Research That Matters (January 17 - 20, 2008)


Calvert Room (Omni Shoreham)

Community Engagement in HIV Vaccine Research: Addressing Challenges to Future HIV Vaccine Dissemination for Canadian Black Women

Peter A. Newman, PhD, University of Toronto, Charmaine C. Williams, PhD, University of Toronto, Notisha Massaquoi, MSW, Women's Health in Women's Hands Community Health Centre, Marsha Brown, MSW, University of Toronto, and Carmen Logie, MSW, University of Toronto.

Purpose: Canadian black women are overrepresented among persons living with HIV/AIDS, with four-fold higher HIV prevalence compared to white women (Public Health Agency of Canada, 2005). HIV vaccines are one of our greatest hopes for controlling the epidemic. HIV vaccines hold particular promise for women given that 25 years into the epidemic the primary method of prevention (the male condom) is ultimately under the control of men (Rudy, Newman, Duan & Swendeman, 2005). Nevertheless, social and structural factors may impede the effectiveness of future HIV vaccines (Newman, Duan, Rudy, Roberts, & Swendeman, 2004). The purpose of this study was to explore in-depth Canadian black women's perspectives on future preventive HIV vaccines and suggestions for gender- and culturally appropriate dissemination.

Method: A qualitative study was undertaken in partnership between a university and a community health centre serving women of color. A community advisory board of six service providers from agencies serving diverse black communities was engaged throughout the project. Four 90-minute focus groups (3 English, 1 French) were conducted with black women using a semi-structured interview guide. Six in-depth key informant interviews were conducted with African and Caribbean community leaders, advocates and health care providers. All interviews were digitally recorded and transcribed verbatim (and translated into English). Narrative thematic analysis and a constant comparative method from grounded theory were used to identify themes, including line-by-line, focused and theoretical coding (Charmaz, 2006) using N-VIVO software. Member checking, peer debriefing, and triangulation of data sources and methods were employed to enhance credibility and trustworthiness of the findings (Charmaz, 2006; Lincoln & Guba, 1985).

Results: Focus group participants (n=26) ranged from 19 to 68 years old (mean = 32 years). Forty-three percent hadn't completed high school. Mean annual income was $13,836. Participants averaged 10 years living in Canada (range: 1 - 40 years). Barriers to future HIV vaccine dissemination included: disparities in research participation (i.e., lack of inclusion of black women in HIV vaccine development and clinical trials); socio-cultural factors (i.e., AIDS stigma and racialization, low perception of risk, certain religious beliefs, disempowerment of women in families and communities); and structural factors (i.e., discrimination based on race, gender and citizenship; mistrust of researchers and government). Facilitators to vaccine acceptability included relationships with people living with HIV/AIDS, women-controlled prevention technology, community-based education and acceptance, mainstreaming HIV vaccines as a part of routine health care, and distribution through community-based providers.

Conclusions and Implications: Sociocultural and structural barriers may limit the future success of HIV vaccines for black women in Canada. Community-based, culturally-appropriate and gender-specific approaches may be vital to ensuring effective and equitable dissemination of future HIV vaccines. HIV vaccine dissemination strategies for this population should support community engagement in medical research, build trust, combat stigma, ensure access, and incorporate existing community institutions, ethno-specific agencies and women's services in planning and implementation. Overall, HIV prevention strategies for black women may benefit from shifting the balance to less focus on individual risk behaviors and greater attention to structural and social factors that produce heightened vulnerability to HIV/AIDS.