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  • 1
    Online Resource
    Online Resource
    Recent sex work and associations with psychosocial outcomes among women living with HIV: findings from a longitudinal Canadian cohort study
    Wiley ; 2022
    In:  Journal of the International AIDS Society Vol. 25, No. 3 ( 2022-03)
    Details
    In: Journal of the International AIDS Society, Wiley, Vol. 25, No. 3 ( 2022-03)
    Abstract: 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.
    Type of Medium: Online Resource
    ISSN: 1758-2652 , 1758-2652
    URL: Issue
    URL: Article
    DOI: 10.1002/jia2.v25.3
    DOI: 10.1002/jia2.25874
    Language: English
    Publisher: Wiley
    Publication Date: 2022
    detail.hit.zdb_id: 2467110-1
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  • 2
    Online Resource
    Online Resource
    Adapting stigma mechanism frameworks to explore complex pathways between intersectional stigma and HIV-related health outcomes among women living with HIV in Canada
    Elsevier BV ; 2019
    In:  Social Science & Medicine Vol. 232 ( 2019-07), p. 129-138
    Details
    In: Social Science & Medicine, Elsevier BV, Vol. 232 ( 2019-07), p. 129-138
    Type of Medium: Online Resource
    ISSN: 0277-9536
    URL: Article
    DOI: 10.1016/j.socscimed.2019.04.044
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2019
    detail.hit.zdb_id: 1500748-0
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  • 3
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    Gender-affirming healthcare experiences and medical transition among transgender women living with HIV: a mixed-methods study
    CSIRO Publishing ; 2019
    In:  Sexual Health Vol. 16, No. 4 ( 2019), p. 367-
    Details
    In: Sexual Health, CSIRO Publishing, Vol. 16, No. 4 ( 2019), p. 367-
    Abstract: Background Transgender (trans) women are overrepresented among people living with HIV, yet trans women living with HIV (WLWH) experience lower access to HIV care. Access to medical transition may facilitate access to HIV care among trans WLWH. This study sought to describe barriers and facilitators to access to medical transition among trans WLWH. Methods: This convergent parallel mixed-methods study drew on cross-sectional quantitative data from 48 trans WLWH analysed using descriptive and bivariate analyses, as well as qualitative semistructured interview data from a subsample of 11 participants analysed using framework analysis. The primary outcome was self-reported transition experience (completed or in the process of medical transition vs planning to but have not begun medical transition). Quantitative and qualitative results were merged and analysed for convergence, divergence and/or expansion of understanding. Results: Just over half the participants reported being fully completed medical transition or in the process of medical transition (52.1% (25/48); 95% confidence interval (CI) 37.5–67.6%), with one-fifth reporting planning to but not having begun medical transition (18.8% (9/48); 95% CI 8.3–29.2%). Factors significantly associated with not having begun one’s medical transition included housing instability, transphobia, HIV-related stigma and barriers in access to care. Qualitative findings revealed varied transition experiences, influenced by community norms, passing and class privilege, HIV and structural barriers. Mixed-methods results showed positive relationships between trans WLWH and HIV care providers in terms of trans and HIV health care. Conclusions: HIV-related stigma and social determinants of health limit access to medical transition for trans WLWH. Stigma must be addressed in a broad range of healthcare settings, in addition to structural barriers, to increase access to gender-affirming HIV care and medical transition for trans WLWH.
