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In Canada, sexual assault laws have been used to criminalize people who do not disclose their HIV status to partners prior to sex that presents a “realistic possibility of transmission.” Women, ART...

Background Widespread policy reforms in Canada, the United States and elsewhere over the last two decades strengthened team models of primary care by bringing together family physicians and nurse practitioners with a range of mental health and other interdisciplinary providers. Understanding how patients with depression and anxiety experience newer team‐based models of care delivery is essential to explore whether the intended impact of these reforms is achieved, identify gaps that remain and provide direction on strengthening the quality of mental health care. Objective The main study objective was to understand patients’ perspectives on the quality of care that they received for anxiety and depression in primary care teams. Methods This was a qualitative study, informed by constructivist grounded theory. We conducted focus groups and individual interviews with primary care patients about their experiences with mental health care. Focus groups and individual interviews were recorded and transcribed verbatim. Grounded theory guided an inductive analysis of the data. Results Forty patients participated in the study: 31 participated in one of four focus groups, and nine completed an individual interview. Participants in our study described their experiences with mental health care across four themes: accessibility, technical care, trusting relationships and meeting diverse needs. Conclusion Greater attention by policymakers is needed to strengthen integrated collaborative practices in primary care so that patients have similar access to mental health services across different primary care practices, and smoother continuity of care across sectors. The research team is comprised of individuals with lived experience of mental health who have participated in all aspects of the research process.

Introduction Understanding differences in knowledge and behaviors among men who have sex with men (MSM), men who have sex with women (MSW), and women, is critical to tailor HIV treatment. We investigated these differences among an international sample of people living with HIV (PLHIV) in 25 countries. Methods Data came from the 2019 Positive Perspectives Study, an online convenience sample of PLHIV in 25 middleand high-income countries. Participants were categorized as MSM (n=1018), MSW (n=479), or women (n=696), based on self-classified gender and sexual orientation. Descriptive and multivariable analyses were performed (p

We assessed patient-provider communication in HIV care; data were from the 2019 Positive Perspectives Survey of people living with HIV (PLHIV) from 25 countries (n = 2389). A significantly greater proportion of recently diagnosed individuals were interested in being involved when it comes to decisions about their HIV treatment compared with any other group (72.8% [399/548], 63.1% [576/913], and 62.6% [581/928], diagnosis year: 2017–2019, 2010–2016, and pre-2010 respectively) but reported less understanding of their treatment compared with those reporting the longest duration (66.8% [366/548], 68.6% [626/913], and 77.3% [717/928], respectively). One-third of PLHIV with salient treatment-related concerns were uncomfortable discussing with providers. Of participants who felt that their HIV medication limited their life but did not discuss their concerns with their provider (n = 203), top reasons for not discussing were: perception nothing could be done (49.3% [100/203]), provider never brought up the issue (37.9% [77/203]), and not wanting to appear difficult (30.5% [62/203]). To continue to identify and address unmet treatment needs among PLHIV, providers need to ensure that there is ongoing open dialogue. Electronic supplementary material The online version of this article (10.1007/s10461-020-02973-4) contains supplementary material, which is available to authorized users.

Summary In Canada, HIV disproportionately affects Black communities. Though Black faith leaders play an influential role engaging Black communities around social care and social justice, their response to HIV has been somewhat muted. Black PRAISE is a novel intervention for Black churches to strengthen congregants’ critical awareness of HIV affecting Black communities. A multi-stakeholder team developed and tested the intervention in 2016 − 17 among six churches in the province of Ontario, where more than half of Black Canadians reside, using a community-based participatory approach. Specifically, the intervention aimed to strengthen how congregants understand HIV among Black communities and reduce their level of stigma toward people living with HIV. We addressed critical awareness among the participating congregations through (i) disseminating a booklet with validated information that promoted critical health literacy related to HIV; (ii) enabling pastors to deliver a sermon on love, compassion and social justice; and (iii) developing and screening a short film that featured Black Canadians discussing their experiences of HIV-related stigma. We assessed changes in knowledge and stigma by surveying congregants (N = 173) at baseline and two follow-ups using validated instruments and other measures. Through Black PRAISE, congregants significantly increased their HIV-related knowledge; moreover, exposure to all the intervention components was associated with a significantly reduced level of stigma. A likely strategic outcome of Black PRAISE is that churches are empowered to help strengthen Black people’s community-based response to HIV and join efforts to eliminate the structural conditions that increase Black people’s vulnerability to HIV.

