Black Canadians' Exposure to Everyday Racism: Implications for Health System Access and Health Promotion among Urban Black Communities

Factorial invariance of the Everyday Discrimination Scale among African, Caribbean, Black, and other racialized women living with and without HIV in British Columbia, Canada

OBJECTIVES

The Everyday Discrimination Scale (EDS) assesses the mistreatment racialized people experience daily. It is widely used in Canadian HIV research to measure racial discrimination among African, Caribbean, and/or Black (ACB), and other racialized women. However, no studies have examined whether the EDS provides valid estimates of racial discrimination that are objectively comparable across racial/ethnic groups or by HIV status in Canada. We aimed to address this gap.

METHODS

We analyzed EDS data from the British Columbia CARMA-CHIWOS Collaboration study of self-identifying women ≥ 16 years of age living with and without HIV. We conducted confirmatory factor analysis (CFA) by race/ethnicity (ACB; Indigenous; other racialized; white) and also by HIV status to assess validity and reliability of the EDS within these groups. Next, we ran multigroup-CFA (mCFA) to determine whether the EDS measures the same construct to the same extent across race/ethnicity- and HIV status-based groups.

RESULTS

Of 504 participants (202 with HIV), 62 were ACB, 152 Indigenous, 90 other racialized, and 200 white. CFA revealed adequate fit within race/ethnicity- and HIV status-based groups-all Cronbach's alpha > 0.9, factor loadings > 0.6, and acceptable fit indices, except for root mean square error of approximation. Residual correlations > 0.4 suggested redundancy between some item pairs. In the mCFA, the EDS was invariant across groups.

CONCLUSION

The EDS provides racial discrimination estimates that are meaningfully comparable across race/ethnicity- and HIV status-based groups. Despite potential redundancy between item pairs that may warrant refinement, the EDS can be included in survey instruments that aim to examine and compare the prevalence and health impacts of racial discrimination among ACB and other racialized women in Canada.

Everyday racism experiences, healthcare access, and self-rated health: A study of Black men in Ontario, Canada

OBJECTIVES

We explored the determinants and health-related outcomes of everyday racism (EDR) experienced by Black men in four Ontario cities in the context of HIV.

METHODS

Data were obtained from a CIHR-funded study that examined HIV vulnerability and resilience among Black men. The sample size was 866 (Ottawa [n = 210], Toronto [n = 343], London [n = 157], and Windsor [n = 156]). We applied the generalized linear model (GLM) to estimate the effects of EDR and other factors on (i) difficulty accessing healthcare and (ii) self-rated health. Next, using GLM, we determined the predictors of EDR. We measured difficulty accessing healthcare (difficulty accessing = 1, otherwise = 0) and self-rated health (good/very good/excellent = 1, otherwise = 0) as binary outcome variables. EDR was measured with the short version of the Everyday Discrimination Scale.

RESULTS

Of the Black men per city, 75‒85% experienced at least one of the five dimensions of EDR. EDR was associated with increased difficulty accessing health care, and fair to poor self-rated health (p < 0.05). EDR increased with residency in a smaller city (e.g. Windsor relative to Toronto), years of living in Canada, housing adequacy, traditional masculinity score, and individual resilience (p < 0.05). Collective resilience predicted reduced EDR.

CONCLUSION

Racism experiences persist among Black men in Ontario and remain a key determinant of healthcare access and well-being among Black men. A multipronged approach, including ending anti-Black racism through transformation of organizational and governmental policies, promoting collective resilience within communities, and encouraging social reconstruction of the Black masculine ideologies, may be a practical approach to improving their health outcomes.

Healthcare lived experiences of African, Caribbean, and Black individuals in Alberta living with HIV/AIDS: A phenomenological study

OBJECTIVE

This study explores the lived experiences of African, Caribbean, and Black (ACB) individuals in Alberta living with HIV/AIDS and the issues they encounter when accessing services.

