Introduction: Numerous publications and public health bodies have hailed the introduction of the HIV self-test (HIVST) into the Canadian market as a significant advancement in enabling individuals, specifically men who have sex with men (MSM), to access the HIV care continuum. Yet, limited attention has been given to why MSM choose the HIVST over traditional testing modalities, or how the HIVST fits into MSM’s sexual health literacy (SHL) and broader understandings of HIV and testing practices.

Methods: Between April 1, 2021, and December 15, 2024, 1441 MSM who had never previously been tested for HIV used GetaKit, an online platform for registering and ordering a free HIVST in Ontario. From this population, twenty individuals were recruited to participate in qualitative interviews exploring MSM’s perceptions of the HIVST and how these intersected with their SHL regarding HIV and testing behaviours.

Results: The sociodemographic characteristics of participants were reflective of other studies of first-time HIVST users. Generally, individuals perceived themselves as having high SHL and being well-informed about HIV and the HIV care continuum; participants spoke knowledgably about physical HIV prevention methods and the importance of testing. However, twelve participants (n=60%, n=12/20) reported significant misinformation, particularly regarding pharmaceutical interventions (PrEP/PEP) and appropriate testing timelines; many doubted PrEP/PEP effectiveness and tested either immediately after sexual encounters or only once symptoms developed.

Conclusions: The observed errors, ranging from minor misconceptions to inaccuracies with potential for serious harm, highlight substantial gaps in both the factual and actionable dimensions of MSM’s sexual health literacy related to HIV and testing. These findings point to an urgent need for more accessible, consistent, and contextually relevant sexual health education from community partners and public health, recognizing that without such education, the HIVST may contribute to widening, rather than narrowing, gaps in MSM’s sexual health literacy.

Background
New long-acting HIV treatment options could improve quality of life and health outcomes for people living with HIV. One standalone injectable long-acting HIV treatment received Health Canada approval in 2020; however, in British Columbia (BC), publicly-funded long-acting HIV treatment remains inaccessible.

Methods
To identify the priorities of people living with HIV for the delivery of long-acting HIV treatment in BC, we conducted a community-based qualitative interview study with 40 participants living with HIV. Participants aged 15+, living with HIV in BC, and who could complete an interview in English or Spanish were eligible. We prioritized participants who identified as Two-Spirit, lesbian, gay, bisexual, trans, non-binary, queer, intersex, and asexual (2S/LGBTQIA+); Indigenous, Black, a Person of Colour (IBPOC); women, and people who use substances. We conducted thematic analysis with peer researchers to understand the priorities of people living with HIV for long-acting HIV treatment.

Results
The majority of participants expressed interest in using long-acting injectables articulating benefits such as improved quality of life, greater convenience, fewer side effects, less stigma, easier medication adherence, and less medication fatigue. However, no participants were currently accessing long-acting treatment. Barriers to accessing long-acting treatment included limited information, eligibility criteria, a lack of support from their HIV care provider, and more frequent doctor’s visits. Many participants pointed out a lack of representation of IBPOC, trans people, and women in long-acting HIV treatment research, which raised questions about safety within these communities. Participants wanted holistic, patient-centered care and emphasized the importance of choice and autonomy, including having long-acting HIV treatment as an option.

Conclusion
Access to long-acting treatment options must be improved to enhance health outcomes and quality of life among people living with HIV in BC. Underrepresented groups such as IBPOC, trans people, and women must be prioritized in long-acting HIV treatment rollout.

Background:
As AI enters HIV care, responsible development is critical to avoid reinforcing stigma and inequities while ensuring sustainability. Digital health tools such as the MARVIN HIV self-management chatbot may generate large volumes of patient messages that can support ART adherence monitoring. Building on previously developed LLM-based triage models to detect adherence barriers and stratify nonadherence risk, we conducted secondary analyses examining model interpretability, fairness, and sustainability as key responsible AI considerations for clinical integration.

Methods:
We evaluated our best-performing fine-tuned models (Flan-T5-xl for barrier detection and Flan-T5-large for risk stratification) against large-scale LLM baselines (GPT4.1 and Gemma-3). Error patterns were identified by inductively categorizing misclassified test-set sentences (n=1,380). Fairness was examined by injecting racial (Asian, Black, Indigenous, Latino, White) and gender (woman, man, trans) descriptors into 837 external validation sentences and measuring prediction shifts. Sustainability was assessed by estimating energy consumption per 1,000 inferences across models.

Results:
Six recurring error patterns were identified: ambiguous inputs, cross-category overlap, annotation inconsistencies, semantic overlap, implicit expressions, and contextual misinterpretation. For fairness, overall mismatch rates were similar for Flan-T5-xl (19.4%) and GPT-4.1 (18.0%), but distributions differed: Flan-T5 predictions with demographic descriptors clustered mainly in Social Situation barriers (65%), while GPT-4.1 often predicted None (44%), risking false negatives. For risk stratification, Flan-T5-large showed fewer mismatches (17.8%) than Gemma-3 (22.2%), which reclassified 33% of cases as None. For sustainability, Flan-T5-xl required 0.013 kWh per 1,000 inferences, higher than Flan-T5-large (0.007 kWh), but 3× lower than Gemma-3 (0.043 kWh) and 30× lower than GPT-4.1 (0.376 kWh).