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.

Background: Improvements in life expectancy and quality of life for HIV-positive women coupled with reduced vertical transmission will likely lead numerous HIV-positive women to consider becoming pregnant. In order to clarify the demand, and aid with appropriate health services planning for this population, our study aims to assess the fertility desires and intentions of HIV-positive women of reproductive age living in Ontario, Canada. Methodology/Principal Findings: A cross-sectional study with recruitment stratified to match the geographic distribution of HIV-positive women of reproductive age (18–52) living in Ontario was carried out. Women were recruited from 38 sites between October 2007 and April 2009 and invited to complete a 189-item self-administered survey entitled ‘‘The HIV Pregnancy Planning Questionnaire’’ designed to assess fertility desires, intentions and actions. Logistic regression models were fit to calculate unadjusted and adjusted odds ratios of significant predictors of fertility intentions. The median age of the 490 participating HIV-positive women was 38 (IQR, 32–43) and 61%, 52%, 47% and 74% were born outside of Canada, living in Toronto, of African ethnicity and currently on antiretroviral therapy, respectively. Of total respondents, 69% (95% CI, 64%–73%) desired to give birth and 57% (95% CI, 53%–62%) intended to give birth in the future. In the multivariable model, the significant predictors of fertility intentions were: younger age (age,40) (p,0.0001), African ethnicity (p,0.0001), living in Toronto (p = 0.002), and a lower number of lifetime births (p = 0.02). Conclusions/Significance: The proportions of HIV-positive women of reproductive age living in Ontario desiring and intending pregnancy were higher than reported in earlier North American studies. Proportions were more similar to those reported from African populations. Healthcare providers and policy makers need to consider increasing services and support for pregnancy planning for HIV-positive women. This may be particularly significant in jurisdictions with high levels of African immigration.

Body Mapping has been used for thousands of years by people who want to achieve a better understanding of themselves, their bodies and the world they live in. Artist Jane Solomon and psychologist Jonathan Morgan transformed Body Mapping for the “Long Life Project”, during the Médecins Sans Frontières (MSF) roll-out of antiretrovirals in Khayelitsha township, South Africa in 2001. Body mapping enables participants to tell their stories in the face of intense HIV/AIDS stigma. We adapted Body Mapping for the Women, Art and Criminalizaton of HIV Non-Disclosure (WATCH) study, a community arts based research (CBR) approach to better understand the impact that Canadian laws criminalizing HIV non-disclosure have on women living with HIV. Our national team includes women living with HIV, service providers, and researchers. This reflection illustrates our collective and iterative process of learning, teaching and doing body mapping workshops with women living with HIV in Canada. We share our experiences of coming to Body Mapping as an arts-based approach to CBR, how our roles as researchers stretched to include community-based education, advocacy, and group facilitation, and how we embodied the artist-researcher identity as we disseminate our research in ways that actively engage the general public on laws criminalizing HIV nondisclosure laws vis-à-vis Body Mapping galleries.

HIV-related stigma impedes adoption and implementation of effective HIV prevention and treatment strategies. It may also exacerbate racial/ethnic HIV disparities. Given high levels of religious observance within African, Caribbean, and Black (ACB) communities and the social capital that faith-based organizations hold, these entities may be promising venues for stigma-remediation and effective partners in community-based, HIV-focused programing. However, more research is needed to understand HIV-related stigma in these institutions. This study examines HIV-related stigma among six ACB churches in Ontario, Canada. Surveys were distributed to ACB attendees (

To assess challenges with daily oral antiretroviral therapy (ART), we analyzed data for 2389 participants in the 2019 Positive Perspectives survey of people living with HIV in 25 countries. ART-related challenges reported included difficulty swallowing pills (33.1% [790/2389]); stress from daily dosing routine (33.3% [795/2389]); bad memories from daily intake of HIV medication (35.1%[839/2389]), and concern “that having to take pills every day means a greater chance of revealing my HIV status to others” (37.9% [906/2389]). Individuals who felt empowered by daily oral dosing [“taking my pill(s) every day reassures me that my HIV is being kept under control”] had 69% higher odds of optimal overall health (AOR 1.69, 95% CI 1.40–2.04). Conversely, odds of optimal overall health were lower among those who felt daily pill intake “limits my day-to-day life” (AOR 0.53, 95% CI 0.44–0.64). These findings show that there is need for increased flexibility of ART delivery to meet diverse patient needs. Electronic supplementary material The online version of this article (10.1007/s10461-020-03055-1) contains supplementary material, which is available to authorized users.

