Background: Indigenous women living with HIV (IWLWH) have the highest attrition rates across the HIV care cascade in Canada, highlighting a need to improve access to HIV care and services. This begins with listening to IWLWH to understand how they understand health, and their experiences accessing healthcare.

Methods: The Canadian HIV Women’s Sexual and Reproductive Health Cohort Study – Positive Aboriginal Women (CHIWOS-PAW) invited six IWLWH on the Coast Salish Territories to participate in three gatherings developed by IWLWH: 1) Introductory Virtual Gathering, to share study objectives; 2) Sharing Circle Gathering, a four-day land and water-connecting art workshop with Sharing Circles, guided by IWLWH; 3) Heart-to-Heart Chats, to connect with each woman who participated to confirm her voice and priorities are shared accurately.

Results: IWLWH who participated in CHIWOS-PAW reported experiences of their culture being denied within the Western healthcare system, with serious consequences. IWLWH described understanding their health through traditional ways of knowing and blood memory, which conflicts with a Western notion of ‘health.’ Care was then compromised when the healthcare provider was unwilling to listen to what women needed for their own healing, and what they felt comfortable with. By denying women their traditional approaches to health and healing, it actively denied women agency over their own bodies, and it interfered with them connecting to their culture. This resulted in a ‘tug-of-war’ phenomenon, where women felt that they were getting pushed and pulled in two different directions - to comply with Western medical care, or to stay true to their culture - rather than providing an opportunity for synergistic approaches to healing.

Next Steps: IWLWH face discrimination and colonialism within healthcare settings, which actively denies women their culture. IWLWH share messages to their healthcare providers to educate how they can be a supportive partner in their healthcare journey.

Background:
Women living with HIV (WLWH) make up a growing proportion of people who are incarcerated globally and in Canada. Post-release from correctional settings WLWH experience significant challenges, including gender disparities with regards to HIV outcomes. This qualitative study investigated the experiences of transition from prison to community among WLWH.

Methods:
Drawing from SHAWNA (Sexual Health and HIV/AIDS: Women’s Longitudinal Needs Assessment), a community-based research project with cisgender and transgender WLWH in Metro Vancouver, experienced peer and community researchers conducted 19 semi-structured interviews (May-December 2017) with recently incarcerated participants. These were supplemented by interviews with service providers. Interviews explored factors that shape incarceration trajectories, including a focus on release and post-release experiences. Drawing on socio-ecological frameworks, transcripts were coded in NVivo.

Results:
Narratives highlighted intersecting structural barriers transitioning from prison to the community, including limited pre-release planning, a lack of immediate support at release (e.g. clothing and transportation) and barriers accessing safe housing and addictions treatment. Participants’ narratives indicated that incarceration experiences were highly disruptive; sustained cycles of criminalization and re-incarceration; and perpetuated symbolic violence, leading WLWH to blame themselves for not being able to break the cycles of criminalization. The lack of structural supports post-release was linked to interruptions in HIV treatment and care for some WLWH. Several participants recounted experiences with HIV-specific prison outreach programs and highlighted the significant benefits of these programs in accessing housing, addiction treatment and HIV care.

Conclusion:
To improve HIV health outcomes and overall well-being for WLWH following incarceration, there is a critical need for increased transition supports from prison to community.
Enhanced pre-release planning, with a priority on housing and addictions treatment options, and collaboration between prison staff, community, and HIV providers is critical to enhance supports and access to care and reduce re-incarceration. Interventions should be gender-sensitive, culturally safe, and trauma-informed.

Background: Fuzzy Cognitive Mapping (FCM) is a participatory research method that takes into account different sources of knowledge. In this study, we used FCM to capture the experiential expertise of women living with HIV to better understand their healthcare priorities. The objectives of this study were to identify factors that promote women’s satisfaction with HIV care.

Methods: Two Peer Research Associates were trained in FCM interviewing and lead the exercise with participants. Using community-based participatory approaches, individual FCM interviews are conducted virtually with women living with HIV in British Columbia and Quebec (n=24). A Fuzzy Cognitive Map was first constructed from a systematic mixed-studies review of factors promoting satisfaction with HIV care among people living with HIV in high-income settings. During the interviews, women individually update the map by adding and removing factors, specifying causal relationships, and assigning weights between 1 and 5 to indicate the importance and direction (+ve or -ve) of the relationships.

Preliminary results: In preliminary findings from completed interviews, the most important promoters of satisfying HIV care were transparent, collaborative and positive relationships between women and their healthcare providers, healthcare provider expertise and training, and receiving care that adapts to each woman’s unique needs. Other important factors that indirectly promoted satisfying HIV care were the coordination and communication between various healthcare services that women receive, receiving appropriate gynecologic care, and healthcare services that are informed by women-specific HIV research.

Conclusions: The maps illustrate the most important factors that contribute to satisfying HIV care from the perspectives of women living with HIV in Canada. Applying an innovative method to visualize women’s knowledge and experiences, this study will highlight priority areas for co-designing healthcare services that align with the needs of women living with HIV.