    Type of Medium: Online Resource
    ISSN: 1448-5028
    URL: Article
    DOI: 10.1071/SH19011
    Language: English
    Publisher: CSIRO Publishing
    Publication Date: 2019
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  • 4
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    Online Resource
    Examining Multilevel Factors Associated with the Process of Resilience among Women Living with HIV in a Large Canadian Cohort Study: A Structural Equation Modeling Approach
    SAGE Publications ; 2019
    In:  Journal of the International Association of Providers of AIDS Care (JIAPAC) Vol. 18 ( 2019-01-01), p. 232595821987128-
    Details
    In: Journal of the International Association of Providers of AIDS Care (JIAPAC), SAGE Publications, Vol. 18 ( 2019-01-01), p. 232595821987128-
    Abstract: We examined how multiple, nested, and interacting systems impact the protective process of resilience for women living with HIV (WLWH). Methods: Using data from a Cohort Study, we conducted univariate analyses, multivariable logistic regression, and a 2-step structural equation modeling for the outcome, high resilience (N = 1422). Results: Participants reported high overall resilience scores with a mean of 62.2 (standard deviation = 8.1) and median of 64 (interquartile range = 59-69). The odds of having high resilience were greater for those residing in Quebec compared to Ontario (adjusted odds ratio [aOR] = 2.1 [1.6, 2.9] ) and British Columbia (aOR = 1.8 [1.3, 2.5]). Transgender women had increased odds of high resilience than cisgender women (aOR = 1.9 [1.0, 3.6] ). There were higher odds of resilience for those without mental health diagnoses (aOR = 2.4 [1.9, 3.0]), non-binge drinkers (aOR=1.5 [1.1, 2.1] ), and not currently versus previously injecting drugs (aOR = 3.6 [2.1, 5.9]). Structural equation modeling confirmed that factors influencing resilience lie at multiple levels: micro, meso, exo, and macro systems of influence. Conclusion: There is a need to consider resilience as the interaction between the person and their environments, informing the development of multilevel interventions to support resilience among WLWH.
    Type of Medium: Online Resource
    ISSN: 2325-9582 , 2325-9582
    URL: Article
    DOI: 10.1177/2325958219871289
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2019
    detail.hit.zdb_id: 2709037-1
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  • 5
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    Online Resource
    Prevalence and Correlates of Forced Sex as a Self-Reported Mode of HIV Acquisition Among a Cohort of Women Living With HIV in Canada
    SAGE Publications ; 2020
    In:  Journal of Interpersonal Violence Vol. 35, No. 21-22 ( 2020-11), p. 5028-5063
    Details
    In: Journal of Interpersonal Violence, SAGE Publications, Vol. 35, No. 21-22 ( 2020-11), p. 5028-5063
    Abstract: Gender-based violence (GBV) is a global epidemic associated with increased HIV exposure. We assessed the prevalence and correlates of HIV acquisition via forced sex among women living with HIV (WLWH) in Canada. Baseline questionnaire data were analyzed for WLWH (≥16 years) with data on self-reported mode of HIV acquisition, enrolled in a community-based cohort study in British Columbia, Ontario, and Québec. We assessed forced sex (childhood, adulthood) as a self-reported mode of HIV acquisition. Of 1,330 participants, the median age was 42 (interquartile range [IQR] = 35-50) years; 23.5% were Indigenous, 26.3% African/Caribbean/Black, 43% White, and 7.2% of Other ethnicities. Forced sex was the third dominant mode of HIV transmission at 16.5% ( n = 219; vs. 51.6% consensual sex, 19.7% sharing needles, 5.3% blood transfusion, 3.8% perinatal, 1.3% contaminated needles, 0.4% other, 1.6% do not know/prefer not to answer). In multivariable analyses, significant correlates of HIV acquisition from forced versus consensual sex included legal status as a landed immigrant (adjusted odds ratio [aOR] = 1.99; 95% confidence interval [CI] = [1.12, 3.54] ) or refugee (aOR = 3.62; 95% CI = [1.63, 8.04]) versus Canadian citizen; African/Caribbean/Black ethnicity versus Caucasian (aOR = 2.49; 95% CI = [1.43, 4.35] ), posttraumatic stress disorder symptoms (aOR = 3.00; 95% CI = [1.68, 5.38]), histories of group home residence (aOR = 2.40; 95% CI = [1.10, 5.23] ), foster care (aOR = 2.18; 95% CI = [1.10, 4.34]), and having one child relative to having three or more children (aOR = 0.52; 95% CI = [0.31, 0.89] ). GBV must be considered a distinct HIV risk factor; forced sex is a significant underrecognized risk factor and mode of women’s HIV acquistion. Public health reporting systems can separate consensual and forced sex in reporting modes of HIV acquisition. Practitioners can engage in screening practices to meet client needs.