While geographic differences in HIV burden are well documented, less is known about regional differences in perceived treatment needs. To fill this gap, the 2019 Positive Perspectives study of people living with HIV (PLHIV) was conducted in 25 countries across Northern America, Latin America, the Asian region, Europe (EU/Schengen countries), Russia, Australia, and South Africa (n = 2389). Overall mean duration of HIV was 10.1 (SD = 9.6) years. The perception that HIV had a negative impact on day-to-day life was lowest among participants from South Africa (14.0%[25/179]) and highest among participants from the Asian region (55.2%[127/230]). Most of the regional gap in the perception that HIV had a negative impact on daily life was explained by regional differences in medication-related unmet needs, stigma, demographic factors, and comorbidities. The percentage who felt they understood their treatment was highest among participants from Australia (87.5%[105/120]) and lowest among those from Russia (62.0%[93/150]), the Asian region (62.2%[143/230]), and South Africa (62.6%[112/179]). Among participants from Northern America, Europe, and Latin America, the treatment goals with the largest absolute increase in perceived importance, from time of starting treatment to time of survey among those diagnosed for ≥1 year, were minimizing the long term impact of antiretroviral treatment and keeping the number of medicines in their antiretroviral regimen at a minimum. Tailored approaches to care of PLHIV are needed as different regions have different disease burden and treatment needs. Equitable approaches to HIV care are needed across and within regions to ensure that patients' unmet needs and preferences are addressed to improve their overall wellbeing and health-related quality of life.

We assess participants’ experience of Black Pastors Raising Awareness and Insight of Stigma through Engagement (Black PRAISE), an intervention for Black churches to promote critical awareness of HIV affecting Black Canadian communities. We used a community-based participatory approach to implement Black PRAISE among six churches in the Greater Toronto Area and Ottawa, in October–November 2016. For the intervention, congregants received a booklet with validated HIV-related information, attended a sermon on compassion and justice, viewed a short film on HIV-related stigma, and completed baseline and follow-up surveys to evaluate the effectiveness of the intervention. We then conducted in-depth interviews with 18 pastors and congregants from the six churches to explore how they experienced the intervention. Three major themes emerged from an iterative exploration of the thematic content of the interviews: the beneficial impact of the intervention; reconciling the moral and theological issues of their faith with the social reality of HIV and stigma; and perspectives on future stigma reduction efforts. Participants spoke approvingly about Black PRAISE and supported stigma reduction but acknowledged uncertainties about their capacity to actualise their commitment. The main overarching lessons from Black PRAISE are as follows: first, our results support a community-based participatory approach to productively engaging Black congregations in stigma reduction and health promotion; second, promising or successful interventions incorporate multiple components to promote critical awareness about the specific health issue for Black life and wellbeing; and third, interventions are more likely to succeed if they support critical reflection on the underlying conceptual issues, implicit assumptions and belief systems among the professional and lay stakeholders.

Modern antiretroviral therapy (ART) has improved the lives of people living with HIV (PLHIV) but currently requires daily adherence. We assessed prevalence and correlates of suboptimal adherence, and measured associations with self-reported health outcomes. Data were from web-based surveys of confirmed HIV+ adults on antiretroviral treatment within 25 countries during 2019 (n = 2389). Suboptimal adherence was a report of ≥1 reason for missing ART ≥5 times within the past month. Multivariable logistic regression examined associations between suboptimal adherence and self-reported overall health and virologic suppression. Overall, 24.1% (575/2389) reported suboptimal adherence, from 10.0% (5/50) in Austria, to 62.0% (31/50) in China. The most common reasons for missing ART ≥5 times in the overall population were feeling depressed/overwhelmed (7.4%, 176/2389), trying to forget about HIV (7.0%, 168/2389), and work (6.1%, 145/2389). Correlates of suboptimal adherence included being heterosexual,50 years old, ≤high school, having gastrointestinal treatment side effects, and privacy concerns. Odds of suboptimal overall health were 1.41 (95%CI, 1.11-1.80), 2.10 (95%CI, 1.65-2.68), and 2.55 (95%CI, 2.00-3.25) among those who reported the maximum number of times missed ART for any reason within the past month as 1, 2-4, or ≥5 times respectively, vs not missing at all. Odds of virologic nonsuppression were 1.80 (95%CI, 1.33-2.45), and 2.24 (95%CI, 1.66-3.02) for 2-4, or ≥5 times of missed ART respectively, vs not missing at all; missing for only 1 time was not significantly associated with virologic nonsuppression. Novel ART strategies designed to improve adherence along with interventions to empower PLHIV and support self-medication may improve health outcomes and quality of life.

