Sociodemographic characteristics of focus group participants (<i>n</i> = 104).

a<p>The <i>n</i> is lower due to missing responses.</p

Overview of focus group participants' (<i>n</i> = 104) descriptions of stigma and discrimination.

<p>Focus Group Key: 1, African Caribbean (Ottawa); 2, African Caribbean (Toronto); 3, Asian and South Asian; 4, formerly incarcerated; 5, Francophone; 6, IDU; 7, Latina; 8, LBQ; 9, Northern Ontario medium-sized city; 10, Northern Ontario small-sized city; 11, sex work; 12, South Western Ontario medium-sized city; 13, transgender; 14, urban; 15, young women.</p

Overview of focus group participants' (<i>n</i> = 104) descriptions of coping strategies.

<p>Focus group key: 1, African Caribbean (Ottawa); 2, African Caribbean (Toronto); 3, Asian and South Asian; 4, formerly incarcerated; 5, Francophone; 6, injection drug use; 7, Latina; 8, LBQ; 9, Northern Ontario medium-sized city; 10, Northern Ontario small-sized city; 11, sex work; 12, South Western Ontario medium-sized city; 13, transgender; 14, urban; 15, young women.</p

Overview of focus groups (<i>n</i> = 15).

<p>Overview of focus groups (<i>n</i> = 15).</p

Tested conceptual model of the relationship between HIV-related stigma, racial discrimination, housing insecurity and wellbeing among African and Caribbean women living with HIV in Ontario.

<p>Fig 1 depicts hypothesized relationships between variables analyzed in the model. Solid lines represent hypothesized direct effects. Ovals represent latent variables, and rectangles represent observed variables.</p

Parameter Estimates for Final Path Model in African and Caribbean Black Women’s Stigma and Health Study: Ontario, Canada, 2011 (n = 157).

<p>Parameter Estimates for Final Path Model in African and Caribbean Black Women’s Stigma and Health Study: Ontario, Canada, 2011 (n = 157).</p

Final model of the relationship between HIV-related stigma, racial discrimination, housing insecurity and wellbeing among African and Caribbean women living with HIV in Ontario (n = 157).

<p>Fig 2 depicts the relationships between the latent variables (depicted as ovals) and observed variables (depicted as rectangles). Solid lines represent statistically significant direct effects and dotted lines represent statistically significant indirect effects. The standardized path coefficients next to each arrow reflect the strength and direction of the effect between variables, and the coefficient is similar to standardized beta weights in regression modeling.</p

Socio-demographic Characteristics of Survey Participants (n = 173) by Ethnicity in the African and Caribbean Black Women’s Stigma and Health Study: Ontario, Canada, 2010–2011.

<p>Socio-demographic Characteristics of Survey Participants (n = 173) by Ethnicity in the African and Caribbean Black Women’s Stigma and Health Study: Ontario, Canada, 2010–2011.</p

Predictors of Covid-19 knowledge and protective behavior scores in Toronto (n = 202).

Predictors of Covid-19 knowledge and protective behavior scores in Toronto (n = 202).</p

#SafeHandsSafeHearts intervention.

PurposeSexual and gender minority and racialized populations experienced heightened vulnerability during the Covid-19 pandemic. Marginalization due to structural homophobia, transphobia and racism, and resulting adverse social determinants of health that contribute to health disparities among these populations, were exacerbated by the Covid-19 pandemic and public health measures to control it. We developed and tested a tailored online intervention (#SafeHandsSafeHearts) to support racialized lesbian, gay, bisexual, transgender, queer, and other persons outside of heteronormative and cisgender identities (LGBTQ+) in Toronto, Canada during the pandemic.MethodsWe used a quasi-experimental pre-test post-test design to evaluate the effectiveness of a 3-session, peer-delivered eHealth intervention in reducing psychological distress and increasing Covid-19 knowledge and protective behaviors. Individuals ≥18-years-old, resident in Toronto, and self-identified as sexual or gender minority were recruited online. Depressive and anxiety symptoms, and Covid-19 knowledge and protective behaviors were assessed at baseline, 2-weeks postintervention, and 2-months follow-up. We used generalized estimating equations and zero-truncated Poisson models to evaluate the effectiveness of the intervention on the four primary outcomes.ResultsFrom March to November 2021, 202 participants (median age, 27 years [Interquartile range: 23–32]) were enrolled in #SafeHandsSafeHearts. Over half (54.5%, n = 110) identified as cisgender lesbian or bisexual women or women who have sex with women, 26.2% (n = 53) cisgender gay or bisexual men or men who have sex with men, and 19.3% (n = 39) transgender or nonbinary individuals. The majority (75.7%, n = 143) were Black and other racialized individuals. The intervention led to statistically significant reductions in the prevalence of clinically significant depressive (25.4% reduction, p ConclusionWe demonstrated the effectiveness of a brief, peer-delivered eHealth intervention for racialized LGBTQ+ communities in reducing psychological distress and increasing protective behaviors amid the Covid-19 pandemic. Implementation through community-based organizations by trained peer counselors supports feasibility, acceptability, and the importance of engaging racialized LGBTQ+ communities in pandemic response preparedness. This trial is registered with ClinicalTrials.gov, number NCT04870723.</div