Community perspectives on addressing and responding to HIV-testing, pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) among African, Caribbean and Black (ACB) people in Ontario, Canada

Community-Driven Recommendations for Developing Culturally Aligned Messaging to Improve Pre-Exposure Prophylaxis Acceptability and Uptake Among US-Based African Immigrants

African immigrants in the United States experience increased HIV risk due to social and structural barriers such as language constraints, stigma, and cultural misconceptions. Despite this, research on effective pre-exposure prophylaxis (PrEP) messaging tailored to this population remains limited. This study examines how PrEP communication can be adapted to meet the needs of Ghanaian immigrants who represent a segment of the larger African immigrant population. Semistructured interviews were conducted, transcribed verbatim, and analyzed using NVivo 12. The analysis highlights key considerations for effective PrEP messaging, including the importance of cultural and linguistic relevance, the role of familiar and relatable messengers, and the need for clear and practical information. Participants emphasized the significance of addressing stigma and misinformation with factual, empathetic messaging and expressed a preference for ongoing community-based education about PrEP. Community leaders and health care professionals were identified as influential sources of information, capable of shaping attitudes and increasing uptake. These findings underscore the necessity of culturally tailored, community-driven approaches to PrEP messaging that bridge linguistic and cultural gaps. Integrating these insights into health communication strategies can improve awareness, acceptance, and utilization of PrEP among Ghanaian immigrants, ultimately contributing to more equitable HIV prevention efforts.

Integrating Afrocentric praxis in intimate partner violence and HIV care for African, Caribbean, and Black women: Navigating disclosure and access to services

OBJECTIVES

This study aims to explore the intersection of intimate partner violence (IPV) and human immunodeficiency virus (HIV) among African, Caribbean, and Black women in the Greater Toronto Area (GTA). It investigates the barriers African, Caribbean, and Black women face in accessing services and examines the effectiveness of Afrocentric praxis in providing culturally informed services.

METHODS

Participants included African, Caribbean, and Black women aged 18-64, IPV survivors who had experience with healthcare and social services in the GTA, and healthcare professionals and social service providers knowledgeable about IPV and HIV in African, Caribbean, and Black communities. Convenience and snowball sampling were used to recruit participants through social media, and community organizations. Six talking circles and 18 semi-structured interviews were conducted. Content analysis was applied to identify key themes and patterns related to IPV, HIV, Afrocentric approaches, and service access. Ethical guidelines, including informed consent and confidentiality, were followed.

RESULTS

Analysis revealed several themes: systemic barriers to accessing IPV and HIV services, fear of disclosure and stigmatization, and the impact of the "Strong Black Woman" schema. The study highlighted the importance of inclusive, safe spaces and the protective role of spirituality and culturally informed therapy. Afrocentric praxis emerged as essential for effective support, emphasizing community engagement, cultural context, and collective responsibility (Ujima) in addressing IPV and HIV.

CONCLUSION

Addressing the intersection of IPV and HIV among African, Caribbean, and Black women requires culturally informed and empowering approaches. Integrating Afrocentric values and perspectives into care is crucial for creating supportive environments that recognize and address the unique challenges faced by African, Caribbean, and Black women.

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.

Post-arrival HIV acquisition patterns: Insights from African, Caribbean, and Black immigrant communities in Canada

OBJECTIVES

This mixed methods study examines post-migration HIV acquisition patterns and sexual health behaviours among African, Caribbean, and Black (ACB) immigrant men who have sex with men (MSM), as well as heterosexual men and women in Ontario, Canada.

METHODS

Data were collected from the MSAFIRI Study, including a cross-sectional quantitative survey (n = 108) and in-depth semi-structured interviews (n = 44). Participants were recruited from the Ontario HIV Treatment Network Cohort Study (OCS) through a purposive sampling of individuals who contracted HIV after migration. Data collection occurred between 2015 and 2017. Quantitative analyses using Fisher's exact tests examined associations between gender and HIV acquisition patterns, while qualitative content analysis identified themes around sexual relationships, HIV disclosure, and health decision-making.

