Background: Integrating gender-affirming healthcare (GAHC) (e.g., gender-affirming hormone therapy) with HIV/STBBI prevention and care improves health outcomes among trans and gender diverse (TGD) people. Availability of integrated care across Canada is unknown. We conducted an environmental scan of HIV/STBBI clinic websites in Western Canada to determine: 1) HIV/STBBI prevention/care service availability; 2) inclusion of TGD people in care delivery, services and/or planning; and, 3) availability of integrated HIV/STBBI prevention/care and GAHC.

Methods: We conducted an environmental scan (February-September 2025) using Shahid & Turin’s 5-step framework to systematically assess information on HIV/STBBI clinic websites across Western Canada (British Columbia [BC], Alberta, Saskatchewan, Manitoba). A community-informed data extraction tool captured clinic characteristics, HIV/STBBI services, and TGD-specific indicators. Quantitative variables were summarized descriptively, geographic differences tested statistically, and eligibility criteria analyzed via qualitative content analysis.

Results: Across 548 HIV/STBBI clinic websites, clinic availability per capita varied substantially, with Manitoba showing the most (133 clinics; 9.91/100,000), then Alberta (181 clinics; 4.25/100,000), BC (207 clinics; 4.14/100,000), and Saskatchewan (27 clinics; 2.38/100,000). TGD website inclusion indicators (e.g., trans flag) were highest in BC (65.5%, n=135/206), then Saskatchewan (25.9%, n=7/27), Manitoba (19.5%, n=26/133) and Alberta (7.2%, n=13/181). Website mentions of medical (e.g. gender affirming hormone therapy) and social/legal (e.g., peer support, identification documentation update support) GAHC services were infrequent: Manitoba (5.3 and 8.3% respectively), Saskatchewan (11.1% and 7.4%), BC (2.4% and 5.3%), Alberta (0.6 and 4.4%). Integrated HIV/STBBI and GAHC appeared infrequently on websites across all provinces, with each province showing <3 services/100,000 population.

Conclusions/Implications: Across Western Canada, geographic inequities to TGD-inclusive and integrated sexual healthcare access exist. Our study draws attention to the relative rarity of HIV/STBBI clinic websites reporting access to GAHC. We highlight opportunities to increase TGD peoples’ access to integrated GAHC and HIV/STBBI prevention/care and inform pathways to structural change (e.g., website updating).

Background:
Self-rated health (SRH) remains undermeasured among women living with HIV (WLWH) of minoritised sexual and gender identities. This warrants attention; SRH is a validated predictor of HIV-related morbidity, mortality, and engagement in care, reflecting how minority stress, material insecurity, and other structural conditions cumulatively shape lived health experiences. SRH offers a person-centred perspective beyond clinical measures. We draw on a syndemics framework to assess associations between co-occurring structural conditions (material insecurity, violence, and substance use) and general SRH among WLWH.

Methods:
Data were drawn from the Sexual Health and HIV/AIDS:Women’s Needs Assessment, a community-based cohort of WLWH in Metro Vancouver (2014–2025). SRH was dichotomised as optimal(“excellent/very good/good”) versus suboptimal(“fair/poor”). Associations between past 6-month substance use(yes/no), food insecurity(yes/no), housing insecurity(yes/no), exposure to violence(yes/no), main income source(full/part-time work[reference],informal work, criminalised work, peer work, no main income source) and SRH were examined using multivariable generalized linear mixed models, adjusting for age, race/ethnicity, immigration status, and duration of HIV diagnosis.

Results:
Analyses were restricted to participants with minoritised sexual identities (‘lesbian’,‘bisexual’,‘asexual’,‘queer’,‘Two-Spirit’,‘other’), yielding 179 participants (46% of the original sample, 389), contributing 1701 observations (Sep-2014-Feb-2025). Among participants, 59.2%(n=106) were Indigenous, 33.5%(n=60) White, and 7.3%(n=13) other Racialized women/women of colour. 31.3%(n=56) reported minoritised gender identities. In multivariable analysis, recent food insecurity (Adjusted Odds Ratio(AOR):0.62[95%Confidence Interval(CI):0.61–0.62;p<0.001]), housing insecurity (AOR:0.75[95%CI:0.75–0.76;p<0.001]) and having no main income source or peer work vs. full/part-time work[reference](AOR:0.59;[95%CI:0.58–0.59;p=<0.001] and 0.90[95%CI:0.90–0.91;p<0.001], respectively) were significantly associated with lower odds of optimal SRH.

Conclusion:
Among WLWH with minoritised sexual identities, housing, food and economic insecurity were significantly associated with lower odds of optimal SRH, underscoring the role of material conditions that shape health and wellbeing. These findings 1) underscore the value of measuring SRH alongside clinical HIV outcomes and 2) identify housing, food, and income precarity as associated with SRH, warranting meaningful intervention.

Background: For many gay, bisexual, and queer men (GBQM), using HIV PrEP has been extremely stigmatizing. PrEP-related stigma is one well documented barrier to its use among GBQM. Our objective was to trace changes in the accounts of PrEP-related stigma longitudinally within a group of GBQM living in Canada, including many who had used, or were currently using, PrEP. To our knowledge, this contribution represents the first qualitative longitudinal analysis of this phenomenon in Canada.

