Background: As part of the DRUM & SASH implementation science team grant, we, a multi-cultural team, are working collaboratively and in allyship with the Métis community in Alberta to address HIV, HCV, STBBI and related mental health issues. As allies, we aim to reduce inequities experienced by the Métis community by supporting community-led initiatives grounded in Métis ways of knowing and doing. Our recent engagement in a multi-partner dried blood spot testing (DBST) pilot for HIV, HCV, HBV, and syphilis with Métis communities in Alberta provided an opportunity to reflect on allyship within the context of our research.
Methods: Using a case study approach, we reflected on our experiences planning, implementing, and evaluating this DBST pilot initiative and considered additional data from interviews with three DBST providers, meeting minutes, observational notes, and notes from team debriefs for themes related to allyship.
Results: We identified seven themes related to acts of allyship within this collaborative endeavor. Acts of allyship demonstrated by individuals from partnered organizations included, 1) establishing regular communication with community representatives; 2) being open and listening without judgement in order to reduce tensions; 3) developing a positive working relationship; 4) decision making (wherever possible) by those who represented the community; 5) acknowledging past and present poor relationships with the Métis community and the impacts of colonialism; 6) acknowledging the right of Indigenous communities to self-determine their health services; and 7) challenging the status quo.
Conclusion: These acts of allyship provide tangible lessons learned as well as guidance to future collaborators, and suggest promising practices for building respectful relationships as allies with Métis communities. Respectful relationships demonstrating allyship between health service providers, researchers, and policy makers and Métis communities are essential to fostering and supporting Indigenous community-led interventions targeting HIV, HCV and other STBBI.

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Background: Gay, bisexual, and other men who have sex with men (GBM) living with HIV (GBMLWH) report more methamphetamine use compared with HIV-negative GBM. Methamphetamine use is consistently associated with adverse sexual health outcomes. However, the drivers of methamphetamine use, such as heterosexist discrimination, internalized stigma, psychological distress, and individual coping styles (e.g., cognitive escape), and how they interrelate to increase GBM’s likelihood of using methamphetamine remain understudied. We examined these potential pathways to predict methamphetamine use in the past six months.

Methods: From the baseline sample of the Engage Cohort Study (2,449 GBM recruited between 02/2017 and 08/2019 in Montreal, Toronto, and Vancouver), there were 355 GBMLWH with complete data. Of these men, 35% reported methamphetamine use in the past six months (versus 6% of HIV-negative GBM). A structural equation model was fit using unweighted least squares estimation with robust (Huber-White) standard errors and a Satorra-Bentler adjusted test statistic to examine correlates of recent methamphetamine use (yes/no).

Results: The hypothesized model (see Figure) was a good fit for the data (CFI=.977, RMSEA=.02 (90%CI [.00,.04]), SRMR=.07). Heterosexist discrimination was directly and indirectly (through proximal stress) associated with psychological distress; childhood sexual abuse was directly associated with psychological distress. In turn, psychological distress was associated with methamphetamine use in the past six months indirectly, through sexual compulsivity and escape motives.

Conclusion: These data support a model in which GBMLWH may be using methamphetamine to escape stigma-related psychological distress. Interventions supporting GBMLWH who use methamphetamine should address heterosexist discrimination and psychological distress.

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Background:
Family physicians (FPs) are key providers of sexual and reproductive health care and the most common specialty caring for people living with HIV. To build frontline provider capacity to reduce stigma related to sexually transmitted and blood-borne infections (STBBIs), the Canadian Public Health Association (CPHA) is launching an online continuing medical education (CME) course targeted to FPs and other clinical care providers (forthcoming March 2021).

Methods:
First, CPHA completed a needs assessment—including findings from 21 key-informant interviews, focus groups with 27 patients and a survey including 21 physician respondents—and convened a scientific planning committee to oversee course content development. Secondly, experts with lived/living, clinical and research experience were engaged to write dialogue for case scenarios which, with the support of game design and development experts, have been developed into digital interactive simulations. Supplementary information, resources and tools were curated and/or developed to form a comprehensive and interactive online course.

Results:
E-learning is a preferred format for CME, and particularly suitable in light of COVID-19. The needs assessment revealed a need for and paucity of CME opportunities addressing psychosocial aspects of STBBIs and intersecting experiences of stigma (e.g., homophobia, transphobia, racism, substance use stigma). Addressing these complex and sensitive issues requires a safe learning environment, engaging and challenging content and opportunities for critical self-reflection. Several methods proved beneficial to achieving this through self-directed e-learning, including taking an interdisciplinary approach and applying adult education theory and game mechanics. Preliminary evaluation results will be shared, showing the extent to which the CME is succeeding at impacting attitudes, knowledge and practices that support stigma reduction.

Conclusions:
CPHA has employed creative solutions to the challenges of addressing the complex, multi-faceted issue of STBBI stigma through e-learning. Lessons learned can inform other stigma reduction initiatives with service providers to advance STBBI prevention and care.

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Data-intensive health research has become an increasingly useful tool for gaining valuable insights into population health. When using large datasets, it is crucial to engage communities in the research process in order to meaningfully address the public’s needs. This is particularly important when engaging Indigenous communities in research, as there is a need to understand the historical and ongoing impacts of colonialism and acknowledge the strengths in Indigenous peoples' knowledges and experiences while advocating for Indigenous leadership and self-determination in research.

The aim of this paper was to describe an allyship-based approach to community-based participatory research that was used to engage and involve Indigenous peoples living with HIV in three data-intensive research projects exploring HIV outcomes of Indigenous populations in Canada. The goals of the project focused on: 1) supporting Indigenous peoples living with HIV to actively participate in the research process, 2) generating research questions that can be answered with the available datasets, and 3) integrating Indigenous and Western ways of knowing throughout the research process.

The methodology and study design employed throughout this project is rooted in meaningfully engaging Indigenous people with living experience to co-lead as researchers throughout their research priorities and responds to issues relevant to Indigenous peoples and communities.

Through our work, we have rediscovered valuable considerations and our recommendations for engaging and involving Indigenous peoples in research are as follows: ensuring stakeholders’ involvement at the start of, and throughout the entire research project; honouring Indigenous ways of knowing, the land, and local protocols and traditions; prioritizing Indigenous voices; encouraging co-learning and building capacity; and developing longitudinal relationships with Indigenous communities.

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Background: Cultural safety in healthcare is most often associated with care provision for Indigenous and ethnic communities. Some argue that cultural safety should be extended to populations such as people who use substances (PWUS) and LGBTQ2S+ individuals - communities that are also marginalized by social-structural inequities. These identities often intersect with HIV, making cultural safety an important concept in HIV care.
Methods: The study objective was to understand barriers and facilitators to home and community care (HCC) experienced by older adults (>50 years) living with HIV (OALHIV) in British Columbia. Peer Research Associates and the study coordinator co-conducted 24 qualitative interviews with OALHIV, which included questions on cultural safety. The interviews were professionally transcribed, and then coded and analyzed using NVivo 12.0 software.
Results: The majority of participants self-identified with one or more communities marginalized by social-structural inequities (African, Indigenous, PWUS, and LQBTQ2S+). The theme of cultural safety was complex, ambivalent and intertwined with participants’ identities. Some participants appreciated HCC workers’ interest in their culture and willingly shared their life experiences; for others such interest was intrusive. Many Indigenous participants recalled facing discrimination because of their ethnicity or substance use, while some shared stories of HCC workers learning about Indigenous culture and respecting sacred objects. Several participants who self-identified as white reported “not having a culture” and simultaneously referred to experiences of discrimination from HCC workers based on their identities (e.g. living with HIV, LGBTQ2S+, PWUS).
Conclusions: Trust, respect and being listened to – this is how participants described cultural safety. Our findings suggest that cultural safety can serve as either a barrier or a facilitator to HCC services access for OALHIV in BC, depending on individual workers. Grounding HCC worker training and services in the concept of cultural safety may contribute to clients feeling their diverse identities are respected.

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Background: This is a story of working collaboratively as reflexive colleagues. Claudette, an Indigenous Elder, engaged with community and recognized peers experiencing similar adverse side effects. Research has also shown gender-related differences in initiation of combination antiretroviral therapy (cART) and regimen changes. We aimed to compare women and transgender individuals to males and identify if they experienced differences in cART regimen changes.
Methods: We used data from the Canadian HIV Observational Cohort (CANOC) including treatment-naïve individuals initiating cART between 2000-2016. Participants with known gender and ≥18-months follow-up were eligible. cART regimen change was defined as any regimen change (excluding brand/generic changes). Treatment change artifacts were minimized by excluding regimen changes that lasted <30 days. Poisson regression models examined the number of cART changes and the relative risk in women and transgender individuals compared to men, adjusting for era of cART initiation, third agent in cART, province, rurality, co-infection with Hepatitis C, baseline CD4 count, baseline viral load, viral suppression and rebound, and age at first cART initiation. Adjusted incidence rate ratio (aIRR) and 95% confidence intervals (CI) were reported.
Results: Of the 10,555 participants (8,728 men, 1,771 women and 56 transgender) women and transgender individuals experienced higher crude numbers of cART changes (1.95 and 2.09 mean changes, respectively) compared to men (1.63 mean changes). Compared to men, women (aIRR1.21, 95%CI:1.16,1.25) and transgender individuals (aIRR1.23, 95%CI:1.03,1.48) experienced significantly higher cART change.
Conclusion: Our team combined positive living experiences with epidemiological methods. It was a long and winding journey, with bumps along the way, to develop an approach to use data from CANOC in a good way. We found truth and relevance to this question as there were significant differences in the rate of cART change between genders. We demonstrated the importance of a gender-based lens in assessing patterns of cART changes.