RESULTS

Findings highlighted gender and orientation-specific differences in HIV acquisition and associated behaviours. Quantitatively, a higher proportion of men than women could not identify their likely source partner (LSP), frequently describing these relationships as casual. Qualitative insights revealed that LSPs often concealed their HIV status, resulting in unintentional post-diagnosis disclosures. Inconsistent condom use was common, with gendered rationales: heterosexual women often cited partner disapproval or relationship exclusivity, while heterosexual men and MSM cited personal aversion and focus on sexual satisfaction.

CONCLUSION

These findings underscore the distinct post-migration HIV acquisition risks among ACB immigrants in Canada. They suggest the need for culturally responsive public health interventions that consider gender-specific barriers, address stigma, and support health decision-making for ACB migrant communities navigating the complex intersections of migration, health, and relationships.

Feasibility, safety and tolerability of estrogen and/or probiotics for improving vaginal health in Canadian African, Caribbean, and Black women: A pilot phase 1 clinical trial

BACKGROUND

A dysbiotic vaginal microbiome (VMB) is associated with clinical conditions such as bacterial vaginosis (BV) and an increased risk of human immunodeficiency virus (HIV-1) infection. Considering the high prevalence of BV among African, Caribbean and Black (ACB) women, we conducted a prospective, randomized, open-label phase 1 clinical trial to determine the feasibility, safety and tolerability of administering low-dose estrogen, probiotics or both in combination to improve vaginal health and decrease HIV-1 susceptibility.

METHODS

ACB women aged 18-49 from the Greater Toronto Area (GTA) were randomized to one of four study arms: intravaginal estradiol (Estring©; 7.5mg/day); a vaginal probiotic (RepHresh™ Pro-B™) administered twice daily; a combination of Estring© and vaginal RepHresh™ Pro-B™ (twice daily); or the Estring© and oral RepHresh™ Pro-B™ (twice daily), for a duration of 30 days. Feasibility was evaluated through enrolment, retention, and adherence rates, while safety and tolerability were determined by a pre- and post-treatment blood panel and reported adverse events (AEs).

RESULTS

Overall, 63 ACB women were screened, 50 were enrolled and received the intervention while 41 completed the study, resulting in 80% enrollment and 82% retention rates. Overall adherence to the study protocol was high at 93%, with an adherence of 92% for RepHresh™ Pro-B™ and 97% for Estring©. A total of 88 AEs were reported by 29 participants which were mild (66/88; 75%) and largely resolved (82/88;93%) by the end of the study, with no serious AEs (SAEs) noted. In addition, a panel of safety blood markers measured pre- and post-intervention confirmed no clinically significant changes in blood chemistry or blood cell count.

CONCLUSION

Overall, the administration of intravaginal estrogen and/or probiotics in pre-menopausal ACB women is feasible, safe, and well tolerated.

TRIAL REGISTRATION

The trial was registered with Clinicaltrials.gov (NCT03837015) and CIHR HIV Clinical Trials (CTN308).

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.

Effectiveness of onsite and online education in enhancing knowledge and use of human immunodeficiency virus pre- and post-exposure prophylaxis

BACKGROUND

Enhancing awareness and use of pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) is vital to curb human immunodeficiency virus (HIV) spread. High-risk behaviors prevalent among sexually transmitted infection clinic outpatients underscore the need for increased PrEP/PEP education in this group.

AIM

To investigate the effects of both onsite and online health education on the knowledge of, and willingness to use, PrEP and PEP among individuals receiving PEP services.

METHODS

Participants were drawn from a cohort study on PEP service intervention at an STD/AIDS outpatient clinic in designated HIV/AIDS hospitals in Beijing, conducted from January 1 to June 30, 2022. Health education was provided both onsite and online during follow-up. Surveys assessing knowledge of, and willingness to use, PrEP/PEP were administered at baseline and again at 24 wk post-intervention.

RESULTS

A total of 112 participants were enrolled in the study; 105 completed the follow-up at week 24. The percentage of participants with adequate knowledge of, and willingness to use, PrEP significantly increased from 65.2% and 69.6% at baseline to 83.8% and 82.9% at the end of the intervention (both P < 0.05). Similarly, those with adequate knowledge of, and willingness to use, PEP increased from 74.1% and 77.7% at baseline to 92.4% and 89.5% at week 24 (P < 0.05). Being between 31 years and 40 years of age, having a postgraduate degree or higher, and reporting a monthly expenditure of RMB 5000 or more were found to be significantly associated with knowledge of PrEP and PEP (both P < 0.05).

