Purpose: HIV/AIDS is a major threat to the health of women of African and Caribbean origin in both industrialized and non-industrialized nations (UNAIDS/WHO, 2004). Yet, a discourse that tends to associate this risk with circumstances in “HIV-endemic countries” or that focuses on risk as an individual-level phenomenon presents obstacles to the design and dissemination of effective HIV prevention interventions. The purpose of this project is to identify barriers to HIV prevention among Black women in Toronto and strategies for effective interventions.

Methods: A Community Advisory Board was formed with representatives of Black women of African and Caribbean descent in Toronto to explore and prioritize research questions and identify key community agency participants. Eight key informant interviews were conducted with Toronto healthcare providers and policymakers with expertise regarding Black woman. Four focus groups were conducted among 32 women of African descent, Carribbean descent, women under 30, and recent immigrants, using a semi-structured interview guide with scripted probes (Morgan, 1998). All interviews and focus groups were digitally recorded with participants' consent, transcribed verbatim, and analyzed utilizing N-Vivo qualitative software. Themes were developed by a team of 4 independent investigators using a method of constant comparison (Glaser & Strauss, 1967; Strauss & Corbin, 1978). Investigator, data source, and methodological triangulation were employed to increase the validity of the data (Lincoln & Guba, 1985).

Results: A number of barriers to HIV prevention were identified: gender-based discrimination, racism, poverty, precarious immigration rights/status, migration, HIV/AIDS stigma from within women's own communities and from the larger society, cultural taboos around discussing sex, lack of knowledge about HIV risk, denial of HIV risk, nonconsensual sex, and mistrust of government and medical research.

Implications for Practice and Policy: A variety of potent and pervasive social determinants of risk suggest the necessity of addressing HIV prevention in the context of multidimensional initiatives to empower and advocate for Black women. Not only are the predominant paradigms of individual risk (e.g., knowledge, attitudes, behaviors) and epidemiology insufficient; they often serve to further stigmatize Black women and may be antithetical to HIV prevention. Laws and social policies that grant rights and status to women immigrants and refugees independent of their spouses, economic opportunity for Black women, the mainstreaming of HIV prevention services and future HIV vaccines as part of culturally competent and accessible routine care, and the engagement of the Black church in HIV prevention as a component of cultural survival in a hostile context (not an isolated HIV/AIDS strategy) may be key to HIV prevention initiatives for Black women, now and for the foreseeable future.

References

Glaser, B., & Strauss, A. (1967). The Discovery of Grounded Theory. Chicago: Aldine.

Lincoln, Y.S., & Guba, E.G. (1985). Naturalistic Inquiry. Newbury Park: Sage Publications.

Morgan, D.L. (1998). The Focus Group Guidebook. Thousand Oaks: Sage Publications.

Strauss, A., & Corbin, J. (1990). Basics of Qualitative Research: Grounded Theory Procedures and Techniques. Newbury Park: Sage Publications.

UNAIDS/WHO. (2004). Joint United Nations Programme on HIV/AIDS and World Health Organization, AIDS epidemic update: December 2003. Geneva: UNAIDS.