abstract: 'Introduction In Manitoba, Canada, there has been an increase in the

  number of people newly diagnosed with HIV and those not returning for

  regular HIV care. The COVID-19 pandemic resulted in increased sex and

  gender disparities in disease risk and mortalities, decreased harm

  reduction services and reduced access to healthcare. These health crises

  intersect with increased drug use and drug poisoning deaths,

  houselessness and other structural and social factors most acutely among

  historically underserved groups. We aim to explore the social and

  structural barriers and facilitators to HIV care and harm reduction

  services experienced by people living with HIV (PLHIV) in Manitoba.

  Methods and analysis Our study draws on participatory action research

  design. Guiding the methodological design are the lived experiences of

  PLHIV. In-depth semi-structured face-to- face interviews and

  quantitative questionnaires will be conducted with two groups: (1)

  persons aged >= 18 years living or newly diagnosed with HIV and (2)

  service providers who work with PLHIV. Data collection will include sex,

  gender, sociodemographic information, income and housing, experiences

  with the criminal justice system, sexual practices, substance use

  practices and harm reduction access, experiences with violence and

  support, HIV care journey (since diagnosis until present), childhood

  trauma and a decision-making questionnaire. Data will be analysed

  intersectionally, employing grounded theory for thematic analysis,

  sex-based and gender-based analysis and social determinants of health

  and syndemic framework to understand the experiences of PLHIV in

  Manitoba.

  Ethics and dissemination We received approval from the University of

  Manitoba Health Ethics Research Board (HS25572; H2022:218), First

  Nations Health and Social Secretariat of Manitoba, Nine Circles

  Community Health Centre, Shared Health Manitoba (SH2022:194) and 7th

  Street Health Access Centre. Findings will be disseminated using

  community-focused knowledge translation strategies identified by

  participants, peers, community members and organisations, and reported

  in conferences, peer-reviewed journals and a website (www.

  alltogether4ideas.org).'
affiliation: 'Rueda, ZV (Corresponding Author), Univ Manitoba, Max Rady Coll Med,
  Rady Fac Hlth Sci, Dept Med Microbiol \& Infect Dis, Winnipeg, MB, Canada.

  Rueda, Zulma Vanessa; Sobie, Cheryl; Villacis, Enrique; Bullard, Jared; Keynan,
  Yoav, Univ Manitoba, Max Rady Coll Med, Rady Fac Hlth Sci, Dept Med Microbiol \&
  Infect Dis, Winnipeg, MB, Canada.

  Haworth-Brockman, Margaret; Keynan, Yoav, Univ Manitoba, Natl Collaborating Ctr
  Infect Dis, Winnipeg, MB, Canada.

  Haworth-Brockman, Margaret; Sanguins, Julianne; Keynan, Yoav, Univ Manitoba, Rady
  Fac Hlth Sci, Dept Community Hlth Sci, Winnipeg, MB, Canada.

  Larcombe, Linda; MacKenzie, Lauren; Kasper, Ken; Keynan, Yoav, Univ Manitoba, Max
  Rady Coll Med, Rady Fac Hlth Sci, Dept Internal Med, Winnipeg, MB, Canada.

  Maier, Katharina, Univ Winnipeg, Criminal Justice, Winnipeg, MB, Canada.

  Deering, Kathleen; Krusi, Andrea, Univ British Columbia, Dept Med, Vancouver, BC,
  Canada.

  Deering, Kathleen; Krusi, Andrea, Univ British Columbia, Ctr Gender \& Sexual Hlth
  Equ, Vancouver, BC, Canada.

  Templeton, Kimberly; MacKenzie, Lauren; Ireland, Laurie; Kasper, Ken, Manitoba HIV
  Program, Winnipeg, MB, Canada.

  Templeton, Kimberly; Ireland, Laurie; Payne, Michael, Nine Circles Community Hlth
  Ctr, Winnipeg, MB, Canada.

  Bullard, Jared, Shared Hlth, Cadham Prov Lab, Winnipeg, MB, Canada.

  Pick, Neora, Univ British Columbia, Div Infect Dis, Vancouver, BC, Canada.

  Myran, Tara, Univ Winnipeg, Indigenous Dev, Winnipeg, MB, Canada.

  Meyers, Adrienne, Indigenous Serv Canada, Lab Integrat, Off Populat \& Publ Hlth,
  Winnipeg, MB, Canada.'
author: Rueda, Zulma Vanessa and Haworth-Brockman, Margaret and Sobie, Cheryl and
  Villacis, Enrique and Larcombe, Linda and Maier, Katharina and Deering, Kathleen
  and Sanguins, Julianne and Templeton, Kimberly and MacKenzie, Lauren and Ireland,
  Laurie and Kasper, Ken and Payne, Michael and Bullard, Jared and Krusi, Andrea and
  Pick, Neora and Myran, Tara and Meyers, Adrienne and Keynan, Yoav
author-email: zulma.rueda@umanitoba.ca
author_list:
- family: Rueda
  given: Zulma Vanessa
- family: Haworth-Brockman
  given: Margaret
- family: Sobie
  given: Cheryl
- family: Villacis
  given: Enrique
- family: Larcombe
  given: Linda
- family: Maier
  given: Katharina
- family: Deering
  given: Kathleen
- family: Sanguins
  given: Julianne
- family: Templeton
  given: Kimberly
- family: MacKenzie
  given: Lauren
- family: Ireland
  given: Laurie
- family: Kasper
  given: Ken
- family: Payne
  given: Michael
- family: Bullard
  given: Jared
- family: Krusi
  given: Andrea
- family: Pick
  given: Neora
- family: Myran
  given: Tara
- family: Meyers
  given: Adrienne
- family: Keynan
  given: Yoav
da: '2023-09-28'
doi: 10.1136/bmjopen-2022-067813
files: []
issn: 2044-6055
journal: BMJ OPEN
keywords: 'COVID-19; HIV \& AIDS; qualitative research; sexual and gender

  minorities; substance misuse; health services accessibility'
keywords-plus: INTERVENTIONS; HIV/AIDS; TRAUMA
language: English
month: AUG
number: '8'
number-of-cited-references: '51'
orcid-numbers: 'Rueda, Zulma Vanessa/0000-0001-6342-1812

  Villacis, Enrique/0000-0003-0033-9410'
papis_id: 02c9c50cecf50bdee3b8f4722ff1b0f3
ref: Rueda2023socialstructural
times-cited: '0'
title: 'Social and structural barriers and facilitators to HIV healthcare and harm
  reduction services for people experiencing syndemics in Manitoba: study protocol'
type: article
unique-id: WOS:001045474900018
usage-count-last-180-days: '0'
usage-count-since-2013: '0'
volume: '13'
web-of-science-categories: Medicine, General \& Internal
year: '2023'