CONCLUSION

The findings show that both onsite and online health education significantly improved the knowledge of, and increased willingness to use, PrEP and PEP in individuals utilizing PEP services.

HIV Screening Among Young Black Men Who Have Sex with Women in New Orleans, LA

There are significant disparities in HIV acquisition, with Black individuals facing disproportionately more new diagnoses. Per Centers for Disease Control and Prevention (CDC), all people aged 13-64 should be tested at least once in their lifetime, and men at increased risk (e.g., those who have male sexual contact, multiple partners, have partners with multiple partners, or share drug injection equipment) should be tested annually. The study included young Black men who have sex with women (MSW), aged 15-26, and who live in New Orleans, LA. Survey data was used to elicit the frequency and factors associated with three self-reported outcomes: (1) history of ever HIV testing, (2) HIV screening in the last year among those who were recommended per CDC, and (3) HIV positivity. Of the 1321 men included, 694/1321 men (52.5%) reported ever having been HIV tested. There were 708/1321 (54.2%) men who met the recommendation for annual screening and 321/708 (45.3%) of these eligible men reported being tested in the previous year. Of those ever tested, 44/694 (6.3%) self-reported testing positive. In logistic regression analysis, older age (OR: 1.27, p < 0.001), prior STI testing (OR: 6.45, p < 0.001), and prior incarceration (OR:1.70, p = 0.006) were positively associated with having ever received an HIV test, and ever having a male partner (OR: 3.63, p = 0.014) was associated with HIV positivity. Initiatives to improve HIV testing rates among young Black men who have sex with women are needed to reduce the burden of HIV and help the End the Epidemic initiative.

Perspectives on menstrual policymaking and community-based actions in Catalonia (Spain): a qualitative study

BACKGROUND

Menstrual research and policymaking have become imperative worldwide. It is necessary that these are informed by women and people who menstruate (PWM) alongside expert professionals and activists.

METHODS

The main aim of this study was to identify and propose policies and community-based actions to address menstrual inequity and promote menstrual health in Catalonia (Spain). This study consisted of two qualitative studies: (a) 34 individual photoelicitation interviews with women and PWM, (b) a World Café study with 22 professionals and activists. Sampling for both studies was purposive and selective. Recruitment was conducted through healthcare centres, social media, key contacts, and snowball sampling techniques. Data were collected in December 2020-September 2022, and analysed using Framework Analysis.

RESULTS

Participants considered the implementation of menstrual policies that address the taboo and stigma of menstruation to be crucial. They stressed the need for menstrual education, which should be integrated into formal education curricula. Participants, and especially women and PWM, highlighted the need to improve the access and quality of healthcare services, so that the menstrual cycle and menstruation are seen as health indicators. Health professionals should encourage agentic informed decisions, hence why both participant groups considered menstrual health education amongst health professionals to be pivotal. Taking action to improve the access and affordability of menstrual products was also imperative for participants, especially for socioeconomically vulnerable populations. Participants agreed on guaranteeing fully equipped menstrual management facilities, and and professionals discussed gender-neutral and sex-segregated bathrooms. Workplace menstrual policies to accommodate and ensure menstrual self-care were also suggested.

CONCLUSIONS

Our study highlights the need for multi-dimensional menstrual policies. These should include actions to address menstrual taboo and stigma, to promote menstrual education that goes beyond the hegemonic biomedical prism, to improve the access and quality of menstrual health services, along with policies ensuring adequate menstrual management facilities in public spaces and the access to menstrual products. Policymaking should also focus on how to ensure menstrual management and care in workplaces. Menstrual policies and community-based actions should be framed within intersectionality, to consider how societal structures of power and oppression influence menstrual experiences.