METHODS

Interpretive phenomenological analysis (IPA) provided the underlying philosophy, data collection, and analysis methods. Participants self-identified after responding to recruitment posters posted at HIV/AIDS-supporting agencies in Alberta and on related social media pages. A total of 22 research informants were recruited and interviewed. Texts resulting from audio-taped interviews constituted data for analysis.

RESULTS

Data analysis yielded four broad themes, with stigma, discrimination, and racism serving as common threads in the lived experiences of ACB individuals accessing HIV/AIDS services in Alberta. These themes were organized into four categories: (a) health literacy and empowerment, (b) non-belonging and invisibility, (c) barriers to care and adherence, and (d) psychosocial life impacts.

CONCLUSION

The findings suggest the need for greater sensitivity and knowledge among healthcare and service providers, such as providing culturally appropriate support services for the ACB population living with HIV/AIDS. Moreover, a comprehensive community awareness program is necessary to address discrimination, anti-Black racism, and stigma. Expanded efforts to recognize and mitigate barriers to care, such as poverty, accessibility, and settlement issues, are also critical. This perspective advocates for intentional policy and practice changes that focus on diversity, equity, and inclusivity in protocols governing how ACB individuals access HIV/AIDS care in Alberta.

Factors associated with self-rated health in Black Canadians: A cross-sectional study

OBJECTIVES

Self-rated health (SRH) has shown to be a strong predictor of morbidity, functional decline, and mortality outcomes. This paper investigates the association between sociodemographic variables (e.g., employment, education, sex) and SRH among Black Canadians.

METHODS

We used cross-sectional survey data (n = 1380) from the A/C (African Caribbean) Study of first- and second-generation Black Canadians in Toronto and Ottawa. Participants were invited to complete an electronic survey questionnaire in English or French in 2018-2019. Generalized linear model analyses were used to evaluate the associations among sociodemographic factors and self-rated quality of health.

RESULTS

A total of 1380 self-identified Black individuals completed the survey and were included in the analysis. The majority of participants were under the age of 60 (89.7%), female (63.4%), born outside of Canada (75.1%), and residing in Toronto, Ontario (61.9%). The strongest association with poor SRH was found for difficulties accessing health care, sexual orientation, and substance misuse/disorder, while accessing/meeting basic needs was associated with better SRH, following adjustment for other socioeconomic conditions and lifestyle factors.

CONCLUSION

Our findings underscore the importance of improving the social determinants of health as a conduit to improving the general health status and the quality of life of Black Canadians. Results revealed that Black Canadians may be demonstrating high levels of resilience in circumventing their current social circumstances and structural disadvantages to live the best quality of life. Understanding sociodemographic and socio-structural barriers that Black people face is essential to reducing vulnerabilities to poor outcomes and improving their health and well-being.

'Sometimes white doctors are not very friendly or inclusive': a Critical Race Theory analysis of racism within and beyond sexual health settings

Many Two-Spirit, gay, bisexual, transgender, and other queer Black, Indigenous, people of colour in Canada encounter racism when testing for sexually transmitted and blood-borne infections. Our objective in this study was to understand how racism shapes testing experiences for these communities in Ontario, Canada. Four peer researchers conducted recruitment and data collection in consultation with a community advisory board. Focus groups and interviews took place with 21 participants and their narrative accounts were analysed using reflexive thematic analysis. Participants identified three interrelated issues when testing: (1) experiencing judgement and discomfort due to racism; (2) lack of community and cultural indicators in testing spaces; and (3) barriers to accessing testing centres and services. Systemic racism was linked to each of these barriers, including increased distance to testing centres due to racial segregation. Participant accounts signal the need for antiracist testing spaces and practices. Key implications include the need for antiracism training for health service providers and others working with Two-Spirit, gay, bisexual, transgender, and other queer Black, Indigenous, people of colour, and the organisations that serve them, in order to make testing spaces safer. Dismantling systemic racism is imperative to achieve health equity for members of these communities.

