Background
The HIV Legal Network’s 2024 report Scaling-up supervised consumption services: what has changed in Canada? showed a promising expansion of supervised consumption services (SCS) in Canada but also noted insufficient legal safeguards for their ongoing operation, persistent funding constraints, and emerging legal and policy barriers provincially. By the end of 2025, only 32 federally exempted SCS were operating compared to 39 in February 2024, more than 11 SCS ceased operations in Ontario, and Canada’s only hospital embedded SCS closed in Alberta. These closures are happening despite a relentless, unregulated toxic drug crisis and increases in new cases of HIV in Canada.

Description
In Ontario, the 2024 Community Care and Recovery Act prohibits SCS from operating within 200 metres of a school or childcare centre and prevents municipalities from operating or supporting a SCS without the province’s approval. In Quebec, new legislation adopted in 2025 requires ministerial authorization for some SCS and imposes rules regarding minimum distances from a school or daycare. Additionally, provinces are limiting access to key HIV prevention and harm reduction services including needle and syringe programs. For instance, Ontario has prohibited the distribution of sterile needles and syringes at recovery-oriented “HART Hubs” meant to replace SCS, while Saskatchewan now requires a one-for-one exchange of equipment. Meanwhile, Health Canada has reportedly added new requirements for SCS applications while shortening the duration of exemptions.

Lessons learned
SCS, and harm reduction more broadly, is highly vulnerable to political context. Two constitutional challenges are ongoing to contest SCS closures and discriminatory legislation in Alberta and Ontario. Political will and funding are urgently required, including from the federal government, to safeguard access to vital harm reduction services that prevent toxic drug deaths as well as HIV and other STBBI infections.

Background: Abstinence-based support groups for people who use drugs (PWUD) often require sobriety, limiting access for those actively using substances and undermining core elements of group support such as belonging, safety, and voice. In Saskatchewan, these barriers are especially consequential given substance-related harms shaped by settler colonialism and dislocation, which disproportionately affect Indigenous communities. Guided by liberatory harm reduction and dislocation theory, this study examines a community-led, low-barrier support group for PWUD in Regina, Saskatchewan.

Methods: Using a community-based participatory research design, AIDS Programs South Saskatchewan (APSS) and the Eaton Lab facilitated a low-barrier, harm-reduction-oriented drop-in support group for people who use drugs (PWUD). Sessions were co-facilitated by APSS First Nations staff and a social work practicum student, with attention to Indigenous ways of being and knowing. Two six-week phases were held (June 12–July 17 and August 7–September 11, 2024), and participation was open to anyone accessing APSS services. Structured group report notes captured session activities, discussion content, forms of engagement, and group dynamics, which were analyzed using qualitative thematic analysis.

Results: Groups ranged from 2 to 11 participants per session. All participants were Indigenous, and no additional demographic or attendance data were collected. Three themes emerged: (1) Storytelling as a Site of Healing and Resistance, enabling non-judgmental sharing and collective witnessing; (2) Peer-Led Learning, marked by horizontal knowledge exchange that recognized PWUD as experts in their own lives; and (3) Environmental and Bodily Safety, fostered through flexible engagement, non-mandated sobriety, and art-making that supported grounding, autonomy, and relational safety.

Conclusions: Findings demonstrate the importance of low-barrier, harm reduction-oriented support groups for PWUD. The group’s model of care actively challenges the potentially exclusionary norms of sobriety-based support systems. Further research that employs formal outcome measures is needed to determine these groups’ efficacy.

Background: Chemsex is commonly reported among gay and bisexual men and trans and non-binary people. Chemsex has been extensively studied in relation to motivations, health risks, and service needs. Research often relies on minority stress frameworks that emphasize vulnerability and risk. While these perspectives are important, they may overlook the informal protective strategies and collective resources that emerge within chemsex networks and that can contribute to safer practices.
Objectives: This presentation aims to (1) explore how people with chemsex experience organize mutual support and share knowledge about safer use, (2) examine the role of social bonds and trust in reducing harms associated with substance use and sexual practices, and (3) identify ways to better integrate these community-based resources into formal harm reduction interventions.
Methods: A community-based qualitative study was conducted with 64 sexually and gender-diverse participants who reported current or past chemsex involvement. Semi-structured interviews lasting approximately 90 minutes explored experiences of chemsex, peer support, and self-care practices. Data were analyzed using thematic analysis to identify recurring patterns related to community resources and harm reduction strategies.
Results: Participants described strong peer networks characterized by information sharing, collective monitoring of safety, and emotional support during and after chemsex sessions. These networks facilitated discussions about dosing, drug interactions, sexual health, and recovery practices. Many participants reported that trust and solidarity within these communities increased their sense of safety and reduced feelings of isolation. Individuals who had stopped practicing chemsex also recognized the value of these networks and emphasized their relevance for designing more acceptable and effective interventions.
Conclusion: Chemsex communities actively generate and circulate harm reduction practices that complement formal health services. Recognizing and partnering with these community resources can support more inclusive, participatory, and context-sensitive harm reduction strategies. Public health programs should incorporate the experiential knowledge of people with chemsex experience.

