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Owino M, Dryden O, Este D, Etowa J, Husbands W, Nelson L, Ojukwu E, Peters E, Tharao W. A Manifesto for transformative action on HIV among Black communities in Canada. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2024; 115:245-249. [PMID: 38389034 PMCID: PMC11027760 DOI: 10.17269/s41997-024-00856-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 01/17/2024] [Indexed: 02/24/2024]
Abstract
Black communities bear a hugely disproportionate share of Canada's HIV epidemic. Black persons annually represent up to one quarter of new diagnoses, while in contrast, diagnoses have been falling among white Canadians for the past two decades. There has been a notable lack of urgency and serious debate about why the trend persists and what to do about it. For too long, public institutions have reproduced hegemonic white supremacy and profoundly mischaracterized Black life. Consequently, Black communities suffer policies and programs that buttress systemic anti-Black racism, socio-economically disenfranchise Black communities, and in the process marginalize knowledgeable, experienced, and creative Black stakeholders. The Interim Committee on HIV among Black Canadian Communities (ICHBCC) is a group of Black researchers, service providers, and community advocates who came together in early 2022 to interject urgency to the HIV crisis facing Black communities. Specifically, the ICHBCC advocates for self-determined community leadership of research, policies, and programs, backed by access to appropriate resources, to change the trajectory of HIV among Black Canadian communities. In this article, we introduce the wider community to the Black HIV Manifesto that we developed in 2022.
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Affiliation(s)
- Maureen Owino
- Faculty of Environmental and Urban Change, York University, Toronto, ON, Canada
| | - OmiSoore Dryden
- Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - David Este
- Faculty of Social Work, University of Calgary, Calgary, AB, Canada
| | - Josephine Etowa
- Faculty of Nursing, University of Ottawa, Ottawa, ON, Canada
| | - Winston Husbands
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
| | - LaRon Nelson
- School of Nursing, Yale University, New Haven, CT, USA
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, ON, Canada
- Center for Interdisciplinary Research On AIDS (CIRA), Yale University, New Haven, CT, USA
- School of Public Health, Yale University, New Haven, CT, USA
- Yale Institute of Global Health, Yale University, New Haven, CT, USA
| | - Emmanuela Ojukwu
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - Eric Peters
- Gay Men's Sexual Health Alliance, Toronto, ON, Canada
| | - Wangari Tharao
- Women's Health in Women's Hands Community Health Centre, Toronto, ON, Canada
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O'Byrne P, Musten A, McCready L, Robinson R, Durrant G, Tigert J, Orser L. HIV self-testing enabled access to testing for Black persons: The GetaKit study. Res Nurs Health 2023; 46:236-241. [PMID: 36573589 DOI: 10.1002/nur.22293] [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: 06/14/2022] [Revised: 12/05/2022] [Accepted: 12/14/2022] [Indexed: 12/29/2022]
Abstract
In Ontario, new HIV diagnoses continue to affect gay, bisexual, and other men who have sex with men (gbMSM) and persons of African, Caribbean, or Black (ACB) ethnicities. Because treatment and suppressed viral loads flow from diagnosis, testing is key. We sought to determine the outcomes of online ordering and mail-out of free at-home HIV self-testing in Ontario, Canada. We implemented the GetaKit study to offer such free HIV self-testing using the INSTI® test and offered it via a website (GetaKit.ca) to eligible persons in Ontario. From April 1, 2021 to January 31, 2022, we distributed kits to 1551 persons; 40% were white and 26% were ACB. We found that ACB participants were less likely to fulfill established criteria for HIV PrEP, such as previous sexually transmitted infections diagnoses and drug use, despite having a similar test positivity rate. We also found that ACB women, who may represent a larger number of new infections than previously thought, did not have a higher rate of first-time testing. Our results suggest that HIV self-testing can enable testing, but that work is required to increase uptake among ACB persons and women. Overall, HIV self-testing thus corresponded with increased testing among persons who were Black, yet lower rates of results reporting. Patient or Public Contributions: Community members from the AIDS Committee of Ottawa, Max Ottawa, and Black Cap, and nurses from Ottawa Public Health were involved in the design, promotion, and implementation of this study.
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Affiliation(s)
- Patrick O'Byrne
- School of Nursing, University of Ottawa, Ontario, Ottawa, Canada
| | - Alexandra Musten
- School of Nursing, University of Ottawa, Ontario, Ottawa, Canada
| | | | - Robin Robinson
- Black Coalition for AIDS Prevention, Ontario, Toronto, Canada
| | | | | | - Lauren Orser
- School of Nursing, University of Ottawa, Ontario, Ottawa, Canada
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Lee-Foon NK, Logie CH, Siddiqi A, Grace D. Exploring young Black gay, bisexual and other men who have sex with men's PrEP knowledge in Toronto, Ontario, Canada. CULTURE, HEALTH & SEXUALITY 2022; 24:301-314. [PMID: 33196378 DOI: 10.1080/13691058.2020.1837958] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 10/13/2020] [Indexed: 06/11/2023]
Abstract
Despite significant advances in the HIV treatment and prevention landscape such as pre-exposure prophylaxis (PrEP), young Black-Canadian gay, bisexual and other sexual minority men continue to experience disproportionately high rates of HIV infection. While research has explored the factors associated with their higher HIV exposure and the efficacy of STI/HIV prevention programmes, there remains a paucity of research on their knowledge of HIV prevention strategies such as PrEP. We interviewed twenty-two young men and used a constructivist grounded theory approach to qualitatively analyse these young men's PrEP knowledge. Intersectionality and the social ecological model allowed us to explore how social locations (e.g. race, sexual orientation), interacted with individual, interpersonal and community contexts to shape their understanding. Our analysis revealed two interrelated barriers to PrEP knowledge and uptake. The first centred on the ineffectiveness of institutions in disseminating PrEP information to participants. The second focused on the impact of participants' social locations and perceptions of PrEP users based on their PrEP knowledge. Findings suggest the need for more targeted, culturally congruent PrEP dissemination strategies and PrEP prescription policies that acknowledge the various social locations and ecologies in which young Black gay, bisexual and other men who have sex with men reside.