Conclusions:
Error analysis highlighted misclassification patterns that can inform model refinement and clinical deployment. Fairness and sustainability assessments indicated that fine-tuned Flan-T5 models were more consistent and energy-efficient than large-scale LLMs. These exploratory findings support such systems’ potential for responsible ART adherence triage, pending further validation in diverse clinical settings.

Background:
Black communities in Ontario are disproportionately affected by HIV, accounting for 25% of new diagnoses while representing only 5% of the population. Existing interventions often fail to address the unique social, structural, and cultural barriers to care engagement for Black people living with HIV. There is a lack of validated tools tailored to assess and support the case management needs of this population.

Objective:
To develop the HIV Care Acuity Tool (H-CAT), a culturally relevant instrument for identifying and categorizing case management needs among Black people living with HIV in Ontario.
Methods:
An exploratory sequential mixed methods design was used. The qualitative phase involved in-depth interviews with healthcare providers, Black people living with HIV, and stakeholders, exploring the relevance of 22 pre-identified case management domains and identifying additional factors. Thematic analysis revealed two new domains: family situation and transitional care. In the quantitative phase, 28 experts rated 24 items for essentiality using Lawshe’s Content Validity Ratio (CVR).

Results:
Of the 24 items assessed, 19 met or exceeded the critical CVR threshold and were retained for further consideration. These items reflect a broad range of clinical, psychosocial, and structural domains relevant to HIV care and support. Five items, including substance misuse and transitional care, were excluded due to lower consensus. The integration of qualitative and quantitative findings ensured the tool’s cultural relevance and contextual

Conclusions:
H-CAT is the first acuity assessment tool specifically designed for Black people living with HIV in Ontario. Its development was grounded in community perspectives and rigorous content validation, ensuring cultural relevance and contextual fit. The tool supports equity-oriented, culturally responsive case management and has potential to improve care engagement and outcomes. Future work will pilot H-CAT in real-world settings to evaluate feasibility, reliability, and impact on care.

Background: Prisons are priority settings for efforts to eliminate HIV, hepatitis C virus, and other sexually transmitted and bloodborne infections. Dried blood spot (DBS) testing enables testing for multiple infections concurrently without the need for venepuncture or a healthcare professional. This qualitative study aimed to explore the acceptability of DBS testing among people incarcerated in Quebec provincial prisons.

Method: Semi-structured interviews were conducted in two Quebec provincial prisons (one men’s, one women’s) following disclosure of DBS test results, two weeks after testing. Participants were purposefully selected to ensure representation of injection drug use history, positive and negative test results, race/ethnicity, and self and assisted collection. Sekhon's Theoretical Framework of Acceptability, comprising seven constructs, informed the interview guide and analysis.

Results: Participants (n=30, 50% women, median age 35 years [range: 23-60]) described the DBS test as “easy” and “fast” (affective attitude). Although some participants reported anxiety waiting for their test results, most considered the wait time acceptable, with some stating that any inconvenience was offset by testing for multiple infections concurrently (burden). Participants valued having a choice between self or assisted collection (ethicality). Those who chose assisted collection (n=26) cited confidence in the research team’s expertise in performing the test, while some with injecting histories preferred assisted collection to avoid being “triggered” (self-efficacy). Finger prick sampling also accommodated those with difficult venous access due to past drug use (self-efficacy). Incarceration was viewed as an opportune time for testing due to few competing priorities (opportunity cost). Trust in the research team underpinned confidence in test results (perceived effectiveness).

Conclusion: People in Quebec provincial prisons consider DBS testing an acceptable method to test for HIV and other sexually transmitted and bloodborne virus infections. Opt-out DBS testing with options for both self and assisted collection could be incorporated into standard practice at prison admission.

Introduction: Approximately 60,000 people living with HIV/AIDS (PLHAs) in Canada experience chronic pain, defined by the International Association for the Study of Pain (IASP) as pain persisting beyond three months. This pain, often associated with HIV infection or antiretroviral therapy side effects, negatively influences physical health, mental well-being, and social functioning, affecting sleep quality, emotional state, cognition, motor skills, and daily activities. PLHAs frequently employ medical, complementary, and mind-body approaches to manage these complex symptoms.

Methodology: This study employed a sequential mixed-methods design, beginning with a bilingual online survey developed collaboratively by researchers, clinicians, and Peer Researchers. The survey included demographic data and explored chronic pain characteristics, medication and alternative treatment use, substance use, mood, and access to services. Adult participants residing in Canada, classified as having chronic pain by the IASP definition, were recruited through a comprehensive network.

