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: Introduction: Women living with HIV across global contexts are disproportionately impacted by food insecurity and housing insecurity. Food and housing insecurity are resource insecurities associated with poorer health outcomes among people living with HIV. Poverty, a deeply stigmatized phenomenon, is a contributing factor towards food and housing insecurity. HIV‐related stigma—the devaluation, mistreatment and constrained access to power and opportunities experienced by people living with HIV—intersects with structural inequities. Few studies, however, have examined food and housing insecurity as drivers of HIV‐related stigma. This study aimed to estimate the associations between food and housing insecurity with HIV‐related stigma among women living with HIV in Canada. Methods: This prospective cohort study of women living with HIV (≥16 years old) in three provinces in Canada involved three waves of surveys collected at 18‐month intervals between 2013 and 2018. To understand associations between food and housing security and HIV‐related stigma, we conducted linear mixed effects regression models. We adjusted for socio‐demographic characteristics associated with HIV‐related stigma. Results and discussion: Among participants (n = 1422), more than one‐third (n = 509; 36%) reported baseline food insecurity and approximately one‐tenth (n = 152, 11%) housing insecurity. Mean HIV‐related stigma scores were consistent across waves 1 (mean [M] = 57.2, standard deviation [SD] = 20.0, N = 1401) and 2 (M = 57.4, SD = 19.0, N = 1227) but lower at wave 3 (M = 52.8, SD = 18.7, N = 918). On average, across time, food insecure participants reported HIV‐related stigma scores that were 8.6 points higher (95% confidence interval [CI]: 6.4, 10.8) compared with food secure individuals. Similarly, participants reporting insecure housing at wave 1 tended to experience greater HIV‐related stigma (6.2 points, 95% CI: 2.7, 9.6) over time compared to stably housed participants. There was an interaction between time and housing insecurity, whereby baseline housing insecurity was no longer associated with higher HIV‐related stigma at the third wave. Conclusions: Among women living with HIV in Canada, experiencing food and housing insecurity was associated with consistently higher levels of HIV‐related stigma. In addition to the urgent need to tackle food and housing insecurity among people living with HIV to optimize wellbeing, getting to the heart of HIV‐related stigma requires identifying and dismantling resource insecurity‐related stigma drivers., INTRODUCTION A robust global evidence base reveals that food and housing insecurity disproportionately impact people living with HIV (PLHIV) [1–6]. Among PLHIV, food and housing insecurity are linked to poorer [...]

Background: Breastfeeding is not recommended for women living with HIV (WLWH) in Canada. We described the prevalence of breastfeeding and explored experiences of care, support, and stigma related to infant feeding. Setting: Quebec, Ontario, and British Columbia (Canada). Methods: Data were obtained from the HIV Women's Sexual and Reproductive Health Cohort Study (CHIWOS) surveys, conducted between 2013 and 2018. Results: Breastfeeding was reported by 73.5% of the 786 women who delivered before HIV diagnosis and 7.3% of the 289 women who delivered after HIV diagnosis. Among them, earlier year of delivery, delivery outside of Canada, and African, Caribbean, Black ethnicity were independently associated with increased odds of breastfeeding. Among WLWH who had a live birth during the last year, 77% (40/52) felt that they had received support regarding infant feeding practices, and 77% (23/30) were concerned that not breastfeeding could lead to them being identified as WLWH. Among 71 women within one year postpartum at any one of the study waves, 89% reported having an undetectable viral load. Conclusion: Breastfeeding experiences were common among WLWH, most often prior to HIV diagnosis. Fear of unintentional HIV status disclosure when not breastfeeding and challenges to maintain an undetectable HIV viral load are important issues to address during postpartum care. [ABSTRACT FROM AUTHOR]

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. In this study, as Indigenous and non-Indigenous researchers, we weave our ways of knowing and doing together on the Ancestral, Traditional, and stolen lands of the xwmƏθkwƏýƏm (Musqueam), Skwxwú7mesh Úxwumixw (Squamish), (Tsleil-Waututh), S'ólh Téméxw (Stó:lō), and the Kwantlen Territories. We conceptualize 're-search' as a cyclical journey that is not about 'discovering' new knowledge but designing a process to search for what is known, existing, and embodied by Mother Earth and our Ancestors. In this paper, we describe our process of using strengths-based approaches grounded in our connections with the Lands and Waters to explore how Indigenous Women living with HIV support their health and well-being by drawing upon Indigenous teachings and healing. Over the course of multiple gatherings conducted over 1 year with the same group of women, we utilized arts-based research methods, Indigenous teachings and ceremony, and Sharing Circles to collect and analyze women's perspectives and experiences of their health and healthcare. The Wise Women were living in the Coast Salish Territories, yet came from different Communities, including Coast Salish, Cree, Blackfoot, and Navajo Nation. Our Indigenized re-search process was healing for the Wise Women who participated in the study and for us as the re-search team, which promoted re-connection to self, nature, and culture. We share insights on our learnings to support other community-based research teams to engage in re-search by, with, and for Indigenous Women that prioritizes safety, healing, and benefit for those who participate. Such insights include the importance of 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. [ABSTRACT FROM AUTHOR]