    Type of Medium: Online Resource
    ISSN: 0886-2605 , 1552-6518
    URL: Article
    DOI: 10.1177/0886260517718832
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2020
    detail.hit.zdb_id: 2028900-5
    SSG: 2
    SSG: 2,1
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  • 6
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    Online Resource
    Key recommendations for developing a national action plan to advance the sexual and reproductive health and rights of women living with HIV in Canada
    SAGE Publications ; 2022
    In:  Women's Health Vol. 18 ( 2022-01), p. 174550572210908-
    Details
    In: Women's Health, SAGE Publications, Vol. 18 ( 2022-01), p. 174550572210908-
    Abstract: Action on the World Health Organization Consolidated guideline on sexual and reproductive health and rights of women living with HIV requires evidence-based, equity-oriented, and regionally specific strategies centred on priorities of women living with HIV. Through community–academic partnership, we identified recommendations for developing a national action plan focused on enabling environments that shape sexual and reproductive health and rights by, with, and for women living with HIV in Canada. Between 2017 and 2019, leading Canadian women’s HIV community, research, and clinical organizations partnered with the World Health Organization to convene a webinar series to describe the World Health Organization Consolidated guideline, define sexual and reproductive health and rights priorities in Canada, disseminate Canadian research and best practices in sexual and reproductive health and rights, and demonstrate the importance of community–academic partnerships and meaningful engagement of women living with HIV. Four webinar topics were pursued: (1) Trauma and Violence-Aware Care/Practice; (2) Supporting Safer HIV Disclosure; (3) Reproductive Health, Rights, and Justice; and (4) Resilience, Self-efficacy, and Peer Support. Subsequent in-person (2018) and online (2018–2021) consultation with  〉  130 key stakeholders further clarified priorities. Consultations yielded five cross-cutting key recommendations: 1. Meaningfully engage women living with HIV across research, policy, and practice aimed at advancing sexual and reproductive health and rights by, with, and for all women. 2. Centre Indigenous women’s priorities, voices, and perspectives. 3. Use language that is actively de-stigmatizing, inclusive, and reflective of women’s strengths and experiences. 4. Strengthen Knowledge Translation efforts to support access to and uptake of contemporary sexual and reproductive health and rights information for all stakeholders. 5. Catalyse reciprocal relationships between evidence and action such that action is guided by research evidence, and research is guided by what is needed for effective action. Topic-specific sexual and reproductive health and rights recommendations were also identified. Guided by community engagement, recommendations for a national action plan on sexual and reproductive health and rights encourage Canada to enact global leadership by creating enabling environments for the health and healthcare of women living with HIV. Implementation is being pursued through consultations with provincial and national government representatives and policy-makers.
    Type of Medium: Online Resource
    ISSN: 1745-5057 , 1745-5065
    URL: Article
    DOI: 10.1177/17455057221090829
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2022
    detail.hit.zdb_id: 2254618-2
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  • 7
    Online Resource
    Online Resource
    High rates of posttraumatic stress symptoms in women living with HIV in Canada
    Public Library of Science (PLoS) ; 2018
    In:  PLOS ONE Vol. 13, No. 7 ( 2018-7-19), p. e0200526-
    Details
    In: PLOS ONE, Public Library of Science (PLoS), Vol. 13, No. 7 ( 2018-7-19), p. e0200526-
    Type of Medium: Online Resource
    ISSN: 1932-6203
    URL: Article
    URL: Article
    URL: Article
    URL: Article
    URL: Article
    URL: Article
    DOI: 10.1371/journal.pone.0200526
    DOI: 10.1371/journal.pone.0200526.t001
    DOI: 10.1371/journal.pone.0200526.t002
    DOI: 10.1371/journal.pone.0200526.t003
    DOI: 10.1371/journal.pone.0200526.t004
    DOI: 10.1371/journal.pone.0200526.t005
    Language: English
    Publisher: Public Library of Science (PLoS)
    Publication Date: 2018
    detail.hit.zdb_id: 2267670-3
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  • 8
    Online Resource
    Online Resource
    Sexual Relationship Power Equity Is Associated With Consistent Condom Use and Fewer Experiences of Recent Violence Among Women Living With HIV in Canada
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  JAIDS Journal of Acquired Immune Deficiency Syndromes Vol. 90, No. 5 ( 2022-08-15), p. 482-493
    Details
    In: JAIDS Journal of Acquired Immune Deficiency Syndromes, Ovid Technologies (Wolters Kluwer Health), Vol. 90, No. 5 ( 2022-08-15), p. 482-493
    Abstract: 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.
