{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T05:15:17Z","timestamp":1787030117865,"version":"build-2736575974"},"reference-count":85,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2024,11,25]],"date-time":"2024-11-25T00:00:00Z","timestamp":1732492800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["EG5-179453"],"award-info":[{"award-number":["EG5-179453"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["2021-13"],"award-info":[{"award-number":["2021-13"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["950-232963"],"award-info":[{"award-number":["950-232963"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]},{"name":"The Manitoba Medical Service Foundation","award":["EG5-179453"],"award-info":[{"award-number":["EG5-179453"]}]},{"name":"The Manitoba Medical Service Foundation","award":["2021-13"],"award-info":[{"award-number":["2021-13"]}]},{"name":"The Manitoba Medical Service Foundation","award":["950-232963"],"award-info":[{"award-number":["950-232963"]}]},{"name":"Canada Research Chairs Program","award":["EG5-179453"],"award-info":[{"award-number":["EG5-179453"]}]},{"name":"Canada Research Chairs Program","award":["2021-13"],"award-info":[{"award-number":["2021-13"]}]},{"name":"Canada Research Chairs Program","award":["950-232963"],"award-info":[{"award-number":["950-232963"]}]},{"name":"Public Health Agency of Canada (PHAC) to the National Collaborating Centre for Infectious Diseases","award":["EG5-179453"],"award-info":[{"award-number":["EG5-179453"]}]},{"name":"Public Health Agency of Canada (PHAC) to the National Collaborating Centre for Infectious Diseases","award":["2021-13"],"award-info":[{"award-number":["2021-13"]}]},{"name":"Public Health Agency of Canada (PHAC) to the National Collaborating Centre for Infectious Diseases","award":["950-232963"],"award-info":[{"award-number":["950-232963"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["TropicalMed"],"abstract":"<jats:p>Marginalized groups in Manitoba, Canada, especially females and people who inject drugs, are overrepresented in new HIV diagnoses and disproportionately affected by HIV and structural disadvantages. Informed by syndemic theory, our aim was to understand people living with HIV\u2019s (PLHIV) gendered and intersecting barriers and facilitators across the cascade of HIV care before and during the COVID-19 pandemic. This study was co-designed and co-led alongside people with lived experience and a research advisory committee. We employed semi-structured interviews with thirty-two participants and three questionnaires. Interviews were audio-recorded, transcribed, and coded, and descriptive statistics were performed on the first two questionnaires. Qualitative data analysis used thematic analysis and focused on identifying categories (individual, healthcare, and social\/structural) related to the barriers and facilitators to HIV care. A total of 32 PLHIV completed this study and over 70% of females and 50% of males reported severe and moderate sexual abuse among other traumatic childhood experiences. Barriers to accessing or continuing in the cascade of HIV care included navigating the initial shock of receiving an HIV diagnosis, mental health challenges and inaccessible supports, substance use, violence (including intimate partner), internalized and enacted compounded stigma related to houselessness and substance use, discrimination by primary care service providers and social networks, lack of preventative and social supports, lack of accessible housing, and programmatic issues. COVID-19 increased mental health problems and disrupted relationships with HIV service providers and peers living with HIV. Facilitators to HIV care included stopping substance use, caring service providers particularly during HIV diagnosis, welcoming healthcare environments, social opportunities and integrated supports, and supportive social networks. Women, men, and non-binary PLHIV experience interconnected factors complicating their experiences with HIV care. Interventions should consider holistic, person-centered, and trauma-informed care options to address the barriers found in this research and appropriately serve PLHIV.<\/jats:p>","DOI":"10.3390\/tropicalmed9120287","type":"journal-article","created":{"date-parts":[[2024,11,25]],"date-time":"2024-11-25T08:38:24Z","timestamp":1732523904000},"page":"287","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Gender and Intersecting Barriers and Facilitators to Access the HIV Cascade of Care in Manitoba, Canada, Before and During the COVID-19 Pandemic: A Qualitative Study"],"prefix":"10.3390","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0033-9410","authenticated-orcid":false,"given":"Enrique","family":"Villacis-Alvarez","sequence":"first","affiliation":[{"name":"Department of Medical Microbiology and Infectious Diseases, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 0J9, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheryl","family":"Sobie","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology and Infectious Diseases, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 0J9, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0678-2854","authenticated-orcid":false,"given":"Katharina","family":"Maier","sequence":"additional","affiliation":[{"name":"Criminal Justice, The University of Winnipeg, Winnipeg, MB R3B 2E9, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margaret","family":"Lavallee","sequence":"additional","affiliation":[{"name":"Ongomiizwin Indigenous Institute of Health & Healing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 0W2, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chantal","family":"Daniels","sequence":"additional","affiliation":[{"name":"Ongomiizwin Indigenous Institute of Health & Healing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 0W2, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heather","family":"Pashe","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology and Infectious Diseases, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 0J9, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joel","family":"Baliddawa","sequence":"additional","affiliation":[{"name":"Peer Research Team, Alltogether4IDEAS, Winnipeg, MB R3E 0J9, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikki","family":"Daniels","sequence":"additional","affiliation":[{"name":"Peer Research Team, Alltogether4IDEAS, Winnipeg, MB R3E 0J9, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca","family":"Murdock","sequence":"additional","affiliation":[{"name":"Peer Research Team, Alltogether4IDEAS, Winnipeg, MB R3E 0J9, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Russell","sequence":"additional","affiliation":[{"name":"Peer Research Team, Alltogether4IDEAS, Winnipeg, MB R3E 0J9, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clara","family":"Dan","sequence":"additional","affiliation":[{"name":"Peer Research Team, Alltogether4IDEAS, Winnipeg, MB R3E 0J9, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Freda","family":"Woodhouse","sequence":"additional","affiliation":[{"name":"Peer Research Team, Alltogether4IDEAS, Winnipeg, MB R3E 0J9, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susie","family":"Cusson","sequence":"additional","affiliation":[{"name":"Peer Research Team, Alltogether4IDEAS, Winnipeg, MB R3E 0J9, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"Patrick","sequence":"additional","affiliation":[{"name":"Peer Research Team, Alltogether4IDEAS, Winnipeg, MB R3E 0J9, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marj","family":"Schenkels","sequence":"additional","affiliation":[{"name":"Peer Research Team, Alltogether4IDEAS, Winnipeg, MB R3E 0J9, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Payne","sequence":"additional","affiliation":[{"name":"Nine Circles Community Health Centre, Winnipeg, MB R3G 0X2, Canada"},{"name":"The Manitoba HIV Program, Winnipeg, MB R3G 0X2, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ken","family":"Kasper","sequence":"additional","affiliation":[{"name":"The Manitoba HIV Program, Winnipeg, MB R3G 0X2, Canada"},{"name":"Department of Internal Medicine, Rady Faculty of Health 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Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kimberly","family":"Templeton","sequence":"additional","affiliation":[{"name":"Nine Circles Community Health Centre, Winnipeg, MB R3G 0X2, Canada"},{"name":"The Manitoba HIV Program, Winnipeg, MB R3G 0X2, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathleen","family":"Deering","sequence":"additional","affiliation":[{"name":"Division of Medicine, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC V6Z 2K5, Canada"},{"name":"Centre for Gender and Sexual Health Equity, Faculty of Medicine, University of British Columbia, Vancouver, BC V6Z 2K5, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margaret","family":"Haworth-Brockman","sequence":"additional","affiliation":[{"name":"Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 0J9, Canada"},{"name":"National 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