Using baseline data from a community-collaborative cohort of women living with HIV in Canada, we assessed the prevalence and correlates of help-seeking among 1,057 women who reported experiencing violence in adulthood (≥16 years). After violence, 447 (42%) sought help, while 610 (58%) did not. Frequently accessed supports included health care providers (n = 313, 70%), family/friends (n = 244, 55%), and non-HIV community organizations (n = 235, 53%). All accessed supports were perceived as helpful. Independent correlates of help-seeking included reporting a previous mental health diagnosis, a history of injection drug use, experiencing childhood violence, and experiencing sexism. We discuss considerations for better supporting women who experience violence. [ABSTRACT FROM AUTHOR]

Introduction: Sex workers are disproportionately impacted by the HIV pandemic across global contexts, in part due to social and structural contexts of stigma and criminalization. Among women living with HIV, there is a dearth of longitudinal information regarding dynamics of sex work engagement and associated social and health outcomes. In order to better understand the social contexts and health needs of sex working women living with HIV, this study aimed to understand recent sex work prevalence and its longitudinal associations with stigma, psychosocial and clinical HIV outcomes among women living with HIV in Canada. Methods: We conducted a three‐wave prospective cohort survey at 18‐month intervals with women living with HIV aged 16 and older in three Canadian provinces between 2013 and 2018. We used generalized estimating equations to examine longitudinal associations between recent (past 6‐month) sex work with three types of outcomes: psychosocial (recent violence, recent injection drug use, hazardous alcohol use, clinical depression and post‐traumatic stress disorder), clinical HIV (CD4 count and viral load) and stigma (HIV‐related stigma, racial discrimination and gender discrimination). Equations were adjusted for socio‐demographic factors associated with sex work across all three waves: province, age, income, gender identity, sexual orientation, education level, ethnicity and housing security. Results and Discussion: Of 1422 participants, 129 (9.1%) reported recent sex work during at least one wave (82 at baseline, 73 at first follow‐up and 32 at second follow‐up). In adjusted analyses, recent sex work was associated with psychosocial outcomes, including: past 3‐month violence (adjusted odds ratio [AOR] = 2.47, 95% CI = 1.70, 3.60), past 6‐month injection drug use (AOR = 3.49, 95% CI = 2.21–5.52), hazardous alcohol use (AOR = 2.00, 95% CI = 1.04–3.89) and depression (AOR = 1.51, 95% CI = 1.06–2.15). In unadjusted analyses, sex work was also associated with clinical HIV outcomes and gender discrimination, but not racial discrimination/HIV‐related stigma. Conclusions: Among women living with HIV in Canada, sex work engagement is dynamic, and sex workers are more likely to report recent violence, recent injection drug use, problematic alcohol use and clinical depression. Violence prevention and support, harm reduction, mental health promotion and sex work‐affirming programs could be employed to optimize health and rights for sex working women living with HIV. [ABSTRACT FROM AUTHOR]