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Introduction: The provision of care and public services for individuals affected by HCV and HIV has been massively disrupted by the COVID-19 pandemic. The further impact of barriers to primary medical care, harm reduction services, food distributions, and other critical supports has yet to be fully understood.

Methods: The Preservation of Sustained Virologic Response (Per-SVR) study is an ongoing prospective clinical cohort study of adults in BC who achieved sustained virologic response (SVR) following direct acting antiviral (DAA) therapy. The Per-SVR survey (administered at 3- and 6-month intervals for up to 10 visits) was expanded in July 2020 to gauge the self-reported impact of COVID-19 on participants. Quantitative and qualitative responses were collected around the impact of COVID-19 on patients’ experiences navigating healthcare, personal relationships, access to harm reduction services, and mental health.

Results
Of 122 participants surveyed between July and December 2020, 27 (22%) of respondents were tested for COVID-19 with 1 reporting a positive test. 47 (38.5%) respondents stated that COVID-19 impacted their ability to access health care between March and November 2020. While 9 (7.4%) did not access any services, 77 (63%) visited their healthcare provider in person. 78 (63.9%) respondents reported changes to employment status. Social distancing affected personal relationships for 22 (18%) respondents and had a negative mental health impact for 38 (31.1%). Our qualitative analysis found that COVID-19 exacerbated existing challenges in respondents’ lives including: new or worsening mental health symptoms, especially depression and anxiety; compounded psychological impact from isolation and increased overdose deaths; and more acute experiences of stigma or discrimination related to homelessness and substance use.

Conclusion
A significant proportion of participants reported disruption in health care because of COVID-19. Responses indicate that COVID exacerbated existing challenges related to poverty, homelessness, substance use disorder, and mental illness.

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Knowledge into Action (KiA) project is funded by the Public Health Agency of Canada (PHAC) as one of the projects to be supported through the HIV and Hepatitis C Community Action Fund (CAF), from April 2017 to March 2022.
Under the Sexuality Education Resource Centre MB (SERC), (KiA) project works with African newcomers and service providers in Winnipeg, focusing on providing information on STBBI prevention, treatment and stigma reduction. This project provides information sessions to African newcomer community members, youth and multicultural leaders (Objective 1), and capacity-building sessions to community leaders/resource people (Objective 2) and service providers (Objective 3).
This presentation will share experiences and findings from the first three years of work with community members, leaderships and community resource people. As a result of the community-based approach adopted in this project, community members and leaders are involved and perform key roles in the organization of all community sessions, provided in different languages.
These workshops are evaluated for the continuous improvement of the project through a comprehensive evaluation plan with SMART objectives, short- and medium-term outcomes and predefined indicators and targets. Evidence indicates that the project has been effective in reaching the short-term outcomes expected in the three Objectives, since the priority populations have consistently demonstrated overall increased knowledge or capacity according to the predefined indicators. Findings also demonstrate that the project has been successful in reaching its expected medium-term outcomes: most participants who joined follow-up evaluation activities reported that information has been useful in their lives and/or communities. We will share learnings presenting qualitative and quantitative data.

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Background: Experts have warned that COVID-19 control measures will amplify pre-existing health inequities among gay, bisexual, queer, and other men who have sex with men (GBM), including those related to HIV. For many HIV-negative GBM, COVID-19 has disrupted access to pre-exposure prophylaxis (PrEP) and has affected their sexual decision-making.

Methods: Our study examines these issues, drawing on in-depth interviews about PrEP conducted with 25 HIV-negative GBM living in Ontario during the first wave of the pandemic. Interviews were coded in NVivo using thematic analysis.

Results: We documented the existence of a public health morality—an emerging and contested ethical framework by which to determine how to be a ‘good’ and ‘responsible’ sexual citizen during the COVID-19 pandemic. This public health morality was shaped by several factors, including: self-concern versus risks posed to others; decreasing anxiety and becoming COVID-19 weary; shaming public health non-compliance; and comparisons between how society has responded to the HIV epidemic versus the COVID-19 pandemic. Our participants altered their sexual practices significantly to avoid COVID-19. Some halted, some continued, others restarted, and some stockpiled PrEP. Some participants’ sexual practices countered public health messaging to avoid all ‘non-essential’ contact with people outside of one’s household. Nonetheless, their COVID-19 prevention strategies, including minimizing the number of sexual partners, avoiding making new sexual connections, establishing trust, and evaluating people’s ‘common-sense’, mirrored the negotiated safety (i.e. seroadaption) strategies earlier developed by GBM to mitigate HIV transmission.

Discussion: Participants modified top-down public health messaging to create pragmatic sexual practices in response to COVID-19. It is necessary to account for the nuanced ways in which GBM mitigate COVID-19 risks and are responding to a complex, ambiguous, and developing public health morality, in order to avoid further stigmatizing GBM sex, amplifying anxiety, and potentially increasing COVID-19 transmission by neglecting practical harm reduction measures.

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Introduction: Racism is a social determinant of health and anti-racist practice is vital for public health equity. Despite ACB women comprising >35% of women living with HIV (WLWH) in Canada, we’ve had challenges engaging ACB communities in HIV research in British Columbia (BC). Local ACB leaders have suggested this is partly due to HIV-related stigma, mistrust, and unfamiliarity with research. Recognizing that researchers must collaborate with ACB communities to engage ACBWLWH in research, we sought to understand barriers and facilitators to research participation and to establish future research priorities for ACB communities.

Methods: We implemented an online survey by, with, and for ACB communities (aged 16+, living in BC) exploring past research experience, barriers and facilitators to research engagement, and future research priorities. We used descriptive statistics to summarize data and identified themes from text responses.

Results: Of 56 respondents, 44 (78.6%) identified as women, 11 (19.6%) as men, and 1 (1.8%) as gender queer, and 50% of respondents were over 25 years of age. While 24 participants (42.9%) previously participated in research, 51 (91.1%) were willing to participate in future studies, and 41 (73.2%) were willing to participate in HIV research. Unfamiliarity with HIV and reporting that HIV was not personally applicable were the primary reasons not to participate (n=8; 14.3%). Barriers to future research participation included time constraints (n=26; 46.4%) and mistrust of researchers (n=15; 26.8%). Facilitators included perceived benefits to individuals and their communities (n=47; 83.9%), and opportunities to share their voices/perspectives (n=34; 60.7%). Future research priorities include mental health and substance use.

Discussion: Findings will be used address the under-representation of ACB communities in HIV research by supporting community-informed engagement and recruitment practices. Learnings offer guidance to researchers on the importance of adopting anti-racist practices, building trusting relationships with ACB communities, and combatting stigma.

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Background: The impact of COVID-19 on different communities is shaped by their respective histories of public health crises and pandemics including HIV/AIDS. Gay, bisexual, and queer men (GBQ) have been the focus of HIV prevention and treatment policies for almost 40 years. Our objective was to explore GBQ’s interpretations and responses to COVID-19 public health measures in relation to their sexual health.

Methods: Engage-COVID-19 is a mixed methods study examining the impact of COVID-19 on GBQ living in Vancouver, Toronto, and Montreal. In-depth qualitative interviews were conducted to understand changes to GBQ’s sexual and social lives, including HIV/STI and COVID-19 prevention strategies they used in the context of multiple pandemics. In this preliminary thematic analysis, we present findings from 27 qualitative interviews (November 2020–January 2021). Participants ranged in age from 23-76 yrs/old and included 5 men living with HIV and 18 men of colour.

Results: Many participants considered COVID-19 to be a significant threat to their health and the health of others. There was variation in how participants applied COVID-19 public health recommendations in their everyday sexual decision-making. Some men had not engaged in in-person sexual activity since the lockdown in March 2020, whereas others limited the number of sexual encounters with new and previously known partners. COVID-19 affected the type of context-dependent sexual activities many participants engaged in with partners outside of their household (e.g., avoiding penetrative sex; wearing masks and/or not kissing partners during encounters; having more virtual sex).

Discussion: Our study reveals that GBQ managed risk and in-person sexual contact in ways that were attentive to COVID-19 public health directives and were shaped by HIV/STI mitigation strategies. In reflecting on their sexual behaviours in the context of multiple pandemics, many GBQ worked to reconcile government COVID-19 safety recommendations and policies with their sexual practices and desires.

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Background: AIDS Community Care Montreal-(ACCM) is a volunteer-driven community organization that provides support services and treatment information to people living with HIV/AIDS and/or hepatitis-C, and education for prevention activities in different settings. It is advised that opinions of service users should be prioritized when designing services in non-profit organizations. While there are several instruments that captures the service user’s needs, little empirical approach has been undertaken to determine those needs.

Objective: Our study aims to describe the people’s perspectives on the services/programs that ACCM should provide in 2021.

Methods: We have designed an online survey to be launched to our members in January-2021 and terminated by March-2021. Out of 200 members, about 70 are active. Although not all have internet access, our Drop-In center provides access to computers and internet. We anticipate reaching a sample size of 60.

We used the patient-generated index-(PGI), a measure of health-related quality-of-life that is used in health and other fields, with modified name and scoring structure (Person-Generated Index). The PGI allows people to identify, rate, and spend tokens on services/programs that are important to them.

