1
|
Antabe R, Sano Y, Amoak D, Anfaara FW, Braimah J. Factors Associated with the Uptake of HIV Testing in Canada: Evidence from a Nationally Representative Study. SOCIAL WORK IN PUBLIC HEALTH 2024; 39:534-547. [PMID: 38801320 DOI: 10.1080/19371918.2024.2359463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
In this study, we explore the factors associated with the uptake of HIV testing at the national level in Canada. Using the 2015-16 Canadian Community Health Survey and applying logistic regression analysis, we examine the associations between HIV testing and factors identified by the Andersen's behavioral model of healthcare utilization. We find that a range of predisposing, enabling, and need factors are significantly associated with HIV testing. For example, compared to the oldest respondents (i.e. 55-64), their younger counterparts (i.e. 45-54, 35-44, and 25-34) are more likely to have been tested for HIV. Compared to those in Atlantic Canada, respondents in Quebec (OR = 1.96, p < .001), Ontario (OR = 1.44, p < .001), Prairies (OR = 1.37, p < .001), British Columbia (OR = 1.99, p < .001), and the Territories (OR = 2.22, p < .001) are all more likely to have been tested for HIV. Based on these findings, we provide several important suggestions for policymakers and future research.
Collapse
Affiliation(s)
- Roger Antabe
- Department of Health and Society, University of Toronto Scarborough, Toronto, Ontario, Canada
| | - Yujiro Sano
- Department of Sociology, Nipissing University, North Bay, Ontario, Canada
| | - Daniel Amoak
- Department of Geography and Environment, Social Science Centre, Western University, London, Ontario, Canada
| | - Florence W Anfaara
- Department of Gender, Sexuality, and Women's Studies, Western University, London, Ontario, Canada
| | - Joseph Braimah
- Department of Health and Society, University of Toronto Scarborough, Toronto, Ontario, Canada
| |
Collapse
|
2
|
Urquhart R, Adams M, Chakraborty S, Burns JC. Real Talk: Conversations on HIV with Black Heterosexual Men in Healthcare Settings. J Community Health 2024:10.1007/s10900-024-01388-9. [PMID: 39126616 DOI: 10.1007/s10900-024-01388-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2024] [Indexed: 08/12/2024]
Abstract
Nearly half of heterosexually transmitted human immunodeficiency virus (HIV) infections occur among Black men in the United States. Yet Black heterosexual men (BHM) are largely ignored in HIV programming, policy implementation, and research. This study explores how masculinity, mental health, and socioeconomic factors such as income, education, and insurance (e.g., enrollment and coverage) correlate with the likelihood of BHM having important conversations surrounding HIV with their healthcare providers and family members. Conversations among social networks (e.g., peers, family, and neighbors) create an opportunity to increase comfortability while discussing HIV-related topics around condom use and testing. This study used a cross-sectional survey design and convenience sampling (N = 279) to recruit participants from a community-academic partnership involving a Federally Qualified Health Center (FQHC) in Detroit between June 1, 2020, and July 31, 2020. Descriptive statistics were used to report demographics, socioeconomic information, and sexual health-related behavior variables. Spearman's correlation test was used to report bivariate correlations between predictor and outcome variables. 49.3% of the study participants disclosed having ever talked to a healthcare provider about HIV/acquired immune deficiency syndrome (AIDS), and 40.9% disclosed having ever talked to a family member about HIV/AIDS and sexually transmitted infections (STIs). The results from this article highlight potential barriers that may inhibit BHM from engaging in conversations about HIV with their healthcare providers and family members. It is important to include BHM in future research that focuses on HIV prevention and education to support community leaders and clinicians who work to address these disparities.
Collapse
Affiliation(s)
- Rakira Urquhart
- School of Health and Human Sciences, University of North Carolina at Greensboro, 1408 Walker Ave 437 Coleman Bldg, Greensboro, NC, 27412, USA.