Navigating ethics in HIV data and biomaterial management within Black, African, and Caribbean communities in Canada

BACKGROUND

This study explored the ethical issues associated with community-based HIV testing among African, Caribbean, and Black (ACB) populations in Canada, focusing on their perceptions of consent, privacy, and the management of HIV-related data and bio-samples.

METHODS

A qualitative community-based participatory research (CBPR) approach was employed to actively engage ACB community members in shaping the research process. The design included in-depth qualitative interviews with 33 ACB community members in Manitoba, Canada. The study was guided by a Community Guiding Circle, which contributed to study design, data analysis, and interpretation. A diverse sample was recruited through community agencies, social media, and flyers, with considerations for variations in age, gender, sexual orientation, and geographical location. The study employed iterative inductive thematic data analysis.

FINDINGS

Participants expressed significant concerns about the collection, sharing, and use of HIV data from healthcare encounters, revealing mistrust towards institutions like police, child welfare, and immigration accessing their health information. Their worries centered on the handling of biological samples, data misuse, potential human rights violations, HIV criminalization, deportations, challenging consent, privacy, and bodily autonomy principles. While open to contributing to medical research, they unanimously demanded greater transparency, informed consent, and control over the secondary use of their health data.

CONCLUSIONS

The study underscores the need for culturally safe approaches in HIV testing and ethical governance in healthcare for ACB communities. It highlights the importance of prioritizing participant empowerment, ensuring transparency, practicing informed consent, and implementing robust data security measures to balance effective HIV information management with the protection of individual rights.

Access to Healthcare for Black Women in Alberta: An Interpersonal-Level Analysis of Barriers and Facilitators

Alberta is home to one of Canada's fastest growing populations of Black people, driven by an influx of African immigrants to major metropolitan areas such as Edmonton and Calgary. As the Black population in Alberta continues to grow, it is crucial to the well-being of these communities that we understand their health service needs. Black women are a vulnerable group within the Black population due to inequities in social determinants of health such as access to healthcare. In Canada, little is known about the healthcare access experiences of Black women despite reported disparities in their health outcomes. As such, we undertook a qualitative study to examine access to health services for Black women in Alberta. Semi-structured interviews were completed with 30 Black women from Edmonton and Calgary. We applied intersectionality as an analytical framework to guide our understanding of how interconnected social processes shape Black women's experiences of accessing healthcare. Following our thematic analysis, we identified two major barriers to healthcare access: patient-provider discordance and negative healthcare encounters. We identified two key facilitators: positive patient-provider dynamics and individual and social network strengths. Our findings suggest that Black women have distinct experiences of accessing the healthcare system which are best understood as a confluence of their race, gender, and other aspects of their personhood.

Anti-Black racism in Canadian health care: a qualitative study of diverse perceptions of racism and racial discrimination among Black adults in Montreal, Quebec

BACKGROUND

Racism has been shown to impact the health of Black persons through its influence on health care, including its expression through implicit biases in provider training, attitudes, and behaviours. Less is known about the experiences of racism in contexts outside of the USA, and how race and racism interact with other social locations and systems of discrimination to shape Black patients' experiences of racism in health care encounters. To help address this gap, this study examined diverse Black individuals' perceived experiences of, and attitudes towards, anti-Black racism and racial discrimination in Canadian health care, specifically in Montreal, Quebec.

METHODS

This descriptive qualitative study adopted a social constructionist approach. Employing purposive maximal variation and snowball sampling strategies, eligible study participants were: self-identified Black persons aged 18 years and older who lived in Montreal during the COVID-19 pandemic, who could speak English or French, and who were registered with the Quebec medical insurance program. In-depth interviews were conducted, and a Framework Analysis approach guided the systematic exploration and interpretation of data using an intersectionality lens.

