“It's for Us—Newcomers and LGBT Persons. You Feel Free to be”: Exploring Support Group Participation Among LGBT African and Caribbean Newcomers and Refugees in Urban Canada

Background: Lesbian, gay, bisexual, and transgender (LGBT) persons who migrate to Canada due to criminalization in their countries of origin negotiate multiple stressors in the immigration process. These stressors, such as limited economic, social and familial resources, contribute to mental health issues and social isolation. Detrimental physical and mental health impacts from immigration and asylum seeking processes may be exacerbated among LGBT African and Caribbean (AC) populations who face ongoing experiences of sexual stigma, transphobia, racism, and classism in Canada. An AIDS service organization (ASO) for African and Caribbean people in an urban Canadian centre implements monthly peer support groups: one (group A) for lesbian, bisexual and transgender AC women, and a second (group B) for LGBT AC newcomers and refugees. The study objective was to explore experiences of participating in peer support groups among LGBT AC newcomers and refugees in an urban centre in Canada.

Methods: We conducted three focus groups with a purposive sample of AC participants (n=29) who attended group A, group B, or both groups. We conducted semi-structured individual interviews with healthcare and social service providers (n=5) from ASO and community health centres serving AC populations. Interviews and focus groups were digitally recorded and transcribed verbatim. Three investigators independently analyzed transcripts using narrative thematic techniques to identify themes in the data. Our study was guided by an intersectionality framework and paid particular attention to the convergence of multiple identity categories (e.g. race, gender, sexuality, immigration status).

Results: Focus group participants (n=29; mean age: 30.5 years [SD 8.0]; cisgender male: 51.7%, cisgender female: 37.9%, transgender: 10.4%) attended group B (64.3%), group A (10.7%) and both groups (25.0%). Participants identified as bisexual (42.9%), gay (32.1%), and lesbian (17.9%). All participants were born outside of Canada (70.4% Caribbean; 29.6% African) and most (79.3%) came as refugees. Participants described how stressors from immigration contributed to social isolation and loneliness, poverty, and mental health issues such as depression. Findings revealed multi-level social and health benefits of social support group participation. Individual/micro level benefits included intrapersonal (e.g. HIV knowledge, self-acceptance, reduced depression) and interpersonal (e.g. friendships, social networks) dimensions. Social/meso level benefits included LGBT and AC community connectedness, sharing knowledge and skills with others, and reduced stigma (HIV-related, sexual). Structural/macro level benefits included increased knowledge of, and access to, employment, health care, housing, and immigration and refugee services.

Implications: Findings highlight the synergistic effects of social exclusion produced through multiple forms of marginalization, including sexuality and newcomer/refugee status. There is an urgent need for social work interventions to reduce stigma and poverty, and improve social/health services access, among AC LGBT newcomers and refugees. Social support groups tailored for LGBT AC newcomers and refugees have the potential to facilitate peer support and knowledge sharing that help newcomers and refugees to negotiate complex social, legal, and health systems—and to build community. Social workers can support AC LGBT newcomers and refugees through providing access to: peer support groups; culturally and LGBT competent mental health services; support and information to enhance access to employment, housing, health and legal services.