Covid-19 Pandemic Concealing a Syndemic of Concern: Sex, Gender, Methamphetamine and Sexually Transmitted and Blood Borne Infections in People Living with HIV in Manitoba

In Manitoba, injection drug use is the most common mode of HIV transmission since 2018. Those who inject drugs are more likely to test positive for HIV, syphilis and Hepatitis C, often at the same time. This is called a "syndemic" (many epidemics at the same time). Over the last three years, syphilis infections are rampant in Manitoba. If not found and treated, syphilis can cause devastating infection, including transmission to newborns. In addition to HIV and syphilis there are 11 other infections transmitted by sexual activity or blood products (called STBBI). For some people, a convergence of socio-economic factors, mental health concerns, violence and exploitation, is driving a syndemic of new HIV and other STBBI cases, with disproportionate representation of women who inject drugs. Methamphetamine use is growing in Manitoba and is known to affect access to care and treatment. These determinants of health and disparities are exacerbated by public health measures, as resources for testing and contact tracing for Covid-19, result in decreased capacity to respond to STBBI and distribute harm reduction services. It is unknown how biological sex differences and gender intersect with living conditions including experiences of violence and injection drug use. In this project we will ask: How many people (by sex and gender) living with HIV have other STBBI before and during Covid-19? Who is most at risk of acquiring other STBBI, and why? What are the barriers and gaps that put people at risk for infection and prevented them from getting proper care and treatment before and during Covid-19? And What are the recipes for successful engagement of people living with HIV and who inject methamphetamine that endured during the Covid-19 pandemic? The explicit understanding of women, men and non-binary persons living with HIV who use methamphetamine can identify unique gaps and resilience factors that can inform better, tailored testing and clinical and program responses.