes and undermine public health efforts to achieve viral suppression and reduce transmission. This project describes a healthcare navigation pilot aimed at bridging HIV care access gaps for structurally excluded patients in New Brunswick.

A low-barrier, client-centred healthcare navigation pilot was implemented to support structurally excluded individuals across the HIV care continuum. Navigation activities included linkage to HIV testing and confirmatory diagnostics, coordination of referrals to HIV specialists, facilitation of interim or alternative medication access, and advocacy within healthcare and social service systems. The model emphasized trauma-informed, culturally responsive, and confidential care, with collaboration between community-based organizations, public health, and clinical providers. A mixed-methods evaluation assessed feasibility, acceptability, and early outcomes. Quantitative measures included time to specialist appointment, time to ART initiation, and retention in care. Qualitative interviews with clients explored experiences of access and perceived impact of navigation.

Preliminary findings indicate that healthcare navigation reduced delays in specialist linkage and treatment initiation for structurally excluded patients. Navigation addressed administrative and systemic barriers, including insurance ineligibility, documentation requirements, and care coordination challenges. Qualitative data highlighted increased client trust, improved understanding of the healthcare system, and enhanced provider capacity. Process data identified recurring system-level gaps affecting access to HIV care.

Healthcare navigation shows promise as an effective strategy to bridge HIV care access gaps for structurally excluded patients in New Brunswick. This pilot provides actionable evidence to inform scalable, equity-focused interventions that support timely treatment, retention, and improved outcomes for marginalized populations.

Introduction: People who use drugs (PWUD) in rural, remote, and Indigenous communities are disproportionately affected by the ongoing overdose crisis, yet there remains limited research on existing harm reduction strategies. One such strategy includes opioid agonist treatment (OAT) that aims to reduce the risks of unregulated opioid use. In rural Canada, there are unique challenges regarding harm reduction service access, including access and adherence to OAT. Meanwhile, most of the research focuses on large urban centres, which cannot be directly translated. Research Aim: We aimed to describe the unique experiences of OAT and harm reduction service access for PWUD and Indigenous-PWUD in the qathet region of British Columbia (BC), Canada. Methods: A rapid ethnography was completed in the qathet between 2024-2025, involving semi-structured qualitative interviews with PWUD and Indigenous-PWUD (n=32). Participants were greater than 19 years old and had been on a prescribed OAT medication program within the 1-year of the start of the study. A feminist relational discourse analysis (FRDA) was used to analyze the interview transcripts. Results: Participants described contradicting discourses on OAT medication and harm reduction experiences, specifically related to the need for in-person witnessed dosing. Power imbalances were described within patient-prescriber relationships that perpetuated structural vulnerabilities, inhibited individual autonomy, and heightened stigma. Conclusions: Our findings illustrate how OAT medication and harm reduction experience barriers are perpetuated by structural vulnerabilities and stigmatization faced by PWUD in the qathet. The use of FRDA allowed us to highlight the individual voices of participants and illuminate the power hierarchies in OAT and harm reduction service structures, whilst un-silencing minority and/or conflicting individual voices that can get erased in traditional qualitative analysis techniques. Overall, we advocate for the inclusion of PWUD in decision-making processes regarding harm reduction service access in rural, remote, and Indigenous communities.

Background: The built environment often informs where people choose to use drugs and consequently impacts drug-related risks, such as overdose mortality. However, research on the relationship between overdose mortality and the built environment is limited. Perceptions of safety also impact how people who use drugs (PWUD) interact with built environments. In Canada, there is limited research outside of larger urban centres on drug use, overdose, and the built environment, despite differences existing across geographic settings. We sought to examine how PWUD perceive and navigate safety in the context of drug-related risks and the built environment. Methods: This study is embedded within a larger mixed-methods study. We conducted 26 semi-structured interviews with people with lived/living experience of drug use (PWLLE). Participants were recruited purposively through peer networks and harm reduction organizations across four communities in British Columbia, Canada (Surrey, Nelson, Prince George, Nanaimo). Spatial modelling guided community selection. The interview guide was informed by our scoping review on fatal overdose and the built environment, and was collaboratively developed with PWLLE. The data was coded inductively and thematically analyzed to identify patterns and develop themes. Results: We identified four ways that safety was conceptualized: 1) interpersonal (e.g., relationships with friends, service providers), (2) built environment (e.g., design of spaces, physical surroundings), (3) community and peer (e.g., peer outreach, knowledge sharing), and (4) communicative (e.g., word-of-mouth, smartphone applications). Conclusion: These themes emphasize the complex nature of safety, tensions within built environments, and challenge the ‘safe’ and ‘unsafe’ dichotomy of drug use and the environment (e.g., designated ‘safe spaces’ felt unsafe). Future research should continue to explore the multifaceted ways that safety is understood and navigated across settings, as this is crucial for the development of future place-based harm reduction interventions that aim to support PWUD and reduce drug-related harms.

Indigenous peoples represented 18.2% of all new HIV
infections in 2020. This had increased since 2018, when
14.7% of new infections were estimated to be among
Indigenous peoples (SPHB, 2018; PHAC, 2020). Males
self-identifying as Indigenous comprised two-thirds or
67% of all male cases in 2018, and females selfidentifying
as Indigenous comprised 87% of all female
cases for 2018 (SPHB, 2018).

Following the 2009 Saskatchewan HIV Strategy, the Ministry of Health and the SK HIV Collaborative have worked toward reducing HIV rates, addressing risk factors, and improving the
quality of life for those living with HIV/AIDS. Of these funded programs, the Regina Area Network of Drug Users (RANDU) is a network of active drug users that strives to improve the lives of people who use drugs (PWUD) in Regina. Operating out of All Nations Hope Network (ANHN) in Regina, RANDU is informed by Indigenous teachings and Indigenous principles of noninterference.

In addition to providing harm reduction workshops and
materials to RANDU community members, we
interviewed several Indigenous people living with HIV in the
Regina, SK area. Recruited via ANHN, participants identified as Indigenous and living with HIV or other STBBIs.
Sharing Circles were conducted in Regina, where RANDU
and the community connections are housed. We are also
interviewed service providers. The literature, sharing
circles, and interviews will be analyzed using a communityled
qualitative framework. A literature review is also ongoing
to provide context to the data collected.

This research project aims to understand the social
impact that RANDU has provided that may not be
recognized within academic metrics. Through
qualitative analysis of quantities of supplies distributed
and regions of the city visited by RANDU peer support
workers, along with lived experiences of Indigenous
community members and service workers, we gain insight
into priority health concerns in Regina.

Context
The Dr. Peter Centre (DPC) is a community-based healthcare facility in Vancouver’s West End offering daytime programs with health, nutrition, harm reduction and connection for participants whomare HIV+, use drugs, and may be unhoused or precariously housed. The DPC’s Day Health Program engages over 500 participants and their Residence, Stabilization, and Enhanced Supportive Housing programs are successful at providing care and connection for those who cannot access it elsewhere. Many changes are coming to the neighbourhood where the DPC has operated for 25-years, including the planned relocation of St. Paul’s Hospital.
A Carescapes approach is a novel geographical approach that explores a multitude of human needs and interactions that shape care for multiply marginalized individuals both within the walls of the DPC’s physical facility but also in broader neighbourhood and municipal contexts. spatial, material, cultural and other aspects of care not limited to significant biomedicosocial markers that have been significantly studied in the DPC’s previous research. to explore the relationships and interactions
Methods
The study employs a novel research design that combines qualitative ethnographic and community-based participatory (CBPR) methods. A small group of informants (n=15) recruited through purposive sampling is being engaged through mobile interviews, storytelling, interpretive mapping, group discussions and other participatory design and/or arts-based methodologies to share perspectives, experiences and ideas about the DPC and its role in their daily lives and circulations. These are supplanted by participant observation, documentary analysis and interviews with decisionmakers and other community stakeholders.
Outcomes
This research is augmenting our knowledge about how participants’ needs for safety and wellbeing are being met (or not met) by our organization, as well as providing concrete, actionable ideas for improvement. Findings contribute to DPC’s suite of knowledge products for communities and frontline organizations in Canada facing similar challenges that will be shared in this presentation.

Background: There is a dearth of research on the unique challenges trans and gender diverse (TGD) newcomers and immigrant young adults face when accessing health and social services in the Canadian context. TGD people have worse mental and physical health outcomes, such as depression and anxiety, compared to their cisgender peers. A highly under-researched community, Middle Eastern and North African (MENA) young adults, including TGD youth face unique challenges in navigating HIV and STBBIs even as the community grows rapidly due to high immigration rates. Objectives: this study used community-based participatory research methodology to: 1) examine barriers and facilitators in achieving positive sexual and mental health among trans, non-binary and gender-nonconforming MENA newcomers in Ontario; 2) catalyze community-led research planning and development activities that ensure the inclusion and meaningful representation of TGD MENA newcomers; 3) develop culturally responsive services that will address the sexual and mental health needs for TGD MENA newcomers; and 4) engage TGD MENA youth and service providers in strengthening capacity for knowledge mobilization. Methodology: The study engaged 21 TGD MENA newcomer young adults, ages 21-35 years in Toronto and Windsor, Ontario as participants and co-researchers in a participatory photovoice and visual arts research to co-create knowledge and understanding and engage in collective action. Stage 1: Co-Activation through Arts-Based Expressions. Stage 2: Interviews and Journal Reflections. Stage 3: Data Analysis. Knowledge Translation: 1) three (3) culturally responsive workshops for addressing sexual and mental health challenges and needs; 2) five (5) workshops for co-creating art content and products; and 3) exhibit. Team: TGD peer knowledge users, people living with HIV, and researchers from across Ontario. Our governance embraces GIPA and MIPA principles. Impact: Through participatory arts-based research processes, our project has the potential to generate culturally-responsive programming that will improve access to services for this highly underserved community.

Background: Arts-based approaches, including the use of filmmaking, drama, hip hop, graffiti, photography, and other visual arts, and culturally-grounded art forms, have recently been identified as engaging, empowering, holistic, and successful strategies for STBBI prevention with a variety of populations in Canada, including Indigenous youth and youth from African, Caribbean, and Black communities. Arts-based STBBI prevention programming is compatible with many best practices for STBBI interventions targeting diverse youth, including youth-led peer education strategies and strategies that address structural/systemic factors including the impact of colonialism, racism, homophobia and transphobia. While one of the strengths of arts-based HIV/STBBI prevention approaches is that they are often highly context specific and tailored to the communities in which they are implemented, the highly contextual nature of arts-based interventions can pose challenges for scaling or implementing interventions in new contexts, as well as the creation of community-oriented implementation guidance/guidelines. The objective of this study is to assess what is known within peer-reviewed literature about the use of the arts for HIV/STBBI prevention with youth in Canada, USA, New Zealand, Australia, and the United Kingdom.
Methods: A scoping review was conducted using the JBI Scoping Review protocol. A search was conducted in 4 databases to identify relevant literature. Title and abstracts and full text reviews were conducted by two independent researchers. Data relevant to our guiding question(s) will be abstracted, analyzed, and summarized.
Discussion: This scoping study will be the first study to systematically examine what is known about the use of the arts in STBBI prevention for youth. We anticipate that our findings will inform the development of future STBBI prevention programming, as well as the creation of community friendly arts-based programming implementation guidelines.

