Background:Nigeria’s HIV epidemic remains a major public health challenge, with adult prevalence at 1.3–1.4% and nearly 2million people living with HIV. Adolescent girls and young women (AGYW) are a priority population for achieving national HIV testing and treatment targets, yet evidence comparing their testing patterns to older women using recent national data is limited. This study examined differences in HIV testing outcomes (awareness and use of HIV self-test kits, ever tested, recent testing, antenatal testing) and testing location between AGYW (10–19 years) and older women (25–49 years).
Methods:Data from the 2024 Nigeria Demographic and Health Survey (NDHS), a nationally representative survey of 39,050 women, were analyzed. Descriptive statistics and multivariate logistic regression were used to compare HIV testing outcomes between AGYW and older women and assess associations with education, employment, and wealth. Results: The analysis included 14,708 AGYW (median age 19, IQR 17–22) and 24,342 older women (median age 35, IQR 29–41). Education differed significantly (p<0.001): 8% of AGYW versus 17% of older women had higher education; employment was higher among older women (61.1% vs 38.9%, p<0.001). AGYW were more likely to be in poorer/middle wealth quintiles, while older women were concentrated in the richest quintile. HIV testing awareness and uptake were consistently lower among AGYW (all p<0.001): most had never heard of HIV self-test kits, recent testing was about half that of older women, and antenatal testing was also lower. Testing location differed (p<0.001): AGYW were more likely to use public facilities and less likely to use private facilities. Education, wealth, and employment were significantly associated with all HIV testing outcomes (p<0.05).
Conclusion: AGYW show markedly lower HIV testing knowledge and uptake and greater reliance on public facilities, highlighting the need for youth-friendly interventions such as school-and community-based testing, HIV self-testing expansion, and strategies addressing educational and economic barriers.

Undetectable equals Untransmittable (U=U) is a public health message that can combat HIV-related stigma. Ensuring widespread awareness and acceptance of U=U is critical to challenging persistent stereotypes about people living with HIV. Yet, population-level data on U=U awareness and acceptance remain limited. This study addresses this gap by assessing U=U-related outcomes among Canadians who may be at risk for HIV and examining variation across sociodemographic characteristics.
Participants (N=3,004) using I’m Ready, Test, a national app that enables Canadians to order HIV self-testing kits, completed a survey when ordering a kit between January and October 2025. Survey questions assessed demographic characteristics and U=U-related outcomes: awareness, knowledge of supporting science, acceptance, and discussions with healthcare providers (HCP).
Participants self-identified as White (37%), Asian (30%), Black (17%), Indigenous (2%) or other (14%). Most identified as cis-men (64%), cis-women (26%) or other genders (10%). Sexual orientations included heterosexual (51%), gay (24%), bisexual (15%), or other (10%). Overall, 42% were aware of U=U. Among those aware, 79% understood the science, 77% accepted it, but only 26% discussed it with an HCP. Using multiple logistic regression, heterosexual participants were less likely to be aware of U=U than gay participants (OR 0.24, 95% CI 0.19–0.31). Asian (OR 0.57, 95% CI 0.45–0.73), Middle Eastern (OR 0.39, 95% CI 0.25–0.62), and Indigenous participants (OR 0.43, 95% CI 0.19–0.95) were less likely to be aware compared with White participants. Cis-women were less likely than cis-men to be aware (OR 0.77, 95% CI 0.60–0.98) and accept U=U (OR 0.63, 95% CI 0.40–0.97).
Promotion of U=U among the public remains a priority. Population-specific and culturally relevant U=U messaging is recommended to engage diverse populations. Beyond awareness, disparities in acceptance of U=U science and message persist, suggesting need for further research to identify barriers to uptake.

Background: Understanding GBM experiences in attempting to obtain PrEP may help develop interventions to improve PrEP access.

Methods: We undertook a community-based survey of GBM accessing sexual health services at community clinics and online in BC and Ontario. Respondents currently or previously using PrEP were asked about various factors (e.g., prior STIs, HIRI-MSM scores, clinic location/type) and the outcome (i.e., whether they were prescribed PrEP) of their first attempts to seek PrEP, with a particular focus on clinic type (sexual health, primary care, on-line service). Factors associated with success at first attempt to obtain PrEP were analysed using bivariate and logistic regression analysis.

Results: Overall 1705 individuals (53.8% in ON, 52.0% White, median age 34, Q1-Q3=28–41) were surveyed June-October 2022. Individuals reported prior STIs (38.2% gonorrhea, 34.1% Chlamydia, 19.6% syphilis) and 13.4% had HIRI-MSM risk scores >25. N=837/938 individuals who reported PrEP use completed responses regarding their first PrEP experience, with 89.6% (n=750/837) able to access to PrEP at first attempt. Individuals were more likely to have success if they accessed PrEP at a sexual health clinic (92.3%) vs. a general practitioner [GP] (85.9%), walk-in clinic (82.2%) or online service (80%), p=0.002. In logistic regression adjusted for age, income, province, prior bacterial STI, and HIRI-MSM risk index score (>25) only clinic type was associated with likelihood of
obtaining PrEP at first attempt: adjusted odds ratio [aOR]=0.483, 95%CI=0.283–0.823 with a GP, aOR=0.369, 95%CI=0.156–0.873 for a walk-in clinic, aOR=0.322, 95%CI=0.149–0.696 for an online provider compared to a sexual health clinic.

Conclusions: Self-reported success at first attempt to access PrEP was inversely associated with clinic type, with non-sexual health clinics being less likely to provide PrEP. Improving access to GBM sexual health services while examining how to improve outcomes for GBM seeking PrEP through other providers remain crucial to expanding PrEP uptake.