It is a self-administered instrument and completed in 3-steps. Participants nominate up to five services/programs that should be prioritized by ACCM. Then, they rate each service/program on a scale of 0–5 (not at all important-to-extremely important) (originally 0–10). Finally, they spend 10-tokens to indicate the relative importance of each service/program. The scores from step two are multiplied by the tokens from step three. This weighted score allows an interpretation about importance and priority of the service/program.

Implication: Person-generated Index will allow us to hear our users’ voices, allocate our resources based on their choices. It is anticipated that this participatory approach will impact the user’s participation and satisfaction in using the services/programs and ultimately improve services/programs performance.

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According to the Institut national de santé publique du Québec (INSPQ), up to one-third of people newly diagnosed with HIV in Montreal are not covered by provincial health care. Without access to health coverage, it is extremely difficult for an individual to pay for essential health services and to enter or navigate the healthcare system at large.

"Le Cercle Orange," a Montreal-based project, is a creative and effective response to the needs of this population. The project, which is entirely free of charge for participants, connects existing resources across the city to provide ongoing care and treatment to PLHIV who do not otherwise have access to care. After assessing the specific needs of each participant, Le Cercle Orange connects them with a primary healthcare provider, treatment, routine tests, community organizations, and legal / immigration support, and provides ongoing follow-up to assure long-term continuity of care. The success of this innovative project is largely due to the dedication of our vast city-wide network of partners, and to the guidance of participants themselves.

Le Cercle Orange is about halfway through its two-year pilot phase. By January 2022, our objective is to have referred 100 people through the project, with 100% of participants receiving initial access to treatment, 90% maintaining an undetectable viral load, 80% continuing regular follow-up visits with their healthcare provider, and 60% taking steps to obtain provincial health coverage. The patient pathway, methodology of the project, characterization of our population and data reporting on the achievement of our objectives at mid-project will be available for presentation at CAHR 2021. Le Cercle Orange is aligned with the 95-95-95 targets of UNAIDS and Montreal sans sida objectives, and we hope it may inspire new strategies to address the healthcare needs of communities across the country.

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Utilizing Western research methodologies and methods are ineffective while conducting research alongside Indigenous Peoples. Research done with Indigenous Peoples using Western practices removes focus from community-driven priorities and instead places priority on data retrieval, analysis, and dissemination independent of the community being researched. Removing retrieved data from the community prevents Indigenous ownership, authority, and autonomy over their data. Bartlett et al. developed the “Collective Consensual Data Analytic Procedure” (CCDAP) in 2006 to address the lack of community involvement in the data analysis process. The CCDAP analyzes qualitative data with a community panel to reach a collective consensus of how to organize findings. This greatly reduces the possibility of introducing personal biases upon analysis while promoting the First Nations Information Governance Centre’s principles of Indigenous Ownership, Control, Access, and Possession® of the data retrieved. Furthermore, group participation helps to foster relationships within Indigenous communities. As Dr. Bartlett’s method can be cumbersome when presented with a large volume of interviews and data entries, Morning Star Lodge has adapted this process to create a method for data analysis that prioritizes Indigenous autonomy and self-determination while also streamlining the process to digital platforms. The adapted process was taken to ceremony and given the Cree name: NANÂTAWIHOWIN ÂCIMOWINA KIKA-MÔSAHKINIKÊHK PAPISKÎCI-ITASCIKÊWIN ASTÂCIKOWIN, translating to Medicine/Healing Stories Picked, Sorted, Stored. The CCDAP process was altered by first doing a thematic analysis of the data using NVivo software. Following the thematic analysis, digitalization was added to the process by means of programs like Microsoft PowerPoint and Excel. The digital aspect of analysis allows for a convenient method to perform analysis remotely using any videoconferencing platform that allows for screen sharing. The adapted method promotes a sense of community during data analysis and processing in a time where social distancing has become the norm during the COVID-19 pandemic.

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Introduction: Many community-based HIV research studies incorporate meaningful engagement principles (GIPA/MEPA) by training people living with HIV as peer researchers. Unfortunately, there are still some aspects of research (e.g., quantitative data analysis and interpretation) where many projects fall short in realizing GIPA/MEPA principles. We developed a framework to connect the expertise of peer researchers (e.g., frontline experience, lived expertise, community connection) and academic researchers (e.g., theoretical knowledge, research methodology, data analysis) to enrich the impact of a research project and to bridge the capacity of both sectors.

Methods: The HIV Stigma Index is developed and implemented by people living with HIV to measure the effects of HIV stigma on health and wellbeing. We developed and used our capacity bridging framework to guide the meaningful engagement of peer researchers in this study. To do so, we created online sessions with peer researchers to teach them about data analysis and interpretation and ways to support knowledge translation and exchange (KTE) activities. Peer researchers in turn brought their lived expertise to guide interpretation of the data in an iterative process that resulted in region-specific, peer-led presentations of our key findings used to engage researchers, policy makers, and community members.

Results: Preliminary observations of the capacity bridging process saw an uptake in engagement from peer researchers, with deeper feelings of belonging and inclusion in the research process. Peer researchers’ knowledge of the data analysis process increased measurably, and they were able to incorporate quantitative data into KTE activities. Academic researchers learned from the expertise of peer researchers to expand future analyses and KTE.

Conclusion: The capacity bridging framework provides greater depth and context of key research findings and integrates peer researchers in the development and implementation of KTE strategies; both increase the potential to make meaningful and “real-life” changes for people living with HIV.

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Background: Community-based research (CBR) brings invaluable peer expertise and knowledge to the table with the unique peer-to-peer connection. Thrive is a CBR project that examines the experiences with Home and Community Care (HCC) services for Older Adults Living with HIV (OALHIV) in the Vancouver Coastal Health region of British Columbia.
Approach: Four PRAs were hired and trained in CBR methods to conduct in-person qualitative interviews with OALHIV about their experience with and knowledge of HCC services. When COVID-19 pandemic restrictions came into effect in BC in March 2020, research teams had to pivot their approach to conduct recruitment and data collection virtually. As a result, seven interviews were conducted in person before the pandemic, and seventeen over the phone. All team meetings and data analysis are also done virtually. We innovated to stay connected to one another, and to participants.
Process: As peers we honed our listening skills while maintaining our focus on the stories of OALHIV and their experiences with HCC services. We became more intuitive about what participants were feeling and saying; there was a reciprocal learning. The team bonded during these COVID-19 restrictions despite the challenges and uncertainty. We edited our interview guides, and developed other projects and documents while maintaining a group consensus. We broadened our IT skills to remotely access the server to code and analyze data, and use software to schedule and participate in secure virtual meetings, NVivo software training, and study interviews. For hearing impaired participants, we submitted an ethics amendment to request nurse’s support in doing phone interview.
Lessons learned: The COVID-19 pandemic impacted PRA-participant interactions, shifted roles and responsibilities within the team, and required the adoption of new skills and approaches to connecting with participants and community. The experience provided us with structure, continuity, and opportunities for community capacity bridging.

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Background: The Feast Centre for Indigenous STBBI Research is dedicated to community-led research and training across the four pillars of health (Clinical, Basic Science, Epidemiology and Social Science). Our intent is to contribute to cultural responses to STBBI in Canada through respectful and dynamic collaborations. Our goal is to increase the use of Indigenous knowledges in STBBI research to encourage transformational change that addresses the physical, emotional, spiritual, and mental health needs of Indigenous peoples living with or at risk of STBBI.

Method: The Anishinaabe conceptualization of collaborating, amaamawi’izing, facilitates the interdisciplinary and collaborative work of scholars working alongside Indigenous communities. As Indigenous peoples collaborating with allied researchers, amaamawi’izing embodies the principles of “all my relations” that honours our first teacher, Ashkaakaamikwe (Mother Earth). Amaamawi’izing is an active stance that embraces the action of coming together with one mind in respectful and inclusive approaches.

Findings: Akin to the Two Row Wampum principles as applied in research, Two-Eyed Seeing and Ermine’s conceptualization of ethical space in research, we conceptualize amaamawi’izing as grounding the work of the Feast Centre. Amaamawi’izing is a relational, process-oriented concept that enriches interdisciplinary research through ethical and culturally sound processes that centres Indigenous knowledges and ways of being in health research.

Discussion: This is an evolving, traditionally informed, research model that emphasizes action, brings diverse people together, and is respectful of and appreciates difference. The Feast Centre’s diverse team of Indigenous and allied researchers and community members is exploring this sophisticated approach to collaboration. Premised on deep listening, appreciating difference, and striving to achieve consensus, our activities and funding opportunities are informed by Indigenous consciousness and ways of being. Furthermore, we will demonstrate how the use of amaamawi’izing in our work offers safe, ethical space where difference does not separate, but is inclusive, valued, and upheld.

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Background: In Canada, the rate of opiate use, opiate use disorder (OUD), and associated mortality and morbidity are higher among Indigenous peoples than the general population. Indigenous peoples on medications for opiate use disorders (MOUD) often face distinct barriers that hinder their clinical progress, leading to treatment attrition. Injection drug use is the main risk factors for blood-borne infections such as HIV and Hepatitis C for many Indigenous clients with OUDs in Saskatchewan. Such clients experience a complex recovery process from their opiate use, which includes treatment dropout.
Methods: We used a social-ecological model to inquire into factors that contribute to risk for opiate use, development of opiate use dependency and treatment outcomes for clients on MOUD. Twenty-two clients with a history of treatment dropout for OUD and currently enrolled in MOUD participated in the study. In-depth, semi-structured interviews lasting an average of 30 minutes were conducted on-site.
Results: The participants' ages ranged from 28-49, 59% were female, and 95.5% self-identified as First Nations. Additionally, 50% of participants live with a blood-borne infection (HIV, Hepatitis C or both). Using a social-ecological framework to analyze the data, we identified four themes from the study relating to a) risk for substance use; b) factors sustaining substance use; c) factors leading to treatment, and d) treatment failure and re-enrollment.
Conclusion: Using a social-ecological model helps to understand factors that influence an individual's risk for OUD, decisions to pursue treatment and treatment outcomes. Furthermore, utilizing a social-ecological model to examine the experiences of clients on MOUD can provide practitioners and policy makers with possibilities to imagine supportive, multilevel interventions that can prevent individuals from developing OUD, and support retention to MOUD. Such interventions include mitigating adverse childhood experiences, supporting families, and creating safe community environments.