All Nations Hope Network (ANHN) is in the process of developing, implementing, and assessing the impact of land and gender-based cultural interventions among urban Indigenous men in Regina, SK. ANHN responds to community needs while creating health-related evidence that serves Indigenous peoples,honours Indigenous knowledges, and integrates Indigenous concepts of health and healing.

Indigenous men’s lives intersect with poverty, homelessness, ill-health, addiction, trauma, child welfare, dislocation from lands, and violence due to settler colonialism. ANHN is
applying past research learnings to develop evidence informed, culturally responsive interventions that address both the origin and impact of imposed inequities.

This project's aim is to evaluate Indigenous men’s programming of cultural intervention practices (CIPs) informed by Indigenous knowledges of the Treaty territories near Regina, SK. Guided by principles of community-based research and Etuaptmumk/Two-Eyed Seeing, qualitative methods (e.g., story-telling, sharing circles) are used to assess program impact for 36-months. Weaving men’s seasonal responsibilities into a program of teachings and practices, the project evaluation activities are integrated with the research approach to ensure iterative program development. Research questions are framed by Indigenous concepts of health as both a social and individual experience and explore men's experiences with cultural intervention practices (CIPs) and how these experiences impact participants' identities and wellbeing.

The project will contribute evidence about culturally responsive programming for and by urban Indigenous men and will inform the design, implementation, and improvement of future programs in diverse settings. Iterative data collection/analysis informs program development and assesses the impact ongoing and long-term. This study innovates beyond one-off, short-term intervention research and adds to discourses about cultural responsiveness for Indigenous men.

Indigenous Peoples in Canada experience a disproportionate burden of HIV, yet uptake of HIV pre-exposure prophylaxis (PrEP) remains low despite its high efficacy. This scoping review examined how Indigenous Peoples conceptualize PrEP across four domains—awareness, motivation, access, and effective use—drawing on literature from Australia, Canada, New Zealand, and the United States to inform implications for the Canadian context. Guided by Arksey and O’Malley’s methodological framework and reported in accordance with PRISMA-ScR, we reviewed qualitative, quantitative, and mixed-methods studies and relevant grey literature published between 2012 and 2024. Out of 181 identified records, 11 publications met inclusion criteria.

Findings revealed substantial heterogeneity in PrEP awareness across Indigenous populations, shaped by social identities, geographic location, and connection to mainstream gay and queer communities where PrEP promotion predominantly occurs. Motivation to use PrEP was primarily driven by desire to prevent HIV and the availability of public funding, while anxiety reduction and increased sexual autonomy were additional motivators. However, multiple barriers constrained access, including overburdened Indigenous-specific health services, prioritization of chronic disease management over preventive care, culturally unsafe mainstream sexual health services, HIV-related stigma, and homophobia. Evidence from Australia and New Zealand further demonstrated lower retention and adherence to oral PrEP among Indigenous participants compared with non-Indigenous peers, highlighting challenges with effective use.

Overall, the review underscores that PrEP uptake among Indigenous Peoples is shaped by intersecting social, structural, and historical factors rooted in colonialism, racism, and health system inequities. While Canadian data remain limited, international findings offer transferable insights. Culturally safe, Indigenous-led PrEP education, diversified delivery models, and structural interventions addressing stigma and access barriers are essential to improving equitable HIV prevention outcomes for Indigenous Peoples in Canada.

Background: In the Northwest Territories (NWT), Canada, Indigenous youth face historical and current structural inequities linked with sexual health disparities and social inequities. We examined temporal trends in social (food insecurity, substance use), sexual health (sexual activity, condom use self-efficacy [CUSE]), and resilience outcomes among Indigenous and non-Indigenous youth in the NWT.

Methods: Data were collected from repeated cross-sectional surveys of adolescents participating in Northern Indigenous sexual health school-based workshops across the NWT between 2018–2025. Mixed-effects regression models estimated adjusted associations between self-reported Indigenous identity and CUSE, sexual activity, food insecurity, resilience, and recent (past-3 month) substance use, accounting for sociodemographic factors and time. Time-by-Indigenous identity interactions were examined.

Results: Among n=1853 youth across seven school years, 70.05% (N=1298) identified as Indigenous youth. Indigenous adolescents experienced significantly higher social and HIV vulnerabilities compared to non-Indigenous peers. Adjusted models showed higher food insecurity (Acoef: 0.17; 95% CI: 0.07, 0.26; p<0.001), recent drug use (Acoef: 0.28; 95% CI: 0.19, 0.36; p<0.001), and sexual activity (Acoef: 0.15; 95% CI: 0.08, 0.22; p<0.001) among Indigenous vs. non-Indigenous youth. CUSE did not differ by Indigenous identity. Significant interactions between time and Indigenous identity were observed for food insecurity which increased over time (Acoef: 0.05; 95% CI: 0.01, 0.10; p<0.05) and recent substance use which decreased over time (Acoef: −0.02; 95% CI: −0.04, −0.01; p<0.05). Indigenous adolescents reported lower resilience scores overall compared to non-Indigenous peers (Acoef: −5.13; 95% CI: -9.20, -1.07; p<0.05); this disparity remaining stable over time.

Conclusions: Persistent inequities in food insecurity, substance use, and resilience among Indigenous adolescents in the NWT highlight the need for HIV prevention strategies that expand beyond individual practices to address structural and social determinants of health. School-based sexual health programs in the NWT can integrate strengths-based, culturally grounded approaches to advance Northern Indigenous youth health and wellbeing.

Problem Statement: Health equity and Social Determinants of Health (SDOH) concerns for Indigenous Peoples in Canada impact their health outcomes such as HIV rates. Data: Data collection sources were gathered from publicly available data from recognized government sites, including Statistics Canada, the Public Health Agency of Canada (PHAC), and Indigenous Services Canada (ISC). Data collection and analysis followed First Nations principles of OCAP. Method: The study design is a mixed method approach for the quantitative data; the descriptive component utilized a method of logistic regression analysis, and for the prescriptive component, the method of simulation analysis was utilized framed by a qualitative analysis from key informant interviews.The HIV/AIDS cascade of care framework is adapted in this research to add a pillar titled: Access to HIV/AIDS healthcare services. Results: The descriptive analysis results indicated that SDOH for First Nations Peoples, Inuit and Métis Peoples significantly impacts health outcomes negatively. Through the qualitative analysis six key themes emerged namely SDOH a holistic health approach, health equity and human rights, culture as a strength of self-determination as well as a list of barriers and innovative and creative approaches as solutions. The prescriptive analysis results indicated that addressing the SDOH of health care access through the Integration of Traditional Medicine with Western Medicine, New Testing Technologies (HIV Point of Care self-testing) and Health Transformation, the 95-95-95 HIV/AIDS global target rates for First Nations Peoples living on reserve will substantially improve. Conclusion: The results derived from the research inform the urgency for policymakers and decision makers to promote, advocate and fund integrated models of care, enhance access to new testing technologies and create pathways for health transformation within the Canadian healthcare system for Indigenous health in general and specifically HIV/AIDS healthcare for First Nations living on reserve.

Migrant and racialized communities (MRCs) face compounded vulnerabilities to sexually transmitted and blood-borne infections (STBBI), including HIV, due to stigma, cultural taboos, systemic racism, and limited access to culturally safe services. As the number of MRCs continues to increase, access to sexual health services remain inadequate. We present results of a recent study where we explored MRCs’ perspectives on strategies and solutions to promote sexual health, HIV and STBBI prevention and care in Saskatchewan. Guided by the socio-ecological model, we conducted fourteen semi-structured interviews and three focus groups with community members, sexual minority groups, and sexual health service users. Data were collected to explore experiences related to sexual health, HIV/STBBI risk, and access to sexual health services. Participants were recruited using purposive sampling supplemented by snowball sampling. Data were analyzed using thematic analysis, incorporating both inductive and deductive coding. Trustworthiness was enhanced through member checking and peer debriefing. Four interrelated themes emerged across socio-ecological levels. At the individual level, personal responsibility, including sexual health knowledge and proactive HIV/STBBI prevention, was emphasized. At the interpersonal level, family systems, encompassing extended and chosen peer networks, shaped sexual health attitudes and behaviours across generations. At the community level, community-based organizations serving MRCs played a key role in delivering culturally responsive sexual health education through trusted social, religious, and cultural spaces. At the structural level, government and institutional action was identified as critical to reducing HIV/STBBI-related stigma and advancing equitable prevention and care within immigration and settlement systems. There is a need for multi-level, equity-oriented HIV/STBBI prevention strategies that integrate individual agency, family and peer networks, community-based leadership, and action aimed at structural change. Strengthening culturally responsive, community-engaged approaches within immigration and settlement systems is essential to reducing stigma and improving sexual health outcomes among MRCs.

Immigration is a significant determinant of health that predisposes individuals to risks of poor physical health, including unmet sexual reproductive health rights concerns such as sexually transmitted and blood borne infections (STBBI) and HIV. There is limited research addressing the sexual health risks experienced by migrants and racialized communities (MRCs) in Saskatchewan, who represent 12% of the population. Ethno-specific sexual reproductive health interventions to mitigating such risks remain scarce. Our purpose was to explore the perceived barriers to HIV/STBBI prevention and care faced by MRCs in Saskatchewan. Guided by the socio-ecological model, we conducted fourteen semi-structured interviews and three focus groups with community members, sexual minority groups, and sexual health service users to explore barriers to HIV/STBBI prevention and care. Participants were recruited using purposive and snowball sampling. Data were inductively and deductively coded and analyzed thematically using NVivo 14. Strategies to enhance rigour included member checking and peer debriefing. Three interrelated themes emerged, highlighting barriers to HIV/STBBI prevention and care across multiple socio-ecological levels. Individual-level barriers included limited awareness and knowledge of available sexual health services, myths and misconceptions of sexual health and HIV/STBBIs risks, and perceived stigma and hesitancy in seeking care due to fear and concerns about confidentiality. Sociocultural barriers, which were pervasive within MRCs, included stigma surrounding sexual health and HIV/STBBIs which lead to silence, fear of judgement, and reduced engagement with testing, treatment, and disclosure. Structural and institutional barriers included a lack of culturally informed and responsive services, language and communication challenges, difficulties navigating healthcare systems, and insufficient community outreach. Findings demonstrate multilevel, intersecting barriers that impact HIV/STBBI prevention and care. The implementation of culturally responsive and community-based approaches within health and immigration systems is crucial for mitigating stigma, enhancing prevention and care efforts, and promoting sexual health equity among MRCs.