Introduction: In 2024 in Canada, 36% of new HIV diagnoses were among women, yet PrEP uptake among women remains low. We explored unmet educational needs, barriers and facilitators to prescribing PrEP to women in Canada.

Methods: Informed by the COM-B framework, which posits that practitioners require adequate Capability, Opportunity and Motivation to engage in changes in Behaviours like PrEP prescribing, we conducted 25 semi-structured qualitative interviews with non-infectious diseases physicians, final-year residents, pharmacists, nurses, or nurse practitioners in Canada. We recruited interviewees from our professional networks, using purposive and snowball sampling. Coding was performed until thematic saturation was reached, and analysis used constructivist grounded theory and constant comparison analysis.

Results: We interviewed two nurses, two psychiatrists, two endocrinologists, five OBGYN, six pharmacists, and eight family doctors across seven provinces. Preliminary themes are: (1) Provider misconceptions of HIV epidemiology and structural barriers perpetuate gender-based inequities in PrEP uptake (e.g., stereotypes of who is affected by HIV, discrimination related to sexual practices of women), (2) The nature of provider-patient relationships impacts willingness to discuss PrEP with women (e.g., reason for visit, longitudinal versus episodic care), (3) Providers expressed interest in communities of practice to support both PrEP prescribing and allied health-led interventions (e.g., collaborative prescribing, access to PrEP experts), (4) Provider education must address women-specific concerns (e.g., PrEP in pregnancy/breastfeeding/chestfeeding, women’s self-perceived HIV risk), and (5) Education on HIV PrEP should be low-barrier, practical, incentivized, tailored to diverse providers, and decoupled from HIV education, and include public education (e.g., share information at OBGYN conferences, women peer-led education).

Discussion: One strategy to increase PrEP uptake among women is via women-centred, specialist-supported, and low-barrier education programs for non-infectious diseases physicians and allied health professionals. Further work is needed to develop tailored models of PrEP care for women that integrate provider-specific priorities with community needs.

Background: Resilience is a key mediator of health disparities and HIV outcomes. This study identifies factors linked to increased resilience among adolescent girls and young women (AGYW) in post conflict Northern Uganda.

Methods: Cango Lyec is an open cohort in Northern Uganda. Between December 2020 and March 2023, 924 AGYW aged 13-24 were enrolled across four districts and completed interviewer-administered questionnaires on trauma, depression and sociodemographic characteristics. Venous blood was collected for HIV, HBV, and syphilis serology. Multivariable logistic regression was used to assess factors associated with increased resilience measured using the Connor-Davidson Resilience Scale.

Results: HIV prevalence was 2.7% (1.1% among 13-14; 1.7% among 15-19; 5.0% among 20-24). Six (25.0%) out of 24 HIV cases were not sexually active. Among sexually active AGYW (N=424), HIV prevalence was 4.2% (2.2% among 15-19; 5.2% among 20-24). Of the 24 HIV+, 50% had detectable viral loads. Resilience scores ranged from 16 to 93, with a mean of 60.5. Separate logistic regression models were fitted using the median (61.0) and the 3rd quartile (69.0) as a cutoff and adjusted for age and district. Factors associated with resilience scores below the median included having been sexually assaulted (OR=0.41;p=0.028), having been physically or verbally abused by a partner (OR=0.42;p<0.001), experiencing ≥3 distinct traumatic events (OR=0.40;p<0.001), sexual assault in the context of war (OR=0.22;p<0.001), and currently experiencing a lack of food or water (OR=0.37;p=0.030). Factors associated with resilience scores above the median included age (OR=1.15;p<0.001), currently attending school (OR=1.72;p=0.004), and having attained a secondary or higher education (OR=1.86;p<0.001). Having tested for HIV (OR=2.37;p<0.001) was associated with a resilience score above the 3rd quartile.

Conclusion: Ongoing legacies of war, especially gender violence, contribute to lower resilience and HIV vulnerability among AGYW in Northern Uganda. Wholistic approaches integrating HIV prevention with culturally-safe mental health initiatives are urgently required.

Background
People with HIV (PWH) are disproportionately impacted by British Columbia’s unregulated drug toxicity crisis compared to people without HIV (PWoH). Unknown-cause deaths among PWH have increased since the crisis’s onset, suggesting some may actually be unregulated drug toxicity deaths (hereafter, “drug-related”). We examined cause-specific mortality among PWH and PWoH in BC from 2015–2020 and adapted a method to classify unknown-cause deaths as likely drug-related.

Methods
From the COAST study, we characterized all deaths occurring 04/2015–03/2020 among PWH and PWoH (a general population sample) by three underlying cause groupings: unknown-cause (ICD-10 coded “R99”), drug-related (X41-X42;X44;Y11-Y12;Y14), and non-drug-related (all other deaths). We examined decedents’ demographic and clinical characteristics, and classified unknown-cause deaths as likely drug-related based on: 1) aged 20-64, 2) an undetermined/unknown/pending manner of death, and 3) drug use history (administrative data).

Results
There were 853 PWH deaths (9% unknown-cause; 18% drug-related) and 17,543 PWoH deaths (2% unknown-cause; 2% drug-related); Table 1. Among PWH, unknown-cause deaths resembled drug-related deaths on demographic characteristics and drug-related healthcare contact within 12 months; among PWoH, these two groups were less similar. Most PWH unknown-cause deaths (76%) had a drug-related healthcare contact within 12 months, compared to 24% of PWoH unknown-cause deaths (Figure 1). Our criteria classified 86% and 40% of unknown-cause deaths in PWH and PWoH as likely drug-related.

Conclusion
Our findings suggested many unknown-cause deaths among PWH in BC between 2015-2020 may be drug-related, and highlighted discrepancies in cause-specific mortality ascertainment compared to PWoH within the unregulated drug toxicity crisis context.