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Bernard I, Ransy DG, Brophy J, Kakkar F, Bitnun A, Sauvé L, Samson L, Read S, Soudeyns H, Hawkes MT. Lower Neutrophil Count Without Clinical Consequence Among Children of African Ancestry Living With HIV in Canada. J Acquir Immune Defic Syndr 2024; 97:78-86. [PMID: 39116334 DOI: 10.1097/qai.0000000000003467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 05/13/2024] [Indexed: 08/10/2024]
Abstract
OBJECTIVE To investigate the association between African ancestry and neutrophil counts among children living with HIV (CLWH). We also examined whether medications, clinical conditions, hospitalization, or HIV virologic control were associated with low neutrophil counts or African ancestry. DESIGN We conducted a secondary analysis of the Early Pediatric Initiation Canada Child Cure Cohort (EPIC4) Study, a multicenter prospective cohort study of CLWH across 8 Canadian pediatric HIV care centers. METHODS We classified CLWH according to African ancestry, defined as "African," "Caribbean," or "Black" maternal race. Longitudinal laboratory data (white blood cells, neutrophils, lymphocytes, viral load, and CD4 count) and clinical data (hospitalizations, AIDS-defining conditions, and treatments) were abstracted from medical records. RESULTS Among 217 CLWH (median age 14, 55% female), 145 were of African ancestry and 72 were of non-African ancestry. African ancestry was associated with lower neutrophil counts, white blood cell counts, and neutrophil-lymphocyte ratios. Neutrophil count <1.5 × 109/L was detected in 60% of CLWH of African ancestry, compared with 31% of CLWH of non-African ancestry (P < 0.0001), representing a 2.0-fold higher relative frequency (95% CI: 1.4-2.9). Neutrophil count was on average 0.74 × 109/L (95% CI: 0.45 to 1.0) lower in CLWH of African ancestry (P < 0.0001). Neither neutrophil count<1.5 × 109/L nor African ancestry was associated with medications, hospitalizations, AIDS-defining conditions, or markers of virologic control (viral load, sustained viral suppression, and lifetime nadir CD4). CONCLUSIONS In CLWH, African ancestry is associated with lower neutrophil counts, without clinical consequences. A flexible evaluation of neutrophil counts in CLWH of African ancestry may avoid unnecessary interventions.
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Affiliation(s)
- Isabelle Bernard
- Department of Pediatrics, University of Alberta, Edmonton, Canada
| | - Doris G Ransy
- Unité d'immunopathologie Virale, Centre de Recherche du CHU Sainte-Justine, Montréal, Canada
| | - Jason Brophy
- Division of Infectious Diseases, Children's Hospital of Eastern Ontario, Ottawa, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, Canada
| | - Fatima Kakkar
- Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, Canada
| | - Ari Bitnun
- Division of Infectious Diseases, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Laura Sauvé
- Department of Pediatrics, University of British Columbia, Vancouver, Canada; and
| | - Lindy Samson
- Division of Infectious Diseases, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Stanley Read
- Division of Infectious Diseases, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Hugo Soudeyns
- Unité d'immunopathologie Virale, Centre de Recherche du CHU Sainte-Justine, Montréal, Canada
- Department of Microbiology, Infectiology and Immunology, Université de Montréal, Montréal, Canada
| | - Michael T Hawkes
- Department of Pediatrics, University of British Columbia, Vancouver, Canada; and
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Darko NA, Wilson CL, Oliver V. "We are mothers, sisters, and lovers too": Examining young Black women's experiences navigating sex and sexual health. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2024. [PMID: 38736243 DOI: 10.1002/ajcp.12753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 01/20/2024] [Accepted: 04/09/2024] [Indexed: 05/14/2024]
Abstract
In Canada, there is a lack of research that addresses the sexual health and well-being of African, Caribbean, and Black young women. This paper aims to gather perspectives of young Black women to address the social contexts of how young Black women navigate issues related to sex and sexual health. Young Black women experience unique dynamics in navigating their sexualities and sexual healthcare. The nuanced experiences stem from social contexts with historical underpinnings, such as the perception of Black women's bodies, Black identity, gender roles, and sexual double standards. This Community-Based Participatory Research study (N = 24) utilized focus groups to examine young Black women's experiences navigating sexual health. Employing a thematic analysis, participants identified four themes representing their narratives of navigating sexual health. The themes included the perceptions and hypersexuality of Black women's bodies, navigating sexual double standards and gender roles as Black women, diverse Blackness, and migration experiences concerning sexual health and surveillance of Black women's bodies. This paper is intended to add to scholarly discourse and will include practical strategies for use by researchers and community practitioners in sexual health within the Black community.