When COVID-19 was first declared a global pandemic in March 2020, it quickly became obvious that the most marginalized populations would experience disproportionate challenges and negative outcomes as a result of the virus and the unrelenting pressure it has placed on already strained social supports and health services. In the time that has passed, the tale of multiple pandemics has become clear: COVID-19 isn’t creating social and health inequities, but merely exposing the existing inequalities and gaps in society that has long failed to protect its most vulnerable members.

In Canada, Indigenous women represent over 41% of federally incarcerated women, despite just representing 4% of the total female population. Epidemiological data shows that Indigenous inmates and federally incarcerated women have been disproportionately impacted by COVID-19. As a result, federally incarcerated Indigenous women are at an elevated risk based on their over-incarceration, gender and ethnicity. As prison lockdowns remain in place and nonessential culturally-safe programming is reduced, incarcerated Indigenous women face not only the health risks posed by COVID-19, but the implications the lack of in-person contact and programming has for their mental health and successful reintegration into society.

NWAC’s Walking the RED Path Project faced numerous challenges in adjusting to the cancellation of in-person culturally-safe programming and had to work in creative ways in order to continue reaching prisoners with programming that aims to increase their knowledge of culturally-safe STBBI interventions. Despite this individual success, incarcerated Indigenous women continue to be disproportionately impacted by the chaos COVID-19 has caused. Further to this, as systemic racism continues to result in the criminalization of racialized women which, in turn, increases their presence in penitentiaries, we all must acknowledge the role we have in addressing these crises within a crisis.

Background:
The objective of this research project is to understand how Indigenous women in Saskatchewan are integrating the wisdom gained from a variety of recently completed research projects which focus on HIV risk and prevention. This research seeks to determine the intersectionality of Indigenous women's lives, communities, and systems working together to better deliver, sustainable and affordable, integrative care through the development, implementation, and assessment of a community-based intervention practice.

Method:
Indigenous methods such as storytelling and research circles were used in this mixed qualitative approach along with culture, language, history, and traditional land-based teachings. This work is grounded in Indigenous Knowledges and cultural practices. Guided by principles of Community-Based Research (CBR) and a Two-Eyed Seeing approach, this intervention research focuses on participants’ experiences of ongoing, long-term Cultural Intervention Practices (CIPs) scheduled in relationship to women’s seasonal teachings and ceremonies. NVivo software and the Nanâtawihowin Âcimowina Kika-Môsahkinikêhk Papiskîci-Itascikêwin Astâcikowin (NAKPA) method were used to analyze the data. This oral presentation will share key themes learned thus far in the research and preliminary data analysis from the research circles to begin the process of knowledge dissemination.

Data was gathered seasonally by asking the women to answer four questions about their wellness as it pertains to them personally: 1) How do Indigenous women experience CIPs? 2) In what ways, if any, do CIPs influence how women experience physical wellness through fitness/strength, stress level, aches, and pains, etc.? 3) In what ways, if any, do CIPs influence how women experience relationships with themselves and/or spirit change? 4) What do women do to encourage wellness in their lives after participating in the CIPs?

Results:
Nanâtawihowin Âcimowina Kika-Môsahkinikêhk Papiskîci-Itascikêwin Astâcikowin [NAKPA] follows an Indigenous Research Methodology and will be utilized during analysis. The preliminary findings from this project will be discussed at CAHR 2021.

The disproportionate impact of HIV/AIDs in African Caribbean and Black (ACB) communities in Canada remains a problem that requires targeted efforts. In this session, we present qualitative findings from the African Canadian (AC) study of HIV behaviours, knowledge, and barriers to healthcare among ACB communities in Ontario. The study meaningfully engaged ACB community members in the interpretation of quantitative study findings and in the generation of best practices. Qualitative data sources included a two-day World Café event where study findings were presented and 12 Focus Group Discussions (FGDs) involving over 107 ACB individuals from Toronto and Ottawa were held. FGDs were transcribed verbatim and thematic analysis guided data interpretation. Credibility of data was established through data validation strategies. Five key themes will be discussed: 1) Community perceptions of research importance and challenges, 2) Factors associated with HIV vulnerability, 3) Experiences with HIV testing, 4) Use of PEP and PrEP, and, 5) Community perspectives on how to address HIV in ACB communities. Fear and stigma remain one of the most frequently cited reasons why ACB community members don’t access HIV testing. Many participants were not aware and /or did not have direct experience with use of PrEP/PEP prevention treatments; one of the main reasons being because these treatments are marketed for white gay men. Participants identified numerous strategies to address the HIV needs in ACB communities, including education, community-level strategies and health provider capacity building strategies. The implications of the qualitative study findings for ACB community, service provision, research, funding and policy action areas will be presented. We conclude that community based participatory research, co-led by community members, is an important strategy for identifying the multi-level individual, interpersonal, community, institutional and structural factors that increase HIV vulnerability in ACB communities, notably anti-Black systemic racism.