Grant: Tm Gr.:Embracing Diversity to Achieve Precision/Health Equity-KM Hub Supplement

Manitoba recorded the highest human immunodeficiency virus (HIV) incidence ever in 2022 with HIV incidence among females surpassing that of males for the first time. Manitoba also consistently reports one of the highest rates of syphilis and congenital syphilis, chlamydia, and gonorrhea in Canada. Our research found that Manitoba has a very distinct epidemiology compared to the rest of Canada. Half of the people newly diagnosed with HIV between 2018 to 2022 in Manitoba are females; 48% of females and 25% of males experience houselessness; and 76% of females and 50% of males inject drugs, with crystal methamphetamine as the drug of choice. The most common modes of HIV acquisition are injection drug use and heterosexual sex. More than 80% of people newly diagnosed with HIV reported one or more comorbidities, led by sexually transmitted and blood-borne co-infections (STBBI), and mental health issues. Females and Indigenous Peoples disproportionately experience intersecting systemic and structural barriers resulting in convergence of risk. Barriers to accessing or continuing HIV care included coping with a new HIV diagnosis, mental health challenges and inaccessible supports, substance use, violence, internalized and enacted compounded stigma related to houselessness and substance use, discrimination by service providers and social networks, lack of preventative and social supports, lack of accessible housing, and programmatic issues. The current HIV and STBBI epidemiology requires a Manitoba-made, Indigenous and community led approach centred on the priorities of people with lived experience. Our interdisciplinary team aims to understand the interaction between epidemiological, clinical, behavioral, environmental, and biological exposures to comprehend the unprecedented HIV and STBBI incidence in Manitoba. We will implement and evaluate Indigenous-led and community-led strategies to increase access to testing, prevention, treatment and engagement in HIV and STBBI care.