Background: Associations between HIV-related stigma and reduced antiretroviral therapy (ART) adherence are widely established, yet the mechanisms accounting for this relationship are underexplored. There has been less attention to HIV-related stigma and its associations with ART initiation and current ART use. We examined pathways from HIV-related stigma to ART initiation, current ART use, and ART adherence among women living with HIV in Canada. Methods: We used baseline survey data from a national cohort of women living with HIV in Canada (n = 1425). Structural equation modeling using weighted least squares estimation methods was conducted to test the direct effects of HIV-related stigma dimensions (personalized, negative self-image, and public attitudes) on ART initiation, current ART use, and 90% ART adherence, and indirect effects through depression and HIV disclosure concerns, adjusting for sociodemographic factors. Results: In the final model, the direct paths from personalized stigma to ART initiation (β = −0.104, P < 0.05) and current ART use (β = −0.142, P < 0.01), and negative self-image to ART initiation (β = −0.113, P < 0.01) were significant, accounting for the mediation effects of depression and HIV disclosure concerns. Depression mediated the pathways from personalized stigma to ART adherence, and negative self-image to current ART use and ART adherence. Final model fit indices suggest that the model fit the data well [χ2(25) = 90.251, P < 0.001; comparative fit index = 0.945; root-mean-square error of approximation = 0.044]. Conclusions: HIV-related stigma is associated with reduced likelihood of ART initiation and current ART use, and suboptimal ART adherence. To optimize the benefit of ART among women living with HIV, interventions should reduce HIV-related stigma and address depression.

Background Women comprise nearly one-quarter of people living with human immunodeficiency virus (HIV) in Canada. Compared with men, women living with HIV experience inequities in HIV care and health outcomes, prompting a need for gendered and tailored approaches to HIV care. Method Peer and academic researchers from the Canadian HIV Women's Sexual and Reproductive Health Cohort Study conducted focus groups to understand women's experience of seeking care, with the purpose of identifying key characteristics that define a women-centered approach to HIV care. Eleven focus groups were conducted with 77 women living with HIV across Quebec, Ontario, and British Columbia, Canada. Results Women envisioned three central characteristics of women-centered HIV care, including i) coordinated and integrated services that address both HIV and women's health care priorities, and protect against exclusion from care due to HIV-related stigma, ii) care that recognizes and responds to structural barriers that limit women's access to care, such as violence, poverty, motherhood, HIV-related stigma, and challenges to safe disclosure, and iii) care that fosters peer support and peer leadership in its design and delivery to honor the diversity of women's experiences, overcome women's isolation, and prioritize women's ownership over the decisions that affect their lives. Conclusion Despite advances in HIV treatment and care, the current care landscape is inadequate to meet women's comprehensive care needs. A women-centered approach to HIV care, as envisioned by women living with HIV, is central to guiding policy and practice to improve care and outcomes for women living with HIV in Canada.

The Women, ART and the Criminalization of HIV Study is a qualitative, arts-based research study focusing on the impact of the HIV non-disclosure law on women living with HIV in Canada. The federal law requires people living with HIV to disclose their HIV-positive status to sexual partners before engaging in sexual activities that pose what the Supreme Court of Canada called a ‘realistic possibility of transmission’. Drawing on findings from seven education and discussion sessions with 48 women living with HIV regarding HIV non-disclosure laws in Canada, this paper highlights the ways in which women living with HIV respond to learning about the criminalisation of HIV non-disclosure. The most common emergent themes included: the way the law reproduces social and legal injustices; gendered experiences of intimate injustice; and the relationship between disclosure and violence against women living with HIV. These discussions illuminate the troubling consequences inherent in a law that is antithetical to the science of HIV transmission risk, and that fails to acknowledge the multiple barriers to HIV disclosure that women living with HIV experience. Women’s experiences also highlight the various ways the law contributes to their experiences of sexism, racism and other forms of marginalisation in society.