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Two Spirit, gay, bisexual, queer, and other transgender and cisgender men who have sex with men (2SGBMSM) in Canada face serious population-specific risks. Mental health issues in this community are well documented, as are higher rates of substance use and suicide. There is also increasing recognition of the socioeconomic risks of being 2SGBMSM, such as housing instability and lower income, sometimes leading to homelessness. At the same time, policies and services focus disproportionately on HIV and other STBBIs. AIDS Service Organizations (ASOs) are expressing growing concern with the lack of public policy attention to mental and emotional health among 2SGBMSM. In the absence of other supports, these organizations find themselves struggling, without mandates or resources, to meet the most urgent needs of their clients.

This paper presents preliminary findings of participatory action research that documents mental health and well-being needs in the 2SGBMSM men’s community in partnership with the Gay Men’s Sexual Health Alliance (GMSH). GMSH is a network of 30 ASOs and other organizations in Ontario concerned with 2SGBMSM health and well-being. Some key findings include: the wellness needs of 2SGBMSM are not being met, the lack of a population-specific health policy, and the need to mobilize the community. The findings of this research will help the GMSH develop resources, programs, and ways to influence policy, as well as add to a growing literature.

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Background: The Canadian HIV Women’s Sexual and Reproductive Health Cohort Study (CHIWOS), a community-based, longitudinal study, has been exploring the experiences of women living with HIV (WLWH) in Ontario, British Columbia, and Quebec since 2011. To inform CHIWOS’s future direction, we used concept mapping to guide our assessment of the physical, mental, sexual and reproductive health experiences, and related care gaps WLWH face in Canada.

Methods: Concept mapping is a method which involves systematically visualizing relations between concepts/ideas using graphical representations. Firstly, we performed content analysis of CHIWOS quantitative manuscripts and conference abstracts published, under review, or near submission before August 1, 2019. Individual concept maps were created for each publication and then analyzed for overall content. By combining similar themes into one visual, six composite maps were developed. Secondly, we presented our results to a group of 10 national experts and 12 WLWH to validate the composite maps and develop a single model summarizing the care gaps and experiences of WLWH.

Results: Of the 116 CHIWOS papers, 59 met our inclusionary criteria. Six main themes emerged to inform the development of six composite maps: 1) quality of life, 2) HIV care, 3) mental health, 4) sexual health, 5) reproductive health, and 6) health and experiences of transgender WLWH. Experiences of lower income, food insecurity, HIV-related and intersecting stigmas, violence, substance use, and depression were inter-related experiences that emerged from the findings. Social support, enhancing resilience, and women-centred HIV care were critical strategies women employed to navigate care gaps.

Conclusion: Experiences of structural barriers and intersecting stigmas emerged as critical factors shaping lived experiences of WLWH enrolled in CHIWOS. Mental health and other non-HIV care experiences were characterized as greater priorities than HIV care itself. Using these findings to influence care programming and delivery will be essential.

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Introduction: People living with chronic HIV are dealing with many parallel but often competing self-management needs. Improving health-related quality of life of people living with HIV is now an ultimate goal of HIV care. Individuals’ behaviour is a central part of chronic disease self-management. Fundamental to the development of tailored self-management strategies is the need to understand influences of self-management behaviours judged by the persons living the condition.
Objective: To identify perceived barriers and enablers to acting on self-management goals among HIV+ older adults in Canada.
Methods: A cross-sectional survey study was conducted with HIV+ men and women in Montreal, Toronto, and Vancouver. A total of 110 participants completed the survey and defined 421 goals in free text format. Using a deductive theory-based analysis, barriers and enablers were categorized to the components of Capability, Opportunity, Motivation, and Behaviour (COM-B) model of behaviour.
Results: Health as a general concept and managing diet and fitness were the most common self-management priorities. Difficulty breaking down routines and habits and lack of time and motivation formed majority of perceived barriers. Perceived enablers were mainly focused on improving psychological capability (establishing better habits) and physical opportunity (time management, financial plans, and seeking treatment). An overview of identified barriers and enablers is presented in Table 1.
Conclusion: HIV+ people are able to report their priorities, areas of challenges, and potential facilitators. Enabling HIV population to translate these self-management ideas into practice is of paramount importance.

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BACKGROUND: Good healthcare provider (HCP)-patient engagement can help address unmet needs that negatively impact quality of life (QoL). We investigated HCP-patient discussions and explored associations with health outcomes among people living with HIV (PLHIV) in Canada.

METHODS: Data were from the 2019 Canada Positive Perspectives Study of PLHIV on treatment (n=120). HCP-patient engagement was modified from the Observing Patient Involvement scale. Descriptive/multivariable analyses were performed.

RESULTS: Demographics were: mean age (SD), 38.3(12.1) years; virally suppressed, 64.2% [77/120]; women, 25.8%[31/120]; and diagnosed between 2017-19, 30.8%[37/120]. Most were uncomfortable discussing with their HCPs concerns regarding having children (57.5%[69/120]), privacy issues (55.8%[67/120]), impact of HIV on their life (52.5%[63/120]), and emotional challenges (52.5%[63/120]).Top reasons for not broaching treatment concerns included: perception little could be done (24.2%[29/120]), perception that HCP’s priorities differed from theirs (24.2%[29/120]), apprehensive of wasting doctor’s time (22.5%[27/120], and difficulty broaching topic (22.5%[27/120]).
Overall, 52.5%[63/120] were updated on new treatment options and 55.0%[66/120] reported their HCP asked their views before prescribing treatment. However, 52.5%[63/120] still wanted more involvement in their care. The top issues considered treatment priorities among those diagnosed for ≥1 year (n=111) included reducing long-term impacts (46.9%[52/111]), minimizing treatment side-effects (46.0%[51/111]), and ensuring viral suppression (44.1%[49/111]).
Positive health-related outcomes increased with increasing HCP-patient engagement (low[n=45], moderate[n=37], high[n=38]), as follows: optimal mental health (42.2%, 27.0%, 60.5%, p=0.014); optimal physical health (20.0%, 35.1%, 63.2%, p<0.001); optimal sexual health (17.8%, 29.7%, 44.7%, p=0.028); optimal overall health (35.6%, 48.6%, 65.8%, p=0.023); and treatment satisfaction (26.7%, 56.8%, 97.4%, p<0.001). Participants who felt their HCP took their concerns to heart and prioritized matters important to them reported 8-fold higher prevalence of treatment satisfaction than those perceiving otherwise (82.5%[66/80] vs 10.0%[4/40], p<0.001).

CONCLUSION: High HCP-patient engagement was associated with better health-related outcomes. Improving the quality of communication may better support the goal of improving health-related QoL

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BACKGROUND: On December 1, 2018, Canada officially endorsed the Undetectable=Untransmittable (U=U) campaign, becoming the first country in the Americas to do so. The uptake of the U=U message within clinical settings since then is however unknown. We investigated the percentage of people living with HIV (PLHIV) in Canada told of “U=U” by their provider and compared this to the U.S.

METHODS: 120 PLHIV on treatment from Canada and 400 from the U.S. participated in the 25-country 2019 Positive Perspectives Survey. U=U discussion was a response of “Agree”/“Strongly agree” to: “My provider has told me about ‘Undetectable=Untransmittable’”. Group comparisons were with χ2.

RESULTS: Among participants in Canada, distributions were: mean age, 38.3(SD=12.1); viral suppression, 64.2%[77/120]; women, 25.8%[31/120]; and recently diagnosed (2017-19), 30.8%[37/120]. Perceived comfort discussing with providers how to prevent HIV transmission did not differ between participants in Canada vs U.S. (49.2%[59/120] vs 55.3%[221/400], p=0.241), yet, participants in Canada reported significantly lower prevalence for having discussed U=U with their provider (55.8%[67/120] vs 70.8%[283/400], p=0.002), and the belief antiretrovirals prevent transmission (50.8%[61/120] vs 68.3%[273/400], p<0.001). Higher prevalence of U=U discussion in Canada was observed among those reporting vs not reporting their provider: ‘empowered them with information to make decisions’ (68.5%[50/73] vs 36.2%[17/47], p<0.001); ‘asked if they experienced any side-effects’ (71.6%[48/67] vs 35.8%[19/53], p<0.001); ‘discussed new available treatments’ (65.1%[41/63] vs 45.6%[26/57], p=0.032), and ‘sought their view before prescribing’ (68.2%[45/66] vs 40.7%[22/54], p=0.003). No significant differences in U=U discussion within Canada were observed by age, gender, sexual orientation, or HIV duration. U=U-exposed PLHIV in Canada reported significantly better health-related outcomes than U=U-unexposed: higher treatment satisfaction (70.1%[47/67] vs 43.4%[23/53]); optimal physical health (50.7%[34/67] vs 22.6%[12/53]); and lower suboptimal adherence (41.8%[28/67] vs 64.2%[34/53]) (all p<0.05).