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Affiliation(s)
- Natasha A Darko
- Department of Psychology, Faculty of Science, Wilfrid Laurier University, Waterloo, Canada
| | - Ciann L Wilson
- Department of Psychology, Faculty of Science, Wilfrid Laurier University, Waterloo, Canada
| | - Vanessa Oliver
- Faculty of Liberal Arts, Child and Youth Studies, Wilfrid Laurier University, Brantford, Canada
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Thomas M, Barnabe C, Kleissen T, Lacaille D, Hazlewood G, Fifi-Mah A, Hassen N, Henry R, Kuluva M, English K, Koehn C, Lane T, Johnson N. Rheumatoid Arthritis Care Experiences of Black People Living in Canada: A Qualitative Study to Inform Health Service Improvements. Arthritis Care Res (Hoboken) 2024; 76:470-485. [PMID: 38073024 DOI: 10.1002/acr.25278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 11/20/2023] [Accepted: 12/05/2023] [Indexed: 01/28/2024]
Abstract
OBJECTIVE To understand experiences related to rheumatoid arthritis (RA) care and propose service-level strategies to reduce and mitigate inequities for Black people living in Canada. METHODS Purposive and respondent driven sampling was used to recruit participants for qualitative interviews to explore population factors relevant to RA care and challenges and facilitators for access to health care services, medications, and enacting preferred treatment plans. Thematic analysis was conducted using the Braun and Clarke method with inductive and deductive coding and critical race theory guiding analysis. RESULTS Six women and two men with RA, and two women health care professionals, expressed how their racial identity contributed to their understanding of RA, preferences for treatment, and outcome goals. Health care access was influenced by financial limitations and racism, by exclusion, and discrimination, and also by cultural norms in seeking health care and awareness about RA within the Black community. Participants experienced health system fragmentation and were not connected to ancillary supports. Treatment decision-making was influenced by the legacy of oppression and medical experimentation on Black people and the predominance of biomedical approaches emphasized by health care providers. Holistic and cultural approaches, provided in safe, trauma-informed care environments, with flexibility in service models, are desired. Partnerships between arthritis care services and Black community organizations are proposed to promote community awareness and knowledge about arthritis and provide support mechanisms for patients within their community. CONCLUSION Our study highlights unique considerations based on race and ethnicity and provides suggestions for arthritis care to mitigate inequities for Black people living with arthritis.
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Affiliation(s)
- Megan Thomas
- University of Calgary, Calgary, Alberta, Canada, and The University of British Columbia and Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Cheryl Barnabe
- University of Calgary, Calgary, Alberta, Canada, and Arthritis Research Canada, Vancouver, British Columbia, Canada
| | | | - Diane Lacaille
- Arthritis Research Canada and The University of British Columbia, Vancouver, Brtish Columbia, Canada
| | - Glen Hazlewood
- University of Calgary, Calgary, Alberta, Canada, and Arthritis Research Canada, Vancouver, British Columbia, Canada
| | | | - Nejat Hassen
- Arthritis Research Canada and The University of British Columbia, Vancouver, Brtish Columbia, Canada
| | - Richard Henry
- Jewish General Hospital and McGill University, Montreal, Quebec, Canada
| | | | - Kelly English
- Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Cheryl Koehn
- Arthritis Consumer Experts, Vancouver, British Columbia, Canada
| | - Therese Lane
- Canadian Arthritis Patient Alliance, Ottawa, Ontario, Canada
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He JW, Terry AL, Lizotte D, Bauer G, Ryan BL. Understanding intersectional inequality in access to primary care providers using multilevel analysis of individual heterogeneity and discriminatory accuracy. PLoS One 2024; 19:e0296657. [PMID: 38241267 PMCID: PMC10798491 DOI: 10.1371/journal.pone.0296657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 12/15/2023] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND Despite the Canadian healthcare system's commitment to equity, evidence for disparate access to primary care (PC) providers exists across individual social identities/positions. Intersectionality allows us to reflect the realities of how social power shapes healthcare experiences at an individual's interdependent and intersecting social identities/positions. The objectives of this study were to determine: (1) the extent to which intersections can be used classify those who had/did not have a PC provider; (2) the degree to which each social identity/position contributes to the ability to classify individuals as having a PC provider; and (3) predicted probabilities of having a PC provider for each intersection. METHODS AND FINDINGS Using national cross-sectional data from 241,445 individuals in Canada aged ≥18, we constructed 320 intersections along the dimensions of gender, age, immigration status, race, and income to examine the outcome of whether one had a PC provider. Multilevel analysis of individual heterogeneity and discriminatory accuracy, a multi-level model using individual-level data, was employed to address intersectional objectives. An intra-class correlation coefficient (ICC) of 23% (95%CI: 21-26%) suggests that these intersections could, to a very good extent, explain individual variation in the outcome, with age playing the largest role. Not all between-intersection variance in this outcome could be explained by additive effects of dimensions (remaining ICC: 6%; 95%CI: 2-16%). The highest intersectional predicted probability existed for established immigrant, older South Asian women with high income. The lowest intersectional predicted probability existed for recently immigrated, young, Black men with low income. CONCLUSIONS Despite a "universal" healthcare system, our analysis demonstrated a substantial amount of inequity in primary care across intersections of gender, age, immigration status, race, and income.
