HIV Legal Network

The purpose of this study was to understand the impact of the coronavirus disease 2019 (COVID-19) pandemic and mitigation efforts on health and social outcomes for people with HIV at the individual, social, and structural levels of the Social Ecological Model. The International Nursing Network for HIV collected data for a cross-sectional survey of people with HIV in Botswana, Canada, Colombia, Hong Kong, Kenya, Nigeria, South Africa, Thailand, and the United States from August 2021 through June 2023. Among 1,400 participants, 47.5% experienced decreased quality of life, 40.9% experienced increased anxiety, 33.0% had reduced connection with friends, and 38.8% had reduced access to resources. Participants’ reported impacts of COVID-19 varied by socioeconomic factors. Among these people with HIV, changes in quality of life, anxiety, social connectedness, and access to resources due to the COVID-19 pandemic were significantly associated with individual, social, and structural level factors using the Social Ecological Framework.

BackgroundHepatitis B virus (HBV) and hepatitis C virus (HCV) infections are major causes of morbidity and mortality worldwide. Measuring the epidemiological burden of HCV and HBV in Canada is essential to measure progress towards global elimination targets and to ultimately eliminate viral hepatitis as a public health concern.ObjectiveThis study aimed to provide the first national estimates of HBV prevalence and unawareness, and to update estimates of HCV incidence, prevalence, and unawareness in the general population and key populations in Canada for 2021. Progress towards elimination targets for 2025, namely incidence, awareness, mortality, and HBV vaccination, was also assessed.MethodsA combination workbook method and mathematical modelling was used to estimate the prevalence and unawareness of chronic hepatitis B (CHB), prevalence and incidence of anti-HCV antibodies, and the prevalence and unawareness of chronic hepatitis C (CHC).ResultsThe estimated prevalence of CHB was 0.68% (plausible range: 0.40%–0.97%) or 262,000 (152,000–371,000) people in the general population, of whom 42.5% (33.9%–51.0%) were unaware of their infection. Immigrants from countries where HBV is common had the highest prevalence at 4.2% (1.9%–5.6%). An estimated 8,212 new HCV infections occurred in 2021, and the estimated prevalence of CHC was 0.56% (0.15%–0.97%) or 214,000 (58,500–369,000) people, of whom 41.5% (34.3%–48.8%) were unaware of their infection. People who inject drugs had the highest prevalence and largest proportion who were unaware at 36.9% (12.6%–55.1%) and 49.9% (29.0%–70.2%), respectively.ConclusionWhile the overall viral hepatitis burden is low in the general Canadian population, these estimates indicate that certain populations and communities remain disproportionately affected. Although Canada has met some of the 2025 targets, more work is needed. To this end, efforts to obtain and standardize provincial and national data will be required to measure progress towards all elimination targets.

Presumptive HIV therapy (PHT) is recommended for post-natal HIV prophylaxis (PNP) in situations at high risk of HIV vertical transmission (VT), for both prevention of transmission and as early treatment in cases of in utero transmission. The objective of this study was to describe the risk of VT and use PHT among newborns in Canada, and specifically, factors associated with the use of PHT. Data were analysed for all mother-infant pairs (MIPs) in the Canadian Perinatal HIV Surveillance Program (1997-2020), collected annually from 22 perinatal HIV centres in Canada. Infants were categorized as high risk (delivery viral load [dVL] ≥1000 copies/ml or maternal combined antiretroviral [cART] <4 weeks prior to delivery), moderate risk (dVL detectable and <1000 copies/ml, and maternal cART ≥4 weeks prior to delivery) and low risk (dVL undetectable and maternal cART ≥4 weeks prior to delivery). Neonatal prophylaxis and HIV transmission risk were compared between groups. A total of 4743 MIPs were included in the analysis. Overall, 13.3% of newborns received PHT; the most prescribed PHT regimens included combinations using zidovudine, lamivudine and nelfinavir (48.5%) or nevirapine (41.9%). While the most significant risk factor for transmission on univariate analysis was a detectable dVL ≥1000 copies/ml versus undetectable (odds ratio [OR] 27.91 [11.20-69.54]), the risk remained significantly increased at dVL between 400 and 999 copies/ml (OR 31.71 [8.31-120.98], but not at dVL between 50 and 399 copies/ml (OR 3.03 [0.72-12.81]). At dVL 50-399 copies/ml, 29.8% of infants received PHT, increasing to 46.7% at dVL 400-999 copies/ml, and 64.4% of infants at dVL≥1000 copies/ml. The overall risk of transmission was 6% in the high-risk group, 0.5% in the moderate-risk group and 0.2% in the low-risk group. PHT has been widely used in Canada in situations at high risk of VT, with 25% of newborns in this risk group receiving PHT as PNP. While PHT may reduce the risk of VT in high-risk situations and may be of benefit in cases of VT, these data also highlight ongoing gaps in perinatal HIV prevention in Canada.

