HIV risk perception and distribution of HIV risk among African, Caribbean and other Black people in a Canadian city: mixed methods results from the BLACCH study

BMC Public Health

The BLACCH Study Team¹  Erica Lawson²  Kathy Nixon Speechley³  Greta R Bauer²  Shamara Baidoobonso³ 

[1] London Cross Cultural Learner Centre, London, ON, Canada;Women’s Studies & Feminist Research, The University of Western Ontario, London, ON, Canada;Epidemiology & Biostatistics, The University of Western Ontario, London, ON, Canada

关键词: Social determinants of health;    HIV risk;    Black;    African-descent;    HIV/AIDS;   

Others  :  1162495
DOI  :  10.1186/1471-2458-13-184

 received in 2012-09-05, accepted in 2013-02-27,  发布年份 2013

【 摘 要 】

Background

African, Caribbean and other Black (ACB) people are a priority group for HIV prevention in Canada, but little is known about the epidemiology of HIV risk in this population. This paper helps fill the knowledge gap by: presenting service providers’ and ACB people’s perceptions about HIV risk in ACB populations; describing the distribution of HIV risk behaviours among ACB people according to markers of social status and position; and comparing results from these two analyses.

Methods

The Black, African and Caribbean Canadian Health (BLACCH) Study is a mixed methods study that used semi-structured interviews and a cross-sectional quantitative questionnaire to collect information about HIV and health from 188 ACB people in London, Ontario, Canada. Qualitative content analysis was used to identify interview themes, and weighted bivariate statistical analyses were performed on the quantitative data. Behaviours related to HIV risk were stratified by sex, poverty status, immigration experience and employment status.

Results

Community members perceived that they were at low risk for HIV and mainly focused on sexual risks. They called for more information about HIV in Canada and culturally appropriate HIV services. Service providers cited marital infidelity and cultural and religious attitudes about condoms as barriers to women protecting themselves. They mentioned cultural norms, beliefs about masculinity and underrepresentation of heterosexual ACB men at AIDS service organizations as barriers to men protecting themselves. There were few statistically significant differences in risk behaviours reported by men and women. Those living in poverty were more likely to abstain from sex (p = 0.006) and use condoms (p = 0.027) in the past year. Those living in Canada longer reported higher prevalences of forced sex (p < 0.001), mixing alcohol or drugs with sex (p = 0.001) and past STI diagnoses (p = 0.032). Stable employment was associated with higher prevalences of not using condoms in the past year (p = 0.005) and past STI diagnoses (p = 0.018).

Conclusions

The results show that perceptions about ACB people’s HIV risk differ from actual risk, and those with higher social standing might be at greater risk. Furthermore, the social determinants of health are important factors in the epidemiology of HIV among ACB people.

