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AbstractIntroductionWomen 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.MethodsThis 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 discussionAmong 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.ConclusionsAmong 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.

AbstractIntroductionSex 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.MethodsWe 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 DiscussionOf 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.ConclusionsAmong 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.

The relationship between the First Peoples of Canada and researchers is changing as processes of self-determination and reconciliation are increasingly implemented. We used storytelling and ceremony to describe a historic event, the Indigenous Women's Data Transfer Ceremony, where quantitative data of 318 Indigenous women living with HIV were transferred to Indigenous academic and community leaders. Relationship building, working together with a common vision, the Ceremony, and the subsequent activities were summarized as a journey of two boats. The Truth and Reconciliation Commission of Canada's Calls to Action and Indigenous ethical principles were central to the process. The article ends with team members' reflections and the importance of shifting power to Indigenous Peoples in regard to data collection, their stories, and the resulting policies.