Background: Public health organizations and authorities have subjected people living with HIV (PLWH) to surveillance and control to address the HIV/AIDS epidemic. In Ontario, public health authorities can issue and enforce orders against PLWH to prevent HIV transmission. However, how public health practitioners determine when someone constitutes a transmission risk remains underexplored. We examined how public health actors establish HIV risk in light of biomedical technologies, institutional practices, legal frameworks and social discourses.

Methods: Between March 2023 and January 2024, we conducted semi-structured interviews with 18 public health personnel across Ontario. Interviews were digitally recorded, transcribed, de-identified and thematically analyzed using Dedoose.

Results: Viral load measurement emerged as a significant factor when considering PLWH as a public health risk. First, high viral load was considered a potential indicator of risk, but only when linked to activities, such as condomless sex or non-disclosure of HIV-positive status. Second, discontinuity in HIV care or non-adherence to antiretroviral therapy may flag individuals for follow-up or intervention. Third, STBBI co-infection triggered a review of viral load status to assess the potential for HIV exposure. Fourth, non-compliance with public health orders positioned PLWH as needing management rather than support. Fifth, U=U (Undetectable=Untransmittable) has reconfigured risk, with participants generally viewing virally suppressed individuals as posing no transmission risk. Participants described using different informational infrastructures, including medical records and laboratory results, to determine one’s viral load, often without the knowledge or consent of PLWH.

Conclusion: The use of medical records to access viral load data without patient consent is concerning, as it introduces the possibility of increased surveillance and could reduce rights to privacy and bodily autonomy. Access to this information should be balanced with accountability mechanisms to ensure that using medical records and viral load data does not result in unnecessary surveillance or further stigmatization of PLWH.

Background: HIV testing and monitoring is a personal and vulnerable act, which can result in social and legal consequences — but what happens to the blood samples and personal health information afterward is rarely discussed, let alone understood. HIV-related test results, even when negative, or undetectable, are recorded in databases and accessed by public health practitioners, often without people’s knowledge or consent. This project was developed to make these practices and the underlying legal and policy pathways visible via an online accessible mapping tool at: www.mappingsero.ca.

Methods: Mapping Sero Surveillance is a collaborative community-based project led by people living with HIV (PLHIV) and people who work in the social sciences, law, community service provision, and advocacy. We conducted 43 semi-structured qualitative interviews across Ontario with clinicians, public health workers, and PLHIV with experiences of interactions with public health. The findings were triangulated with outcomes of legal and policy analysis to map the pathways of biomaterial and health information from HIV-related tests.

Results: Findings indicate a patchwork of knowledge, understanding, and approaches to manage the HIV-related health information and biomaterial across Ontario. Gaps in knowledge may result in misinformation and undermine informed consent processes for those in being tested. To address this context, our website details the process of HIV tests, including anonymous, nominal, and self-tests, along with ongoing monitoring of viral load, CD4/CD8, and genotyping/resistance testing. We provide details on key actors, legislation, and public health procedures, making the processes transparent to those tested and involved in the process, from clinical settings, to private and public health laboratories, to aggregate data in surveillance reports.

Conclusions: The aim of this community-based online resource is to help increase knowledge, and to assist with informed consent, the awareness of privacy rights, understanding of public health practices, and support the bodily autonomy of PLHIV.

Undetectable equals Untransmittable (U=U) remains a critical public health message. Beyond its biomedical importance, U=U may reduce HIV-related stigma by alleviating internalized shame and anticipated discrimination among people living with HIV. Limited evidence exists on how acceptance of U=U may affect stigma, and if so what are the underlying mechanisms.
People living with HIV from across Canada (N=730) completed the People Living with HIV Stigma Index between September 2018 and October 2024. Surveys assessed demographics, internalized and anticipated stigma, U=U awareness and acceptance. Causal mediation analyses examined individual resilience and healthcare empowerment around HIV treatment as potential mediators of the association between U=U acceptance and stigma, with nonparametric bootstrap 95% confidence intervals calculated based on 5,000 resamples.
Results indicated 72% of participants had heard of U=U, and among those, 71% fully accepted the message. Accepting U=U was associated with higher levels of resilience and healthcare empowerment, which in turn were linked to lower internalized and anticipated stigma (p <.05). Mediation analyses indicated that resilience partially mediated the association between U=U acceptance and lower internalized (ACME = -0.22, 95% CI [-0.33, -0.11], 28% mediated) and anticipated stigma (ACME = -0.15, 95% CI [-0.24, -0.08], 34% mediated). A smaller mediating effect for healthcare empowerment was found for internalized (ACME = -0.06, 95% CI [-0.12, -0.01], 7% mediated) and anticipated stigma (ACME = -0.04, 95% CI [-0.09, -0.01], 10% mediated).
Acceptance of U=U is associated with lower internalized and anticipated stigma among people living with HIV, in part through enhanced resilience and, to a lesser extent, healthcare empowerment with HIV treatment. Promoting U=U can be a key strategy for enhancing resilience and reducing stigma and its impacts. These findings highlight importance of including U=U in public health messaging and community-based interventions aimed at improving the health and wellbeing of people living with HIV.