| | - Mackenzie Adams
- School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
| | - Shawtaabdee Chakraborty
- College of Human Medicine, Michigan State University, 15 Michigan St, NE Grand Rapids, MI, 49503, USA
| | - Jade C Burns
- School of Nursing, University of Michigan, 400 North Ingalls Street Room 3175, 400 NIB, Ann Arbor, MI, 48109, USA
| |
Collapse
|
3
|
Kangmennaang J, Siiba A, Bisung E. Does Trust Mediate the Relationship Between Experiences of Discrimination and Health Care Access and Utilization Among Minoritized Canadians During COVID-19 Pandemic? J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01809-w. [PMID: 37787945 DOI: 10.1007/s40615-023-01809-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 09/14/2023] [Accepted: 09/18/2023] [Indexed: 10/04/2023]
Abstract
OBJECTIVES We sought to determine if trust in government institutions mediate the relationship between experiences of discrimination and health care utilization during the COVID-19 pandemic. METHODS We used data from Statistics Canada's Crowdsourcing Data: Impacts of COVID-19 on Canadians-Experiences of Discrimination. We used generalized linear latent and mixed models (Gllamm) with a binomial and logit link function as well as generalized structural equation modeling (GSEM) to determine if reported discrimination and trust were associated with difficulties in accessing health services, health care, and the likelihood of experiencing negative health impacts. We also examined if trust mediated the relationship between experiences of discrimination and these health outcomes. Our analytical sample consisted of 2568 individuals who self-identified as belonging to a visible minority group. RESULTS The multivariate results indicate that experiences of discrimination during COVID-19 were associated with higher odds of reporting difficulties in accessing general health services (OR = 1.99, p ≤ 0.01), receiving care (OR = 1.65, p ≤ 0.01), and higher likelihood of reporting negative health impacts (OR = 1.68, p ≤ 0.01). Our mediation analysis indicated that trust in public institutions explained a substantial portion of the association between reported discrimination and all the health outcomes, although the effects of experiencing discrimination remain significant and robust. CONCLUSION The findings show that building and maintaining trust is important and critical in a pandemic recovery world to build back better.
Collapse
|
4
|
Etowa EB, Wong JPH, Omorodion F, Etowa J, Luginaah I. Addressing HIV Misconceptions among Heterosexual Black Men and Communities in Ontario. Healthcare (Basel) 2023; 11:healthcare11070997. [PMID: 37046924 PMCID: PMC10094559 DOI: 10.3390/healthcare11070997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 03/25/2023] [Accepted: 03/29/2023] [Indexed: 04/03/2023] Open
Abstract
Background. Black males accounted for 19.7% of all the new HIV diagnoses in Canada in 2020, yet Black people make up only 4.26% of the population. Persistent misconceptions about modes of HIV transmission need to be addressed to reduce the relatively high HIV prevalence among Black men. We described the HIV misconceptions held by some HBM in Ontario. We also identified the social determinants that are protective versus risk factors for HIV misconceptions among heterosexual Black men (HBM) in Ontario with a view to building evidence-based strategies for strengthening HIV prevention and stigma reduction among HBM and their communities in Ontario. Methods. We report quantitative findings of the weSpeak study carried out among HBM in four cities (Ottawa, Toronto, London, and Windsor) in Ontario. Sample size was 866 and sub-samples were: Ottawa (n = 210), Toronto (n = 343), London (n = 157), and Windsor (n = 156). Data were collected with survey questionnaire. The outcome variable, HIV misconception score ranging from 1 to 18, was measured by the number of statements on the HIV Knowledge Questionnaire with incorrect answers. We included three categories of independent variables in the analysis based on a stepwise and forward model selection approach. The variable categories include (i) sociodemographic background; (ii) personalised psychosocial attributes (levels of HIV misconceptions, negative condom attitude, age at sexual debut, and resilience); and (iii) socially ascribed psychosocial experiences (everyday discrimination and pro-community attitudes). After preliminary univariate and bivariate analyses, we used a hierarchical linear regression model (HLM) to predict levels of HIV misconceptions while controlling for the effect of the city of residence. Results. More than 50% of participants in all study sites were aged 20–49 years, married, and have undergone a college or university undergraduate education. Yet, a significant proportion (27.2%) held varying levels of misconceptions about HIV. In those with misconceptions, the two most common misconceptions were: (i) people are likely to get HIV by deep kissing, putting their tongue in their partner’s mouth, if their partner has HIV (40.1%); and (ii) taking a test for HIV one week after having sex will tell a person if she or he has HIV (31.6%). Discrimination (β = 0.23, p < 0.05, 95% CI = 0.01, 0.46), negative condom attitudes (β = 0.07, p < 0.05, 95% CI = 0.01, 0.12), and sexual debut at an older age (β = 0.06, p < 0.05, 95% CI = 0.01, 1) were associated with more HIV misconceptions. Being born in Canada (β = −0.96, p < 0.05, 95% CI = −1.8, −0.12), higher education (β = −0.37, p < 0.05, 95% CI = −0.52, −0.21), and being more resilient (β = −0.04, p < 0.05, 95% CI = −0.08, −0.01) were associated with fewer HIV misconceptions. Conclusion and recommendations. HIV misconceptions are still common, especially among HBM. These misconceptions are associated with structural and behavioural factors. We recommend structural and policy-driven interventions that promote more accessible and equity-driven healthcare, education, and social integration of HBM in Ontario. We also recommend building capacity for collective resilience and critical health and racial literacy as well as creating culturally safe spaces for intergenerational dialogues among HBM in their communities.