CONCLUSION: U=U discussions were significantly associated with positive health outcomes. Proactive engagement of PLHIV by providers can help improve health-related outcomes.

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Objectives/Background:
African, Caribbean and Black (ACB) people make up 4.7% of Ontario’s population, yet they account for 27% of first-time HIV diagnoses. And more than 60% of all women newly diagnosed with HIV in Ontario are ACB. These numbers highlight the dangerous interplay between health outcomes and social determinants of health, including anti-Black racism. The Care Collective is a campaign whose objective is to encourage ACB women to know their HIV status by incorporating regular testing into their self-care practices.

Methods:
To determine the campaign’s direction:
• Focus groups, interviews, stakeholder discussions
• Online surveys with ACB women, service providers, community members.

COVID-19 pivot:
Originally conceptualized to be implemented in-person, by taking conversations about HIV and HIV testing into numerous wellness and self-care spaces, the Campaign had to pivot. Templates on creating successful virtual The Care Collective events have been produced, model events have been shared and the arrival of HIV self-tests has meant that virtual events can have the key elements of a successful and impactful event.

Currently:
The campaign has been championed by “influencers”, is enjoying an active social media presence and continues to come to life through virtual events organized mainly by ACB women for ACB women.

Results:
Survey data indicated that 57% of ACB women had never had an HIV test. Given the uptake, the campaign is well-placed to increase HIV knowledge, reduce stigma and increase testing among women. Women involved in campaign development and launch highlighted the far-reaching benefits of centering ACB women in HIV conversations, while promoting holistic health.

Conclusion:
The Care Collective is on track to have a significant impact on HIV testing rates for ACB women in Ontario, generate a necessary shift in how HIV is discussed, and highlight the need for greater resources and focus on ACB women in HIV programming.

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People living with HIV/AIDS (PLHIV) who use drugs experience a disproportionate burden of serious co-morbidities (e.g, depression, pain, other persistent conditions). Yet there are few examples of integrated service models for this population grounded in harm reduction approaches and responsive to their wider structural vulnerabilities (e.g. poverty, food insecurity, etc.). The potential role of such supports in fostering inclusion and influencing HIV care and outcomes among, and addressing the wider harms experienced by people who use drugs remains poorly understood. We examined how an integrated HIV care facility in Vancouver, Canada operating under a harm reduction approach and providing comprehensive supports (e.g., food services, counselling, etc.) influenced the functionality, health, and social inclusion of PLHIV who use drugs with complex comorbidities. Qualitative interviews were conducted with 30 PLHIV who use drugs with complex comorbidities who are clients of the Dr. Peter Centre. Interviews were audio-recorded, transcribed, and analyzed using inductive and deductive approaches. Our analysis identified four key themes. Participants discussed how the facility acted as a “lifeline” that helped them through periods of extreme instability (precipitated by homelessness, intense substance use, or the loss of a loved one), by connecting them with necessary supports and care. They also asserted that the facility plays an important role in the management of their HIV and co-morbidities, through connecting them to outside medical and community resources, as well as “in-house” management of health conditions. Participants discussed how the supportive and non-judgmental atmosphere of the facility contributed to enhanced mental wellness. Finally, participants reported that the facility’s approach to harm reduction supported their substance use goals – from safer injection practices to pursuing abstinence. Our findings improve understandings of how an integrated service model, incorporating harm reduction practices and comprehensive supports, can respond to various health and social needs, enhancing quality of life.

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Vancouver, Canada is considered an international leader in the implementation of harm reduction programming. While other cities struggle to implement syringe exchange programs due to discrimination towards people who inject drugs (PWID) and funding issues, Vancouver has a city-wide syringe distribution policy intended to facilitate access to unlimited syringes and related injection equipment. These harm reduction supplies are more widely available in the Downtown Eastside (DTES), a neighbourhood with the highest concentration of PWID and services for PWID, than other parts of the city. We sought to understand spatial access to syringe distribution services among PWID both living within and outside the DTES. Between January and March 2020, we conducted qualitative interviews with 40 PWID regarding harm reduction in a field office located in the DTES. Interviews were audio-recorded, transcribed, and coded. Important themes related to syringe access were identified using inductive and deductive approaches. Study participants described different experiences related to spatial proximity and syringe access. First, those living in the DTES reported greater access to harm reduction supplies, often through social housing facilities and harm reduction facilities that were close to where they lived, than those living outside the area. Second, those who lived outside the DTES described having to make trips to the neighbourhood to access harm reduction supplies. A few expressed a desire for more accessible harm reduction services closer to where they reside. While some participants who lived outside of the DTES described accessing syringes through mobile delivery vans, they expressed dissatisfaction with long waits for delivery. These findings enhance knowledge around spatial inequities and harm reduction service delivery in Vancouver, where syringe access is embedded in policy as ‘city-wide’. These findings emphasize the importance of making syringe distribution services more spatially equitable for PWID living in areas outside the DTES.

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Background: The Canadian HIV Women’s Sexual and Reproductive Health Cohort Study – Positive Aboriginal Women (CHIWOS-PAW) actively Indigenizes and honours re-search by, with, and for Indigenous communities. To do so, Indigenous and non-Indigenous re-searchers must weave their ways of knowing and doing.

Methods: We share our team’s journey of reflecting and re-defining what it means to ‘do re-search’ that honours Indigenous worldviews, using water teachings.

Results: Water connects us all; it is a living thing, it has memory and movement, and it will travel where it is needed. The process of re-search can be similarly conceptualized, as a cyclical journey laid down by our ancestors. We do not ‘discover’ new knowledge, but design a process to search for what is known and embodied by Mother Earth and our ancestors.

Indigenous re-searchers challenged traditional methodologies to prioritize connection with the lands and waters, and to let the women participating guide the questions. This felt natural to the Indigenous re-searchers; but they also felt apprehensive of the response within institutional systems and guidelines. However, as water teaches us to be fluid and ever-changing, so must re-search shift to highlight the strength of Indigenous communities.

Re-searchers trained in traditional academic settings had new learnings of how things are to be done, and under the mentorship and guidance of the Indigenous leads, began a journey to reconceptualizing re-search in a Good Way. This included centering Indigenous ways of knowing, ceremony, and cultural practices; changing re-search jargon to more inclusive and honouring language; and reaffirming commitment to Indigenous communities.

Next Steps: Our re-search approach reflects the knowledge gifted from the lands and waters. Allied re-searchers undertook a process of un-privileging traditional academic re-search paradigms to center Indigenous worldviews. Our Indigenized approach has implications for how re-search and knowledge translation can be done in the future.

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Background: Gay, bisexual, and other men who have sex with men (GBM) living in areas further from urban core face challenges in accessing HIV/STI prevention, as services are concentrated in gay neighbourhoods located within urban cores. A lack of general openness about one’s sexual orientation and openness to one’s healthcare providers are factors that may contribute to this disparity. This analysis examined associations between area of residence, openness, and STI testing, HIV testing, and PrEP use among a sample of urban Canadian GBM.
Methods: Using baseline data from Engage (N=2449; 440 self-reported living with HIV), a respondent-driven sampling (RDS) cohort study, we examined the relative contribution of area of residence (based on postal code: within urban-core vs. not), general openness (out to all) and openness-with-providers on STI testing (in past 6 months:P6M), HIV testing (P6M) and PrEP use (P6M), separately. We fit a series of generalized estimating equation models accounting for age, race/ethnicity, income, marital status, perceived HIV risk, city and recruitment related clustering.
Results: In the non-RDS-adjusted (considering unlinked recruitment chains) three-city combined sample (Mage=36; 71%White) 62% reported a STI test, and among HIV-negative GBM, 60% reported an HIV test and 18% reported PrEP use. Main effect models indicated area of residence, general-openness, and openness-with-provider were independently related with each outcome (all p <.05). Final adjusted models with three main effects and two interaction terms (residenceXgeneral-openness and residenceXopenness-with-provider) indicated significant effects of openness-with-providers on STI testing (RR=1.17,95%CI:1.02-1.34; p=.02), HIV testing (RR=1.27,95%CI:1.10-1.48; p=.001) and PrEP use (RR=1.68,95%CI:1.13-2.50; p=.01), unlike area of residence and general openness (all p >.05).
Conclusion: Openness and comfort with one’s healthcare providers are significantly associated with recent STI testing, HIV testing, and PrEP over area of residence. GBM and provider interventions to facilitate disclosing one’s sexual orientation may improve sexual health care among Canadian GBM.

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Introduction:
Black communities are structurally disadvantaged and bear a disproportionate burden of HIV despite biomedical advances in HIV treatment. Studies demonstrate that people living with HIV on antiretroviral treatment can achieve viral suppression or undetectability, which is fundamental for optimizing health outcomes, decreasing HIV-related mortality and morbidity and preventing HIV transmission. This work problematizes how efforts to manage HIV/AIDS ignore inequities shaping the social world of Black communities.

Method:
The study employed Institutional Ethnography as a method of inquiry to conduct 30 in-depth interviews with ACB migrants living with HIV in Toronto and 20 in-depth interviews with health care providers and policy/decision makers involved in the delivering of HIV care in Toronto. Textual analysis of regulations, policies, legislations, and guiding principles connected to HIV care and healthcare in general were also conducted. Mapping of institutional orders s and social relations that organize and coordinate HIV healthcare and treatment was done.