RESULTS

We interviewed 32 participants, the majority of whom were women (59%), university educated (69%), and modestly comfortable financially (41%), but diverse in terms of age (22 to 79 years), country of origin, and self-defined ethnicity. We identified five major themes demonstrating substantial variations in perceived racism in health care that are influenced by unique social locations such as gender identity, age, and immigration history: (1) no perceptions of racism in health care, (2) ambiguous perceptions of racism in health care, (3) perceptions of overt interpersonal racism in health care, (4) perceptions of covert interpersonal racism in health care (including the downplaying of health concerns, stereotyping, and racial microaggressions), and (5) perceptions of systemic racism in health care.

CONCLUSIONS

Perceptions of anti-Black racism and racial discrimination in Canadian health care are complex and may include intra-racial group differences. This study begins to address the dearth of empirical research documenting experiences of anti-Black racism in health care in Quebec, highlighting a continued need for serious consideration of the ways in which racism may manifest in the province, as well as a need for anti-racist advocacy. Advancing racial health equity requires greater sensitivity from providers and decision makers to variations in Black patients' health care experiences, towards ensuring that they have access to high quality and equitable health care services.

Depression and suicidal ideation among Black individuals in Canada: mediating role of traumatic life events and moderating role of racial microaggressions and internalized racism

PURPOSE

Although suicidal ideation (SI) is a serious concern in Canada, its prevalence and related factors among Black individuals are poorly documented. Using data from the Mental Health of Black Communities in Canada project (BeCoMHeal), this study aimed to assess the prevalence of SI in Black individuals aged 15-40 years old in Canada, the mediating role of traumatic life events in the association between depression and SI, and the moderating role of racial microaggressions and internalized racism.

METHODS

Eight hundred and sixty participants aged between 15 and 40 years (Mage =24.96, SD = 6.29) completed the online questionnaire assessing sociodemographic data, depression symptoms, traumatic life events, racial microaggressions, internalized racism, and SI.

RESULTS

Findings showed that 25.7% of the participants reported having experienced SI (26.5% women, 22.7% men, 𝛘2 = 1.08, p = .299). The moderated-mediation model revealed that traumatic life events fully mediated the association between depression and SI (B = 0.12, p = .004; 95% CI, [0.04, 0.20]) and that racial microaggressions (B = - 0.03, p = .042; 95% CI [-0.07, - 0.00]) and internalized racism (B = 0.06, p = .006; 95% CI [0.02, 0.10]) moderated this relationship.

CONCLUSION

These findings underscore the importance of addressing racial microaggressions and internalized racism in therapy contexts among Black individuals to mitigate the potential negative impacts on their mental health. They also emphasize the need to develop effective, culturally sensitive, and racially adapted suicide prevention and intervention programs for Black communities in Canada.

'Ain't I a Nurse', implementing a digital illustration of resistance when challenging anti-Black racism in nursing education

Since the COVID-19 pandemic, ongoing reports have highlighted the urgency of addressing anti-Black racism within Canada's healthcare system. The paucity of research within a Canadian context has created growing concerns among Millennials and Generation Zs for healthcare to address growing health disparities and health inequities that are attributed to institutional and structural racism. Recognizing the paradigm shift that has occurred because of the pandemic and the sleuth of racial killings, the nursing classroom has witnessed a change and a need for nursing education to be relevant for the cohort of nursing students who are seeking answers. The scarcity of nursing literature addressing diverse forms of learning demonstrates the need for nursing education to explore new ways of being diverse, inclusive and innovative when teaching intergenerationally. In this paper, the author challenges nurse educators to revisit the student-educator relationship by introducing critical digital pedagogy to dismantle anti-Black racism and promote student-educator engagement for transformative learning to occur. As an educator, the author implements the use of digital illustration as a tool of resistance for students and educators to assess, engage, act and reflect on creating change within nursing education. Using Black feminist thought and culturally responsive learning, the author introduces an arts-based approach through the innovative design of an illustration, titled, 'Ain't I a Nurse. Combining historical stories with contemporary socio-political experiences, the author demonstrates how students and educators can enter a cognitive learning experience where they can connect mentally and emotionally, and in so doing re-envision and recreate a new world that centralizes equity, diversity and inclusivity through critical discourses. Through the illustration anti-Black racism is challenged and anti-Black racism resistance is discovered as an antidote in dismantling anti-Black racism within nursing education.