Collapse
Affiliation(s)
- Egbe B. Etowa
- Daphne Cockwell Health Sciences Complex, Toronto Metropolitan University, Toronto, ON M5B 2K3, Canada
- Correspondence:
| | - Josephine Pui-Hing Wong
- Daphne Cockwell Health Sciences Complex, Toronto Metropolitan University, Toronto, ON M5B 2K3, Canada
| | - Francisca Omorodion
- Department of Sociology, Anthropology and Criminology, University of Windsor, Windsor, ON N9B 3P4, Canada
| | - Josephine Etowa
- School of Nursing, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Isaac Luginaah
- Department of Geography, University of Western Ontario, London, ON N6A 3K7, Canada
| |
Collapse
|
5
|
Antabe R, McIntosh M, Lawson E, Husbands W, Wong JPH, Arku G, Luginaah I. Black heterosexual men's resilience in times of HIV adversity: findings from the "weSpeak" study. BMC Public Health 2023; 23:182. [PMID: 36707783 PMCID: PMC9880929 DOI: 10.1186/s12889-023-15103-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 01/13/2023] [Accepted: 01/20/2023] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND In Canada, heterosexual African, Caribbean and Black (ACB) men tend to suffer a disproportionate burden of HIV. Consequently, studies have examined the underlying contributors to this disparity through the nexus of behavioral and structural factors. While findings from these studies have been helpful, their use of deficit and risk models only furthers our knowledge of why ACB men are more vulnerable to HIV infection. Thus far, there is a dearth of knowledge on how heterosexual ACB men mobilize protective assets to promote their resilience against HIV infection. METHODS As part of a larger Ontario-based project called weSpeak, this study examined how ACB men acquire protective assets to build their resilience to reduce their HIV vulnerability. We analyzed three focus group discussions (n = 17) and 13 in-depth interviews conducted with ACB men using NVivo and a mixed inductive-deductive thematic analyses approach. RESULTS The findings show that ACB men mostly relied on personal coping strategies, including sexual abstinence, to build resilience against HIV. Interpersonal resources such as family, friends, and religious communities also played an important role in constructing ACB men's resilience. ACB men bemoaned their lack of access to essential institutional resources, such as health services, that are important in managing HIV adversity. CONCLUSION Based on these findings, there is an urgent need for HIV policy stakeholders, including service providers, to engage the ACB community in the design of intervention programs. Additionally, addressing the socioeconomic disadvantages faced by ACB communities will increase the capacity of ACB men to develop resilience against HIV.
Collapse
Affiliation(s)
- Roger Antabe
- Department of Health and Society, University of Toronto Scarborough, 1265 Military Trail, M1C 1A4, Toronto, ON, Canada.