BackgroundOlder adults living with HIV face challenges accessing regular geriatric care, and while virtual care services could offer a solution, they may come with limitations.ObjectiveThis study aimed to co-design a culturally appropriate virtual care model tailored to older adults’ needs using the experience-based co-design methodology.MethodsWe used a qualitative, experience-based co-design approach with 19 older adults living with HIV. The process involved 3 phases: identifying needs through interviews and questionnaires, codeveloping a care model prototype through focus groups and a workshop, and refining the model using feedback from a world café format. Data were analyzed using thematic content analysis.ResultsThe co-design process led to a virtual care model prototype that directly addressed participants’ key needs. These included personalized communication methods, simplified technology interfaces for easier access, and culturally responsive care practices. Participants emphasized the importance of privacy in virtual consultations, flexible scheduling to accommodate health fluctuations, and ongoing support for managing both HIV and aging-related conditions. Their feedback shaped a model designed to bridge service gaps, offering a more inclusive, accessible, and patient-centered approach to virtual geriatric care.ConclusionsThis study co-designed a potential virtual geriatric care model grounded in the experiences of older adults living with HIV. By integrating participants’ insights throughout the design process, the model offers a promising approach to improving care for this vulnerable population. Future directions for research to test this model are proposed.

ABSTRACT Given the current organ shortage crisis, organ transplantation among people with HIV (PWH) has become a reality. To effectively implement this practice, understanding the attitudes and beliefs about organ donation among PWH in Canada is imperative. PWH receiving care at the McGill University Health Centre were recruited to participate in a survey between October 2023-June 2024. The questionnaire assessed knowledge of organ donation and willingness to donate or receive organs from donors with HIV. Descriptive statistics were performed. Of 100 participants, 33.0% knew that PWH can undergo organ transplantation in Canada, and 26.0% knew that PWH in Canada can donate their organs to PWH. Additionally, 74.5% would consider accepting an organ from a deceased donor with HIV, 78.0% would consider accepting an organ from a living donor regardless of HIV status, 78.0% would be willing to be deceased donors, and 44.0% would be willing to be a living organ donor. Female-identifying and African, Caribbean or Black participants showed higher awareness about organ donation, whereas male-identifying and White participants demonstrated higher willingness to donate and receive organs from donors with HIV. While willingness among PWH was high, knowledge of organ transplantation was suboptimal, highlighting the need for increased awareness efforts.

BackgroundMany health education institutions in African countries such as Nigeria face increasing enrolment of students but lack an adequate number of instructors to train them. If digital learning can be demonstrated effective in augmenting knowledge and skills, this approach could help fill this gap and improve education efficiency. A needs assessment in two Nigerian midwifery schools confirmed that digital learning would be feasible and welcomed. In this study, the Midwifery Active Digitization Empowerment Initiative (MADE-I) program was tested to determine if digital delivery of the Fundamental Interventions, Referral and Safe Transfer (FIRST) course is at least equally effective for training midwifery students compared to conventional small-group delivery.MethodsA non-inferiority randomized controlled trial design was used, enrolling 130 s-year students from 2 midwifery schools in Benue State, Nigeria. Students were randomly assigned into six cohorts. Each cohort received half of the course on a Learning Management Platform on their mobile phones, the other half through standard small-group teaching. Students’ knowledge, thinking, and technical skills were assessed using a pre-test, post-test, Objective Structured Clinical Exam (OSCE), and daily modular quizzes. The data was analyzed using the difference-in-difference method.ResultsThe study revealed that post-intervention student knowledge and thinking skills did not significantly differ between digital learning (75.26%) and small-group learning arms of the trial (75.02%, p = 0.404). Student knowledge improved significantly compared to the pre-test in both groups (by 25.03 points in the digital arm, 26.39, in small-group). Some differences were observed between digital and small-group learning in disaggregated analysis by specific module and midwifery school. Although there was a trend toward small-group learning of technical skills being more effective than digital learning, no significant differences between groups were observed in the post-intervention OSCE. Students in both groups learned equally well regardless of age, gender, and midwifery school entrance exam score.ConclusionDigital learning is as effective as small-group learning, for midwifery trainees, in augmenting knowledge, thinking, and technical skills addressed in the FIRST course, and have lighter human resource requirements, an important consideration especially in LMIC. However, similar assessments would be needed to assess effectiveness for other digitally delivered clinical education programs.