Disparities in Healthcare Accessibility and Discrimination Faced by Black Quebecers: a Race and Language Perspective

The Black population in Canada is characterized by its long-established history and diversity. The present study aims to expand our current understanding of the relation between discrimination and disparities in healthcare by including race and language as determinants of health. We recruited 531 Black adults who are currently living in Quebec, Canada, to complete a survey measuring socio-demographic characteristics, mental and physical health, accessibility to healthcare, and experiences of discrimination. Results showed that being a racialized and linguistic minority population in Quebec, English-speaking Black participants experienced more discrimination, fewer healthcare providers, less access to COVID-19 information during the COVID-19 pandemic, and were more dissatisfied with the healthcare system than French-speaking Black participants. Furthermore, the negative impacts of healthcare access associated with being a racialized and linguistic minority population in Quebec (e.g., the English-speaking Black population) were shown to be mediated by experiences of discrimination and dissatisfaction with the healthcare system.

Variegated racism: exploring experiences of anti-Black racism and their progression in medical education

BACKGROUND

Addressing anti-Black racism in medical education in Canada has become increasingly urgent as more Black learners enter medical institutions and bring attention to the racist harms they face. We sought to gather evidence of experiences of racism among Black medical learners and to explore the contexts within which racism is experienced by learners.

METHODS

Drawing on critical race and structural violence theories, we conducted interviews with Black medical faculty, students, residents, and staff at the University of Saskatchewan College of Medicine between May and July 2022. We thematically analyzed interviews using instrumental case study methodology.

RESULTS

Thematic analyses from 13 interviews revealed 5 central themes describing experiences of racism and the compounding nature of racist exposures as learners progressed in medicine. Medical learners experienced racism through uncomfortable encounters and microaggressions. Blatant acts of racism were instances where patients and superiors harmed students in various ways, including through use of the N-word by a superior in 1 instance. Learners also experienced curricular racism through the absence of the Black body in the curriculum and the undue pathologizing of Blackness. Medical hierarchies reinforced anti-Black racism by undermining accountability and protecting powerful perpetrators. Finally, Black women medical learners identified intersecting oppressions and misogynoir that compounded their experience of racism. We propose that experiences of racism may worsen as learners progress in medicine in part because of increases in the sources of and exposure to racism.

INTERPRETATION

Anti-Black racism in medical education in Canada is experienced subtly through microaggressions or blatantly from different sources including medical faculty. As Black learners progress in medicine, anti-Black racism may become worse because of the compounding effects of exposures to a wider range of sources of racist behaviour.

Racial discrimination in healthcare services among Black individuals in Canada as a major threat for public health: its association with COVID-19 vaccine mistrust and uptake, conspiracy beliefs, depression, anxiety, stress, and community resilience

OBJECTIVES

To examine the prevalence of major racial discrimination (MRD) in healthcare services and its association with COVID-19 vaccine mistrust and uptake, conspiracy theories, COVID-19-related stressors, community resilience, anxiety, depression, and stress symptoms.

STUDY DESIGN

The study used a population-based cross-sectional design.

METHODS

Data from the BlackVax dataset on COVID-19 vaccination in Black individuals in Canada was analyzed (n = 2002, 51.66% women). Logistic regression analyses were performed to examine the association between MRD and independent variables.

RESULTS

32.55% of participants declared having experienced MRD in healthcare services. Participants with MRD were less vaccinated against COVID-19, presented higher scores of vaccine mistrust, conspiracy beliefs, COVID-19 related stressors, depression, anxiety, and stress, and had lower scores of community resilience. They were more likely to experience depression (AOR = 2.13, P < 0.001), anxiety (AOR = 2.00, P < 0.001), and stress symptoms (AOR = 2.15, P < 0.001). Participants who experienced MRD were more likely to be unvaccinated (AOR = 1.35, P = 0.009).