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Affiliation(s)
- Jennifer W. He
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
- Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Amanda L. Terry
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
- Department of Family Medicine, Western University, London, Ontario, Canada
| | - Dan Lizotte
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
- Department of Computer Science, Western University, London, Ontario, Canada
| | - Greta Bauer
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
- Institute for Sexual and Gender Health, University of Minnesota Medical School, Minneapolis, Minnesota, United States of America
| | - Bridget L. Ryan
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
- Department of Family Medicine, Western University, London, Ontario, Canada
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Edwards B, Marshall LJ, Ahmadzadeh G, Ahmed R, Angarso L, Balaji S, Okoh P, Rogers E, Neves P, Boakye P, Gill J, James CE, Mucsi I. Exploring barriers to living donor kidney transplant for African, Caribbean and Black communities in the Greater Toronto Area, Ontario: a qualitative study protocol. BMJ Open 2023; 13:e073176. [PMID: 37586868 PMCID: PMC10432620 DOI: 10.1136/bmjopen-2023-073176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 07/27/2023] [Indexed: 08/18/2023] Open
Abstract
INTRODUCTION Living donor (LD) kidney transplant (KT) is the best treatment option for many patients with kidney failure as it improves quality of life and survival compared with dialysis and deceased donor KT. Unfortunately, LDKT is underused, especially among groups marginalised by race and ethnicity. African, Caribbean and Black (ACB) patients are 60%-70% less likely to receive LDKT in Canada compared with white patients. Research from the USA and the UK suggests that mistrust, cultural and generational norms, access, and affordability may contribute to inequities. To date, no Canadian studies have explored the beliefs and behaviours related to LDKT in ACB communities. Research approaches that use a critical, community-based approach can help illuminate broader structural factors that may shape individual beliefs and behaviours. In this qualitative study, we will investigate barriers to accessing LDKT in ACB communities in the Greater Toronto Area, to enhance our understanding of the perspectives and experiences of ACB community members, both with and without lived experience of chronic kidney disease (CKD). METHODS AND ANALYSIS Hospital-based and community-based recruitment strategies will be used to recruit participants for focus groups and individual interviews. Participants will include self-identified ACB individuals with and without experiences of CKD and nephrology professionals. Collaboration with ACB community partners will facilitate a community-based research approach. Data will be analysed using reflexive thematic analysis and critical race theory. Findings will be revised based on feedback from ACB community partners. ETHICS AND DISSEMINATION This study has been approved by the University Health Network Research Ethics Board UHN REB file #15-9775. Study findings will contribute to the codevelopment of culturally safe and responsive educational materials to raise awareness about CKD and its treatments and to improve equitable access to high-quality kidney care, including LDKT, for ACB patients.
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Affiliation(s)
- Beth Edwards
- Ajmera Transplant Centre, University Health Network, Toronto, Ontario, Canada
| | | | - Ghazaleh Ahmadzadeh
- Ajmera Transplant Centre, University Health Network, Toronto, Ontario, Canada
| | - Ranie Ahmed
- Ajmera Transplant Centre, University Health Network, Toronto, Ontario, Canada
| | - Lydia Angarso
- Ajmera Transplant Centre, University Health Network, Toronto, Ontario, Canada
| | - Shilpa Balaji
- Ajmera Transplant Centre, University Health Network, Toronto, Ontario, Canada
| | - Princess Okoh
- Ajmera Transplant Centre, University Health Network, Toronto, Ontario, Canada
| | - Emma Rogers
- Ajmera Transplant Centre, University Health Network, Toronto, Ontario, Canada
| | - Paula Neves
- Ajmera Transplant Centre, University Health Network, Toronto, Ontario, Canada
| | | | - Jagbir Gill
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Istvan Mucsi
- Ajmera Transplant Centre, University Health Network, Toronto, Ontario, Canada
- Medicine (Nephrology), University of Toronto, Toronto, Ontario, Canada
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Kemei J, Tulli M, Olanlesi-Aliu A, Tunde-Byass M, Salami B. Impact of the COVID-19 Pandemic on Black Communities in Canada. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1580. [PMID: 36674335 PMCID: PMC9862348 DOI: 10.3390/ijerph20021580] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 01/09/2023] [Accepted: 01/13/2023] [Indexed: 06/17/2023]
Abstract
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.
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Affiliation(s)
- Janet Kemei
- Faculty of Nursing, University of Alberta, Edmonton, AB T6G 1C9, Canada
| | - Mia Tulli
- Faculty of Nursing, University of Alberta, Edmonton, AB T6G 1C9, Canada
| | | | - Modupe Tunde-Byass
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - Bukola Salami
- Faculty of Nursing, University of Alberta, Edmonton, AB T6G 1C9, Canada
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