| | - Martin McIntosh
- Regional HIV/AIDS Connections (RHAC), 30-186 King Street, N6A 1C7 London, ON Canada
| | - Erica Lawson
- grid.39381.300000 0004 1936 8884Department of Gender, Sexuality, and Women’s Studies, Western University, 1151 Richmond Street, Lawson Hall Room, 3260, N6A 5B8 London, ON Canada
| | - Winston Husbands
- grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, 155 College Street, M5T 3M7 Toronto, ON Canada
| | - Josephine Pui-Hing Wong
- Daphne Cockwell School of Nursing, Faculty of Community Services, Toronto Metropolitan University, Podium Building, Room POD-481, 350 Victoria St, M5B 2K3 Toronto, ON Canada
| | - Godwin Arku
- grid.39381.300000 0004 1936 8884Department of Geography and Environment, Social Science Centre, Western University, 1151 Richmond St, N6A 5C2 London, ON Canada
| | - Isaac Luginaah
- grid.39381.300000 0004 1936 8884Department of Geography and Environment, Social Science Centre, Western University, 1151 Richmond St, N6A 5C2 London, ON Canada
| |
Collapse
|
6
|
Antabe R, Robinson K, Husbands W, Miller D, Harriot A, Johnson K, Wong JPH, Poon MKL, Kirya JW, James C. "You have to make it cool": How heterosexual Black men in Toronto, Canada, conceptualize policy and programs to address HIV and promote health. PLoS One 2022; 17:e0278600. [PMID: 36584118 PMCID: PMC9803177 DOI: 10.1371/journal.pone.0278600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 11/18/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Black Canadian communities are disproportionately impacted by HIV. To help address this challenge, we undertook research to engage heterosexual Black men in critical dialogue about resilience and vulnerability. They articulated the necessity of making health services 'cool'. METHODS We draw on the analyses of focus groups and in-depth interviews with 69 self-identified heterosexual Black men and 12 service providers who took part in the 2016 Toronto arm of the weSpeak study to explore what it means to make health and HIV services 'cool' for heterosexual Black Canadian men. RESULTS Our findings revealed four themes on making health services cool: (1) health promotion as a function of Black family systems; (2) opportunities for healthy dialogue among peers through non-judgmental interactions; (3) partnering Black men in intervention design; and (4) strengthening institutional health literacy on Black men's health. CONCLUSIONS We discuss the implications of these findings for improving the health of Black Canadians.
Collapse
Affiliation(s)
- Roger Antabe
- Department of Health and Society, University of Toronto Scarborough, Toronto, ON, Canada
- Graduate Department of Geography and Planning, University of Toronto, Toronto, ON, Canada
| | - Kimberley Robinson
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Winston Husbands
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- * E-mail:
| | - Desmond Miller
- Daphne Cockwell School of Nursing, Faculty of Community Services, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Andre Harriot
- Daphne Cockwell School of Nursing, Faculty of Community Services, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Kwesi Johnson
- School of Child and Youth Care, Faculty of Community Services Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Josephine Pui-Hing Wong
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Daphne Cockwell School of Nursing, Faculty of Community Services, Toronto Metropolitan University, Toronto, Ontario, Canada
| | | | | | - Carl James
- Faculty of Education, York University, Toronto, ON, Canada
| |
Collapse
|
7
|
Mbuagbaw L, Husbands W, Baidoobonso S, Lawson D, Aden M, Etowa J, Nelson L, Tharao W. A cross-sectional investigation of HIV prevalence and risk factors among African, Caribbean and Black people in Ontario: The A/C Study. CANADA COMMUNICABLE DISEASE REPORT = RELEVE DES MALADIES TRANSMISSIBLES AU CANADA 2022; 48:429-437. [PMID: 38125394 PMCID: PMC10730175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
Background The human immunodeficiency virus (HIV) epidemic has disproportionately affected African, Caribbean and Black (ACB) communities in Canada. We investigated the prevalence and factors associated with HIV infection among ACB people in Ontario. Methods A cross-sectional survey of first- and second-generation ACB people aged 15-64 years in Toronto and Ottawa (Ontario, Canada). We collected sociodemographic information, self-reported HIV status and offered dried blood spot (DBS) testing to determine the prevalence of HIV infection. Factors associated with HIV infection were investigated using regression models. Results A total of 1,380 people were interviewed and 834 (60.4%) tested for HIV. The HIV prevalence was 7.5% overall (95% confidence interval [CI] 7.1-8.0) and 6.6% (95% CI 6.1-7.1) in the adult population (15-49 years). Higher age (adjusted odds ratio [aOR] 2.8; 95% CI 2.77-2.82), birth outside of Canada (aOR 4.7; 95% CI 1.50-14.71), French language (aOR 9.83; 95% CI 5.19-18.61), unemployment (aOR 1.85; 95% CI 1.62-2.11), part-time employment (aOR 4.64; 95% CI 4.32-4.99), substance use during sex (aOR 1.66; 95% CI 1.47-1.88) and homosexual (aOR 19.68; 95% CI 7.64-50.71) and bisexual orientation (aOR 2.82; 95% CI 1.19-6.65) were associated with a positive HIV test. Those with a high school (aOR 0.01; 95% CI 0.01-0.02), college (aOR 0.00; 95% CI 0.00-0.01) or university education (aOR 0.00; 95% CI 0.00-0.01), more adequate housing (aOR 0.85; 95% CI 0.82-0.88), a higher social capital score (aOR 0.61; 95% CI 0.49-0.74) and a history of sexually transmitted infections (aOR 0.40; 95% CI 0.18-0.91) were less likely to have a positive HIV test. Conclusion Human immunodeficiency virus infection is linked to sociodemographic, socioeconomic, and behavioural factors among ACB people in Ontario.