Background: Rollout and uptake of HIV pre-exposure prophylaxis (PrEP) has been limited among people who use substances (PWUS) in Canada compared with other priority populations. We assessed facilitators and challenges to PrEP implementation among PWUS in Vancouver’s Downtown Eastside to understand how access can be improved within these communities.

Methods: We conducted in-depth semistructured key informant interviews with diverse healthcare workers serving PWUS in the Downtown Eastside from July-December 2025. Eligible participants were aged 19+ and were recruited from participating clinic sites. Interviews (n=18) were transcribed and thematically analyzed.

Results: Participants were doctors (n=6), nurses (n=5), peer workers (n=4), pharmacists (n=2), and administrative staff (n=1). While some prescriber participants currently provided PrEP to PWUS, most highlighted that provider and patient knowledge and overall implementation within this population was suboptimal. Many participants were uncertain about determining eligibility for PrEP in PWUS clients under current guidelines related to sexual and substance use practices. Actual and anticipated challenges with adherence to daily oral PrEP among PWUS (e.g., forgetting to take pills) were a common concern. Participants shared that low-barrier integrated care models that connected patients with primary care, mental health, harm reduction, pharmacy, and social services ‘under one roof’ helped facilitate PrEP uptake among PWUS. Peer-based approaches to outreach and linkage to care were crucial in PrEP initiation and maintenance in this population. Many participants viewed long-acting injectable PrEP as a feasible alternative to daily oral pills that could optimize adherence, reduce barriers, and be offered alongside other frequently prescribed injectable medications (e.g., Injectable Opioid Agonist Treatment).

Discussion: Improving PrEP implementation among PWUS will require integrated and peer-based care models and improved access to long-acting modalities that may reduce adherence challenges among this population. Clearer guidelines and training are needed to support healthcare providers to determine which PWUS would most benefit from PrEP.

Background:
Saskatchewan has Canada’s highest rates of new HIV diagnoses for >15 years due to ongoing colonialism, systemic racism, and criminalization. Injection drug use is the primary transmission route and co-occurring endemics are syphilis and hepatitis C. People who use drugs face multiple barriers to testing, including stigma and inaccessible services. We offered combined point-of-care HIV, syphilis, and hepatitis C testing at outdoor pop-up clinics geo-located to areas of high discarded needle density in Regina.

Methods:
From June to November 2025, 147 people who use drugs were tested for HIV, syphilis, and hepatitis C at 9 pop-up clinics. Clinic staff trained in culturally safe and trauma-informed practices included nursing, phlebotomy, and Indigenous Peoples with lived experience of substance use. HIV and syphilis testing was conducted using the INSTI Multiplex HIV-1/HIV-2/Syphilis Antibody Test, and hepatitis C testing used the OraQuick HCV test. We conducted on-site phlebotomy and offered first-dose treatment for syphilis.

Results:
Participants were 57% men, 80% Indigenous, and 46% unstably housed. All but one person who approached pop-up and consented to participate completed testing. We identified 19 positive HIV cases and connected 17 to care, identified 21 positive hepatitis C cases and connected 12 to care, and identified 19 positive syphilis cases, treated 8 onsite, and connected 8 to care. We had one false positive HIV result. This low-barrier model is scalable and has identified a large number of previously undiagnosed infections.

Conclusion:
This model of geospatial pop-up testing clinics appears feasible and acceptable at identifying new cases of HIV, syphilis, and hepatitis C while linking participants to follow-up care. Collectively, these testing methods support real-world implementation in low-barrier, community-based environments. We discuss how to improve engagement with people who use drugs in HIV/STBBI testing and prevention and how future work aims to align with Indigenous data sovereignty frameworks.