Result:
Findings reveal that structural violence embedded in Canada’s social fabric, including legislative frameworks, policies, and institutional practices, produces inequities. Structural determinants and social determinants including poverty, homelessness, housing instability, food insecurity, unemployment, stigma and discrimination, anti-Black racism, comorbidities and bureaucratic institutional practices such as long wait times, difficulty finding a doctor shape Black people’s experiences and constrain their work of retention in care, adherence to ART and achieving and maintaining undetectability, leading to violation of their right to health. These findings indicate that HIV healthcare discourses and practices create hierarchy, where privileged individuals who achieve undetectability are considered good people. Black communities are reduced to a stigmatized and impoverished viral underclass, producing another layer of anti-Black racism and HIV stigma.

Conclusion:
Effective management and eradication of HIV/AIDS require the implementation of policies and institutional practices that address structural inequities and social determinants of health among Black communities.

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Background: Complex decisions about whether or not to disclose their HIV positive status in workplaces can be an important concern for people who have associated episodic health challenges, precarious employment or marginalization in other areas of their lives. The need for high-quality online supports for living well became increasingly evident during the COVID-19 pandemic. We designed an interactive online decision guide for workplace disclosure decision-making.
Methods: We used a participatory design process with people living with HIV, service providers, policy makers and researchers. The process consisted of consecutive phases of a survey (N=94) and community consultation (N=30). Using design thinking methods, results were transformed into an interactive online Decision Guide prototype. People living with HIV and service providers/employment experts (N=14) provided feedback on the prototype using the think-aloud approach.
Results: The cumulative results of the design process emphasized the importance of context in decision-making. The decision guide needed to present a balance of options without emphasizing either disclosure or non-disclosure. Privacy and confidentiality were important. The resulting Decision Guide consists of multiple pages. The first pages describe who the Decision Guide is for and privacy and confidentiality in the use of the guide. The next several pages provide information about making complex disclosure decisions and workplace rights. Subsequent pages are interactive and encourage people using the guide to explore their perceptions about safety around disclosure in their workplaces, their need for extra supports at work such as accommodations, their current life situations and supports, and their values related to disclosure. The guide includes opportunities to explore a continuum of disclosure options.
Conclusion: This presentation will summarize the design process and demonstrate the functionality of the Decision Guide. The guide can be used individually or with peer or healthcare provider support, and serve as an educational tool within workplaces.

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Currents of Knowledge project is funded by the Public Health Agency of Canada (PHAC) as one of the projects to be supported through the HIV and Hepatitis C Community Action Fund (CAF), from April 2017 to March 2022.

Under the Sexuality Education Resource Centre MB (SERC), Currents of Knowledge project works with incarcerated youth, trans and non-binary youth, Indigenous youth and their service providers in Manitoba, focusing on providing prevention education on STBBI and stigma reduction. This presentation will share experiences and findings from the first three years of work with youth involved in the project.

This work is evaluated for the continuous improvement of the project through a comprehensive evaluation plan with SMART objectives, short- and medium-term outcomes and predefined indicators and targets. Expected outcomes are to increase knowledge about STBBI prevention and related stigma, resulting in uptake of personal behaviours that reduce the risk of transmission in incarcerated youth. Specialized Peer Support trainings will be delivered to transgender youth in Winnipeg and to northern and rural Indigenous youth to increase awareness and knowledge about how to support other youth in stigma related to STBBIs, and to apply this knowledge in peer to peer intervention in Manitoba.

Evidence indicates that the project has been effective in reaching the short-term outcomes expected, since the priority populations have consistently demonstrated

overall increased knowledge or capacity according to the predefined indicators. Findings also demonstrate that the project has been successful in reaching its expected medium-term outcomes: most participants who joined follow-up evaluation activities reported that information has been useful in their lives and/or communities. We will share learnings presenting qualitative and quantitative data.

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Contexte : La Riposte communautaire québécoise au VIH/sida s’inscrit dans le contexte d’intensification des cibles mondiales de l’ONUSIDA à atteindre pour 2025, dans le but de mettre fin à l’épidémie de sida d’ici 2030. Riposte découle des états généraux de la COCQ-SIDA, effectués en 2018, où les membres avaient à dégager les actions prioritaires à mettre en place. Cela a fait ressortir le besoin de créer une stratégie de riposte nationale collaborative et concertée pour mettre en commun les voix du secteur communautaire québécois en lutte VIH/sida et de s’approprier les cibles de l’ONUSIDA à atteindre pour 2025.
Processus : Démarré en septembre 2020, Riposte s’organise autour d’une consultation nationale utilisant trois méthodes, soit, (1) un sondage utilisant la méthode DELPHI en 2 tours pour consulter les 33 organismes-membres de la COCQ-SIDA; (2) six focus groups (n=30) pour consulter les personnes vivant avec le VIH et les personnes issues des populations clés; et (3) des entretiens semi-dirigés (n=4) pour consulter les partenaires de santé publique.
Discussion: Les états généraux de la COCQ-SIDA ont fait ressortir les besoins prédominants des organismes communautaires de lutte contre le VIH/sida de consolider leur réseau et de mettre en commun leurs efforts qui font partie intégrante de la mission de la Coalition. Les membres ont rappelé la grande nécessité de s’entraider, de revendiquer et de se former. Cet exercice a démontré la nécessité du regroupement d’organisme communautaire de faire une pause pour porter une réflexion sur leurs actions afin de mieux catalyser leurs efforts pour mettre fin à l’épidémie. Les données de la consultation actuelle vont permettre de construire une stratégie de riposte collaborative et concertée à l’échelle nationale qui servira de ligne directrice au secteur communautaire québécois en lutte VIH/sida. Ces données sont attendues dans les prochains mois et seront ajoutées à notre communication.

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Background: Implementation of harm reduction services (HRS) in hospitals serving people living with HIV/AIDS (PLHIV) is important to prevent overdose deaths, facilitate retention in care and increase adherence to antiretroviral medication, thereby improving the HIV treatment cascade. Donor support plays a key role in delivering innovative HRS which might fall outside current funding streams. However, little is known about how the implementation of HRS, which are often highly stigmatized, may impact donor behaviours. We explored this issue within Casey House, a speciality HIV hospital in Canada.
Methods: A total of n=106 donors from Casey House, completed a short anonymous web-based survey assessing their knowledge of HRS and the potential impact of implementing new hospital-based HRS on donors’ future support. Additionally, we conducted n=12 semi-structured qualitative interviews with donors examining their perspectives about harm reduction and their hopes/concerns for such programming at Casey House. Data were analysed using descriptive statistics and thematic analysis.
Results: Survey data show a high level of support for hospital-based HRS, with participants reporting that they "strongly agree/agree" with providing harm reduction equipment (85%), supervised consumption services (82%), and prescription opioid treatment (76%) at Casey House. A majority of participants (66%) claimed that implementing new HRS at Casey House would not impact their future donation, while 6% said they would be less inclined to donate. Interview participants were supportive of HRS at Casey House, but many spoke of the potential impact on “other” donors who might be opposed. Although some believed HRS should be fully funded by the government, most saw a role for donors in supporting such services.
Conclusions: Our findings show support of hospital-based HRS among donors and provide insight into how donor support may be affected when such services are introduced. This research has significant relevance for healthcare and other community-based AIDS service organizations.

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Background: Positive Plus One is the first large-scale mixed methods study of mixed HIV serostatus couples in Canada. As few studies had explored the lived experiences of mixed serostatus couples, we aimed to understand how biomedicalization i.e., a social process of commodification and expansion of the jurisdiction of medicine over health, influenced the everyday relationships of mixed HIV-serostatus couples.

Methods: We completed semi-structured, in-depth interviews among a purposive sample of HIV-positive and HIV-negative partners in current or past mixed-status relationships. Participants were recruited after completing an online survey where they consented to be re-contacted for qualitative interviews. Data were uploaded to Dedoose (ver.8.3.43) and analyzed by inductively identifying themes within dyads and across serostatus and sexual orientations.

Results: Fifty-one participants were interviewed (27 HIV-positive; 24 HIV-negative), representing a diversity of sexual orientations, gender identities, and other sociodemographic characteristics. Our findings illustrated the importance of learning biomedical knowledge for mixed-serostatus couples, its contribution to discourse around undetectable=untransmittable (U=U), and its role in rendering HIV mundane through routine ART adherence. By helping to make relationships work, biomedical knowledge normalized the experience of living in a mixed-serostatus relationship.

Conclusion: This work contributed novel evidence regarding the role of biomedicalization in the normalization of mixed-serostatus identities. We argue that everyday lives of mixed-serostatus couples are shaped by biomedical knowledge, and enacted through routine adherence to ART. These findings have implications for people who do not readily accept or have access to biomedical knowledge, particularly when treatment-as-prevention frames a “right” and “wrong” approach to HIV management. We introduce the concept of ‘dual pharmaceutical citizenship’ to underscore a process by which particular biopolitical and biomedical expectations are fulfilled in mixed-serostatus relationships. Future studies should focus on couples where at least one partner does not readily accept or have access to biomedical knowledge.