Collapse
Affiliation(s)
- Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON
- Biostatistics Unit, The Research Institute, St Joseph’s Healthcare, Hamilton, ON
- Centre for the Development of Best practices in Health (CDBPH), Yaoundé Central Hospital, Yaoundé, Cameroon
- Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Winston Husbands
- Ontario HIV Treatment Network, Toronto, ON
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON
| | - Shamara Baidoobonso
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS
| | - Daeria Lawson
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON
| | - Muna Aden
- Women’s Health in Women’s Hands Community Health Centre, Toronto, ON
| | - Josephine Etowa
- Faculty of Health Sciences, University of Ottawa, Ottawa, ON
| | - LaRon Nelson
- Ontario HIV Treatment Network, Toronto, ON
- School of Nursing, Yale University, New Haven, CT, United States
| | - Wangari Tharao
- Women’s Health in Women’s Hands Community Health Centre, Toronto, ON
| |
Collapse
|
8
|
Konkor I, Luginaah I, Husbands W, Omorodion F, Antabe R, Wong J, Kuuire V, Mkandawire P, Etowa J. Immigrant generational status and the uptake of HIV screening services among heterosexual men of African descent in Canada: Evidence from the weSpeak study. J Migr Health 2022; 6:100119. [PMID: 35668734 PMCID: PMC9163559 DOI: 10.1016/j.jmh.2022.100119] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 04/24/2022] [Accepted: 05/25/2022] [Indexed: 11/19/2022] Open
Abstract
Objective Canada became a preferred destination for many non-European and non-American migrants since the introduction of favorable immigration policies in the late 1960 s. Blackimmigrants from the African and Caribbean regions however are a known vulnerable population to HIV infection in Canada. Even though first-generation immigrants might differ from subsequent generations in terms of culture and beliefs which are important for health outcomes and behaviors, research examining disparities in their use of preventative healthcare is limited. This study aimed to examine generational disparities in the uptake of HIV screening services among a sample of heterosexual Black men in Ontario, Canada. Methods We used data from a cross-sectional survey sample (n = 829) that was collected from heterosexual Black men in four Ontarian cities (Toronto, Ottawa, London and Windsor) between March 2018 and February 2019. We used the negative log-log link function of the binomial family to examine the independent relationship between immigration status and the uptake of HIV testing and the cumulative effect of other predictor variables on HIV testing in nested models. Results Findings from multivariate analysis show second-generation immigrants were significantly less likely to test for HIV compared with their first-generation immigrant counterparts. After controlling for theoretically relevant variables, the second-generation immigrants were 53% less likely to test for HIV. We further observed that participants with good knowledge of HIV transmission (OR=1.05; p > 0.05) and those who were older were more likely to test for HIV. Those with masculine tendencies (OR=0.98; p > 0.05) and those who reported not having sexual partner were less likely to test (OR=0.57; p > 0.01). Religion emerged as a significant predictor of HIV testing as Christians (OR=1.62; p > 0.05) and other believers (OR=1.59; p > 0.05) were more likely to test for HIV when compared to their Muslim counterparts. Conclusion HIV prevention policies may need not only prioritize first-generation immigrants, but the wellbeing of their descendants as well. This could be achieved by implementing programs that will enhance second-generation immigrants’ use of HIV screening services. Additionally, HIV educational programs would be of relevance and especially so as respondents with good knowledge of HIV transmission consistently demonstrated higher likelihood of testing for their HIV status.
Collapse
Affiliation(s)
- Irenius Konkor
- Department of Geography and Planning, University of Toronto, Mississauga Campus, Canada
- Corresponding author.
| | - Isaac Luginaah
- Department of Geography and Environment, Western University, London, Canada
| | | | - Francisca Omorodion
- Department of Sociology, Anthropology and Criminology, University of Windsor, Canada
| | - Roger Antabe
- Department of Geography and Environment, Western University, London, Canada
- Department of Health and Society, University of Toronto Scarborough, Toronto, Canada
| | - Josephine Wong
- Daphne Cockwell School of Nursing Ryerson University, Toronto, Canada
| | - Vincent Kuuire
- Department of Geography and Planning, University of Toronto, Mississauga Campus, Canada
| | - Paul Mkandawire
- Institute of Interdisciplinary Studies, Carleton University, Ottawa, Canada
| | | |
Collapse
|