The article Physical, Emotional, and Psychosocial Challenges Associated with Daily Dosing of HIV Medications and Their Impact on Indicators of Quality of Life: Findings from the Positive Perspectives Study, written by Patricia de los Rios · Chinyere Okoli · Erika Castellanos · Brent Allan · Benjamin Young · Garry Brough · Marvelous Muchenje · Anton Eremin · Giulio Maria Corbelli · Marta McBritton · W. David Hardy· Nicolas Van de Velde was originally published electronically on the publisher’s internet portal on 17th December 2020 without open access. With the author(s)’ decision to opt for Open Choice the copyright of the article changed on 16th February 2021 to © The Author’s 2021 and the article is forthwith distributed under a Creative Commons Attribution.

Over 60 countries criminalise 'the "willful" transmission of HIV'. Such a law has the potential to hinder public health interventions. There is limited literature discussing the perceptions of this law and the impact, it has had on HIV-positive women. This paper describes the knowledge of and attitudes of this law by HIV-positive women living in Ontario; and their experiences with its application. Three group discussions (n = 10) and 17 in-depth interviews with HIV-positive women age: 21-56 years. Data were analysed using a modified thematic approach. Most of the respondents knew about the law with regard to adult HIV transmission. However, very few knew about any laws related to mother to child HIV transmission, although some reported having had their children taken away because of breastfeeding. Respondents felt that the law could be fair and protective if there were means of providing a priori support to those women who have been disadvantaged social-culturally and structurally. Without this support, the law could potentially lead HIV-positive women into hiding and not accessing services that could help them. There is need for the law implementers to consider these findings if they are to support the public health efforts to control HIV.

Background Despite effectiveness of antiretroviral therapy (ART), some people living with HIV (PLHIV) still face barriers to daily oral ART adherence, including inconvenient scheduling, food requirements, adverse effects, and privacy concerns. We characterized treatment-related physical, emotional, and psychosocial challenges among PLHIV from 25 countries. Methods 2389 PLHIV adults on ART were surveyed in the 2019 Positive Perspectives Study, a standardized, self-reported survey of HIV patients aged 18-84 years on treatment. Data were collected on ART-related perceptions and behaviors. Descriptive and multivariable analyses were performed. Results Most participants were male (67.9%), aged < 50 years (70.7%), and reported viral suppression (74.1%). ART-related challenges included cueing of bad memories (58.4%), disguising HIV pills (57.9%), stress (33.3%), and difficulty swallowing pills (33.1%). Privacy and emotional challenges were generally similar between the USA and Canada (Figure 1). In the pooled sample, those who felt limited by their ART had higher odds of reporting suboptimal overall health (AOR 1.90, 95%CI:1.57-2.29), treatment dissatisfaction (AOR 2.21, 95%CI:1.82-2.69), and suboptimal adherence (AOR 1.90, 95%CI:1.57-2.29). Difficulty swallowing, any side effects, and privacy concerns were associated with increased odds of suboptimal overall health (AOR 2.10, 1.88, and 1.43, respectively) and suboptimal adherence (AOR 2.51, 1.50, and 1.87, respectively; all P< 0.05); results for other outcomes are in Figure 2. Overall, 12.6% (302/2389) had shared their HIV status solely with their primary HIV provider, whereas 6.8% (163/2389) “always” shared their HIV status. Only 52.0% were comfortable discussing ART-related privacy concerns with providers, although 29.0% overall missed ≥1 ART dose in the past month from privacy concerns. Overall, 54.7% preferred a nondaily regimen if their HIV stays suppressed, while 72.3% were open to ART with fewer therapies. Figure 1 Figure 2 Conclusion This study identified several challenges with ART among PLHIV, underscoring the need for increased flexibility of ART delivery to meet diverse patient needs. Addressing these needs may improve overall health outcomes for more PLHIV on therapy. Disclosures Patricia De Los Rios, MSc, GlaxoSmithKline (Shareholder)ViiV Healthcare (Employee) Chinyere Okoli, PharmD, MSc, DIP, ViiV Healthcare (Employee) Benjamin Young, MD, PhD, ViiV Healthcare (Employee) Garry Brough, BA Joint Hons in French/Italian, ViiV Healthcare (Employee, Independent Contractor, Other Financial or Material Support, Speakers Fees and Honoraria) Anton Eremin, MD, ViiV Healthcare (Advisor or Review Panel member) Marvelous Muchenje, BSW, MSc. in Global Health, ViiV Healthcare Canada (Employee) Nicolas Van de Velde, PhD, GlaxoSmithKline (Shareholder)ViiV Healthcare (Employee)