【 授权许可】

   
2013 Baidoobonso et al; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Public Health Agency of Canada: Population-Specific HIV/AIDS Status Report: People from Countries where HIV is Endemic: Black People of African and Caribbean Descent Living in Canada. Surveillance and Risk Assessment Division, Centre for Infectious Disease Prevention and Control. Ottawa, ON: Public Health Agency of Canada; 2009.
• [2]Public Health Agency of Canada: HIV/AIDS Epi Updates, November 2007. Surveillance and Risk Assessment Division, Centre for Infectious Disease Prevention and Control. Ottawa, ON: Public Health Agency of Canada; 2010.
• [3]Milan A, Tran K: Blacks in Canada: a long history. Canadian Social Trends 2004, 72:2-7.
• [4]Husbands W, Makoroka L, George C: MaBwana: Health, Community and Vulnerability to HIV among African. Toronto: Caribbean and Black Gay and Bisexual Men; 2009.
• [5]Gray K, Calzavara L, Tharao W, The East African Health Study in Toronto (EAST): Results from a Survey of HIV and Health-Related Behavior, Beliefs, Attitudes, and Knowledge. Toronto: HIV Social Behavioural and Epidemiological Studies Unit, Dept. of Public Health Sciences, Faculty of Medicine, Univ. of Toronto; 2008.
• [6]Liu J, Remis RS: Race/Ethnicity Among Persons with HIV/AIDS in Ontario, 1981–2004. Toronto, Ontario: Ontario HIV Epidemiologic Monitoring Unit; 2007.
• [7]Global HIV Prevention Working Group: Behavior Change and HIV Prevention: (Re)Considerations for the 21st Century. Pretoria, South Africa: Global HIV Prevention Working Group; 2008.
• [8]Ajzen I, Fishbein M: The influence of attitudes on behavior. In The Handbook of Attitudes Edited by Albarracín D, Johnson B, Zanna M, Mahwah NJ, Erlbaum . 2005, 173-221.
• [9]World Health Organization Commission on Social Determinants of Health: A Conceptual Framework for Action on the Social Determinants of Health. Geneva, Switzerland: World Health Organization; 2007.
• [10]What Determines Health?. http://www.phac-aspc.gc.ca/ph-sp/determinants/index-eng.php#determinants webcite
• [11]Mikkonen J, Raphael D: Social Determinants of Health: The Canadian Facts. Toronto: York University School of Health Policy and Management; 2010.
• [12]Gender R: Class & Health: Intersectional Approaches. San Francisco: Jossey-Bass; 2006.
• [13]Walby S, Armstrong J, Strid S: Intersectionality: multiple inequalities in social theory. Sociology 2012, 46:224-240.
• [14]Madise N, Zulu E, Ciera J: Is poverty a driver for risky sexual behaviour? Evidence from national surveys of adolescents in four African countries. Afr J Reprod Health 2007, 11:83-98.
• [15]Booysen FR, Summerton J: Poverty, risky sexual behaviour, and vulnerability to HIV infection: evidence from south Africa. J Health Popul Nutr 2002, 20:285-288.
• [16]Agadjanian V, Arnaldo C, Cau B: Health costs of wealth gains: labor migration and perceptions of HIV/AIDS risks in Mozambique. Soc Forces 2011, 89:1097-1117.
• [17]Hargreaves JR, Glynn JR: Educational attainment and HIV-1 infection in developing countries: a systematic review. Trop Med Int Health 2002, 7:489-498.
• [18]Hargreaves JR, Bonell CP, Boler T, Boccia D, Birdthistle I, Fletcher A, Pronyk PM, Glynn JR: Systematic review exploring time trends in the association between educational attainment and risk of HIV infection in sub-Saharan Africa. AIDS 2008, 22:403-414.
• [19]Msisha WM, Kapiga SH, Earls F, Subramanian SV: Socioeconomic status and HIV seroprevalence in Tanzania: a counterintuitive relationship. Int J Epidemiol 2008, 37:1297-1303.
• [20]Awusabo-Asare K, Annim SK: Wealth status and risky sexual behaviour in Ghana and Kenya. Appl Health Econ Health Policy 2008, 6:27-39.
• [21]Gatali M, Archibald C: Women and HIV. BMC Womens Health 2004, 4:S27. BioMed Central Full Text
• [22]Tharao E, Massaquoi N: Black women and HIV/AIDS: contextualizing their realities, their silence and proposing solutions. Canadian Woman Studies 2000, 21:72-80.
• [23]Newman PA, Williams CC, Massaquoi N, Brown M, Logie C: HIV prevention for black women: structural barriers and opportunities. J Health Care Poor Underserved 2008, 19:829-841.
• [24]Bowleg L, Teti M, Massie JS, Patel A, Malebranche DJ, Tschann JM: “What does it take to be a man? what is a real man?”: ideologies of masculinity and HIV sexual risk among black heterosexual men. Cult Health Sex 2011, 13:545-559.
• [25]Tompkins M, Smith L, Jones K, Swindells S: HIV education needs among Sudanese immigrants and refugees in the Midwestern United States. AIDS Behav 2006, 10:319-323.
• [26]Stolte IG, Gras M, Van Benthem BHB, Coutinho RA, van den Hoek JAR: HIV testing behaviour among heterosexual migrants in Amsterdam. AIDS Care 2003, 15:563-574.