Knowledge About Renal Transplantation Among African, Caribbean, and Black Canadian Patients With Advanced Kidney Failure

Introduction

Variable transplant-related knowledge may contribute to inequitable access to living donor kidney transplant (LDKT). We compared transplant-related knowledge between African, Caribbean, and Black (ACB) versus White Canadian patients with kidney failure using the Knowledge Assessment of Renal Transplantation (KART) questionnaire.

Methods

This was a cross-sectional cohort study. Data were collected from a cross-sectional convenience sample of adults with kidney failure in Toronto. Participants also answered an exploratory question about their distrust in the kidney allocation system. Clinical characteristics were abstracted from medical records. The potential contribution of distrust to differences in transplant knowledge was assessed in mediation analysis.

Results

Among 577 participants (mean [SD] age 57 [14] years, 63% male), 25% were ACB, and 43% were White Canadians. 45% of ACB versus 26% of White participants scored in the lowest tertile of the KART score. The relative risk ratio to be in the lowest tertile for ACB compared to White participants was 2.22 (95% confidence interval [CI]: 1.11, 4.43) after multivariable adjustment. About half of the difference in the knowledge score between ACB versus White patients was mediated by distrust in the kidney allocation system.

Conclusion

Participants with kidney failure from ACB communities have less transplant-related knowledge compared to White participants. Distrust is potentially contributing to this difference.

Resisting and disrupting HIV-related stigma: a photovoice study

BACKGROUND

The stigma associated with human immunodeficiency virus (HIV) is a significant global public health concern. Health care providers and policy makers continue to struggle with understanding and implementing strategies to reduce HIV-related stigma in particular contexts and at the intersections of additional oppressions. Perspectives and direction from people living with HIV are imperative.

METHODS

In this project we amplified the voices of people living with HIV about their experiences of HIV-related stigma in Manitoba, Canada. We used an arts-based qualitative case study research design using photovoice and narrative interviews. Adults living with HIV participated by taking pictures that represented their stigma experiences. The photos were a catalyst for conversations about HIV and stigma during follow-up individual narrative interviews. Journaling provided opportunities for participants to reflect on their experiences of, and resistance to, stigma. Interviews were audio recorded and transcribed. Photos, journals, and transcribed interviews were analyzed using inductive qualitative methods RESULTS: Through pictures and dialogue, participants (N = 11; 64% women) expressed the emotional and social impacts of stigmas that were created and supported by oppressive structures and interpersonal attitudes and behaviours. These experiences were compounded by intersecting forms of oppression including racism, sexism, and homophobia. Participants also relayed stories of their personal strategies and transitions toward confronting stigma. Strategies were themed as caring for oneself, caring for children and pets, reconstituting social support networks, and resisting and disrupting stigma. Participants made important recommendations for system and policy change.

CONCLUSIONS

These stories of oppression and resistance can inspire action to reduce HIV-related stigma. People living with HIV can consider the strategies to confront stigma that were shared in these stories. Health care providers and policy makers can take concerted actions to support peoples' transitions to resisting stigmas. They can facilitate supportive and anti-oppressive health and social service systems that address medical care as well as basic needs for food, shelter, income, and positive social and community connections.

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.

"Live a normal life": Constructions of resilience among people in mixed HIV status relationships in Canada

Positive Plus One is a mixed-methods study of long-term mixed HIV-serostatus relationships in Canada (2016-19). Qualitative interviews with 51 participants (10 women, 41 men, including 27 HIV-positive and 24 HIV-negative partners) were analyzed using inductive thematic analysis to examine notions of relationship resilience in the context of emerging HIV social campaigns. Relationship resilience meant finding ways to build and enact life as a normal couple, that is, a couple not noticeably affected by HIV, linked to the partner with HIV maintaining viral suppression and achieving "undetectable = untransmittable" (U = U). Regardless of serostatus, participants with material resources, social networks, and specialized care were better able to construct resilience for HIV-related challenges within their relationships. Compared to heterosexual couples and those facing socioeconomic adversity, gay and bisexual couples were easier able to disclose, and access capital, networks and resources supporting resilience. We conclude that important pathways of constructing, shaping, and maintaining resilience were influenced by the timing of HIV diagnosis in the relationship, access to HIV-related information and services, disclosure, stigma and social acceptance.