Background Quality communication between patients & HCPs is important to help to identify/address treatment gaps. Who initiates this communication may vary, but impact of good quality communication as a marker of successful care has not been fully explored in PLHIV. We investigated whether perceived comfort discussing salient issues with HCPs differed between PLHIV with vs without specific treatment challenges. Methods We analyzed self-reported data for 520 PLHIV from the 2019 Positive Perspectives study from Canada and USA. Engagement in care (low, moderate, high), was modified from the Observing Patient Involvement scale. Using Chi-squared tests, we compared communication barriers among those uncomfortable discussing with their HCP (p< .05). Results Mean age was 39.6 years. Perceived comfort discussing salient issues with HCPs was significantly lower among PLHIV with than without the specified challenges: discussing side effects (those experiencing side effects=50.4%[135/268] vs without=60.7%[153/252], p=.018); discussing privacy concerns (those hiding medications=41.3%[138/334] vs not hiding =66.7%[124/186], p< .001); discussing adherence challenges (those with suboptimal =42.4%[78/184] vs optimal adherence=57.7%[194/336], p=.001); discussing concerns about HIV illnesses (those without viral suppression=43.1%[90/209] vs virally suppressed=64.6%[201/311], p< .001); and discussing impact of HIV on their life (45.4%[100/220] vs 62.7%[188/300] among those reporting vs not reporting that HIV negatively impacts their life, respectively, p< .001). Among those uncomfortable discussing HCP/clinic-related barriers (eg, no time during visits, worried HCP might perceive them as “difficult”) and limited self-efficacy were particularly more prevalent among those with vs without specific challenges (Figure 2). Pooled analysis showed that optimal self-rated health was 33.9%[42/124]; 52.1%[112/215]; and 68.5%[124/181] among those with low, moderate, & high engagement (p< .001, Figure 3). Figure 1 Figure 2 Figure 3 Conclusion Individuals uncomfortable discussing issues with their HCP reported greater treatment challenges. Proactive HCP-driven high-quality communications with all patients is necessary to help address these concerns. Disclosures Patricia De Los Rios, MSc, GlaxoSmithKline (Shareholder)ViiV Healthcare (Employee) Benjamin Young, MD, PhD, ViiV Healthcare (Employee) Marvelous Muchenje, BSW, MSc. in Global Health, ViiV Healthcare Canada (Employee) Nicolas Van de Velde, PhD, GlaxoSmithKline (Shareholder)ViiV Healthcare (Employee) Chinyere Okoli, PharmD, MSc, DIP, ViiV Healthcare (Employee)

Background : Women have historically been under-represented in HIV research, partly due to ineffective recruitment strategies. Objective : To improve the existing understanding of recruitment for HIV-positive women based on a province-wide cross-sectional study. Methods : A survey was emailed to all site coordinators who recruited participants in a study involving 490 HIV-positive women living in Ontario, Canada. The survey consisted of questions regarding the important recruitment barriers and successes. Quantitative data were then contextualized within extensive knowledge from research personnel and team members. Results : Completed surveys were received from (89%) site coordinators (34/38) and 98% (31/34) were women. The highest ranked recruitment barriers identified were: sensitivity of the research topic (59%), time/availability constraints (59%), language barriers (53%), HIV disclosure/stigma issues (47%), lack of trust of research personnel (41%), fear of research (41%) and inaccessibility to child care and transportation (41%). The respondents felt that the most important personal attributes for recruitment were research personnel who were respectful (97%), skilled (91%), flexible (88%) and empathetic (88%) and had good communication skills (88%). The most successful recruitment strategies identified were: developing a strong rapport (88%) that was facilitated by an empathetic relationship (100%), acknowledging the sensitive nature of the research topic (94%), providing cash financial compensation (88%), and developing recruitment strategies unique to women (88%). Conclusion : There are differences in the approaches needed for the recruitment of HIV-positive women in research. For successful recruitment of HIV-positive women, a strong rapport between the research personnel and study participants is important. This rapport is facilitated by having study personnel who are respectful, trustworthy, empathetic, and flexible. Population-specific recruitment strategies are important to ensure adequate recruitment of minority groups in research with greater gender consideration for women requiring specific attention.