There is a growing population of adults aged 50 years or older living with HIV, facing unique challenges in care due to age, minority status, and stigma. Co-design methodologies, aligning with patient-centered care, have potential for informing interventions addressing the complex needs of older adults with HIV. Despite challenges, co-design has shown promise in empowering older individuals to actively participate in shaping their care experiences. The scoping review outlined here aims to identify gaps in existing co-design work with this population, emphasizing the importance of inclusivity based on PROGRESS-Plus characteristics for future patient-oriented research. This scoping review protocol is informed by the Joanna Briggs Institute Manual to explore co-design methods in geriatric HIV care literature. The methodology encompasses six stages: 1) developing research questions, 2) creating a search strategy, 3) screening and selecting evidence, 4) data extraction, 5) data analysis using content analysis, and 6) consultation with key stakeholders, including community partners and individuals with lived experience. The review will involve a comprehensive literature search, including peer-reviewed databases and gray literature, to identify relevant studies conducted in the past 20 years. The inclusive criteria focus on empirical data related to co-design methods in HIV care for individuals aged 50 or older, aiming to inform future research and co-design studies in geriatric HIV care. The study will be limited by the exclusion of papers not published or translated to English. Additionally, the varied terminology used to describe co-design across different research may result in the exclusion of articles using alternative terms. The consultation with key stakeholders will be crucial for translating insights into meaningful co-design solutions for virtual HIV care, aiming to provide a comprehensive synthesis that informs evidence-based strategies and addresses disparities in geriatric HIV care.

After years of advocacy by a range of civil society groups, supported by scholarly and empirical research, Canada's federal prison service implemented a needle exchange program at select carceral institutions in 2018. Since the program rollout, however, uptake has remained minimal. To understand why, we conducted the first independent and national study of the program, interviewing 30 people who were incarcerated at one of the prisons with a needle exchange. Our findings show that drug use stigma and anticipated or actual reprisal from correctional officers, particularly related to breaches of confidentiality for program participants, markedly impede access and utilization.

&lt;p&gt;Interventions addressing the sexual health need of HIV-positive men who have sex with men (MSM) in Latin America are scarce. We adapted and evaluated GPS, a group-based intervention led by peers, developed using the Information-Motivation-Behavioral (IMB) model and motivational interviewing (MI). We used McKleroy et al framework to culturally adapt GPS to MSM living with HIV infection in Colombia. Then, a one-armed pilot trial examined changes in depressive symptoms, loneliness, self-efficacy for engaging in sexual risk reduction behaviors, sexual sensation seeking and sexual compulsivity at pre-intervention, post-intervention, and 3-month follow-up. These results were complemented with semistructured interviews with participants 3 months after the intervention. GPS was identified to be culturally acceptable with few changes in materials and exercises. Facilitators showed high levels of adherence and fidelity to MI principles. Seven of 11 eligible participants finished the intervention; GPS positively influenced self-efficacy for condom negotiation, depressive symptoms, and condomless anal sex with partners of unknown HIV status. Exit interviews revealed that GPS was well-designed, relevant, facilitated discussion of sex in a nonjudgmental manner, and helped make positive changes in participants' sexual lives. These results provided preliminary evidence of an intervention to address sexual and mental health of MSM living with HIV in Latin America.&lt;/p&gt;