Sexual and Reproductive Health

Principal Investigators: Mona Loutfy MD FRCPC, Angela Kaida PhD, Alexandra de Pokomandy MDCM, Marissa Becker MD FRCPC, Sharon Bruce PhD, Saara Greene PhD

Established in 2010, the Canadian HIV Women’s Sexual and Reproductive Health Cohort Study (CHIWOS) was the largest Canadian cohort study of women with HIV to date, enrolling 1422 women living with HIV in three Canadian provinces (Ontario, British Columbia, and Quebec) using community-based research principle between 2013 and 2017s. CHIWOS aimed to understand how women living with HIV use health and social services, and how women-specific services could address their unique needs in a supportive, inclusive, and accessible manner. Accompanying arts-based research projects were conducted to understand these aims using different research methods.

Notable findings of CHIWOS include:

• The women who participated in CHIWOS were diverse 
• 57 percent of women perceived the care they received from primary HIV doctor or clinic had been woman-centred, but significant regional differences were evident (67 percent BC, 63 percent ON, only 37 percent QC)
• 80 percent of women agreed that women-centred HIV care is important to them

CHIWOS has grown from a study to a movement and has inspired the development of the Women Centred HIV Care Model, the Trans Women and HIV Research Initiative (TWIRI), and countless partnerships with community members and organizations. To learn more about CHIWOS, visit www.CHIWOS.ca

Principal Investigators: Mona Loutfy MD FRCPC, Mark Yudin MD, Heather Shapiro MD FRCSC, V Logan Kennedy RN, PhD(c), Vanessa Poliquin MD, Frederick Dzineku, Nicola L. Dean PhD, Shari Margolese, Alison Symington LLM, Deborah M. Money MD, Scot Hamilton PhD, Tracey Conway CYC, Sarah Khan MD

The Canadian HIV Pregnancy Planning Guidelines (CHPPG) Core Team’s mission is to work with all stakeholders across Canada to increase awareness and uptake of HIV pregnancy planning resources as a routine part of care, support, and people’s lives. We are a community of health care providers, community-service agencies, and people affected by HIV who have been championing the reproductive rights of people living with HIV for over two decades.  This movement has been fuelled by the fertility desires and intentions of men and women living with HIV across Canada and is responsible for the development of Canadian HIV Pregnancy Planning Guidelines (CHPPG) in 2012 and updated in 2018. Informed by implementation science and relevant theoretical models, our team adapts various strategies and tools to support the dissemination and implementation of the CHPPG across Canada.

Principal Investigators: Mona Loutfy MD FRCPC, Wangari Tharao MA, Neora Pick MD FRCPC, Angela Kaida PhD, Alexandra de Pokomandy MDCM, Mina Kazemi MSc, Carmen Logie MSW PhD, Angela Underhill MSc PhD (c), Nadia O’Brien MPH PhD, Mary Kestler MD, Jesleen Rana MD MPH, Jay MacGillivray Reg. Mid., Denise Jaworsky MD FRCPC, Adriana Carvalhal MD MSc PhD, Tracey Conway PRA, Kath Webster PRA, Melanie Lee PRA, Shaz Islam RA, Valerie Nicholson PIRA, Mary Ndung’u BA, Karène Proulx-Boucher MA, Allison Carter MPH PhD, Rebecca Gormley MPH, CHIWOS Research Team

The comprehensive care needs of women living with HIV in Canada have not been thoroughly addressed due to the historic focus of the HIV response on men who have sex with men and the underrepresentation of women in decision-making roles. The novel Women-Centred HIV Care (WCHC) model was developed using data from the Canadian HIV Women’s Sexual and Reproductive Health Cohort Study (CHIWOS). The goal of the model is to provide healthcare personnel, both HIV specialists and primary practitioners, with a framework that will allow them to provide the best and most informed care to female HIV patients. WCHC is defined as care that supports women living with HIV to achieve the best health and wellbeing as defined by them.  The WCHC model integrates 5 care components as determined by community members and CHIWOS participants and places an emphasis on flexibility of implementation to meet the needs of all women . The five care components include 1. person-centred care; 2. trauma- and violence-aware care; 3. integrated HIV care; 4. women’s health care (including sexual and reproductive health and rights); 5. mental and emotional health care (including substance use health),; and 6. peer support, leadership and capacity building.

Principal Investigators: Yasmeen Persad, Ashley Lacombe Duncan RSW, PhD, Mona Loutfy MD FRCPC, Carmen Logie PhD

The Trans Women and HIV Research Initiative (TWIRI) consists of a diverse team conducting mixed-methods research on trans women living with HIV. There is very little research being done with this important population and TWIRI takes a community-driven, interdisciplinary approach to trans health and social welfare. TWIRI is establishing a knowledge-translation (KT) plan focused on accessible, trans-specific knowledge sharing and extending the initiative’s national and international reach.