Results: Among 248 respondents, 60.1% were male, 31.5% female, with gender-diverse participants represented. Most were aged 40–59 (50.8%) and reported low annual incomes (<$20,000 CAD). While 43.5% engaged in employment or structured activity, 24.6% received disability benefits and 9.7% were unemployed seeking work. Common comorbidities included chronic joint pain (69.4%), soft tissue pain (68.5%), mental health disorders (55.2%), sleep difficulties (54.4%), and substance use disorders (26.6%). Support was mainly from family (55.1%), with fewer accessing physiotherapy or community organizations (28.4%). Qualitative responses expressed gratitude for care but also frustration with stigma, treatment delays, and inadequate pain management, emphasizing the need for greater empathy and improved access, particularly regarding financial barriers and wait times.

Discussion: Despite overall satisfaction with healthcare, persistent issues like stigma, treatment delays, and inadequate pain management remain. This highlights the need for patient-centered, empathetic care that addresses clinical and systemic barriers. Future research should target underrepresented groups and ways to overcome these obstacles in HIV-related pain management.

Background: Black women continue to experience an inequitable impact of the Canadian HIV epidemic yet are underrepresented in prevention programs and PrEP uptake. While women account for 30% of HIV cases nationally, 98% of PrEP users are men, primarily white gbMSM. This gap underscores the need for community-driven strategies to improve access and uptake of PrEP among Black women.

Methods: Women’s Health in Women’s Hands Community Health Centre conducted two listening sessions (September 2025) with Black women with no prior PrEP experience. Sessions explored perceptions of HIV risk, testing practices, and attitudes toward PrEP to inform service delivery. Discussions were audio-recorded, transcribed verbatim, and analyzed. Pre- and post-session surveys assessed changes in awareness and willingness to use PrEP.

Results: Sixteen women participated (n=7; n=9). Four emerging themes were identified. (1) Risk Perception and Management: HIV risk was often underestimated due to reliance on partner assurances and stigma around partner count; mental health impacted risk tolerance. (2) Knowledge Gaps: Limited awareness of PrEP; lack of early sexual health education; believed PrEP is for gbMSM. (3) Barriers: Confidentiality concerns; HIV-related stigma; mistrust of pharmaceutical companies; lack of provider initiation of sexual health and PrEP discussions; accessibility and cost. (4) Motivators: Peer-led education; Black-aware providers; desire to protect oneself; culturally-tailored sexual health approaches; community-based outreach. Participants expressed interest in long-acting PrEP, despite concerns about side effects. Post-session surveys showed increased HIV and PrEP awareness (from 66.7% moderate to 73.3% high) and greater willingness to use PrEP (from 4 to 8 participants reporting high willingness).

Discussion: Findings emphasize the need for integrated, stigma-free HIV prevention within trusted community/clinical settings. Strategies include culturally-tailored education that integrates intersectional experiences of Black women, peer ambassadors, and proactive provider engagement. Expanding PrEP messaging beyond gbMSM and preparing for long-acting options could improve uptake of PrEP among Black women.

Background: Trans and gender diverse (TGD) peoples’ health is scantly covered in allied healthcare professional post-secondary education. This contributes to a lack of providers with knowledge of gender-affirming healthcare (GAHC), particularly gender-affirming hormone therapy, surgery referrals, and integrated GAHC and HIV/STBBI prevention/care. In response, we identified and characterized trainings available for care providers in Canada in three areas: HIV/STBBI prevention/care, 2SLGBTQ+ inclusion/affirmation (including GAHC), and integrated 2SLGBTQ+ affirmative HIV/STBBI prevention/care.

Methods: Drawing from Shahid and Turin, we conducted an environmental scan of available trainings in Canada, analyzing website content. We extracted data relevant to each training: the type of training (HIV/STBBI prevention and care; 2SLGBTQ+ inclusion/care; integrated 2SLGBTQ+ affirmative HIV/STBBI prevention/care), availability (provincial/territorial; federal) and other characteristics (e.g., format [virtual/in-person]). We analyzed extracted data utilizing descriptive statistics (frequencies, proportions).

Results: We identified 163 trainings available in Canada (55.2% [n=90/163] HIV/STBBI prevention/care; 42.3% [n=69/163] 2SLGBTQ+ inclusion/affirmation in clinical settings; 2.5% [n=4/163] integrated). Of the limited integrated trainings, 75% (3/4) were federally created and offered. Less than one-sixth (15.3%; n=25/163) of the total trainings were federal, with the remaining region-specific. Quebec had the most trainings available (26.4% [n=43/163]), with the majority in French. Of all national and provincial trainings, 25% (n=41/163) were in French. None of the integrated trainings specifically addressed the clinical considerations of HIV/STBBI prevention/care and GAHC. Instead, 2SLGBTQ+-focused trainings addressed the health needs or inclusion of the 2SLGBTQ+ community broadly.

Conclusions/Implications: Despite many available HIV/STBBI prevention/care and 2SLGBTQ+inclusion/care trainings, there is still a pressing need for clinical trainings on GAHC and on integrated HIV/STBBI and GAHC for allied healthcare providers to prescribe gender-affirming hormone therapy, make referrals for gender-affirming surgeries, and to holistically integrate HIV/STBBI prevention/care. These trainings are urgently needed to address gaps in access to care among TGD communities and to improve sexual and overall health equity.