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Difficulties accessing health care services can result in delaying in seeking and obtaining treatment. Although these difficulties are disproportionately experienced among vulnerable groups, we know very little about the role of interaction between immigrant status and visible minority status on difficulties accessing health care services during the COVID-19 in Canada. Using Statistics Canada’s Crowdsourcing Data, we apply the intersectionality framework to address this void in the literature. Specifically, intersectionality is a theory that seeks to examine the ways in which various socially and culturally constructed categories such as visible minority status and immigrant status do not act independently but rather interact on multiple levels creating a system of oppression that contribute to inequities in society. Results indicate that compared to white native-born, visible minority immigrants are less likely to report difficulties accessing non-emergency surgical care (OR=0.55, p<0.001), non-emergency diagnostic test (OR=0.74, p<0.01), dental care (OR=0.71, p<0.001), seeking help for mental health (OR=0.77, p<0.05), and making an appointment for rehabilitative care (OR=0.56, p<0.001) but more likely to report difficulties accessing emergency/urgent care (OR=1.46, p,<0.05). There is a dynamic interplay of factors operating at multiple levels to shape the impact of COVID-19, and COVID-19 related health inequities needs to be addressed through changes in social policies, strengthening institutional resources and relationships, and supporting the development of community leaders and key community social settings. Altering individual level determinants will be insufficient to reduce health inequities unless supported by structural changes.

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Background: Group membership can confer benefits such as improved wellbeing to members of marginalized groups, including men who have sex with men (MSM); however, these benefits are not equal across all MSM. Bisexual men may experience bi-phobic stigma and unique health disparities related to HIV and other sexually transmitted infections (STIs). We examined differences between gay, bisexual, and queer identifying men in terms of HIV/STI risk. We hypothesized that bisexual-identifying men would report more HIV risk behaviour (e.g., engaging in higher risk condomless anal sex: CAS).

Methods: Sexually active HIV-negative, cisgender MSM aged 16+ (total n=1,897; gay=1,584, queer=121, bisexual=122) were recruited via respondent-driven sampling (RDS) in Montreal, Toronto, and Vancouver. We examined the association of sexual identity with higher risk CAS at last sexual encounter (where no PrEP was used and partner status was unknown or with a partner who was living with HIV with an unknown/detectable viral load) and with having STI/HIV testing in the past six months (P6M); controlling for age, education, financial strain, and city cluster.

Results: RDS-weighted regression analyses indicated that bisexual men were significantly more likely to engage in higher risk CAS (aOR=10.70, p<.001, 95%CI:3.75,30.54; 71.8%) compared to gay (60.9%)or queer (56.4%) men . Bisexual men were also significantly less likely to have received P6M HIV testing (aOR=0.58, p<.001, 95%CI:0.44,0.75) or P6M STI testing (aOR=0.48, p<.001, 95%CI: 0.36,0.63).

Conclusion: Although they represent a small portion of MSM, bisexual MSM in Canada’s largest cities were most underserved in HIV and STI testing, despite higher levels of risky sex. This may be due to higher levels of internalized stigma and lower levels of sexual orientation disclosure among bisexual MSM; which have both been associated with higher HIV risk (Feinstein & Dodge, 2019). Bisexual MSM may benefit from targeted HIV/STI testing interventions to improve their sexual health outcomes.

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In this research, we return to interview data from a 2017 community-based case study on the impacts of the criminalization of HIV non-disclosure on Indigenous people living with HIV. A total of 26 semi-structured interviews were completed and in this poster presentation, we discuss the results from a second round of coding the data, in which we focused on strengths, resilience, and the possibilities of allyship. Participants in the research included Indigenous people living with HIV, as well as Indigenous people (and one non-Indigenous person) not living with HIV who we are referring to as allies. While it is crucial to center Indigenous people living with HIV, we argue that there is also value in examining the role of allies in Indigenous HIV research and advocacy. Those allies, which included Elders, brought different perspectives to this research and we frame their relational engagement with others as allyship through kinship. Key themes that emerged from both those living with HIV and allies include: the importance of non-judgment and inclusion, community pedagogy as a practice of self-determination, honouring healing and supporting others, and centering Indigenous approaches to HIV. We reflect on the tensions and possibilities of allyship as kinship and examine ways forward for challenging criminalization and the impacts of settler colonialism.

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Background: This study examined the relationship between the disclosure of sexual identity to healthcare providers and HIV or sexually transmitted and blood-borne (STBBI) testing among Two-Spirit, gay, bisexual, queer (2SGBQ+) men in Manitoba.

Methods: Data were drawn from a community-based, Manitoba-wide online survey of 2SGBQ+ men in 2019. Participants were asked if they talked openly about their sexual orientation with their healthcare providers. To assess HIV/STBBI testing, we asked participants if they had ever been tested for HIV/STBBI (tested vs. not). Chi-square and logistic regression analyses were used to examine the relationship between the disclosure of sexual identity to healthcare providers, socio-demographics (age, ethnicity, income, and education), and lifetime HIV & STBBI testing (outcome variable).

Results: Among 304 participants: the mean age was 32 years (SD=8.4, range=18-80); 56.4% were White/Caucasian, 18.5% Indigenous, and 25.1% were men of colour; 25% reported incomes less than $30,000; 19.4% and 27.3% reported never being tested for HIV or any STBBI, respectively; and 25.5% did not talk openly about their sexual orientation with healthcare providers. Younger people were more likely to be tested (AOR=0.93,95%CI:0.88-0.98). Participants with highest household incomes ($100,000 versus <$30,000) were more likely to test for both HIV (AOR=3.89,95%CI:1.62-33.34) and STBBI (AOR=4.66,95%CI:1.59-13.68). No other socio-demographics emerged as significant. We also found that disclosure of sexual identity to healthcare providers versus not was positively associated with HIV (AOR=9.34; 95%CI:1.09–13.92) and STBBI (AOR=5.31; 95%CI:2.69–10.47) testing.

Conclusion: Our findings indicate a strong relationship between the disclosure of sexual identity to healthcare providers and HIV/STBBI testing. Future research needs to understand the relationship between HIV and STBBI testing uptake and healthcare settings conducive to 2SGBQ+ men’s disclosure of their sexuality and sexual practices.

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Background: Two-spirit, gay, bisexual and other trans and cisgender men who have sex with men (GBM) in Canada continue to experience multiple barriers to achieving sexual, physical, and emotional well-being. HIV rates within this group are among the highest in the country, and GBM often experience higher rates of mental health difficulties and substance use and misuse than the general population. Community-based interventions, such as those provided by AIDS Service Organizations (ASOs), are vital to providing highly effective services for GBM, but often lack the requisite resources to provide pseudo-clinical services (e.g., PrEP, rapid HIV testing, or counselling) that are essential for responding to health inequities. Addressing this issue, the following study examined the potential evidence-based role of task-shifting as a method of ensuring that community workers are empowered to provide a wide range of care, therefore reducing the burden on clinicians and increasing accessibility to essential sexual health and health services. This analysis focused on inter- and intra- organizational needs and factors that serve as necessary supports for engagement in task-shifting activities within the context of community-based services for GBM.
Methods: Using community-based research approaches, a four-phase, multi-year implementation study was conducted, including interviews with 31 clinicians and community workers serving GBM in Toronto. A thematic analysis of the interview data was conducted to identify organizational factors supporting task-shifting in community-based services.
Results: Inter-organizational factors included effective referral processes, inter-organizational trust, strong communication, mutual reciprocity, accountability, and knowledge sharing, while intra-organizational factors included financial incentives, resource sharing, role flexibility, openness to change, engagement in evaluation, and use of evidence.
Implications: Findings will be applied to the development of effective partnerships between organizations, as well as within organizational units. Specific implications for the management of ASOs will also be discussed, including linkages to leadership, organizational culture, and strategic resource management.

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Background:
Operating under Community-Based Research (CBR) and Greater Involvement of People with HIV/AIDS philosophies, CHIWOS (a longitudinal cohort study aiming to improve care for women with HIV) values the leadership of women with HIV throughout the research process. To honour our CBR commitment, it was essential that peer research associates (RAs) be supported in identifying and leading KTE efforts. In this pilot, one of the CHIWOS RAs (henceforth KTE Champion) developed and led an innovative, reciprocal KTE workshop series for a small group of CHIWOS participants. We discuss the process, lessons learned, and the final co-created anthology.

Methods:
The KTE Champion’s CHIWOS participants were invited to participate; six accepted. Workshops were co-facilitated with a participant, the KTE Champion, and the KTE Champion project coordinator. Six workshops occurred in September 2019 (once or twice per week). Workshops included: a check-in, meal, presentation/discussion regarding CHIWOS findings, and writing/creative exercises not tied to CHIWOS findings. During and following the workshops, we worked with participants one-on-one to develop and polish their anthology contributions; the wider CHIWOS Ontario team also contributed.

Results:
Each participant submitted at least one piece to the final, 21-page anthology that includes poetry, autobiographical works, art, photography, and more. The co-creation process required personalized adaptations to enable each participant to complete the workshop series and anthology contribution. The discussions and contributions reflected and offered more nuance regarding the CHIWOS quantitative findings; for instance, some elaborated on who they considered a ‘peer’. Many of the submissions reiterate the CHIWOS Women-Centred HIV Care Model – specifically, person-centred and community-centred care.

Conclusion:
With responsive facilitation to each participant’s needs, the workshop series successfully led to the development of a CHIWOS anthology. This process presents a novel form of KTE; an innovative version of ‘member-checking’ for quantitative research; and invites new CBR directions.

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PROBLÉMATIQUE
Le message de santé publique « Indétectable= Intransmissible » (I=I) réfère au fait que les personnes vivant avec le VIH (pvVIH) sous médication et qui maintiennent une charge virale supprimée ne transmettent pas le VIH à leurs partenaires sexuels. Or, le niveau de confiance des pvVIH envers ce message est variable, et toutes n’accordent pas la même signification à l’indétectabilité dans la transmission du virus. Cette étude menée en 2020 a ainsi pour objectif de décrire, de comprendre et d’analyser plus formellement l'expérience de l’indétectabilité à l’ère d’I=I de pvVIH québécoises dans le but de mieux comprendre leur réception de ce message.