The Canadian government states that migrant women experience particular intersecting oppressions that increase their vulnerability to HIV and impact their access and engagement with HIV care, if diagnosed. Migrant women living with HIV (mWLWH) experience significant barriers to care, resulting in delays to accessing care upon arriving in Canada. While previous studies have identified these barriers, there is a need to understand these barriers within the context of existing structural processes, policies, and practices. In this interpretive description study, we examined mWLWH’s healthcare experiences and the structural and institutional factors shaping their experiences. Drawing on data from 24 semi-structured interviews with mWLWH (n=10) and service providers (n=14), as well as select federal and provincial policies, we examined how migration status influences mWLWH’s access to healthcare coverage and, subsequently, HIV care. Our findings show how delays and interruptions in healthcare coverage structurally marginalize migrant WLWH, impacting their ability to access timely HIV care. Two specific policy issues were identified: the initial 3-month wait period and interruptions in healthcare coverage occurring alongside visa expiration. In response to these structural constraints, mWLWH, HIV-serving organizations, and HIV clinics employ various strategies. For example, mWLWH may travel to their home country to access HIV care and medication. Organizations implement peer advocacy and support, and clinics/clinicians may do pro-bono work or establish alternative clinic payment structures to allow patients without healthcare coverage to access care. However, laboratory or diagnostic tests costs continue to be a challenge. Lastly, we also found that mWLWH experienced policing of their migration status in ways that sowed distrust in the healthcare system and further discouraged care engagement. Ultimately, these findings highlight the ongoing need to examine intersecting barriers to HIV care within Canada’s complex policy landscape and the importance of considering migration status as a key determinant of health.

Background: 2Spirit people (Indigenous LGBTQI+) faced the challenge of the North American AIDS pandemic that began in the early 1980's. Indigenous gay men were experiencing the brunt of the AIDS pandemic at the time and a gathering of 2Spirit people was eventually organized in Minneapolis, Minnesota, in 1988. The event was called, Basket and the Bow, which describes a historical Indigenous ceremony about gender identities and choices. The gathering, now in its 39th year of being hosted in North America, represents a culturally safer Indigenous response to HIV/AIDS and other STBBI.

Approach: The International Council of 2Spirit Societies is composed of representatives of 2Spirit organizations and groups in Canada and the US. They oversee hosting bids for the annual gathering which is shared between Canada and the US on alternating years. Involvement in this cross-border network has enabled 2Spirit people to be leaders in the response to HIV/AIDS. They have collaborated with governmental health departments as advisors, participated in research development and studies, provided awareness, education, outreach, and advocacy regarding the HIV pandemic and created community organizations and services to support health and wellness.

Key Contributions: The 2Spirit re-emergence has reduced the stigma about talking about gender identity and expression, and sexual orientation and sexual health. Today there are nine nine 2Spirit non-profit organizations and five council in Canada.

Critical Reflections: More research is required to determine if the HIV rate of transmission has decreased because of the 2Spirit gathering intervention.

Implications: The Annual International 2Spirit Gathering represents an Indigenous intervention in the response to the HIV pandemic. It's cross-border scope and culturally safe activities can me modeled to other populations such as Indigenous women and youth.

Background

People living with HIV (PLHIV) in Canada face significant structural barriers to care, including health insurance status, immigration status, systemic racism, and stigma, leading to delayed treatment and gaps in the HIV care continuum. These inequities disproportionately affect racialized communities, particularly Black and Latinx populations, Indigenous peoples, and newcomers. Community-first care models, situated in trusted, non-clinical spaces, are theorized to mitigate these barriers but remain under-described within Canadian health services.

Methods

Freddie, in partnership with PWA Toronto, implemented a low-barrier, community-driven HIV care program running one half-day per week. The integrated model provides ongoing virtual and in-person HIV care, including same-day consultations and antiretroviral initiation, regardless of insurance or immigration status. Services are delivered within a community hub already accessed for social supports such as food programs, housing and immigration assistance.
A retrospective programmatic analysis was conducted on patients accessing care during the initial implementation period, examining demographic characteristics, insurance/residency status at entry, and engagement across the HIV care continuum.

Results

During the initial implementation, 114 unique patients booked an intake, and 66 initiated care. Thirty-three (50%) had precarious or non-permanent immigration status. Individuals primarily identified as Black and Latinx or Latin American. Many reported delayed or interrupted care, citing cost, stigma, and challenges navigating the fragmented health system. The low-barrier approach enabled timely initiation of antiretroviral therapy for 59 (89%) clients, supporting the achievement or maintenance of viral suppression for those with available lab data.

Conclusions

This small-volume, community-driven HIV clinic demonstrated feasibility and meaningful social impact by advancing the HIV care continuum for racialized, newcomer, and structurally marginalized populations. These findings underscore the critical role of culturally responsive, trust-based, and community-embedded models in addressing persistent inequities in Canada’s HIV response and meeting national targets. Next steps involve expansion of this program to consolidate learnings for application elsewhere.

Background :

Stigma and discrimination remain persistent barriers to effective HIV prevention , treatment, and care . These social determinants not only limit access to health services but also exacerbate mental health challenges among people living with HIV .Older women and marginalized populations are particularly vulnerable, facing intersecting forms of stigma related to age, gender , and HIV status.

Methods:

This study employed a mixed-methods approach combining quantitative surveys with qualitative interviews among women aged 50+ engaged in HIV health services navigation programs Data were collected over six months (April- September) to assess experiences of stigma , discrimination, and mental health outcomes .Thematic analysis was used to identify recurring patterns, while descriptive statistics quantified prevelence and impact.

Results:

Findings revealed that 72% of participants reported experiencing HIV related stigma in healthcare settings, while 65% noted discrimination based on age or gender , Mental health impacts included heightened anxiety, depressive symptoms , and reduced self-efficacy in navigating care . However, participation in capacity development and health promotion activities fostered resilience, peer support ,and improved coping strategies mitigating some negative effects.


Conclusion:

Stigma and discrimination continue to undermine mental health and equitable access to HIV services . Community-based interventions that integrate capacity building and peer support can reduce psychosocial burdens and empower older women to advocate for their health. Addressing these social determinants is essential to achieving equitable HIV care and improving mental health outcomes.

Keywords:

HIV ,stigma , discrimination , mental health, social determinants , women 50+,community-based interventions

Background: Understanding the diverse experiences of people with HIV (PWH) is crucial for enhancing engagement in care and improving long-term treatment outcomes.
Methods: A 45-minute, cross-sectional, online survey was co-developed by investigators and community advocates from Canada, Mexico, and the US and translated into local languages. The survey captured treatment experiences of PWH across the HIV care continuum. Participants ≥ 18y were recruited through patient databases, patient panels, advocacy groups, and physician referrals.
Results: Among 852 participants, 24% were in Canada, 29% in Mexico, and 47% in the U.S. Most participants (97%) were currently on or had previously taken antiretroviral therapy (ART), with the majority (77%) of those currently treated taking single-tablet oral daily ART. Among those who were or had been on ART, 36% initiated treatment >30 days after diagnosis, including 48% of those diagnosed ≥ 10 years ago and 28% of those diagnosed < 10 years ago. Top reasons for delayed initiation were fear of potential side effects (29%), needing time to accept HIV diagnosis (28%), and physician recommendation based on CD4 count (25%).
Difficulties with treatment adherence were reported by 16% of participants taking oral ART and 13% taking injectable ART. The most important treatment features identified for staying on treatment long-term or for switching were that the treatment allowed PWH to achieve/maintain an undetectable viral load, was well tolerated and effective over a long period of time and had limited or manageable side effects.
Conclusions: Participants identified treatment effectiveness, long-term safety, and side effects as top considerations for remaining on or switching HIV medication. A substantial proportion of participants delayed starting treatment. These factors highlight important considerations for supporting PWH to remain engaged in care and take medication as prescribed.

Background:
African, Caribbean, and Black (ACB) migrants in Canada face unique social and structural challenges that shape their vulnerability to HIV after migration. Experiences of post-migration HIV acquisition occur within complex social environments that can provide critical emotional and practical support or, conversely, exacerbate isolation and stigma. Understanding how these dynamics affect coping is essential for designing culturally responsive interventions. This study draws on Social Support Theory to examine how formal and informal relationships influenced coping among ACB migrants following post-migration HIV acquisition.

Methods:
This qualitative study draws on the Msafiri Study, a mixed-methods investigation of post-migration HIV vulnerability among ACB migrants in Ontario. Forty-four in-depth semi-structured interviews were conducted with ACB individuals living with HIV who acquired the infection post-migration. Participants (61% male; 39% female) included diverse sexual orientations (MSM and heterosexual) and origins (Caribbean and Sub-Saharan Africa). Recruitment occurred through the Ontario HIV Treatment Network Cohort Study (OCS) between 2015 and 2017, using purposive sampling. Qualitative content analysis explored themes related to social support and coping.

Results:
Participants described diverse experiences:
(1) Positive family and peer relationships provided emotional stability and acceptance, buffering stigma and isolation.
(2) Unstable familial ties and migration-related separation limited kin support, increasing reliance on peers or partners.
(3) Community networks were ambivalent: while some offered belonging, others were perceived as judgmental, prompting withdrawal.
(4) Formal supports (healthcare providers, counselling, HIV peer groups) were pivotal in reducing anxiety and fostering resilience.
(5) Life stability factors (employment, education, immigration status) intersected with social support availability, shaping coping trajectories.

Conclusions:
Post-migration HIV acquisition among ACB migrants occurs within layered social contexts. Enhancing coping and well-being requires culturally safe formal supports, inclusive community networks, and stigma reduction within diaspora communities. Interventions should integrate family-based approaches and multiple forms of social support to strengthen resilience and long-term health.