• [27]Shedlin MG, Drucker E, Decena CU, Hoffman S, Bhattacharya G, Beckford S, Barreras R: Immigration and HIV/AIDS in the New York metropolitan area. J Urban Health 2006, 83:43-58.
• [28]Barrett H, Mulugeta B: Human Immunodeficiency Virus (HIV) and migrant “risk environments”: The case of the Ethiopian and Eritrean immigrant community in the West Midlands of the UK. Psychol Health Med 2010, 15:357-369.
• [29]Statistics Canada: Focus on Geography Series, 2011 Census. Ottawa, ON: Statistics Canada; 2012.
• [30]Leung MW, Yen IH, Minkler M: Community based participatory research: a promising approach for increasing epidemiology’s relevance in the 21st century. Int J Epidemiol 2004, 33:499-506.
• [31]Minkler M: Community-based research partnerships: challenges and opportunities. J Urban Health 2005, 82:ii3-ii12.
• [32]Wallerstein NB, Duran B: Using community-based participatory research to address health disparities. Health Promot Pract 2006, 7:312-323.
• [33]Teddlie C, Yu F: Mixed methods sampling: a typology with examples. Journal of Mixed Methods Research 2007, 1:77-100.
• [34]Neergaard MA, Olesen F, Andersen RS, Sondergaard J: Qualitative description – the poor cousin of health research? BMC Med Res Methodol 2009, 9:52. BioMed Central Full Text
• [35]Sandelowski M: Focus on research methods-Whatever happened to qualitative description? Res Nurs Health 2000, 23:334-340.
• [36]Hsieh H-F: Three approaches to qualitative content analysis. Qual Health Res 2005, 15:1277-1288.
• [37]Zapka J, Chasen-Taber L, Bigelow C: Methodological issues for health-related surveys of multicultural older women. Eval Health Prof 1994, 17:485-500.
• [38]Ogilvie LD, Burgess-Pinto E, Caufield C: Challenges and approaches to newcomer health research. J Transcult Nurs 2008, 19:64-73.
• [39]McLean C, Campbell C: Locating research informants in a multi-ethnic community: ethnic identities, social networks and recruitment methods. Ethn Health 2003, 8:41-61.
• [40]Dillman D: Mail and Internet Surveys: The Tailored Design Method. Second. 2nd edition. Hoboken, NJ\: John Wiley & Sons, Inc.; 2007.
• [41]Statistics Canada: Income Research Paper Series, Low Income Cut-offs for 2006 and Low Income Measures for 2005. Ottawa, ON: Statistics Canada; 2009.
• [42]SAS Institute Inc: Version 9.3 of the SAS System for Windows. NC, USA: Cary; 2011.
• [43]Grau E, Potter F, Williams S, Diaz-Tena N: Nonresponse adjustment using logistic regression: To weight or not to weight? In American Statistical Association, Survey Research Methods Section. Alexandria. VA: American Statistical Association; 2003:3073-3080.
• [44]Geneletti S, Richardson S, Best N: Adjusting for selection bias in retrospective, case–control studies. Biostatistics 2009, 10:17-31.
• [45]Creswell J: Mixed methods procedures. In Research Design: Qualitative, Quantitative, and Mixed Methods Approaches. 3rd edition. Thousand Oaks, CA: Sage Publications; 2009:203-226.
• [46]Baidoobonso S, Mokanan H, Meidinger L, Pugh D, Bauer G, Nleya-Ncube M, Ehiemua J: The BLACCH Study Team: Final Report from the Black, African and Caribbean Canadian Health (BLACCH) Study. London, Canada: The University of Western Ontario; 2012.
• [47]Hancock A-M: When multiplication doesn’t equal quick addition: Examining intersectionality as a research paradigm. Perspectives on Politics 2007, 5:63-79.
• [48]Johnson LF, Dorrington RE, Bradshaw D, Plessis H, Makubalo L: The effect of educational attainment and other factors on HIV risk in South African women: Results from antenatal surveillance, 2000–2005. AIDS 2009, 23:1583-1588.
• [49]Ng E: The healthy immigrant effect and mortality rates. Health Rep 2011, 22:1-5.
• [50]O’Sullivan L, Harrison A, Morrell R, Monroe Wise A, Kubeka M: Gender dynamics in the primary sexual relationships of young rural South African women and men. Cult Health Sex 2006, 8:99-113.
• [51]Adimora AA, Schoenbach VJ, Martinson FE, Coyne-Beasley T, Doherty I, Stancil TR, Fullilove RE: Heterosexually transmitted HIV infection among African Americans in North Carolina. J Acquir Immune Defic Syndr 2006, 41:616-623.
• [52]Lawson E, Gardezi F, Calzavara L, Husbands W, Myers T, Tharao WE: Behavioural HIV., Unit ES, others: HIV/AIDS Stigma, Denial, Fear and Discrimination: Experiences and Responses of People from African and Caribbean Communities in Toronto. African and Caribbean Council on HIV/AIDS in Ontario (AACHO); HIV Social Behavioural and Epidemiological Studies Unit, Dept. of Public Health Sciences, Faculty of Medicine. Toronto: Univ. of Toronto; 2006.
• [53]Hasnain M, Levy JA, Mensah EK, Sinacore JM: Association of educational attainment with HIV risk in African American active injection drug users. AIDS Care 2007, 19:87-91.
• [54]Stuart GS, Grimes DA: Social desirability bias in family planning studies: a neglected problem. Contraception 2009, 80:108-112.