Decision-making related to pregnancy planning is complex and human immunodeficiency virus (HIV) may further complicate the process. With increasing rates of pregnancy among individuals affected by HIV, the need to understand decision-making is imperative. The primary objectives of this pilot study were to confirm the feasibility of using discrete choice experimentation (DCE) to elicit an understanding of this process and to determine the acceptability of the choice factors that were included in two novel DCEs, while gathering a preliminary understanding of preference. The choice attributes were risk of vertical HIV transmission, risk of horizontal HIV transmission, cost, probability of conception, method of conception, and travel time. Thirteen respondents completed a DCE for serodiscordant couples in which the female partner was HIV-positive, and 12 respondents completed a DCE for seroconcordant couples. All respondents’ utility for an increased chance of a successful pregnancy was positive and statistically significant. In the serodiscordant dyads, the attributes of risk of horizontal transmission, risk of vertical transmission, a 5-h travel time to clinic, and cost were significantly associated with decreased utility. In the seroconcordant dyads, only the attributes of chance of risk of vertical transmission and cost were significantly associated with decreased utility. The serodiscordant dyads preferred home insemination with a syringe and the seroconcordant couples preferred conception methods within fertility clinics, over condomless sex with timed ovulation. On average, participants were willing to pay more for greater chance of conception and less willing to pay for increased risk of transmission. Couples affected by HIV are willing to participate in a DCE and the attributes that were included all seem relevant except risk of vertical transmission. There are various real-life trade-offs that are made during pregnancy planning with HIV and better understanding of these can be useful for clinicians during preconception counseling.

Background The African, Caribbean and Black communities have been found to be reluctant to participate in health research in North America. This is partly attributed to historical experiences as well as their cultural beliefs. Cultural beliefs about the uses of breast milk/fluids could further hinder the participation of African, Caribbean, and Black communities in research involving the collection of breast milk/fluids samples. Methods We conducted 17 in-depth interviews and three group interviews (n = 10) with HIV+ African, Caribbean and Black women living in Ontario, Canada to explore their cultural beliefs about breast milk/fluids and their acceptance of participating in research that involves the provision of breast fluid samples. Study design Qualitative study involving in-depth interviews. Results Our respondents believed that breast milk/fluids should be used for infant feeding and for curative purposes for a variety of children’s health ailments as well as ailments experienced by other family members. The cultural belief that breast milk/fluids could be used to bewitch the baby and mother and the perception that it is intrusive (equating breast milk/fluids research to DNA testing), could prevent African, Caribbean and Black women from participating in research involving the collection of breast milk/fluids. Despite these fears, some respondents expressed that they would participate if the research results would benefit them directly, for example, by finding a cure for HIV, enabling HIV+ mothers to breastfeed, or contributing to developing new drugs or vaccines for HIV. Women’s recommendations to facilitate successful recruitment included giving incentives to participants, and employing a recruiter who was trustworthy, informed, and culturally sensitive. Conclusion Cultural beliefs could present barriers to recruitment and participation of Africa, Caribbean and Black communities in health research involving breast milk/fluid samples. Successful recruitment for future studies would necessitate researchers to be culturally aware of the beliefs held by African, Caribbean and Black women, to build trust, and use an appropriate recruiter. While the findings relate to breast milk/fluids, the suggested recommendations for facilitating recruitment of research participants from these communities may be useful to consider when recruiting ethnically and culturally similar participants for research involving biological samples. Electronic supplementary material The online version of this article (doi:10.1186/s13104-016-2326-6) contains supplementary material, which is available to authorized users.

Decreased mortality, decreased risk of vertical HIV transmission, and many people living with HIV (PLWHIV) being of reproductive age have led many PLWHIV to consider pregnancy. However, scarce data exist regarding the conception planning resources required and available for PLWHIV to have safe and healthy pregnancies. This study aimed to identify gaps between the need for, knowledge of, and access to conception planning information and services among PLWHIV in Ontario, Canada. PLWHIV from three large and two small urban sites in Ontario were recruited (n = 63). Participants completed a cross-sectional survey assessing demographics, expectations and plans for conception, and knowledge about and access to existing conception information and services for PLWHIV. Univariate correlations and ranked analyses were used to assess the associations between the need for, knowledge of, and access to conception planning resources with various demographic variables. Participants’ median age was 40 years (interquartile ...