Background:
African, Caribbean, and Black (ACB) migrants in Canada experience HIV vulnerability shaped by migration-related transitions, relationship dynamics, and structural inequities. Post-migration HIV acquisition often occurs in contexts of trust, exclusivity, and limited perceived risk, where prevention practices may be inconsistent or deprioritized. Understanding how individuals interpret risk and make decisions about testing and protection is critical for effective interventions. This study uses the Health Belief Model (HBM) to examine how perceptions of susceptibility, severity, benefits, and barriers intersect with structural contexts to shape HIV vulnerability among ACB migrants.

Methods:
This analysis draws on the qualitative component of the Msafiri Study, a mixed-methods investigation of post-migration HIV vulnerability among ACB migrants in Ontario. Forty-four semi-structured interviews were conducted with ACB individuals living with HIV who acquired the infection post-migration. Participants (61% male; 39% female; diverse sexual orientations) were recruited through the Ontario HIV Treatment Network Cohort Study (OCS) between 2015–2017. Qualitative content analysis explored narratives related to perceived risk and prevention behaviours.

Results:
Perceived susceptibility was often low, shaped by trust in partners, assumptions of exclusivity, and beliefs that Canada was “safe.” These perceptions intersected with structural barriers (stigma, gendered power dynamics, immigration stress, and limited access to culturally responsive prevention), reinforcing delayed health-seeking. Condom use declined in long-term relationships, reflecting perceived barriers (comfort, intimacy) and perceived benefits (pregnancy planning). Limited knowledge and underestimation of HIV severity contributed to inconsistent prevention and delayed testing. Substance use and “heat of the moment” contexts further reduced negotiation capacity. Conversely, some participants demonstrated proactive behaviours (routine testing, condom advocacy), indicating variability in perceived benefits and self-efficacy.

Conclusions:
HBM constructs reveal how low perceived susceptibility and structural narratives amplify HIV vulnerability post-migration. Interventions should recalibrate risk perception, normalize prevention in trusted relationships, and address systemic barriers through culturally tailored education and accessible testing.

The proportion of older adults (aged ≥50) living with HIV (PLWH) is growing rapidly across the globe. In Canada, African, Caribbean and Black (ACB) people constitute 2.5% of the population but 16% of people living with HIV. In the province of Ontario, ACB people constitute only 5% of the population but represent 25% of all new infections. For older ACB people in Canada, HIV stigma intertwines with ageism, racism, and minority stress, creating complex pathways to poor mental health outcomes. The prevalence of HIV/AIDS in ACB communities is among the highest in Canada, yet no empirical research has explored the experience of stigma and mental health among older members of these communities. Thus, the aim of this proposed study is to explore the intersecting stigma and mental health experiences of older PLWH in ACB communities in Ontario, Canada.
An explanatory sequential mixed methods will be utilized. Phase 1 will involve a cross-sectional survey using standardized scales (DASS-42; HIV self-stigma scale) to examine the prevalence of depression and anxiety and their association with HIV-related stigma among older PLWH in Ontario. Phase 2 involves in-depth qualitative interviews; purposively sampled from community-based HIV organizations in Ontario, to contextualize quantitative findings. Interviews will probe stigma experiences, experiences related to mental wellbeing, access to mental health services/support and coping with mental health. Analysis will integrate descriptive and bivariate statistics (STATA) and thematic coding (Nvivo) with integration occurring at the interpretation stage.
This study will generate insights and inform policies and services to reduce stigma and poor mental health outcomes among ACB people living HIV/AIDS. The study aims to improve engagement in care, adherence treatment, and overall health outcomes. This study will also generate and disseminate scholarly insights into how HIV-related stigma is enacted and experienced by older people in ACB communities.

The COVID-19 pandemic and the HIV epidemic have both highlighted the need of race/ethnicity-based data to inform responses to infectious disease outbreaks. However, no such public health data exist in Canada. To generate some such data, we extracted data from the GetaKit.ca study, which is a website through which persons in Canada could obtain free HIV self-tests. We used data from April 1, 2021, to March 31, 2024. From 8,459 participants, of whom 16% (n = 1240) identified as Black, we found that Black participants reported low levels of risk factors for STI/HIV acquisition. We also identified that Black compared to White participants reported lower rates of prior STI/HIV testing and prevention services, and lower overall rates of self-reported prior STI/HIV diagnoses, although this difference mainly only applied to prior chlamydia or gonorrhea infections among cis-male participants; there were no differences for the rates of self-reported prior syphilis infections (overall and in gay, bisexual, or other men who have sex with men) or chlamydia infections in cis women. Finally, diagnostic outcomes in the study identified non-significantly different rates of HIV diagnoses (from the HIV self-tests) but higher rates of chlamydia (from laboratory testing) among Black participants. These results highlight the need for more race/ethnicity-based data. They also suggest that current metrics of STI/HIV risk may not work well for Black populations.

Background: Understanding the diverse experiences of people with HIV in Canada is crucial for enhancing engagement in care and improving long-term health outcomes.

Methods: A 45-minute, cross-sectional, online survey was co-developed by investigators and community advocates from 11 countries. This sub-analysis of the global survey summarizes the responses of adult participants in Canada regarding their treatment-related quality of life, motivators for staying on HIV treatment, and experiences with stigma. The HIV Treatment Satisfaction Questionnaire status version (HIVTSQs) measured patient satisfaction with current antiretroviral therapy (ART) treatment (range: 0-60).

Results: Among 200 participants, 65% were cis-men; 32% were older than 50 years old; 29% identified as Black and Latinx MSM and other BIPOC communities; 23% identified as a person who uses drugs. 90% (180/200) were on ART at the time of the survey; 78% (139/179, excluding missing data) were taking one single-tablet oral daily ART. Among respondents currently on ART, the median HIVTSQs score was 52 (interquartile range [IQR] 45, 59). Achieving and/or maintaining an undetectable viral load with a treatment that is well-tolerated and effective over a long period of time were ranked among the most selected top motivators for staying on treatment. Dosing frequency and a treatment that requires fewer clinic visits were ranked numerically higher as motivators for staying on treatment than mode of ART administration. The majority did not feel judged by their HCP regarding their sexual orientation. However, over 40% reported having to work hard to keep their HIV status a secret, feeling like it affects their relationships in a negative way, and feeling uncomfortable in their romantic partnerships because of their diagnosis.

Conclusion: Despite high reported treatment satisfaction, these findings suggest further opportunities to facilitate treatment adherence and connect PWH in Canada with resources to deal with stigma and foster resilience.

Background: We developed “Healthy Aging Talks”- a series of Knowledge Mobilization (KM) events that bring personalized research results from the BCC3 study back to its participants. This initiative aimed to bridge capacity and peer relationships among women with shared experiences, while centering their roles in the research they made possible. Through events led by Community Research Associates (CRAs), we created an inclusive KM space to share study results and interactively highlight community-based research.
Methods: We partnered with Ribbon Community, a BC AIDS Service Organization, to plan and host the events. Their space and peer navigators were essential for attendee recruitment given their long-standing relationship with women in the community. The “Healthy Aging Talks” team included BCC3 CRAs, students, and staff. A BCC3 participant was hired in a paid role to co-develop the booklets and event artwork. Each event included CRA-led trivia, a presentation on healthy aging informed by study findings, a shared meal, Q&A with a physician, evaluations (Engage with Impact Toolkit), honoraria, and gift card draws.

Results: We identified actionable BCC3 research results and developed four booklets: Liver Health, Heart Health, Kidney Health, and Stress & Wellness Roadmaps. Each booklet included personalized research results, health-promoting information, and links to additional resources upon request. For each booklet, we hosted two events for women living with HIV (in-person and virtual) and one virtual event for women without HIV, resulting in 12 events engaging over 150 women. Virtual province-wide events maintained confidentiality to foster open sharing.

Conclusions: “Healthy Aging Talks” demonstrates that community-driven KM works to reduce stigma surrounding healthy aging with HIV. More funding is needed to scale this approach and create meaningful opportunities for connection, empowerment, and mutual learning by taking KM beyond standard presentations, embedding innovative engagement strategies, such as sharing personalized research results, and holistically promoting healthy aging.

Stamsh Slhanay Llawat II (SSLII), which roughly translates to English as Warrior Women Healing II, is a research initiative developed in collaboration with urban Indigenous community members in Vancouver’s Downtown Eastside (DTES) to address the enduring impacts of coloniality. Historically and to this day, the DTES is characterized as a high‑risk environment for HIV and other sexually transmitted and blood‑borne infections (STBBI). In addition, community members experience disproportionate exposure to chronic environmental stressors, including acoustic trauma, intensified by limited access to green space and nature‑based environments.

A year‑long wellness program grounded in Indigenous knowledges and supported by Wise Ones, cultural facilitators and a licensed music therapist strengthened participants’ connection to culture, self and land. The program centered culturally safe, trauma‑informed and relational engagement. Participants created personal cultural bundles containing medicines, cultural teachings, a rattle, a hand drum and songs. A ceremony was led to awaken the spirits of the instruments. The music therapist facilitated playful sessions to create safety and (re)awaken the inner child. Cultural facilitators led song-learning circles. Through this process, the profound potential of sound emerged as a healing modality.
To further explore sound’s therapeutic value, SSLII partnered with Lobe Spatial Sound, the first 4D immersive sound studios founded in North America. As the connection to the land, self and one another deepened, sound played a vital role in restoring balance and slowing the nervous system—inviting attentive listening and honouring relationality. In this way, sound became a bridge between place, community and ancestry, reminding us of its capacity to hold emotion, care and memory.

Initial findings from this study will be shared, highlighting how culturally grounded sound and music‑based practices can counter chronic environmental and colonial stress, foster acoustic sovereignty and enhance wellness for urban Indigenous people living with or at risk of HIV and other STBBI.

Context:
Peel Region has experienced a rising number of HIV diagnoses, particularly among gay, bisexual, and other men who have sex with men (gbMSM) migrants from Sub-Saharan Africa. This population faces intersecting barriers to HIV prevention and care, including stigma, limited culturally appropriate services, and challenges navigating local health systems. In partnership with Gilead, this project aimed to address these gaps by introducing community-based, co-located HIV prevention and treatment services at Moyo Health and Community Services, a local HIV/AIDS Service Organization, in collaboration with the PrEP Clinic.
Objectives:
1. To connect 300 gbMSM migrants in Peel Region to culturally responsive, status-neutral HIV prevention and care services.
2. To link approximately 75 people living with HIV (PLWH) to HIV treatment and support their integration into long-term local care systems.
Methods:
A co-located, community-based model was implemented, integrating HIV testing, prevention, treatment linkage, and wraparound supports informed by a peer advisory committee and staffed by peers. Outreach was conducted through shelters, community events, and Pride initiatives to increase awareness and access. Clinic data and client surveys were reviewed for program evaluation.
Results:
A total of 685 individuals were engaged through the initiative. Approximately 325 migrants were connected to appropriate HIV care using a status-neutral approach, with nearly 90% identifying as gbMSM. Thirty-nine PLWH were successfully linked to HIV treatment, and 100% of individuals newly diagnosed with HIV initiated and remain engaged in treatment. Client surveys indicated 100% satisfaction, with participants describing the clinic as welcoming, professional, and supportive of privacy and individual needs. Collaboration with local clinical partners strengthened the regional HIV care continuum leading to expanded HIV clinical services.
Conclusion:
This project demonstrates the effectiveness of a co-located, community-based, status-neutral model in improving access to HIV prevention and treatment for gbMSM migrants, highlighting its potential for scalability in other underserved regions.

