Longitudinal impacts of violence and stigma on HIV care continuum and broader health care access among WLWH: the SHAWNA Project

This study will characterize relationships between violence and stigma, and HIV and broader clinical care outcomes among women living with HIV (WLWH) over time. Persistent gaps exist in science and interventions to address gender disparities in HIV treatment and care continue to exist, with women falling behind men in all HIV clinical outcomes in BC. WLWH also experience high levels of violence and HIV stigma throughout their lifetimes, which has been linked to reduced HIV and broader healthcare access. There is limited data characterizing co-occurring harms of violence and stigma on HIV outcomes. Global calls exist to incorporate 'trauma- and violence-informed care' principles into HIV care and practice to address these barriers, but limited research exists to understand how this can be done, and how to tailor these programs to meet the needs of marginalized groups including Indigenous women and women identifying as gender and sexual minority people. Leveraging phase I cohort of 350 cis and trans WLWH in a Metro Vancouver, Canada (Sexual Health and HIV/AIDS: Women's Longitudinal Needs Assessment (SHAWNA)), funded by CIHR (2015-2019), we have the unique opportunity to refresh and extend this cohort to 500 WLWH to inform programs and interventions designed with and for WLWH. This study brings an established interdisciplinary team, including social scientists, epidemiologists and clinical researchers, together with knowledge users and collaborators, representing community experts, to examine how violence and HIV stigma shapes WLWH's access to HIV treatment and care. Our study offers an unprecedented opportunity to create an evidence base to understand how to mitigate violence and stigma impacts on HIV treatment and care outcomes. Knowledge translation and exchange will be conducted throughout the study, playing a key role in informing policy and programs that promote trauma- and violence-informed HIV practice for WLWH in BC, and can be replicated across Canada.