Principal Investigators: Mona Loutfy MD FRCPC, Renee Masching

To further strength-based and culturally grounded research for the wellbeing of Indigenous women living with/at risk of HIV, WHRP and The Canadian Aboriginal AIDS Network Inc (CAAN) have an agreed upon mutual desire to work together to recognize the diversity and rights of Indigenous Peoples regardless of residency, including the rights of Indigenous Peoples to access and benefit from HIV/AIDS related research, and to maintain a quality of life in a culturally appropriate manner. This has been formalized through a Memorandum of Understanding and formal partnership. This collaboration honours the OCAP principle. Ownership control access and possession (OCAP) is being used by Indigenous Peoples to highlight the right to self-determination in the area of HIV/AIDS research.

Principal Investigators: Notisha Massaquoi RSW PhD, Wangari Tharao, Mary Ndung’u BW, Mona Loufty MD FRCPCP

The involvement of WHRP in the research work with African, Caribbean, Black (ACB) women living with HIV has been ongoing since 2004. It started as a partnership between Women’s Health in Women Hands (WHIWH) , an Ontario-based Community Health Centre that serves Black and racialized women who live in Toronto and the surrounding area. The first project WHIWH and WHRP partnered on was a CIHR-funded Community-based HV mixed method study asking women living with HIV across Ontario and their care providers what were the most pressing issues to research for them. WHIWH and WHRP also collaborated on several community-based research (CBR) projects related to pregnancy planning, parenting, assisted reproductive health, and infant feeding from 2005 to today. That work has changed the landscape of pregnancy and parenting with HIV to one that is normalized and celebrated. In 2011, the Canadian HIV Women’s Sexual and Reproductive Health Cohort Study (CHIWOS) was funded and the CHIWOS ACB Advisory Board (ACB-CAB) was formed.  The purpose of the ACB-CAB was to bring together stakeholders committed to research with, and care of ACB women living with HIV in Canada. The ACB-CAB aimed to ensure the voices of ACB women were heard and influenced the progress and direction of CHIWOS, highlighting the unique needs and lived experiences of ACB women. The ACB-CAB contributed to tailoring programs and interventions to improve the wellbeing of ACB women living with HIV.  After completing several research endeavours, including an analysis of experiences of intersecting stigmas including HIV-related stigma, sexism, and racism by CHIWOS participants, there is now a realization of the gap that exists between the original work and today’s realities for ACB women.  After 10 years since the establishment of CHIWOS the movement will now be focused on a process led by and for ACB women with mentorship and support by Dr. Loutfy and the WHRP staff.

Canadian Institutes for Health Research (CIHR). Partnerships for Health System Improvement. Michael Smith Foundation, BC Women’s Hospital

Principal Investigator(s): Kendall T, Norman WV Co-investigators: Blake J, Brant R, Brooks M, Bryan S, Christilaw J, Costescu D, Dunn S, Emberley P, Foster A, Guilbert E, Kaczorowski J, Meuser J, Munro S, Renner R, Soon J, Stroulia E, Teng F, Waddington A. 492,500 CAD

In preparation for mifepristone’s availability in 2017, the Contraception and Abortion Research Team-Groupe de recherche sur l’avortement et la contraception launched the CART-Mife Study, a 4-year national implementation research project that aimed to identify and mitigate barriers to implementing mifepristone abortion practice, particularly those affecting primary care providers. The project had two interventions: 1) integrated knowledge translation with health policy-makers to mitigate health system barriers and support facilitators to adoption of mifepristone abortion by community-based healthcare providers and 2) a virtual Community of Practice (VCoP), the Canadian Abortion Providers Support-Communauté de pratique Canadienne sur l’avortement (CAPS-CPCA) online platform, that supported community-based health care providers across Canada to implement mifepristone abortion in their practices.

Principal investigators: Norman WV, Hendry B, McGrail K

Following the availability of mifepristone in Canada, administrative data was leveraged to examine abortion availability, specifically the availability of mifepristone abortion on 1) abortion access and service distribution; 2) abortion related adverse events and 3) abortion related health system costs.

Women-Centred HIV Care (WCHC)

• Peer Reviewed Manuscript – (https:// doi: 10.1177/2325958221995612)
• WCHC Toolkits for Clinician’s and Community Members - https://cep.health/clinical-products/hiv/
• Previously Recorded Webinars (EN/FR) - https://www.catie.ca/women-centred-hiv-care-toolkits-webinar-for-women-living-with-hiv-and-community-based-service
• Canadian Fertility & Andrology Society (CFAS)
• Canadian Aboriginal AIDS Network (CAAN)
• Women’s Health In Women’s Hands (WHIWH)
• Community AIDS Treatment Information Exchange (CATIE)
• The Ontario HIV Treatment Network (OHTN)
• Women and HIV/AIDS Initiative

Abortion and Contraception

• What’s Next for Me?
• Contraception and Abortion Research Team-Groupe de recherche sur l’avortement et la contraception (CART-GRAC)
• Canadian Abortion Providers Support-Communauté de pratique Canadienne sur l’avortement (CAPS-CPCA)