Background:

Indigenous Peoples in Canada continue to experience disproportionate HIV and STBBI burdens, with communities on reserves facing persistent inequities in access to culturally grounded harm reduction services. Despite national expansion of harm reduction approaches, reserve-based programs remain inconsistent due to jurisdictional fragmentation, stigma, racism, confidentiality concerns, and chronic underfunding. Communities, Alliances & Networks (CAAN) has generated over two decades of Indigenous-led and community-based research documenting culturally rooted harm reduction strategies informed by youth, adults, and people living with HIV/STBBIs. This study mobilizes CAAN’s community-led data to identify systemic barriers, cultural strengths, and actionable pathways to strengthen harm reduction access on reserves.

Methods:

A secondary qualitative synthesis was conducted using an Indigenous methodological framework grounded in OCAP®, Two-Eyed Seeing, relational accountability, and decolonizing analysis. Data were drawn from multiple CAAN-led initiatives, including Weaving Our Wisdoms, GIPA Homefire, 2SHAWLS, Re:Membering, and Keeping Our Fires. Additional sources included community surveys, program evaluations, knowledge exchange events, and narrative datasets. Reflexive thematic analysis identified cultural, structural, relational, and community-defined determinants influencing harm reduction engagement and service uptake.

Results:

Three interrelated themes emerged.
Cultural supports as harm reduction: Ceremony, land-based practices, kinship, language, storytelling, and intergenerational knowledge strengthened belonging, reduced shame, and increased trust in services.
Systemic and structural barriers: Participants identified jurisdictional silos, discrimination in off-reserve settings, confidentiality challenges in small communities, and inconsistent harm reduction supply access as barriers that undermined safety and uptake.
Community-driven and youth-informed innovation: Peer-led distribution systems, cultural harm reduction bundles, and community-developed outreach approaches improved engagement, reduced stigma, and supported collective protection.

Conclusion:

Participants across age groups described harm reduction as culturally grounded and relational. Strengthening reserve-based harm reduction requires sustained Indigenous-governed funding, community-designed programming, integrated on-reserve services, and policy frameworks rooted in cultural safety, OCAP®, and distinctions-based Indigenous governance.

Background:
Indigenous people in Manitoba experience disproportionately high and rising rates of HIV, driven by intersecting structural, social, and historical determinants rooted in colonization, racism, and inequitable access to care. This community-based participatory research study (2019–2024) examined barriers, facilitators, and systems-level recommendations across the HIV care cascade for Indigenous people in Manitoba, using a socio-ecological and systems-change lens.
Methods:
We conducted 29 in-depth semi-structured interviews with 18 Indigenous people living with HIV and 11 healthcare providers across urban, rural, and northern Manitoba. Two Indigenous research associates with lived HIV experience supported data collection and analysis. Interview data were analyzed thematically and interpreted using Bronfenbrenner’s socio-ecological model alongside the Six Conditions of Systems Change framework. Findings were validated and expanded through a Two-Eyed Seeing data interpretation workshop with 44 stakeholders, including Indigenous leaders, policymakers, healthcare providers, researchers, and people with lived experience.
Results:
Participants identified persistent barriers across the HIV care cascade, including limited access to healthcare in rural and remote communities, stigma and discrimination, confidentiality concerns, gaps in HIV-related knowledge, and unmet social determinants such as housing insecurity, poverty, and substance use. Key facilitators included culturally safe, relationship-based care; comprehensive care hubs offering wrap-around services; peer and community supports; and access to cultural and spiritual connections. Recommendations emphasized the need for Indigenous leadership in health governance, improved healthcare access and transportation, equitable resource distribution, community-led solutions, enhanced HIV education, and mandatory culturally safe, trauma-informed care training. A community report and recommendations from the study informed a strategy provided to policymakers.
Conclusions:
Applying a systems-change and Two-Eyed Seeing approach reveals that improving HIV outcomes for Indigenous people requires coordinated structural, relational, and transformational change across health, community, and societal systems. This study provides actionable, Indigenous-informed recommendations to strengthen the HIV care cascade and advance health equity in Manitoba and similar contexts.

Background: Heterosexual-identified men who have sex with men (H-MSM) challenge dominant assumptions that sexual identity, attraction, and behaviour neatly align. Stage-based models of sexual identity, which presume linear progression toward a fixed endpoint, may not adequately reflect how H-MSM experience and make meaning of their sexuality. This study moves away from developmental frameworks that assume fixed, linear, or teleological trajectories and instead foregrounds sexuality as flexible, shifting, and at times contradictory. Drawing on queer theory and Interpretative Phenomenological Analysis (IPA), we examine how H-MSM navigate and negotiate sexual identity and attraction.

Methods: Ten heterosexual-identified men who reported sex with men participated in semi-structured Zoom interviews. Interviews averaged 65 minutes. Nine coders trained in interpretive phenomenological analysis conducted multimodal coding to capture emotional nuance and meaning-making. Analysis followed an interpretivist-constructivist paradigm informed by queer theory, emphasizing flexibility, context, and resistance to normative categorization.

Results: Two overarching themes were identified, each with accompanying subthemes. Theme 1, Situating Same-Sex Attraction, described how participants understood same-sex attraction as physical, exploratory, and often context-driven, shaped by gender and relational scripts that distinguished encounters with men from those with women. Theme 2, Sustaining Heterosexual Identity reflected how participants maintained a heterosexual self-concept while making space for same-sex attraction, achieved through decoupling identity from attraction and privileging heteroromantic desire as central to identity. Together, findings highlight flexibility, compartmentalization, and parallel meaning-making within H-MSM sexual identity and attraction.

Conclusions: The present study contributes to knowledge on sexual identity by showing how H-MSM sustain heterosexual identities while continuing to engage in same-sex desire. Participants grounded identity in heterosexual romantic commitment while positioning same-sex attraction as separate from its emotional weight. By showing how individuals weigh and assign meaning to sexuality, this study broadens understandings of sexual identity and supports queer perspectives that view sexuality as flexible, non-linear, and context-dependent.

Introduction: Racialized immigrants in Canada face disproportionately high rates of new HIV infections, compounded by persistent stigma and heightened vulnerabilities emanating from a confluence of factors including racism, systemic discrimination, lack of culturally sensitive HIV care, unequal healthcare access, and selective criminalization related status non-disclosure. Amid inadequate policy attention, this implementation study evaluates the effectiveness of an online HIV stigma reduction intervention, designed for racialized immigrants in Canada.
Methods: From a community-driven, collaborative, and knowledge co-creation standpoint, we engaged key stakeholders in a multi-phase implementation across Ontario and Alberta. Data were collected via focus group discussions, and pre- and post-intervention surveys.
Results: Results showed that:1) the intervention effectively reduced interpersonal HIV stigma between service providers and their clients, previously perpetuated unconsciously in the course of service delivery; 2) it enhanced psychological flexibility and acceptance of lived HIV experiences, empowering some service providers to become HIV anti-stigma activists in both their workplaces and communities;3) the online format bridged access barrier by offering service providers the opportunity to meet colleagues from different local sites/provinces based on facilitation cohorts that favored their schedule; and 4) long-term adoptability of the intervention and the scope of adoption (full versus partial adoption) are dependent on the size, vision and mission/goals of the collaborating organizations. Statistically, participants’ empowerment readiness [pre-intervention(x̄=31.47,CI:29.79-33.14);post-intervention(x̄=33.15,CI:31.68-34.63)] and confidence to combat HIV stigma and social injustice [pre-intervention(x̄=40.63,CI:38.78-42.48);post-intervention(x̄=43.28,CI:41.50-45.07)] significantly increased post-intervention.
Conclusion: The ACE intervention effectively promoted psychological flexibility and acceptance of lived HIV realities/ experiences, as well as promoted collective empowerment against HIV stigma and related forms of social injustices. However, sustained adoption requires organizational commitment and supportive government policies for integration into health service delivery settings.

Introduction: Through a governance lens, we approach STBBIs as not only a health matter, but also as something that gets framed as a social problem that state actors and institutions aim to manage. One such governance practice includes partner notification (PN), a common public health practice for attempting to identify and contact the sexual partner(s) of a person who received an STBBI diagnosis. We ask: Is PN an ethical and effective governance model for upholding well-being and for responding to the challenges of STBBIs?

Methods: Applying a critical socio-legal lens, we conducted a scoping review of the social science and public health/social well-being literature where PN practices have been evaluated in Canada, in English language academic and grey literature. A total of 19 sources published between 2014 and the summer of 2025 made up the core scoping review. A supplementary scoping review of the older literature evaluating PN in Canada from 2003 up to 2014 (11 sources total) was also conducted to better understand the recent research. A modest purposive review of select international literature was also done to speak to gaps in the Canadian research.

Findings: The core scoping review evaluated PN in the context of various STBBIs. The literature primarily evaluates whether PN is effective in identifying cases, and the social complexities of healthcare-patient interactions and of patient referral are under-examined. Ethics, law, policy, and governance are under-analyzed. Key populations, such as Indigenous people, are regularly overlooked.

Conclusion: While broadly on STBBIs, our findings are of relevance to HIV scholars. There is a need for interdisciplinary research and for social science perspectives to be included in evaluations of PN, given how PN is shaped by law and governance, by social interactions between healthcare and partners, and by power relations that can intersect with different forms of STBBI stigma.

Background: Women living with HIV experience high rates of childhood and adulthood abuse. Pathways affecting health-related quality of life (HRQoL) have been demonstrated, however, interactions with sexual wellbeing and its impact on HRQoL remain unclear. These connections are vital as sexual wellbeing is theoretically affected by abuse, understudied, and important to humans. We examined the effects of childhood abuse on HRQoL, directly and mediated by sociobehavioural exposures, adulthood abuse, and sexual wellbeing across three timepoints (T1–T3).

