Studies of people living with HIV who are homeless or unstably housed show a high prevalence of food insufficiency (>50%) and associated poor health outcomes; however, most evidence is in the form of cross-sectional studies. To better understand this issue, we conducted a longitudinal study to examine the impact of food insufficiency and housing instability on overall physical and mental health-related quality of life (HRQoL) among people living with HIV in Ontario. Six hundred and two adults living with HIV were enrolled in the Positive Spaces, Healthy Places study and followed from 2006 to 2009. Interviewer-administered questionnaires were used, and generalized linear mixed-effects models constructed to examine longitudinal associations between food insufficiency, housing instability and physical and mental HRQoL. At baseline, 57% of participants were classified as food insufficient. After adjusting for potential confounders, longitudinal analyses revealed a significant, negative association between food insufficiency and physical and mental HRQoL outcomes, respectively [effect size (ES) with 95% confidence interval (CI): (ES = -2.1, CI = -3.9,-0.3); (ES = -3.5, CI = -6.1,-1.5)]. Furthermore, difficulties meeting housing costs were shown to have additional negative impacts on mental HRQoL. Food insufficiency is highly prevalent among people living with HIV in Ontario, particularly for those with unstable housing. This vulnerable group of individuals is in urgent need of changes to current housing programmes, services and policies, as well as careful consideration of their unmet nutritional needs.

The objective of our mixed-methods research study was to present the discourse on racism experiences of Indigenous women living in two urban Canadian cities. A failure to recognize the impacts of racism on Indigenous women in Canada has emerged from the literature. Sharing circles, interviews, and a questionnaire including validated scales were used to collect data. The findings demonstrated that urban Indigenous women experience a number of racism events that span individual, collective and institutional, and cultural racism. The diversity of racist events was better captured in the questionnaire, whereas the roots of racism were understood more clearly in the qualitative findings to be an extension of historical colonial events to current day manifestations. Keywords racism, Indigenous women, determinant of health, Two-Eyed Seeing AcknowledgmentsThe authors of this manuscript would like to thank all the study participants who shared information and told part of their stories around racism.

We measured stress, depression and post-traumatic stress disorder (PTSD) levels of urban Indigenous women living with and without HIV in Ontario, Canada, and identified correlates of depression. We recruited 30 Indigenous women living with HIV and 60 without HIV aged 18 years or older who completed socio-demographic and health questionnaires and validated scales assessing stress, depression and PTSD. Descriptive statistics were conducted to summarize variables and linear regression to identify correlates of depression. 85.6 % of Indigenous women self-identified as First Nation. Co-morbidities other than HIV were self-reported by 82.2 % (n = 74) of the sample. High levels of perceived stress were reported by 57.8 % (n = 52) of the sample and 84.2 % (n = 75) had moderate to high levels of urban stress. High median levels of race-related (51/88, IQR 42-68.5) and parental-related stress (40.5/90, IQR 35-49) scores were reported. 82.2 % (n = 74) reported severe depressive symptoms and 83.2 % (n = 74) severe PTSD. High levels of perceived stress was correlated with high depressive symptoms (estimate 1.28 (95 % CI 0.97-1.58), p < 0.001). Indigenous women living with and without HIV reported elevated levels of stress and physical and mental health concerns. Interventions cutting across diverse health care settings are required for improving and preventing adverse health outcomes.

The literature has identified housing as a fundamental unmet need for people living with HIV; yet there has been little qualitative evidence exploring housing and HIV, particularly from a Canadian context. This paper focuses on our qualitative analyses of the housing experiences of 48 HIV-positive people living in Ontario. Findings from our interviews illustrate healthy housing as a dynamic interconnection between health, housing and other social factors that are influential to the health and well-being of people with HIV. Four salient themes have emerged from our qualitative findings: the interplay between healthy housing and economic security; the relationship between HIV, health and housing precariousness; the interconnection between housing, HIV, safety, stigma, social isolation and social exclusion; and the meaning of healthy housing for people living with HIV. These findings reemphasize the importance of housing policies that consider housing as more than just a roof over one's head, but also as something that supports the physical, mental, emotional and social well-being of people living with HIV. This article is dedicated to the memory of LaVerne Monette, co-investigator with the Positive Spaces, Healthy Places (PSHP) research project, who passed away on December 1, 2010. Responsible for the Aboriginal arm of the study, she played a key role in developing the larger study. She brought to our team her life experiences as an Aboriginal woman and her passion to help Aboriginal people living with and at risk of HIV. She understood the critical role of housing in health and quality of life, and was a strong advocate for research to identify the housing needs of Aboriginal people in Ontario and for policy change that will lead to safe, stable housing for all.

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