MÉTHODE
Un devis qualitatif de théorisation ancré a permis d’informer empiriquement l’expérience du message I=I et de l’indétectabilité des participant·es. Seize pvVIH recrutées par références communautaires ont partagé leurs expériences avec la chercheuse principale dans le cadre d’une entrevue en visioconférence semi-dirigée. Les entrevues ont été retranscrites intégralement, codées et analysées afin de faire émerger des thématiques relatives aux phénomènes étudiés.

RÉSULTATS
Trois aspects émergent des analyses préliminaires. D’abord, les participant·es construisent en grande partie leurs compréhensions du message I=I à l’aide de leurs expériences communautaires. Dans l’ensemble, les participant·es n’ont pas l’impression que le grand public est bien renseigné sur les réalités de la vie avec le VIH, et la tâche d’informer ce public leur revient souvent. Finalement, si les participant·es se disent rassuré·es par le message I=I, iels partagent une inquiétude certaine quant à l’avenir de l’étiquette préventive au sein de leurs groupes sexuels.

DISCUSSION
Les analyses finales permettront une compréhension qualitative de la réception et de l’appropriation de I=I au Québec, près de 10 ans après les premières discussions scientifiques et communautaires sur le sujet, et alors qu’il existe toujours des écarts importants entre réalité scientifique et perceptions du grand public sur le VIH.

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Background: The proportion of older adults (50 years+) living with HIV (OALHIV) is increasing across Canada. This population has distinct health needs, and challenges accessing home and community care (HCC) services as compared to the general population. As OALHIV age, their need for non-acute care, such as HCC, will increase. Despite the role that HCC plays in the healthcare experiences of OALHIV, this field remains relatively unexplored.
Methods: The study objective was to understand barriers and facilitators experienced by OALHIV when accessing HCC services in British Columbia, and how aging with HIV affects well-being. Peer Research Associates and the study coordinator co-conducted 24 qualitative interviews with OALHIV, of whom 14 had ever used HCC services, and 10 who have not used these services. Interviews were conducted over the phone July-Dec 2020, with the exception of 7 in-person interviews conducted in Feb 2020 prior to pandemic restrictions. The interviews were professionally transcribed, and then coded and analyzed by the team using NVivo 12.0 software.
Results: The study yielded rich data describing multiple barriers and facilitators to accessing HCC services experienced by OALHIV in BC. Barriers included ethnicity, substance use, cumbersome application process, and lack of information. The main facilitator in accessing HCC services was extra support provided by care teams. In the area of aging with HIV, our team identified individual resiliency and informal support networks as the main themes.
Conclusions: There are individual and systemic level barriers and facilitators to accessing HCC services; critically, the support offered by care teams or community is precarious due to its non-formalized nature, and caregiver fatigue. Our findings suggest that formalized peer navigation support, and a simplified application process may improve equitable access to HCC services. Despite significant strengths in the HIV community, OALHIV continue to struggle with episodic disability, stigma, and social isolation.

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Background: The life span of older adults (>50 years) living with HIV (OALHIV) who have achieved viral suppression approaches that of the general population. Nevertheless, OALHIV have distinct physical and mental health needs as compared to their HIV-negative counterparts. Stigma and discrimination continue to discourage some OALHIV from accessing help from non-HIV specific organizations and thus benefitting from services available to other older adults. Studies call for more research on how resiliency can be fostered among OALHIV.
Methods: One of the study objectives was to understand how aging with HIV affects the well-being of OALHIV. Peer Research Associates and the study coordinator co-conducted 24 qualitative interviews with OALHIV. Interviews were conducted over the phone July-Dec 2020, except for 7 in-person interviews conducted in Feb 2020 prior to pandemic restrictions. The interviews were professionally transcribed, and then coded and analyzed by the team using NVivo 12.0 software.
Results: Despite participants’ accounts of the pervasive poverty, precarious housing, racism, and HIV-related stigma and discrimination in their lives, our research also gleaned many examples of resiliency, which we then categorized into two broad types: extrinsic and intrinsic. Intrinsic sources of resiliency included: 1) setting boundaries in the care they want to receive; 2) knowing their aspirations and needs; and 3) cultural and religious or spiritual practices. Extrinsic sources of resiliency included having the following: 1) someone to talk to; 2) trusting relationships with their care teams; 3) community and personal networks support; 4) and the support of AIDS service organizations.
Conclusions: Our findings echo previous research about the importance of positive therapeutic relationships and interpersonal bonds within their communities in fostering resiliency among OALHIV. Participants remarkably demonstrated resiliency which they fostered independent of external forces. Our research supports strengths-based approaches to identifying, cultivating, and celebrating resiliency in this community.

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Current acute care models do not adequately meet the needs of people who use drugs (PWUD). Formal and implied abstinence-based policies can exacerbate risks associated with in-hospital substance use, and contribute to high rates of premature discharge among PWUD, increasing the risk of readmission, overdose, and death. In 2018, the Royal Alexandra Hospital (RAH) implemented the first supervised consumption service (SCS) for patients as a harm reduction strategy to improve health outcomes and experiences of PWUD in acute care. Harm reduction programs show promise in acute care settings although they may be met with resistance among hospital staff due to tensions between harm reduction and the medical model. To date, no research has explored hospital staff perspectives on the delivery of SCS in acute care. We aimed to understand barriers and facilitators to providing high quality care to patients who access the RAH SCS. We employed qualitative methods using a focused ethnographic design and conducted semi-structured interviews lasting between 40 – 119 minutes with 20 RAH staff members in 2019 – 2020. Our analysis is ongoing but preliminary findings identify some barriers to providing high quality care, including stigmatizing attitudes toward PWUD, misconceptions about harm reduction principles, and a lack of clarity regarding proper post-consumption care policies. Staff report that when the acute care SCS is integrated effectively into a patient’s care plan, it can improve patient-provider relationships and reinforce support for a harm reduction-oriented model of care. Findings from this study are informing quality improvement for the RAH SCS and hospital units and will ultimately support the development of new standards of acute care for PWUD.

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Sexually diverse communities have historically experienced higher rates of substance use than their heterosexual peers. Recently, healthcare providers and community members have increasingly engaged in conversations about the impact and role of sexualized methamphetamine use within these diverse communities, sometimes termed chemsex or PnP (party and play). Previous research and healthcare provision have predominantly understood these substance use practices and communities through a deficit model that undervalues the complex role that sexualized meth use plays in developing and maintaining social relationships, managing experiences of trauma, and seeking sexual fulfillment. To address this gap, we recruited 33 sexually and racially diverse men from across British Columbia to participate in semi-structured interviews with members of the research team. Interviews were then transcribed verbatim and coded for emergent themes. The research team identified strategies that sexually diverse communities who use substances employ to prevent the transmission of HIV and other sexually transmitted and blood borne infections, to protect their health and wellbeing, and to navigate the barriers that they face in accessing care. Participants shared how their social relationships were central to how they understand not only their methamphetamine use, but also their experiences with substance use support programs and service provision. PnP culture represented both an opportunity to find sexual partners and for connecting to people socially. Participants interested in changing, reducing, or stopping their chemsex involvement, felt it might have consequences for their social support. When entering substance use support programs, participants identified feeling marginalized for both their sexual orientation and their substance use, as non-cisheteronormative sex and methamphetamine use were disparaged by others. Through our interviews we show that in order to better address and support sexually diverse communities who use methamphetamine we need to develop programs and services that engage with these complex social relationships and phenomena.

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Background: Positive Plus One (PP1) is a study of mixed HIV-serostatus relationships in Canada (2016-19), involving PLHIV engaged in long-term relationships and HIV-negative partners. We report on qualitative findings related to relationship wellbeing embedded within our multi-method inquiry.

Methods: PP1 participants completing online study surveys were purposively recruited into private, semi-structured interviews to explore individual, dyadic and social situations that shaped wellbeing in their current/recent relationships. Qualitative data were thematically analyzed under a resilience framework.

Results: Participants included 27 PLHIV and 24 HIV-negative partners (10 female, 41 male). Despite sample heterogeneity, a common conceptualization of resilience emerged; that which supported the ideology of normalcy despite the daily presence of infectious disease risk. Treatment as Prevention (TasP) for PLHIV and an undetectable viral load were viewed to secure healthiness, HIV prevention, and achievement of life “as normal”. However, limited income and lack of third-party health insurance disrupted access to healthcare or medical supports for some, and subsequent attainment of safety/normalcy. Participants who benefited from established supports in the gay community or healthcare providers with a shared identity or social network appeared better positioned to combat threats and maintain relationship wellbeing. However, participants who felt unable to rely on others, largely due to stigma and/or discomfort about HIV, experienced compounded difficulty. Positive partners felt disabled from pursuing external resources to achieve healthiness, because disclosure itself could disrupt impressions of their life “as normal”.

Conclusion: TasP and undetectable=untransmittable (U=U) may enable normalcy and resilience for mixed HIV-serostatus couples. Social capital, particularly from the gay and wider HIV community, may offer protection for some couples facing other socioeconomic barriers. Such buffers appear to be absent for marginalized people of less social capital. The intersectional social determinants of couple’s resilience may be addressed through improved community awareness and acceptance of U=U.

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