Methods: Longitudinal data of women living with HIV (n=1422) from Ontario, British Columbia, and Québec were collected from the Canadian HIV Women's Sexual and Reproductive Health Cohort Study. Childhood abuse was measured through surveys. Structural equation modelling with maximum likelihood estimation assessed the direct effects of childhood abuse history (sexual, physical, verbal) at T1 on HRQoL (mental, physical) at T3. Indirect effects were tested through sociobehavioural exposures (drug use, incarceration, sex work) at T1 and adulthood abuse and sexual wellbeing at T2. Covariates included age, education, immigration, and marital status.

Results: Among participants (mean age: 43, SD=10.6; ethnicity: 22% Indigenous, 29% Black, 41% white, 7% other), 68.7% experienced ≥1 form of childhood abuse. Their mean mental-HRQoL (41.8, SD=14.3) and physical-HRQoL (44.1, SD=14.3) were lower than established general population norms (50.0, SD=10). Childhood abuse was directly associated with mental-HRQoL (β=-0.17, p<0.001), as were sociobehavioural exposures (β=-0.097, p<0.05) and sexual wellbeing (β=-0.097, p=0.001). The total effect of childhood abuse on mental-HRQoL (β=-0.19, p<0.01) combined direct with indirect effects via sociobehavioural exposures and sexual wellbeing (β=-0.01, p=0.03). No significant pathways included physical-HRQoL. Childhood abuse was associated directly with sociobehavioural exposures (β=-0.0.414, p<0.001) and adulthood abuse (β=0.223, p<0.001).

Conclusions: Childhood abuse history was associated with poorer mental-HRQoL directly and through sociobehavioural and sexual wellbeing pathways. Considering these pathways could provide avenues for trauma healing and sexual wellbeing interventions.

Background:
Black African immigrant women living with HIV often enter the Canadian health system expecting timely, compassionate, and equitable care. Instead, many encounter racial bias, stigma, and delayed emergency responses that worsen health outcomes. For women who are newcomers, refugee claimants, or living with precarious immigration status, these harms are intensified by intersecting systems of oppression, including anti-Black racism, gendered discrimination, migration trauma, and HIV stigma. Despite frequent reports from peer navigators and community organizations, little research has examined how intersectional racism shapes emergency care access for this population. This work-in-progress study addresses a critical evidence gap.

Methods:
This ongoing qualitative project uses a community-engaged framework informed by intersectionality, Black feminist thought, and Critical Race Theory. Data collection includes: (1) a rapid literature and policy scan on racialized emergency care disparities; (2) consultations with Black African immigrant women living with HIV, peer navigators (including PWA), and cultural safety facilitators; and (3) preliminary informal interviews exploring triage delays, pain dismissal, misdiagnosis, and perceived bias. Thematic analysis examines how intersecting identities influence clinical interactions, communication patterns, and structural barriers to timely care.

Preliminary Insights:
Early findings highlight repeated triage delays, dismissal of pain, stereotyping, and harmful assumptions linked to immigration status. Participants describe feeling unsafe, misunderstood, and discouraged from seeking emergency care due to previous trauma. Many expressed disappointment with Canada’s well-resourced system, stating, “We expected better.” Peer workers report multiple cases of delayed access, worsening symptoms, and avoidable poor health outcomes among newcomer Black women.

Next Steps:
Upcoming phases include formal interviews, expanded community engagement, and development of recommendations to improve culturally safe, anti-racist emergency care. Findings will support training modules, policy advocacy, and creation of an intersectional framework to reduce racial bias and prevent delayed treatment.

Background/Purpose
As the population with HIV ages, older women (aged ≥50 years) living with HIV face unique challenges due to the intersection of aging, gender, and HIV-related factors. These challenges necessitate a nuanced, multidisciplinary approach to care. This study aimed to explore the application of the 5-Ms framework—Mind, Mobility, Medications, Multimorbidity, and what Matters Most—developed in geriatric medicine to address the diverse needs of this population, incorporating insights from interviews with older women living with HIV.
Methods
A qualitative study was conducted involving interviews with nine cisgender and transgender women aged ≥50 years living with HIV. Data were analyzed to understand the medical, psychosocial, and functional challenges they face. Findings were contextualized using the 5-Ms framework to propose tailored care strategies.
Results
Findings revealed significant cognitive vulnerabilities, including impairments in attention, memory, and psychomotor speed. Mobility issues, such as sarcopenia, low bone density, and increased fall risks, were prevalent, exacerbated by HIV therapies and substance use. Polypharmacy, hyperpolypharmacy, and multimorbidity posed substantial challenges, with adverse outcomes such as falls, cognitive decline, and drug interactions. Participants emphasized the importance of person-centered care, addressing stigma, sexual health, and their lived experiences.
Discussion
Geriatricians, in collaboration with multidisciplinary teams, are uniquely positioned to tailor care, reduce medication-related risks, and enhance quality of life.
Conclusion
Applying the 5-Ms framework can optimize health outcomes by addressing their medical, psychosocial, and functional needs, ensuring equitable, tailored care for this underserved population.

Background: Condomless anal sex (CAS) is considered a risk factor for STIs among sexual minority men (SMM) and can lead to additional health burdens for SMM living with HIV (LWH). However, STI acquisition may differ based on their relationship with sexual partners. We examined how variation in CAS across casual (e.g., a one-night stand), close non-romantic (e.g., friends with benefits), and romantic partners was associated with STI acquisition among single and non-monogamous SMM who are HIV-negative or LWH.

Methods: We used data from a longitudinal study of SMM health across Vancouver, Toronto, and Montreal (Engage Cohort Study; N = 2206). Participants completed STI testing and reported sexual and relationship details on their five most recent sexual partners, including information about condom use, every 6-12 months. We modelled how variation in the number of CAS events with casual, close non-romantic, and romantic partners was associated with STI acquisition, moderated by HIV-status.

Results: Engaging in CAS with casual (aOR=1.31, 95%CI:1.21, 1.42) and close non-romantic partners (aOR=1.30, 95%CI:1.21, 1.40) was positively associated with STI acquisition for all participants. However, SMM LWH had lower odds of STI acquisition when they reported more CAS events more romantic partners, aOR=0.40, 95%CI:0.22, 0.71; this effect was non-significant for HIV-negative SMM, aOR=0.89 95%CI: 0.69, 1.13.

Conclusion: Attending to who SMM are choosing to engage in CAS with is important for understanding their sexual health needs, as our results show CAS may not always elevate STI risk. Having more CAS partners was associated with STI acquisition only when this occurred with casual and non-romantic partners. When participants engaged in CAS with more romantic partners, there was either no increased risk for STI acquisition (among HIV-negative SMM) or lower odds (for SMM-LWH). These findings suggest there is a continued need for more tailored sexual health interventions among diverse SMM.

Introduction: In the context of culture is healing, we discuss wellness through a community program of gathering to engage in traditional activities.

Background: In August, 2024 Nine Circles’ Indigenous Cultural Support Worker (ICSW) launched a series of group programming at Nine Circles: Beading, Drumming Circle, Mending Mondays, Ribbon Skirt/Shirt Making, and Sewing Class. The ICSW leads a program of accessible, low-barrier, inviting cultural activities. Open to community members that access our walk-in harm reduction services (The Pit Stop) and Nine Circles clinic clients, groups are drop-in, all ages, beginner-friendly with tools and materials being provided.

Methods: Using a post-session evaluation questionnaire with closed and open-ended questions, participants were asked to indicate whether they enjoyed the session, their connection with others, improvements and future directions, as well as the opportunity for feedback on the benefits of attending the group.

Results: As of November 2025, 147 sessions were held with an average of 7 attendees per session. Outcomes include: the majority of respondents (99%) indicated they enjoyed the group and 98% indicating they were able to make social connection/s during the group (n = 447). Additional results will be presented as groups are regularly scheduled and ongoing. Qualitative feedback includes themes of gratitude, feeling welcomed, receiving teachings and mentorship, being creative, joy and laughter, as well as quotes reflecting insights on the impact the programming has had on individuals. To also be presented are visuals of creations by participants and physical examples for viewing at the conference poster site.

Conclusions: Participants have been able to make connections with fellow community members, learn new skills and traditional techniques, and create meaningful items as part of their wellness journey. In addition to their one-to-one support work the ICSW will continue to facilitate group programming and grow and adapt content as informed by community needs.

Background: Transgender (trans) and gender diverse (TGD) people are disproportionately impacted by HIV/STBBIs in Canada. Timely access to gender-affirming healthcare (GAHC; e.g. gender-affirming hormone therapy) is essential for optimizing HIV/STBBI prevention and care engagement among TGD communities. Yet, little is known about the barriers to accessing such care at a provincial-level. We explored barriers and facilitators to HIV/STBBI prevention/care among TGD people in Ontario, with special interest in GAHC integration.

Methods: We conducted brief demographic surveys and semi-structured interviews with HIV/STBBI clinic service providers/leaders and TGD community members/leaders across seven Ontario health regions. Interviews explored barriers, facilitators, current and best practices in providing integrated HIV/STBBI prevention and care and GAHC. Audio recordings were transcribed verbatim and analyzed in Atlas.ti using directed qualitative content analysis. We summarized participant characteristics with descriptyive statistics.

Results: Forty-two participants (n=20 HIV/STBBI clinic service providers/leaders; n=22 TGD community members/leaders) represented Ontario’s seven health regions. 90% (n=18/20) of service providers worked in urban centres. Notably, 20% (n=4/20) reported no TGD health training. Approximately one-third (32%; n=7/22) of TGD participants had never been tested for HIV/STBBIs. Anti-trans stigma (e.g., misgendering, limited provider knowledge about TGD healthcare), structural barriers (e.g., long wait times), and geographic inequities impeded care access. Peer support, warm referrals, integrated service models, and flexible care delivery (e.g., virtual care) facilitated access. Participants felt TGD care engagement was better when trauma-informed, culturally-aware care approaches were used and racialized and TGD staff were present.

Conclusions/Implications: Our findings highlight significant barriers to integrated HIV/STBBI prevention/care and GAHC for TGD people across Ontario, especially outside urban centres. Strengthening provider training and clinic inclusion, particularly in GAHC, may improve care access and engagement.