CONCLUSIONS

Racial discrimination experienced by Black individuals in health services is a major public health concern and threat to population health in Canada. Federal, provincial, and municipal public health agencies should adapt their programs, strategies, tools, and campaigns to address the mistrust created by racial discrimination.

A Manifesto for transformative action on HIV among Black communities in Canada

Black communities bear a hugely disproportionate share of Canada's HIV epidemic. Black persons annually represent up to one quarter of new diagnoses, while in contrast, diagnoses have been falling among white Canadians for the past two decades. There has been a notable lack of urgency and serious debate about why the trend persists and what to do about it. For too long, public institutions have reproduced hegemonic white supremacy and profoundly mischaracterized Black life. Consequently, Black communities suffer policies and programs that buttress systemic anti-Black racism, socio-economically disenfranchise Black communities, and in the process marginalize knowledgeable, experienced, and creative Black stakeholders. The Interim Committee on HIV among Black Canadian Communities (ICHBCC) is a group of Black researchers, service providers, and community advocates who came together in early 2022 to interject urgency to the HIV crisis facing Black communities. Specifically, the ICHBCC advocates for self-determined community leadership of research, policies, and programs, backed by access to appropriate resources, to change the trajectory of HIV among Black Canadian communities. In this article, we introduce the wider community to the Black HIV Manifesto that we developed in 2022.

The state of COVID-19 vaccine confidence and need in Black individuals in Canada: Understanding the role of sociodemographic factors, health literacy, conspiracy theories, traumatic stressors and racial discrimination

BACKGROUND

Black communities in Canada have been among the most affected by the COVID-19 pandemic, in terms of number of infections and deaths. They are also among those most hesitant about vaccination against COVID-19. However, while a few studies have documented the factors associated with COVID-19 vaccine hesitancy, those related to vaccine confidence remain unknown. To respond to this gap, this study aims to investigate factors associated to vaccine confidence in Black individuals in Canada.

METHODS

A total of 2002 participants (1034 women) aged 14 to 89 years old (Mean age = 29.34, SD = 10.13) completed questionnaires assessing sociodemographic information, COVID-19 vaccine confidence and need, health literacy, conspiracy beliefs, major racial discrimination, and traumatic stressors related to COVID-19.

RESULTS

Results showed an average score of COVID-19 vaccine confidence and need of 33.27 (SD = 7.24), with no significant difference between men (33.48; SD = 7.24) and women (33.08; SD = 7.91), t (1999) = 1.19, p = 0.234. However, there were significant differences according to employment status, migration status, age, inhabited province, spoken language, education, marital status, religion, and income. The linear regression model explained 25.8 % of the variance and showed that health literacy (B = 0.12, p < 0.001) and traumatic stressors related to COVID-19 (B = 0.21, p < .001) predicted COVID-19 vaccine confidence and need positively, while conspiracy beliefs (B = -1.14, p < 0.001) and major racial discrimination (B = -0.20, p = 0.044) predicted it negatively.

CONCLUSIONS

This study showed that building the confidence of Black communities in vaccines requires health education, elimination of racial discrimination in the Canadian society and a focus on certain groups (e.g., young people, those living in Quebec and Ontario). The results also argue in favor of involving community leaders and organizations in the development and implementation of vaccination-related tools, strategies and programs by city, provincial and federal public health agencies.

Healthcare Service Utilization and Perceived Gaps: The Experience of French-Speaking 2S/LGBTQI+ People in Manitoba

Ethnolinguistically diverse 2S/LGBTQI+ (two-spirit, lesbian, gay, bisexual, transgender, queer and intersex) populations have unique healthcare needs and experience health inequities compared to their cisgender or heterosexual peers. This community-based participatory study sought to describe the profile and healthcare needs and experiences of official language minority French-speaking 2S/LGBTQI+ adults in Manitoba. Participants (N = 80) reported that gender and sexual identity were often concealed from service providers; many respondents faced discrimination based on their ethnolinguistic and sexual identities. Service gaps are identified pertaining to mental and sexual health; locating 2S/LGBTQI+-friendly, patient-centred care in French is difficult. Policy and practice should address systemic inequity and discrimination experienced by this equity-seeking population.

