Background: African, Caribbean, and Black (ACB) im/migrant women experience a disproportionate burden of HIV relative to people born in Canada, yet there is scarce empirical evidence about the social and structural barriers that influence access to HIV care. The objectives of this study are to understand how stigma and im/migration trajectories shape access to HIV care and peer supports among ACB im/migrant women living with HIV (WLWH) in Canada.

Methods: This mixed-methods analysis draws on interviewer-administered questionnaires and in-depth interviews with self-identifying ACB WLWH in the community-based SHAWNA (Sexual Health and HIV/AIDS: Women’s Longitudinal Needs Assessment) cohort. Bivariate and multivariable logistic regression using generalized estimating equations (GEE) was performed to model associations between ACB background and outcomes including stigma, HIV disclosure and social support. Drawing on a social and structural determinants of health framework, qualitative analysis of interviews elucidated the interplay between migration trajectories, stigma, racialization, and HIV.

Results: In multivariable GEE analysis, ACB participants (n = 20) were significantly more likely to be outed as living with HIV (AOR 2.20, 95% CI 0.94-5.13; p= 0.068). Reflecting on their im/migration trajectories, participants’ narratives (n = 9) highlighted the severe trauma, stigma, and discrimination associated with HIV in their place of origin and the racialization and stigmatization of HIV in Canada. Fear of disclosure without consent was linked to barriers of accessing care and peer-based supports.

Conclusion: Our findings indicate that im/migration trajectories of ACB WLWH are critically related to accessing HIV care and supports in Canada and compound HIV stigma and discrimination. HIV disclosure without consent complicates access to care and social/peer support, underscoring the need for privacy, confidentiality, and the importance of building trust in the context of clinical encounters. The results of this study emphasize the critical need for culturally sensitive trauma-informed care models rooted in peer-based approaches.

Background: Globally 1.7 million new HIV infections occurred in 2019, therefore, new prevention methods are needed. Inflammation is a risk factor for HIV acquisition as it attracts HIV target cells to the female genital tract (FGT). Our lab conducted a study aimed at reducing HIV target cells at the FGT using safe, affordable, and globally available anti-inflammatory drug: acetylsalicylic acid (ASA/Aspirin). We found ASA decreased the proportion of HIV target cells (CD4+CDCR5+Tcells) at the FGT by 35%. However, this decrease in inflammation must not hamper the immune response to other infectious agents.
Hypothesis: We expect ASA to decrease HIV target cells without adversely effecting the immune response to recall antigens.
Methods: Women from Nairobi, Kenya took low dose ASA (81mg) daily for 6 weeks. Blood was drawn prior to ASA and following 6 weeks daily ASA. Peripheral blood mononuclear cells (PBMCs) were isolated, frozen, and shipped to Winnipeg, Canada where they were stimulated with either 2µg/mL CEF (Cytomegalovirus, Epstein Barr, Influenza) or 8µg/mL HPV (Human Papilloma Virus) peptide pools. Stimulations were for 12 hours for cytokine detection or 7 days for proliferation.
Results: Following 6 weeks ASA there was an increase in the pro-apoptotic receptor CD95 in unstimulated CD8+Tcells (p=0.011) with increased IFNγ (p=0.006) and IL-2 (p=0.040), in CD4+Tcells and TNFα in CD4+ and CD8+Tcells (p=0.031, p=0.024 respectively) following HPV peptide stimulation. There was no change with CEF peptide stimulation and no impact of either stimulation on proliferative ability.
Conclusion: We show that the immune response to recall antigens is not impaired by 6 weeks of ASA treatment and may be boosted with HPV peptide stimulation. Our observation that ASA decreases HIV target cells at the FGT without adversely altering the ability of immune cells to respond to recall antigens supports ASA’s further assessment as a new HIV prevention tool.

Background: Black populations in Ontario are disproportionately impacted by HIV. This disparity continues despite a robust network of HIV services administering biomedical HIV prevention interventions. HIV research is beginning to implicate anti-black racism in critiquing this disjuncture. However, research typically emphasizes individual-level racism, obscuring structural forms (e.g. institutional practices, policy frameworks, knowledge systems) that continue to limit service access. Subsequently, discourses critical of how racism structurally shapes HIV services remain conceptually underdeveloped in Canadian scholarship.

Method: Critical race theory (CRT) is a theoretical framework that fosters a race consciousness in understanding the social ordering of society and the structural nature of racism. Building on its tenets, a theoretical application of CRT is used here to frame HIV service access barriers for Black communities and to challenge discourses attributing individual-level responsibility to their adverse prevention outcomes.

Results: CRT disrupts discourses of race removed from a context of racism. It critiques social and epidemiological constructs of Black populations as being inherently ‘risky’. In rationalizing suboptimal rates of service uptake, these constructs then hold sexual practices to be a result of poor individual merit. Alternatively, CRT asserts that these stigmatizing racial profiles underscoring service delivery and discriminatory socio-economic systems dually shape safer sex decision-making. Historically contextualizing Black communities as ‘hard-to-reach’, CRT further provokes a shifted focus from this population’s medical distrust to the institutional trustworthiness of healthcare and research settings by integrating past and ongoing unethical medical and research practices. CRT also aims to counter ‘at-risk’ and ‘hard-to-reach’ ‘master narratives’ by centering Black communities’ experiences and perspectives of service access.

Conclusion: With the uptake of research on racism in healthcare, it is important that conceptual tools are able to critically examine its multiple forms in HIV services in Ontario towards informing a coordinated prevention response that synchronously intervenes for structural and behavioural change.

Background: People living with HIV may experience a higher risk of COVID-19 due to the syndemic factors, including disproportionate impact by race and income. We examined syndemic factors, including gender, race, and occupation to assess the risks and exposures in the OHTN Cohort Study (OCS).

Methods: The OCS is a cohort of people with HIV receiving care at Ontario clinics, including clinical and interview-administered in-person or virtual questionnaire data. We assessed the impacts of COVID-19 on participants, through self-report of COVID-19 diagnoses, household exposure, physical distancing, and work outside the home.

Results: Results from 1,1166 responses collected between May 2020 and December 2020, including 276 (23.9%) women, 880 (76.1%) men and 10 missing gender (1%); (Overall median age: 52 years, 61% white, 22% black, 7% Asian). 284 (24.5%) participants were tested for coronavirus in the sample, with 11 testing positive (1.0%; 95% CI 0.3%, 1.5%). 23 people (2%) were told by a healthcare provider that they had COVID-19, with higher percentages among women (11/273; 4%) and Black participants (7/249; 3%). 10 participants (1%) had household contacts who tested positive, with higher percentages in Black participants (7/249; 3%). 332 participants (28%) worked outside the home during the pandemic, with higher rates in women (84/273; 31%), Black participants (92/249; 37%) and Asian participants (29/77; 38%). Relative to White participants, Black and Asian participants were more likely to be working in Healthcare (30/692, 4% White; 31/249, 12% Black; 5/77, 6% Asian) and Manufacturing (8/692, 1% White; 7/249, 3% Black).

Conclusions: Our analyses indicate disparities in the impact of coronavirus. Black people and women living with HIV were more likely to be working outside the home, exposed through household contacts and experiencing coronavirus infection. Asian participants were also more likely to work outside the home in higher risk occupations.