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Affiliation(s)
- Nakia K Lee-Foon
- Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Carmen H Logie
- Factor-Inwentash Faculty of Social Work, Factor Inwentash School of Social Work University of Toronto, Toronto, Ontario, Canada
| | - Arjumand Siddiqi
- Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Daniel Grace
- Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
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Orser L, O'Byrne P. Examining patient characteristics and HIV-related risks among women with syphilis as indicators for pre-exposure prophylaxis in a nurse-led program (PrEP-RN). Int J STD AIDS 2020; 32:45-51. [PMID: 33121363 DOI: 10.1177/0956462420958347] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Current HIV pre-exposure prophylaxis (PrEP) guidelines primarily target men who have sex with men (MSM) as candidates for HIV prevention; however, such recommendations often come at the expense of other ethnic and gender minorities, including women. To address barriers to PrEP care among non-MSM, we developed and implemented the first nurse-led PrEP program in Canada, known as PrEP-RN. As part of PrEP-RN, patients who meet objective indicators of HIV risk are offered a referral for PrEP, regardless of sexual orientation. One such measure is syphilis, which has increased in incidence among various population groups and is known to cause biological vulnerabilities to HIV. To better understand HIV-related risks and assess intentions for PrEP use among women, we undertook an 18-month retrospective review of syphilis diagnoses within this group in Ottawa, Canada. As part of this review, we examined 23 patient files, noting their unique characteristics, socio-behavioural risk factors, and noted barriers to PrEP uptake. While none of the women diagnosed with syphilis were diagnosed with HIV, the findings raise some important considerations to facilitate opportunities for HIV prevention among non-MSM, which must take into consideration individual risk practices, sexual health histories, and population groups.
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Affiliation(s)
- Lauren Orser
- School of Nursing, University of Ottawa, Ottawa, Canada.,Ottawa Public Health, Ottawa, Canada
| | - Patrick O'Byrne
- School of Nursing, University of Ottawa, Ottawa, Canada.,Ottawa Public Health, Ottawa, Canada
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Carter A, Greene S, Money D, Sanchez M, Webster K, Nicholson V, Brotto LA, Hankins C, Kestler M, Pick N, Salters K, Proulx-Boucher K, O'Brien N, Patterson S, de Pokomandy A, Loutfy M, Kaida A. Love with HIV: A Latent Class Analysis of Sexual and Intimate Relationship Experiences Among Women Living with HIV in Canada. ARCHIVES OF SEXUAL BEHAVIOR 2019; 48:1015-1040. [PMID: 30891711 DOI: 10.1007/s10508-019-1418-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Revised: 02/04/2019] [Accepted: 02/06/2019] [Indexed: 06/09/2023]
Abstract
Love remains hidden in HIV research in favor of a focus on risk. Among 1424 women living with HIV in Canada, we explored (1) whether eight facets of sex and intimacy (marital status, sexual activity, physical intimacy, emotional closeness, power equity, sexual exclusivity, relationship duration, and couple HIV serostatus) may coalesce into distinct relationship types, and (2) how these relationship types may be linked to love as well as various social, psychological, and structural factors. Five latent classes were identified: no relationship (46.5%), relationships without sex (8.6%), and three types of sexual relationships-short term (15.4%), long term/unhappy (6.4%), and long term/happy (23.2%, characterized by equitable power, high levels of physical and emotional closeness, and mainly HIV-negative partners). While women in long-term/happy relationships were most likely to report feeling love for and wanted by someone "all of the time," love was not exclusive to sexual or romantic partners and a sizeable proportion of women reported affection across latent classes. Factors independently associated with latent class membership included age, children living at home, sexism/genderism, income, sex work, violence, trauma, depression, HIV treatment, awareness of treatment's prevention benefits, and HIV-related stigma. Findings reveal the diversity of women's experiences with respect to love, sex, and relationships and draw attention to the sociostructural factors shaping intimate partnering in the context of HIV. A nuanced focus on promoting healthy relationships and supportive social environments may offer a more comprehensive approach to supporting women's overall sexual health and well-being than programs focused solely on sexual risk reduction.
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Affiliation(s)
- Allison Carter
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall Room 10522, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
- Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
- Kirby Institute, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Saara Greene
- School of Social Work, McMaster University, Hamilton, ON, Canada
| | - Deborah Money
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Margarite Sanchez
- ViVA, Positive Living Society of British Columbia, Vancouver, BC, Canada
| | - Kath Webster
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall Room 10522, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Valerie Nicholson
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall Room 10522, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Lori A Brotto
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Catherine Hankins
- Amsterdam Institute for Global Health and Development (AIGHD), Department of Global Health, University of Amsterdam, Amsterdam, The Netherlands
- Department of Epidemiology, Biostatistics, and Occupational Health, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Mary Kestler
- Division of Infectious Diseases, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Neora Pick
- Division of Infectious Diseases, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Oak Tree Clinic, British Columbia Women's Hospital and Health Centre, Vancouver, BC, Canada
| | - Kate Salters
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall Room 10522, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
- Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Karène Proulx-Boucher
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada
| | - Nadia O'Brien
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada
- Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Sophie Patterson
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall Room 10522, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Alexandra de Pokomandy
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada
- Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Mona Loutfy
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall Room 10522, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada.
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