Background: People living with HIV (PLWH) continue to experience structural marginalization, including stigma, inequitable access to services, and the impacts of HIV criminalization, such as fear, gender-based violence, and mistrust related to HIV non-disclosure. In Alberta, where HIV rates have nearly doubled since 2019, these dynamics disproportionately affect equity-deserving groups. While the impacts of HIV criminalization on stigma and health outcomes are increasingly recognized, less is known about how PLWH make sense of accessing legal supports and articulate their legal needs in everyday life.
Methods: This project was conducted in December 2025 in collaboration with HIV Edmonton, an AIDS Service Organization. Four focus groups were completed with 19 PLWH as part of a community consultation process. The discussion explored experiences accessing legal services, perceived legal needs, and the role of community organizations in legal navigation and support. Audio recordings and field notes were analyzed using thematic analysis to identify patterns in participants’ sensemaking practices.
Emerging Themes: Participants described legal needs as deeply intertwined with health and social experiences rather than as standalone concerns. Key issues included fear and uncertainty related to HIV criminalization and disclosure, as well as the challenges of navigating fragmented and unclear legal systems. Participants highlighted the cumulative effects of structurally embedded HIV stigma, racism, and prior negative encounters with legal and health systems. Community organizations were identified as sites of trust and relational support; however, structural and resource constraints created gaps in available legal support and navigation pathways.
Implications: Integrated, relational, and justice-oriented approaches to HIV care that recognize legal needs as inseparable from health and social conditions are needed. Strengthening partnerships between HIV service organizations and legal supports may improve trust, access, and continuity of care for PLWH, informing community-based interventions aimed at advancing health equity across HIV service delivery and the broader care continuum.

Background
LGBTQI+ immigrants and refugees (IRN) in Canada experience intersecting barriers related to migration status, sexual orientation, gender identity, racism, and HIV-related stigma, yet many health services are often not designed to adequately address these layered realities (Ghabrial et al., 2024). In Ontario, service models frequently lack culturally responsive and affirming approaches, contributing to delayed diagnosis, disengagement from care, and poorer mental health outcomes for this community (Logie et al., 2018; Vlassoff & Ali, 2011; Comeau et al., 2023).

Methods
This study draws on a needs assessment conducted through the Community Alliance for Accessible Treatment’s Rainbow Resilience Program, using a Gender-Based Analysis Plus lens to examine access to sexual health services for LGBTQ+ IRN. We employed a mixed-method, community-based approach engaging 42 service users and 51 service providers involving a total of 93 participants across Ontario. Data collection included 7 focus groups, 5 key informant interviews, and 44 surveys.

Results
Emerging findings reveal persistent system-level gaps, including limited provider capacity and training in cultural humility and trauma-informed care. Participants described fragmented referral pathways and reliance on informal networks to navigate services, highlighting systemic limitations. Layered stigma around sexual orientation, gender identity, HIV/HCV, race, and immigration status undermined trust and often delayed or prevented care, with key barriers including fear of disclosure, language barriers, and lack of representation in services and outreach tools/campaigns. Participants emphasized the need for peer-led, community-based approaches, centralized navigation, wraparound supports, and cross-sector collaborations to achieve equitable care.

Conclusion
Collectively, these findings add to existing literature by reframing inequities in HIV/HCV and sexual health care for LGBTQI+ IRN as consequences of structural fragmentation, limited cultural responsiveness, and capacity gaps rather than individual disengagement. Ongoing data collection will refine priorities and inform recommendations and tools to support equitable access to affirming HIV, HCV, and sexual health services.