    Type of Medium: Online Resource
    ISSN: 1525-4135
    URL: Article
    DOI: 10.1097/QAI.0000000000003008
    RVK:
    XA 10000
    RVK:
    XA 51942
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
    detail.hit.zdb_id: 2038673-4
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  • 9
    Online Resource
    Online Resource
    Pathways From HIV-Related Stigma to Antiretroviral Therapy Measures in the HIV Care Cascade for Women Living With HIV in Canada
    Ovid Technologies (Wolters Kluwer Health) ; 2018
    In:  JAIDS Journal of Acquired Immune Deficiency Syndromes Vol. 77, No. 2 ( 2018-02-1), p. 144-153
    Details
    In: JAIDS Journal of Acquired Immune Deficiency Syndromes, Ovid Technologies (Wolters Kluwer Health), Vol. 77, No. 2 ( 2018-02-1), p. 144-153
    Abstract: 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 [χ 2 (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.
    Type of Medium: Online Resource
    ISSN: 1525-4135
    URL: Article
    DOI: 10.1097/QAI.0000000000001589
    RVK:
    XA 10000
    RVK:
    XA 51942
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
    detail.hit.zdb_id: 2038673-4
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  • 10
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    Online Resource
    Pathways From HIV-Related Stigma, Racial Discrimination, and Gender Discrimination to HIV Treatment Outcomes Among Women Living With HIV in Canada: Longitudinal Cohort Findings
    Ovid Technologies (Wolters Kluwer Health) ; 2023
    In:  JAIDS Journal of Acquired Immune Deficiency Syndromes Vol. 94, No. 2 ( 2023-10-1), p. 116-123
    Details
    In: JAIDS Journal of Acquired Immune Deficiency Syndromes, Ovid Technologies (Wolters Kluwer Health), Vol. 94, No. 2 ( 2023-10-1), p. 116-123
    Abstract: HIV-related stigma, gender discrimination, and racial discrimination harm mental health and hamper HIV treatment access for women living with HIV. Maladaptive coping strategies, such as substance use, can further worsen HIV treatment outcomes, whereas resilience can improve HIV outcomes. We examined resilience and depression as mediators of the relationship between multiple stigmas and HIV treatment outcomes among women living with HIV. Setting: Ontario, British Columbia, and Quebec, Canada. Methods: We conducted a longitudinal study with 3 waves at 18-month intervals. We used structural equation modeling to test the associations of multiple stigmas (HIV-related stigma, racial discrimination, and gender discrimination) or an intersectional construct of all 3 stigmas at wave 1 on self-reported HIV treatment cascade outcomes (≥95% antiretroviral treatment [ART] adherence, undetectable viral load) at wave 3. We tested depression and resilience at wave 2 as potential mediators and adjusted for sociodemographic factors. Results: There were 1422 participants at wave 1, half of whom were Black (29%) or Indigenous (20%). Most participants reported high ART adherence (74%) and viral suppression (93%). Racial discrimination was directly associated with having a detectable viral load, while intersectional stigma was directly associated with lower ART adherence. Resilience mediated associations between individual and intersectional stigmas and HIV treatment cascade outcomes, but depression did not. Racial discrimination was associated with increased resilience, while intersectional and other individual stigmas were associated with reduced resilience. Conclusion: Race, gender and HIV-related stigma reduction interventions are required to address intersectional stigma among women living with HIV. Including resilience-building activities in these interventions may improve HIV treatment outcomes.
    Type of Medium: Online Resource
    ISSN: 1525-4135
    URL: Article
    DOI: 10.1097/QAI.0000000000003241
    RVK:
    XA 10000
    RVK:
    XA 51942
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2023
    detail.hit.zdb_id: 2038673-4
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