Methods: We conducted annual longitudinal qualitative interviews with 46 HIV-negative GBQM living in Ontario or British Columbia, Canada. A total of 128 in-depth interviews were conducted over three years (2020–2022), transcribed verbatim, and coded in NVivo using reflexive thematic analysis.

Results: Most participants described experiencing little or no PrEP stigma in the last few years, attributing this to PrEP normalization within queer communities. PrEP stigma was not only commonly described as a thing of the past; the (reclaimed) trope of the ‘Truvada whore’ had been remade anew into the mainstreamed ‘responsible’ gay citizen. However, some men said PrEP stigma was still anticipated or enacted in social, sexual, and healthcare contexts. Although a few participants expressed recent concerns about being perceived as ‘slutty’ due to PrEP use, no one reported increased PrEP stigma over time nor linked stigma to PrEP discontinuation. For some participants, a new PrEP-related stigmatized status had emerged—the non-PrEP using sexually active GBQM as deviant and irresponsible.

Conclusion: PrEP stigma must be understood as a dynamic and frequently resisted social phenomenon. Many GBQM noted a significant discursive transformation, storying PrEP use not as a stigmatized status but a responsibilized health behaviour. Rather than eliminated, PrEP stigma has been recapitulated, taking on altered states with the emergence of new categories of non-biomedical engagement for HIV prevention as deviant.

Background:
South Asian and Middle Eastern (MENA) brown newcomers in Canada, including 2SLGBTQI+ and queer Muslim communities, face layered barriers to HIV prevention and care, including language gaps, stigma, conservative cultural norms, fear of disclosure, and limited culturally safe services. Experiences of Islamophobia and discrimination can further reduce trust in healthcare systems and discourage engagement with HIV prevention messaging, testing, and PrEP.

Methods:
From July to December 2025, HIV Buddies Canada implemented a multilingual, culturally responsive outreach initiative to increase HIV literacy, promote U=U/TasP, and enhance access to prevention through peer-led education and community dialogue. Program activities included nine multilingual awareness videos (English, Punjabi, Arabic), four HIV awareness postcards (English print), one HIV Buddies educational pamphlet, 25 peer discussion sessions “Let’s Talk”, two Dancing Buddies outreach events, and two storytelling sessions focused on stigma in South Asian and MENA communities. Outreach also included condom distribution, prevention messaging, and promotion of referrals for HIV/STBBI testing and clinical linkage through partner collaboration.

Results:
The initiative reached 500+ community members (South Asian, MENA, newcomers, and queer communities) through in-person outreach and digital platforms, with 5,000+ online views of U=U-related content. Outcomes included increased HIV literacy, improved confidence in discussing sexual health, reduced fear related to U=U, and improved awareness of prevention options(testing, TasP, and PrEP). Key challenges included conservativeness, community division, fear of being recognized within diaspora networks, language barriers, and misinformation. Queer Muslim participants highlighted additional concerns related to safety, stigma, and discrimination, reinforcing the need for trusted peer-based and culturally safe services.

Conclusions:
Multilingual, community-led HIV education can effectively engage diverse newcomer communities in Canada, including 2SLGBTQI+ and queer Muslim populations. Results support scaling culturally grounded peer models that address stigma, discrimination, and language equity to strengthen HIV prevention and care pathways.

Introduction: Gay, bisexual, and other men who have sex with men (GBM) may be at increased risk of sexually transmitted infections when sexualized substance use (SSU) and condomless anal sex (CAS) occur together, but this co-occurrence remains underexplored. Therefore, we examined factors associated with concurrent SSU-CAS at the sexual event level among GBM in Metro Vancouver, Canada.
Methods: We used data from the Momentum Health Study, a prospective cohort study of GBM recruited via respondent-driven sampling. Study visits with computer-assisted self-interviews occurred every 6 months from February 2012 to July 2019. At each visit, participants reported details on their last sexual events with up to five male partners in the past 6 months. We examined participant- and event-level variables. Concurrent SSU-CAS was assessed by asking if CAS occurred when using one or more of the following up to two hours prior to or during sex: poppers, methamphetamine, cocaine, crack, gamma-hydroxybutyrate, or erectile drugs. Multivariable generalized linear mixed models identified factors associated with SSU-CAS.
Results: Overall, 598 GBM, followed for a median of 3.5 years, contributed 1,922 visits and 3,810 sexual events, of which 449 (11.78%) involved SSU-CAS. Meeting partners online/apps (vs. other than community venue) was associated with higher odds of SSU-CAS (adjusted odds ratio [aOR]=2.73; 95% confidence interval [CI]=1.17-6.38). Living with HIV (vs. HIV-negative/unknown; aOR=9.73; 95% CI=4.15-22.83), prior knowledge of partner HIV status (vs. none/unsure; aOR=2.74; 95% CI=1.43-5.27), and more than one partner at that event (vs. only one; aOR=5.62; 95% CI=2.64-11.97) were also associated with SSU-CAS. Each additional male partner in the past 6 months was associated with higher odds of SSU-CAS (aOR=1.07; 95% CI=1.02-1.11).
Discussion: Findings underscore the need to integrate substance use and sexual harm reduction supports into health promotion and clinical services targeting GBM who are living with HIV and/or engaging with multiple sex partners.