Background While advances in treatment have dramatically improved the life-expectancy of people living with HIV (PLHIV), a number of unmet needs remain. We conducted an international survey of PLHIV to explore their level of satisfaction with current treatment and potential areas of improvement for ARVs. Methods Qualitative in-depth interviews were performed with PLHIV to identify key hypotheses. A steering group developed the survey questions which was fielded online from November 2016 to April 2017 in 9 countries across North America, Europe and Australia. A mixed sampling/recruitment approach was used to ensure a broad cross-section of PLHIV. Respondents were screened for eligibility prior to receiving access to the online survey Results Overall 1085 PLHIV completed the survey with 40% of respondents from North America. The demographic breakdown was 25% women, 34% >50 years, 49% diagnosed >10 years ago, 76 % with co-morbidities. 40% had a college degree or higher, 33% were in full-time employment and 62% lived in a large city. Majority (98%) were currently taking ARVs with 53% taking a Single Tablet Regimen (STR). 87% of those diagnosed within last 2 years had started treatment within 6 months of diagnosis, compared with 40% of those diagnosed > 10 years ago. Of those on treatment, 87% were satisfied with their current ARV regimen. 33% had changed treatment in the last 12 months with the main reasons for switching being reducing severity or frequency of side effects (43%) and reducing the pill burden (31%). 73% of those on treatment were worried about the long-term effects of ARVs. Reducing these long-term effects (25%) and the potential availability of longer lasting treatments (21%) were identified as the 2 most important potential improvements to current regimens. 62% were open to changing to an ARV regimen with fewer drugs as long as their HIV remained suppressed. Demographics and results for the North American cohort were generally similar to the overall global results. Conclusion In this international survey, the majority of PLHIV were satisfied with their current regimen, with reducing long-term adverse effects of ARVs and a longer lasting treatment identified as the most important potential improvements. Disclosures B. Young, ViiV Healthcare: Consultant and Scientific Advisor, Consulting fee and Research support; Gilead: Consultant and Scientific Advisor, Consulting fee and Research support; Merck: Consultant, Scientific Advisor and Speaker’s Bureau, Consulting fee and Research support; B. Spire, Gilead: Scientific Advisor, Consulting fee; MSD: Scientific Advisor, Consulting fee; D. Garcia Morcillo, ViiV Healthcare: Consultant, Consulting fee; K. Parkinson, ViiV Healthcare: Consultant, Consulting fee; M. Krehl, ViiV Healthcare: Consultant, Consulting fee; S. Marcotullio, Abbvie, Gilead sciences, Janssen-Cilag: Scientific Advisor, Consulting fee and Research grant; B. Allan, ViiV Healthcare: Consultant, Consulting fee; Y. Punekar, ViiV Healthcare: Employee and Shareholder, Salary; A. deRuiter, ViiV Healthcare: Employee and Shareholder, Salary; S. Barthel, GlaxoSmithKline: Employee and Shareholder, Salary; J. Koteff, ViiV Healthcare: Employee and Shareholder, Salary; C. Garris, ViiV Healthcare: Employee and Shareholder, Salary; C. Nguyen, ViiV Healthcare: Employee and Shareholder, Salary; A. Ustianowski, ViiV: Speaker’s Bureau, Conference sponsorship; Gilead: Grant Investigator, Scientific Advisor and Speaker’s Bureau, Consulting fee, Grant recipient and Speaker honorarium; MSD: Scientific Advisor and Speaker’s Bureau, Consulting fee and Speaker honorarium; Janssen: Scientific Advisor, Consulting fee; Abbvie: Grant Investigator, Grant recipient; P. Eitz Ferrer, ViiV Healthcare: Employee and Shareholder, Salary; A. Murungi, ViiV Healthcare: Employee, Salary

Mothers in HIV-endemic countries are advised to exclusively breastfeed their babies until six months because of lack of resources and better chances for child survival while in developed countries replacement feeding is advised. What are the experiences of HIV-positive women who migrate from HIV-endemic countries to developed countries when making infant feeding choices? METHODS: In-depth interviews and focus group discussions with a total of 25 women living with HIV in Toronto and Hamilton Ontario. RESULTS: Free infant formula alleviates the practical constraints in making infant feeding choices. However cultural beliefs and social expectations constrain HIV-positive mothers decision not to breastfeed. This is further complicated by the different policies. Service providers should understand the psychological and emotional experiences of the mothers in order to provide the appropriate support. Peers could be potential sources of support. The differences in policies are issues of global justice that need to be addressed.