This article explores how First Nations people living with HIV in northern Manitoba and the health care providers who support them articulate their experiences of diagnosis, treatment, and long-term care through imagery and narrative storytelling. Grounded in Indigenous methodologies of Two-Eyed Seeing, storywork, and Ethical Space, the study engaged participants (n = 25) in qualitative interviews incorporating imagery-elicitation prompts at six milestones along the HIV care cascade. Participants described images or words symbolizing or describing each stage, producing a corpus of visual and verbal data analyzed through a semiotic lens. For some, visualization was difficult or deferred; moments of silence, pause, or narrative substitution held meaning in themselves, revealing the affective and embodied weight of remembering. The resulting interpretations trace a symbolic movement from disconnection to renewal, illuminating how participants with lived experience construct meaning within and against dominant biomedical discourses. Early imagery expressed fear, stigma, and rupture, while later imagery evoked rebuilding, learning, and relational continuity. Service providers emphasized both the structural barriers and moments of human connection that shape care, reflecting the intertwined experiences of those receiving and delivering services. Integrating Indigenous epistemologies with semiotic analysis reframes HIV care as a communicative and relational process, highlighting the power of creative and participatory approaches to advance decolonizing health research. The findings underscore the importance of culturally grounded, trauma-informed, and relationship-based models of HIV care and call for greater inclusion of Elders, Knowledge Keepers, and peer navigators to strengthen trust and cultural safety across the HIV care cascade.

During the COVID-19 pandemic, population-level administrative health data from Manitoba indicated that people living with HIV (PLHIV) had higher COVID-19 vaccination rates than the general population, while also experiencing higher rates of COVID-19 infection. These patterns differed from other STBBI-affected populations and raised critical questions about how HIV care and public health services functioned during periods of rapid system disruption. However, administrative data alone cannot explain how HIV service providers navigated pandemic-related challenges or supported PLHIV amid evolving public health guidance. This qualitatively driven mixed-methods study was designed to contextualize population-level administrative findings related to COVID-19 vaccination and infection among PLHIV through the perspectives of service providers and PLHIV. Semi-structured interviews and focus groups were conducted in Manitoba, Canada with 15 HIV service providers and 25 PLHIV who were engaged in care between April 2020 and March 2022. Guided by constructivist and critical paradigms, qualitative data were analyzed using reflexive thematic analysis. Service providers described three interrelated challenges. First, participants highlighted difficulties navigating complex and frequently changing public health regulations, often describing uncertainty and strain associated with shifting guidance. Second, providers reported extensive efforts to counteract COVID-19 misinformation and misconceptions among clients, requiring additional relational and educational labour. Third, service providers leveraged long-standing, trust-based relationships with PLHIV to respond to broader pandemic impacts, including heightened mental health distress and substance use challenges. These relationships enabled flexibility in service delivery and helped maintain continuity of care despite systemic disruptions. Findings underscore the central role of relational care and provider adaptability in sustaining HIV services during COVID-19 and other public health emergencies. Supporting HIV care during future pandemics and public health emergencies will require policy environments that enable relational work, allow flexible service delivery, and recognize the emotional and regulatory burden placed on frontline providers.

Title: Healthcare Provider Perspectives on the Alberta Recovery
Model: Early Reflections

Introduction: Alberta’s transition to a recovery-oriented system of care (commonly referred to as the Alberta Model) is positioned as a transformative shift in substance use and mental health policy. Grounded in an abstinence-based framework, the Alberta Model reorients the delivery of publicly funded mental health and substance use supports through a recovery-oriented lens. This policy shift has significant implications for registered healthcare practitioners and addiction counsellors, who are navigating changing expectations around clinical care delivery, professional discretion, and patient/client engagement.

Methods: This study draws on 25 qualitative semi-structured interviews with registered healthcare practitioners (including physicians, nurses, social workers, paramedics, and psychologist) as well as addiction counsellors throughout Alberta. Interviews explore how participants are navigating, interpreting, and in some cases, resisting the policy shift toward a recovery-oriented system of care.

Results: This study presents the preliminary qualitative analysis from a PhD project. Early analysis suggests that clinical conceptualizations of recovery are more variable than the Alberta Model assumes. Healthcare practitioners describe significant tensions between recovery-oriented policy decisions and the realities of clinical and community-based practice. While most participants describe alignment with recovery principles and values, many highlight the potential dangers around abstinence-based expectations and the marginalization of alternative care approaches, contributing to real and significant forms of ethical distress.

Conclusions: While recovery is often celebrated as a deeply personal and transformative experience, these early reflections invite closer exploration of how recovery is defined and operationalized in various healthcare professions.

Background: Canada’s unregulated drug supply is increasingly adulterated with non-opioid sedatives (e.g., xylazine, medetomidine) and ultra-potent synthetic opioids (e.g., nitazenes). Concurrently, policy changes in several jurisdictions have reduced/eliminated harm reduction and HIV/hepatitis C virus (HCV) prevention services, including needle and syringe programs, supervised consumption services, safer supply prescribing, and HIV/HCV testing. Using a structural vulnerability framework (SVF), we examine how these developments intersect with housing and income insecurity, food insecurity, criminalization, and engagement across the HIV/HCV care continuum.
Methods: We conducted a narrative review of scientific and grey literature published up to January 1, 2026. Searches focused on xylazine, medetomidine, and nitazenes in relation to HIV/HCV prevention, testing uptake, linkage to care, treatment continuity, and access to harm reduction services. Findings were synthesized using an SVF to examine how social, economic, and policy conditions shape exposure to a toxic drug supply, constrain access to HIV/HCV prevention technologies, and disrupt engagement in care.
Results: Xylazine, medetomidine, and nitazenes do not appear to directly increase biological susceptibility to HIV or HCV infection. However, the synthesis identifies indirect pathways through which these adulterants may elevate transmission risk, including increased injection frequency, prolonged sedation, assisted injecting, soft-tissue injury, and heightened exposure to sexual violence. Concurrent reductions in harm reduction and testing services undermine prevention infrastructures that support access to new injecting supplies, early diagnosis, and treatment as prevention. Structural vulnerabilities—particularly housing and income insecurity—amplify these risks by shaping drug use environments, limiting access to testing and care, and undermining the stability required for sustained antiretroviral therapy and direct-acting antiviral adherence.
Conclusions: Effective HIV/HCV prevention in the context of an increasingly toxic unregulated drug supply cannot be separated from broader structural and policy conditions. Maintaining low-barrier harm reduction, testing, and treatment services is critical to mitigating transmission risk and supporting continuity of care.

Introduction: Talking circles are an inclusive way of communicating that honours Indigenous cultural safety and prioritizes holistic connection. Within research, talking circles as a methodology offer a fundamentally relational approach that can maintain safety, trust, and cultural significance for communities. This project reflects on the application of talking circles within a research study assessing HIV care and treatment.

Methods/Methodologies: Within the CARE (Community, Aboriginal, Relationships, Experiences) Study, an evaluation of HIV care engagement pathways for Indigenous Peoples living across British Columbia, talking circles were selected as the methodology. We have started facilitating talking circles with Indigenous People Living with HIV across all health authorities in BC. The talking circles are facilitated by two research team members, a community researcher, and an Elder from the region. Our results outline the reflections on the project to date.

Results: Incorporating talking circles has yielded several important reflections. First, talking circles create a relational environment where participants can find comfort, common ground, and community support as they share their stories. However, in some communities, concerns around HIV disclosure may create barriers to participating, requiring consideration in selecting locations that balance representation of diverse experiences with meaningful participation. Secondly, the team reflects on that the nature of these talking circles may over-generalize the diversity of Indigenous experiences. Finally, reflections are offered on analysis. Rather than reducing stories to codes, analysis emphasizes making sense of experiences through storytelling and Indigenous ways of understanding, with Western analytic tools used only to support structure, not define, interpretation.

Conclusion: This study demonstrates that talking circles can be well-suited for conducting HIV research with Indigenous communities and peoples. Lessons from this project may help inform future studies seeking to safely and respectfully engage and include Indigenous communities in their work, in ways that honour their knowledge and ways of knowing.

Introduction: Community-based research (CBR) approaches are becoming increasingly visible, and many HIV researchers are looking to utilize these methodologies. We share a model of community and academic collaboration to co-develop a community-led quantitative analysis from hypothesis generation through manuscript development, situated within a basic and clinical sciences research team.
Approach: This project is embedded within the BC CARMA-CHIWOS Collaboration (BCC3), a community-based, cell-to-society study examining healthy aging among women living with and without HIV through biomedical/clinical and community visits. We created a mentorship team composed of: a community-based research mentor (academic research coordinator), a statistics mentor (post-doc with basic science and statistics expertise), and 3 community learners (women living with HIV employed as community research associates, with previous study-led introductory quantitative data training). This team pursued a research question identified by the community learners: what barriers do BCC3 participants face in completing the community visit?
The process involved a 5-part series of training sessions and participatory workshops from July 2025 to January 2026, focused on each stage of the research process: 1) hypothesis generation (one hour virtual, three hours in-person), 2) identifying and defining variables within the BCC3 study for our exploratory analysis (three hours virtual), 3) training on data cleaning followed by instruction on how survey data is prepared for statistical analysis (one hour virtual), 4) data interpretation of the univariate model presented by the statistics lead and key decision-making for developing a multivariable model (four hours virtual), and 5) abstract development and submission (two hours virtual).
Conclusion: This collaborative approach offers an opportunity to promote bi-directional learning between academic researchers and community learners to advance good practices in data management, analysis, and presentation. Our next steps involve development of a multivariate model, and preparing knowledge mobilization outputs to share findings with community and academic audiences.

Background: In health research, exclusion of “hard-to-reach” communities erases lived experiences and contributes to policies and programs misaligned with community priorities. This analysis assessed the prevalence and determinants of delays and loss to follow-up completing the community-engaged British Columbia CARMA CHIWOS Collaboration (BCC3) study, which examines healthy aging among cis and trans women living with and without HIV.
Methods: Data collection involved two steps: a biospecimen collection and clinical survey, followed within 30 days by a community survey administered by a research associate living with HIV. Two community-led analyses examined factors associated with community survey completion, comparing (1) on-time (≤30 days) versus late (>30 days) or lost (never), and (2) on-time versus late completion. Significance was assessed using Kruskal–Wallis, Wilcoxon, chi-squared, and Fisher’s exact tests.
Results: Among 638 participants, 440 (69.3%) completed the community survey on time, 120 (18.8%) completed it late, and 72 (11.9%) were lost. Being lost was associated with living with HIV, Indigenous identity, living rurally, current substance use, and current smoking. Late completion (versus on-time) was associated with living with HIV, African, Caribbean, or Black ethnicity, and self-reported anxiety, PTSD, or depression. Trauma score was also significant, but with no clear driver. Higher burden of physical or mental health diagnoses, homelessness, social support, and resilience were not associated with survey completion.
Conclusion: Although current procedures successfully engage many women, Indigenous women, those living rurally, and individuals who use substances or smoke are disproportionately lost. These findings highlight opportunities to adapt research approaches to improve accessibility.