HIV and Black People in Canada: Protocol for a Scoping Review

BACKGROUND

Race-based health information is necessary to address disproportionate barriers racial communities face and to achieve optimal health outcomes. In Canada, Black people are disproportionately affected by HIV. There is an emerging body of literature on this topic, but a concise summary is lacking. There is a need to collectively and critically analyze research on HIV in the Black population in Canada to identify knowledge gaps and address this disproportionate burden.

OBJECTIVE

The aim of this scoping review is to summarize the evidence on HIV and Black people in Canada. The main outcomes of interest are HIV prevalence, access to care, HIV prevention and treatment, the HIV care cascade, and related HIV outcomes. Through this scoping review, we aim to provide a comprehensive overview of the existing literature and highlight topics that need more investigation in future research.

METHODS

We will conduct a scoping review of electronic databases using a systematic search strategy for qualitative, quantitative, or mixed methods studies reporting on HIV and Black people in Canada. We will conduct our searches in MEDLINE, Embase, CINAHL, Web of Science, EBSCO, and Google Scholar for literature published between 1985 and 2023. Gray literature, including government reports, dissertations, and other reports, will be included. Search results will be screened, and the full text of relevant literature will be retrieved. The extraction of data will be conducted independently by 2 reviewers. Consensus meetings will be held to resolve conflicts. Our results will be reported according to the PRISMA-ScR (Preferred Reporting Items for the Systematic Reviews and Meta-Analyses Extension for Scoping Reviews).

RESULTS

The initial title and abstract review identified 447 articles. These articles will be critically appraised, and relevant information will be extracted. Information from these articles will be compared using charts and tables. Screening will start in November 2023, and we anticipate publishing the scoping review in June 2024.

CONCLUSIONS

The findings from this scoping review will help inform policy, practice, and research on HIV and Black people in Canada.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/49066.

Racial humility over competence: Addressing anti-Black racism and healthcare leadership responsibility

Health leaders' response to anti-Black racism should not solely be a reaction to the police brutality and violence faced by Black communities. As part of healthcare leadership practice, we are responsible for recognizing the profound impact of anti-Black racism on all aspects of society, organizations, policies, practices, and behaviours. Based on interviews with health leaders responsible for implementing anti-Black racism strategies in their organizations, racial humility has been proposed as a necessary skill required to dismantle anti-Black racism. This requires a non-negotiable commitment, evaluation, and assessment of accountability, as well as the power to disrupt the impact of historical inequities, disparities, and discrimination experienced by Black community members. Racial humility is perceived as creating an ongoing practice to address anti-Black racism in healthcare, moving leaders from competence and discussion to reflection and transformative action.

Vaccine mistrust among Black individuals in Canada: The major role of health literacy, conspiracy theories, and racial discrimination in the healthcare system

