Abstract: Exploring HIV Acquisition Patterns and Sexual Risk Among African, Caribbean, and Black Immigrants in Canada: A Mixed-Methods Study (Society for Social Work and Research 29th Annual Conference)

Schedule:

Sunday, January 19, 2025

Issaquah A, Level 3 (Sheraton Grand Seattle)

* noted as presenting author

Wangari Tharao, MPH, Research Director, Women's Health in Women's Hands Community Health Centre, Toronto, ON, Canada

Thabani Nyoni, PhD, Assistant Professor, Dalhousie University, Halifax, NS, Canada

Amrita Daftary, PhD, Associate Professor, York University, Toronto, ON, Canada

Sandra Bullock, PhD, Associate Professor, University of Toronto, Toronto, ON, Canada

Soraya Blot, Former Staff, African and Caribbean Council on HIV/AIDS in Ontario (ACCHO), Former Staff, Toronto, ON, Canada

Valerie Pierre-Pierre, Former Executive Director, The African and Caribbean Council on HIV/AIDS in Ontario (ACCHO), Former Exceutive Director, Toronto, ON, Canada

Mona Loutfy, MPH, MD, FRCPC, MPH, Professor, University of Toronto & Maple Leaf Medical Clinic, Toronto, ON, Canada

Rupert Kaul, PhD, Professor, University of Toronto, ON, Canada

Darrell Tan, PhD, Associate Professor, St. Michael's Hospital & University of Toronto, Toronto, ON, Canada

Anita Rachlis, MD, Medical Doctor, Sunnybrook Health Sciences Centre, Toronto, ON, Canada

Curtis Cooper, MD, FRCPC, Professor, University of Ottawa & The Ottawa Hospital, Ottawa, ON, Canada

Irving Salit, MD, FRCPC, Professor, Toronto General Hospital Research Institute (TGHRI), Toronto, ON, Canada

Henry Luyombya, Chief Visionary Officer, New African Canadians (NAC), Charlottetown, PE, Canada

Shannon Ryan, Former Executive Director, The Black Coalition of AIDS Prevention, former Executive Director, Toronto, ON, Canada

Liviana Calzavara, PhD, Professor, University of Toronto, Toronto, ON, Canada

the MSAFIRI Study Team, Women's Health in Women's Hands Community Health Centre, Toronto, ON, Canada

Background and Purpose: African, Caribbean, and Black (ACB) populations in Canada experience persistent health disparities contributing to the disproportionate burden of HIV, especially for immigrants from African and Caribbean countries. Addressing these challenges is hindered by the lack of evidence regarding post-arrival sexually transmitted HIV acquisition among ACB immigrants. The purpose of this mixed-methods study is to describe patterns of HIV acquisition and sexual risk among ACB men who have sex with men (MSM) and heterosexual men and women who acquired HIV after migrating to Canada.

Methods: Data was drawn from the MSAFIRI Study, an investigation that combines a cross-sectional quantitative survey (n=108) and in-depth semi-structured interviews (n=44) involving ACB immigrants who acquired HIV after arrival in Ontario, Canada. Fisher's exact tests were conducted to examine associations between gender identity and patterns of HIV acquisition [i.e., ability to identify the "likely source of HIV" (LSP), relationship status with LSP, and LSP's racial/ethnic background] and associations between gender identity and three measures of HIV risk: (i.e., knowledge of LSP's HIV status, the extent of condom use, and reason for non-condom use). Content analysis of in-depth interviews supported the identification of recurring themes concerning sexual relations, HIV awareness, and decision-making on sexual safety among respondents who could identify their LSP.

Results: Quantitative analysis revealed gender disparities in HIV acquisition, notably in the ability to identify and define relationships contributing to HIV acquisition. More men than women could not identify their LSP and classified their LSP as a casual partner. Qualitative results substantiated these findings. Additionally, the low levels of disclosure of LSPs' HIV status were supported by qualitative insights, which revealed that LSPs often concealed their HIV status, leading to disclosure only occurring inadvertently after the respondent's HIV diagnosis. Quantitative results indicate high levels of inconsistent condom use. Regarding significant reasons for inconsistent condom use, heterosexual women cited partner disapproval of condom use, while heterosexual men expressed personal aversion to condoms. In qualitative responses, women cited perceived relationship exclusivity, partner disapproval, and pregnancy goals as deterrents. Condom use was most normalized, albeit not consistent, among MSM engaged in casual encounters. Generally, men's decisions were shaped by the desire for sexual satisfaction or pleasure. In contrast, women were shaped by a desire to maintain relationships, prioritize partners' preferences over their own, and/or conceive.

Conclusion: Findings indicate gender differences in risky sexual behaviors and patterns of HIV acquisition among ACB immigrants, with men often identifying casual partners as the source. Additionally, there is a lack of HIV status disclosure among partners across genders, coupled with widespread inconsistent condom use, attributed by women to partner disapproval and by men to personal aversion. These findings underscore the need for tailored interventions targeting ACB immigrant populations to address specific challenges in HIV prevention and sexual health promotion. Social workers and policymakers can use these insights to develop culturally sensitive programs aimed at improving HIV prevention and promoting safer sexual practices within ACB immigrant communities, thus contributing to reducing health disparities and improving overall well-being.