Background: Sexual relationship power (SRP) inequities, including having a controlling partner, have not been widely examined among women living with HIV (WLWH). We measured the prevalence and key outcomes of relationship control among WLWH in Canada., Methods: Baseline data from WLWH (≥16 years), reporting consensual sex in the last month enrolled in a Canadian community-collaborative cohort study in British Columbia, Ontario, and Quebec, included the relationship control SRP subscale by Pulerwitz (2000). Scale scores were dichotomized into medium/low (score = 1-2.82) vs. high relationship control (score = 2.82-4), and high scores indicate greater SRP equity. Cronbach's alpha assessed scale reliability. Bivariate analyses compared women with high vs. medium/low relationship control. Crude and adjusted multinomial regression examined associations between relationship control and condom use [consistent (ref), inconsistent, or never]; any sexual, physical, and/or emotional violence; and physical and/or sexual violence [never (ref), recent (≤3 months ago), and previous (>3 months ago)]., Results: Overall, 473 sexually active WLWH (33% of cohort), median age = 39 (IQR = 33-46) years, 81% on antiretroviral therapy, and 78% with viral loads <50 copies/mL were included. The subscale demonstrated good reliability (Cronbach's alpha = 0.92). WLWH with high relationship control (80%) were more likely ( P < 0.05) to be in a relationship, have no children, have greater resilience, and report less sociostructural inequities. In adjusted models, high relationship control was associated with lower odds of inconsistent vs. consistent condom use [adjusted odds ratio (aOR): 0.39 (95% confidence interval: 0.18 to 0.85)], any recent violence [aOR: 0.14 (0.04-0.47)] as well as recent physical and/or sexual [aOR : 0.05 (0.02-0.17)] but not previous violence (vs. never)., Discussion: Prioritizing relationship equity and support for WLWH is critical for addressing violence and promoting positive health outcomes., Competing Interests: CHIWOS is funded by the Canadian Institutes of Health Research (CIHR), the CIHR Canadian HIV Trials Network (CTN 262), the Ontario HIV Treatment Network (OHTN), and the Academic Health Science Centers (AHSC) Alternative Funding Plans (AFP) Innovation Fund. K.C. is supported by a CIHR Vanier Canadian Graduate Scholarship. A.G. received financial support from the South African Medical Research Council. A.d.P. received support from Fonds de Recherche du Québec-Santé (FRQS) (Chercheur-boursier clinician-Junior 1), and A.K. received salary support through a Tier-2 Canada Research Chair in Global HIV and Sexual and Reproductive Health. The remaining authors have no conflicts of interest to disclose., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Increasingly, women living with HIV are entering menopause (ie, cessation of menses for ≥1 year) and experiencing midlife symptoms. Menopausal hormone therapy (MHT) is first-line therapy for bothersome hot flashes and early menopause (ie, before age 45 years); however, its use in women living with HIV is poorly described. We conducted a cross-sectional assessment of MHT uptake and barriers to use in this group., Setting: This study was conducted across 3 Canadian provinces from 2015 to 2017., Methods: Perimenopausal and postmenopausal women living with HIV (35 years or older) in the Canadian HIV Women's Sexual and Reproductive Health Cohort Study who answered questions related to MHT use were included. Univariable/multivariable logistic regression evaluated factors associated with MHT use, adjusted for age and contraindications., Results: Among 464 women, 47.8% (222 of 464) had a first-line indication for MHT; however, only 11.8% (55 of 464) reported ever using MHT and 5.6% (26 of 464) were current users. Only 44.8% had ever discussed menopause with their care provider despite almost all women having regular HIV care (97.8%). African/Caribbean/Black women had lower unadjusted odds of MHT treatment compared with White women [odds ratio (OR) 0.42 (0.18-0.89); P = 0.034]. Those who had discussed menopause with their care provider had higher odds of treatment [OR 3.13 (1.74-5.86); P < 0.001]. In adjusted analyses, only women having had a menopause discussion remained significantly associated with MHT use [OR 2.97 (1.62-5.61); P < 0.001]., Conclusion: Women living with HIV are seldom prescribed MHT despite frequent indication. MHT uptake was associated with care provider-led menopause discussions underscoring the need for care provider education on menopause management within HIV care., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

In Canada, women make up 25% of the prevalent HIV cases and represent an important population of those living with HIV, as a high proportion are racialized and systemically marginalized; furthermore, many have unmet healthcare needs. Using the knowledge-to-action framework as an implementation science methodology, we developed the "Women-Centred HIV Care" (WCHC) Model to address the needs of women living with HIV. The WCHC Model is depicted in the shape of a house with trauma- and violence-aware care as the "foundation". Person-centred care with attention with attention to social determinants of health and family make up the "first" floor. Women's health (including sexual and reproductive health and rights) and mental and addiction health care are integrated with HIV care, forming the "second" floor. Peer support, leadership, and capacity building make up the "roof". To address the priorities of women living with HIV in all their diversity and across their life course, the WCHC Model should be flexible in its delivery (e.g., single provider, interdisciplinary clinic or multiple providers) and implementation settings (e.g., urban, rural).

Women living with HIV (WLWH) are over-represented in corrections in Canada, yet little is known about women's experiences post-release. We used CHIWOS cross-sectional data from WLWH to estimate associations between social determinants of health and HIV-related care outcomes among WLWH with recent (within past year) or ever (before past year) incarceration experience. Lifetime incarceration prevalence was 36.9% (6.5% recent; 30.4% ever), with significant differences by province of residence (British Columbia: 10% recent; 52% ever; Ontario: 5%; 24%; Quebec: 6%; 22%; p < 0.001). In adjusted multinomial logistic regression analyses, compared with never incarcerated, recent incarceration was associated with Indigenous ancestry, lower annual income (< $20,000 CAD), unstable housing, current sex work, injection drug use (IDU), and sub-optimal antiretroviral therapy (ART) adherence, while ever incarceration was associated with current sex work, IDU, and experiencing adulthood violence. Our findings have implications regarding supports needed by WLWH in the post-release period, including ART adherence and achieving health and social goals.