The COVID-19 pandemic disproportionately affected Black communities in Canada in terms of infection and mortality rates compared to the general population. Despite these facts, Black communities are among those with the highest level of COVID-19 vaccine mistrust (COVID-19 VM). We collected novel data to analyze the sociodemographic characteristics and factors associated with COVID-19 VM among Black communities in Canada. A survey was conducted among a representative sample of 2002 Black individuals (51.66% women) aged 14-94 years (M = 29.34; SD = 10.13) across Canada. Vaccine mistrust was assessed as the dependent variable and conspiracy theories, health literacy, major racial discrimination in healthcare settings, and sociodemographic characteristics of participants were assessed as independent variables. Those with a history of COVID-19 infection had higher COVID-19 VM score (M = 11.92, SD = 3.88) compared to those with no history of infection (M = 11.25, SD = 3.83), t (1999) = -3.85, p < 0.001. Participants who reported having experienced major racial discrimination in healthcare settings were more likely to report COVID-19 VM (M = 11.92, SD = 4.03) than those who were not (M = 11.36, SD = 3.77), t (1999) = -3.05, p = 0.002. Results also showed significant differences for age, education level, income, marital status, provinces, language, employment status, and religion. The final hierarchical linear regression showed that conspiracy beliefs (B = 0.69, p < 0.001) were positively associated with COVID-19 VM, while health literacy (B = -0.05, p = 0.002) was negatively associated with it. The mediated moderation model showed that conspiracy theories completely mediated the association between racial discrimination and vaccine mistrust (B = 1.71, p < 0.001). This association was also completely moderated by the interaction between racial discrimination and health literacy (B = 0.42, p = 0.008), indicating that despite having a high level of health literacy, those who experienced major racial discrimination in health services developed vaccine mistrust. This first study on COVID-19 VM exclusively among Black individuals in Canada provides data that can significantly impact the development of tools, trainings, strategies, and programs to make the health systems free of racism and increase their confidence in vaccination for COVID-19 and other infectious diseases.

Black heterosexual men's resilience in times of HIV adversity: findings from the "weSpeak" study

BACKGROUND

In Canada, heterosexual African, Caribbean and Black (ACB) men tend to suffer a disproportionate burden of HIV. Consequently, studies have examined the underlying contributors to this disparity through the nexus of behavioral and structural factors. While findings from these studies have been helpful, their use of deficit and risk models only furthers our knowledge of why ACB men are more vulnerable to HIV infection. Thus far, there is a dearth of knowledge on how heterosexual ACB men mobilize protective assets to promote their resilience against HIV infection.

METHODS

As part of a larger Ontario-based project called weSpeak, this study examined how ACB men acquire protective assets to build their resilience to reduce their HIV vulnerability. We analyzed three focus group discussions (n = 17) and 13 in-depth interviews conducted with ACB men using NVivo and a mixed inductive-deductive thematic analyses approach.

RESULTS

The findings show that ACB men mostly relied on personal coping strategies, including sexual abstinence, to build resilience against HIV. Interpersonal resources such as family, friends, and religious communities also played an important role in constructing ACB men's resilience. ACB men bemoaned their lack of access to essential institutional resources, such as health services, that are important in managing HIV adversity.

CONCLUSION

Based on these findings, there is an urgent need for HIV policy stakeholders, including service providers, to engage the ACB community in the design of intervention programs. Additionally, addressing the socioeconomic disadvantages faced by ACB communities will increase the capacity of ACB men to develop resilience against HIV.

Impact of the COVID-19 Pandemic on Black Communities in Canada

The COVID-19 pandemic has resulted in differential impacts on the Black communities in Canada and has unmasked existing race-related health inequities. The purpose of this study was to illuminate the impacts of the COVID-19 pandemic on Black people in Canada. Historically, social inequalities have determined the impacts of pandemics on the population, and in the case of the COVID-19 pandemic, disproportionate infections and mortalities have become evident among racialized communities in Canada. This qualitative descriptive study utilized an intersectionality framework. We invited Black stakeholders across Canada to participate in semi-structured interviews to deepen our knowledge of the impacts of the COVID-19 pandemic on Black communities in Canada. A total of 30 interviews were recorded, transcribed verbatim, and analyzed using content analysis. Our findings fell into three categories: (1) increased vulnerability to COVID-19 disease, (2) mental impacts, and (3) addressing impacts of the COVID-19 pandemic. The findings show the underlying systemic inequities in Canada and systemic racism exacerbated health inequities among the Black communities and undermined interventions by public health agencies to curb the spread of COVID-19 and associated impacts on Black and other racialized communities. The paper concludes by identifying critical areas for future intervention in policy and practice.