Background: Previous literature reported that immigrant women living with HIV have higher disclosure worries than non-immigrant women. Reducing HIV disclosure worries among immigrant women may affect their healthcare utilization, treatment adherence and subsequent HIV transmission. Psychosocial factors such as trauma, family/community disruption, and limited social support may underlie this disparity. This study examined the association between immigration status and HIV disclosure worries among women living with HIV in Canada, which has not previously been studied.

Methods: We analyzed data from a longitudinal cross-sectional cohort survey in three Canadian provinces (CHIWOS). HIV disclosure worries were measured using the HIV/AIDS-Targeted Quality of Life (HAT-QoL) scale. We assessed descriptive statistics, including associations between sociodemographic and health variables with immigration status (Canadian-born citizen, foreign-born citizen, permanent resident, refugee). Multivariable logistic regression was used to adjust for sociodemographic and health-related variables that may affect the relationship between immigration status and HIV disclosure worries.

Results: Of the 1,389 women in our sample (mean age=43.0 years [SD: 10.6]), 911 (65.6%) were Canadian-born citizens, 238 (17.1%) foreign-born citizens, 166 (12.0%) permanent residents and 74 (5.3%) refugees. The proportion of women with high disclosure worries (HAT QoL ≥60) was highest for refugees (81.1%), followed by permanent residents (71.7%), foreign-born citizens (66.8%) and lowest for Canadian-born citizens (43.6%). In the adjusted logistic regression model, less secure immigration status, heterosexual sexual orientation, higher level of education, personal income ≥$20,000, unstable housing, never being on antiretroviral treatment, higher sexism scores, residing in Quebec, and higher HIV stigma were associated with high HIV disclosure worries (p≤0.05).

Conclusion: We found a clear association between immigration status and disclosure worries, where women with a more precarious immigration status reported higher disclosure worries. Our findings underscore the need for trauma-informed, community-based interventions that reduce disclosure worries for immigrant women living with HIV in Canada.

African, Caribbean, and Black (ACB) youth living with HIV face intersecting barriers related to stigma, racism, isolation, and fragmented access to care. While youth-focused HIV initiatives increasingly emphasize engagement and education, less attention has been paid to conditions of implementation that enable racialized youth to safely engage with systems of care. This abstract presents a reflective implementation analysis of HYPE Forum 2025: Equitable Futures, a youth-led, culturally grounded HIV convening designed with and for ACB youth living with HIV.

Drawing on program evaluation data collected for quality improvement, this analysis integrates matched pre–post evaluation findings (N = 36), anonymized aggregate participant feedback, and observations from program implementation. This work does not involve individual-level analysis or human subjects research. The forum combined HIV education and healthcare rights literacy with healing-centred, culturally grounded practices. Same-day access to health, legal, housing, and mental health services was also supported through an embedded resource fair.

Participants reported increased HIV knowledge, healthcare rights confidence, and system navigation, alongside strong psychosocial outcomes. Reduced isolation and new peer connections emerged as central outcomes, with over 90% of participants in the matched sample (n = 32) reporting increased connection and belonging. Aggregate qualitative feedback highlighted youth leadership, cultural grounding practices, and explicit engagement with anti-Black racism in healthcare as mechanisms that validated youths’ experiences, shifted blame away from individual patients, and fostered emotional safety and trust. These conditions emerged as enablers of immediate service uptake and same-day referrals, based on participant feedback and implementation observations.

The analysis documents limitations, including persistent structural barriers including housing insecurity and HIV criminalization, underscoring limits of time-limited interventions. Reflecting on strengths and constraints, analysis of the HYPE Forum offers actionable guidance for HIV programs and funders seeking to operationalize equity, trauma-informed care, and youth leadership, with implications for program design and scale.

Background: Geographic context plays an important role in shaping HIV prevention–related needs, priorities and practices among adolescents. Youth living in rural and remote communities may face distinct social and structural conditions that influence sexual practices, condom use self-efficacy, substance use, and access to basic resources. Evidence on rural–urban differences in HIV prevention outcomes among Northern and Indigenous youth in Canada remains limited. This study examined rural–urban disparities and temporal trends in HIV prevention indicators among adolescents in the Northwest Territories (NWT), Canada.

Methods: We analyzed repeated cross-sectional survey data from 1,930 adolescents participating in FOXY and SMASH HIV and sexual health workshops across the NWT between 2018 and 2025. Rural youth comprised 68.1% of the sample (n = 1,315). Mixed-effects regression models were conducted to assess adjusted associations between rural residence and HIV prevention–related outcomes, including condom use self-efficacy, sexual activity, food insecurity, and drug use in the past three months. Time-by-residence interactions were examined.

Results: In adjusted analyses, adolescents living in rural communities reported higher sexual activity (Acoef: 0.18; 95% CI: 0.10, 0.24; p < 0.001), greater food insecurity (Acoef: 0.11; 95% CI: 0.02, 0.21; p < 0.05), and higher recent (past 3-month) drug use (Acoef: 0.20; 95% CI: 0.11, 0.28; p < 0.001) compared to urban youth. Condom use self-efficacy did not differ by residence overall; however, a significant time-by-rural interaction was observed (Acoef: −0.24; 95% CI: −0.44, −0.05; p < 0.05), indicating a steeper decline in CUSE over time among rural adolescents.

Conclusions: Findings underscore rural–urban inequities in HIV prevention–related needs among NWT youth while highlighting opportunities for strengthening place-based, equity-oriented HIV prevention strategies. Interventions that build on community strengths and address resource and service gaps may help support condom use self-efficacy and reduce HIV vulnerability among rural adolescents over time.

HIV stigma negatively affects the health and well-being of people living with HIV. Undetectable = Untransmittable (U=U) is a key public health message with potential to reduce stigma, showing that people living with HIV who maintain an undetectable viral load cannot sexually transmit HIV. This study examines differences in U=U outcomes between people living with HIV and the general population to quantify disparities among these outcomes.
A total of 3,439 Canadian participants were included with 1,438 people living with HIV from the People Living with HIV Stigma Index study (September 2018 – October 2024) and 2,001 people from a general population survey conducted by Ipsos on behalf of the Canadian Positive People Network (CPPN) in 2025. Demographic information, including age, gender, and race/ethnicity was collected alongside U=U-related outcomes. Multivariable logistic regression models examined differences in U=U outcomes between groups, adjusting for demographic covariates.
Compared to people living with HIV general population participants had lower odds of being aware of U=U (OR = 0.12, 95% CI: 0.09-0.14), believing in the science behind U=U (OR = 0.49, 95% CI: 0.39-0.62), accepting U=U (OR = 0.72, 95% CI: 0.59-0.87), and having discussed U=U with their healthcare provider (OR = 0.02, 95% CI: 0.02-0.03). In contrast, participants from the general population had higher odds of believing that promoting U=U could reduce HIV stigma (OR = 6.34, 95% CI: 4.99-8.10).
These findings indicate that general population Canadians were far less likely to be aware of or believe in U=U, likely reflecting limited promotion in civil society; however, they were more likely to believe U=U could reduce stigma, despite limited exposure to its broader social and emotional impacts. Overall, gaps in public knowledge highlight the need to improve awareness and acceptance of U=U to reduce HIV-related stigma and broaden its impact on people living with HIV.

Background:
MSM in Canada face significant mental health challenges that heighten vulnerability to HIV and related adverse health behaviors. While existing research highlights elevated risks in this population, limited attention has been given to the distinct experiences of key subgroups, including Indigenous MSM, East and Southeast Asian MSM, and transgender MSM. This review examines how mental health, HIV risk, and sociocultural factors intersect within these understudied communities.
Methods:
A systematic literature review was conducted across Medline, Web of Science, and Scopus. A total of 139 peer-reviewed articles were screened, and 15 studies met inclusion criteria. Eligible studies focused on MSM in Canada and explored mental health experiences in relation to HIV risk or health behaviors. Thematic analysis was used to identify recurring patterns and subgroup-specific challenges.
Results:
Three overarching themes were identified: (1) Psychological distress, including depression, anxiety, and trauma; (2) Identity conflicts, such as internalized stigma, cultural alienation, and challenges navigating sexual and gender identities; and (3) Self-concept difficulties, reflected in low self-esteem, social marginalization, and strained interpersonal relationships. Subgroup analyses revealed unique vulnerabilities: Indigenous MSM experienced compounded effects of historical trauma and systemic discrimination; Asian MSM faced cultural stigma, fear of disclosure, and social isolation that contributed to healthcare avoidance; and transgender MSM reported heightened body image anxiety and stigma, resulting in risky sexual practices and reduced access to affirming healthcare. These mental health challenges were linked to substance use, inconsistent HIV testing, and elevated HIV risk.
Conclusions:
Mental health disparities among MSM in Canada are shaped by complex social and structural determinants. Culturally responsive mental health services, stigma reduction efforts, and inclusive policy strategies are essential. Future research should prioritize subgroup-specific barriers to strengthen mental health and HIV prevention initiatives.

Background: Community engagement and involvement are essential for the successful implementation of interventions to improve population health amongst Black communities, a group that has historically been made marginalized. Engagement/involvement of communities most impacted by a health problem must span across the various phases of the development, implementation, and sustainment of an intervention. The ensuing describes the academic-community partnership, and outcomes between the African, Caribbean, and Black (ACB) Steering Committee (SC) (a community implementation group) and REACH Nexus (an implementation-science research group).
Methods: Guided by Black centered epistemologies, the ACB SC is a pan-Canadian community implementation group composed of Black-led and Black-serving community-based organizations, researchers and trainees, policymakers, people living with HIV, and Black Canadians with lived experience. The ACB SC was created in response to the need to ensure that Black community leadership meaningfully shaped REACH Nexus’ HIV prevention and treatment strategies. The initial partnership began with collaboration on the development and implementation of a national HIV self-testing program - the I’m Ready program. However, the Committee’s work has now progressed from process-focused engagement to defining outcomes in eight key areas: knowledge synthesis to identify community needs, co-designing evidence-based strategies, resource mobilization, capacity building, expanding networks, project implementation and evaluation, and knowledge translation.
Results: In the last seven years, the partnership has delivered meaningful impact to Black communities in Canada, including reaching the undiagnosed through the successful implementation of HIV self-testing programs, tailoring knowledge translation to inform policy decisions on HIV prevention, and mobilizing funding for the sustainment of HIV testing programs in Black communities
Conclusion: The ACB SC and REACH Nexus partnership demonstrates how sustained, ground-up community leadership can translate research into measurable impact and inform future priorities. This model offers a replicable approach for advancing equitable, community-driven HIV prevention and care for other key communities in Canada.