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ARCHIVED - Population-Specific HIV/AIDS Status Report: People from Countries where HIV is Endemic - Black people of African and Caribbean descent living in Canada

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CHAPTER 1 - Introduction

1.1 Background

This report focuses on Black people of African and Caribbean descent living in Canada from countries where HIV is endemic. Most of the sources of data and information used for this report do not necessarily refer to this population but rather to the Black population in Canada or to the epidemiological term “people from countries where HIV is endemic.” The decision to include information related to the Black population in this report was guided by data indicating that over the period of 1998 to 2006 in Canada, the vast majority of individuals with a positive HIV test and whose exposure was associated with heterosexual contact within the epidemiologic HIV-endemic subcategory are reported as having an ethnic origin associated with the Black population (92.7%) [1].

As shown in Figure 1, people from countries where HIV is endemic—Black people of African and Caribbean descent living in Canada (the focus of this report) are represented in the overlap of these two primary sources of data or population categories. Given limited data related to this specifi c population, the report will at times present information on the Black population in Canada, principally to assist in identifying the conditions or factors that increase vulnerability to HIV and AIDS, and on people from countries where HIV is endemic, particularly when describing the status of the epidemic.

Figure 1: Population Categories

Figure 1: Population Categories

The term “people from countries where HIV is endemic” is an epidemiologic term often used in HIV/ AIDS surveillance and research activities. “HIV endemic” refers to countries or populations where there is:

  • a male-to-female ratio of 2:1 or less, or
  • HIV prevalence of 2% or greater among women receiving prenatal care, or
  • a high prevalenceviii of HIV infection in the adult population (generally, 1% or greater) and the predominant mode of transmission is heterosexual contact [1].

According to surveillance data reported to the Joint United Nations Programme on HIV/AIDS (UNAIDS), the countries where HIV is endemic are mainly located in the Caribbean and sub-Saharan Africa, where populations are predominantly Black. Based on UNAIDS reporting and other data, PHAC has developed a list of countries where HIV is endemic to assist its surveillance efforts (see Appendix A for list of countries).

Canada’s Black communities are diverse – ethnically, culturally, linguistically and religiously. They comprise individuals that have been established in Canada for many generations, as well as more recent newcomers. Acknowledgment of this diversity is necessary to reduce potential stereotyping, stigma and discrimination, while recognizing both the commonalities and differences that exist within and between Black communities. For example, immigration challenges are common to many newcomers to Canada, including Black people, regardless of their country of origin. However, the realities of thirdand fourth-generation Black people living in Halifax, for example, are different from those of recent African and Caribbean immigrants living in Toronto or Calgary.

As a general rule, retrieved information addressing HIV/ AIDS in broader ethnocultural, immigrant, ethnoracial or refugee communities that did not specifi cally mention Black, African, Caribbean or people from countries where HIV is endemic was not included in this report to maintain its specificity.

This status report presents current evidence about the factors and/or conditions, which increase or decrease vulnerability, and to a lesser extent, resiliency to HIV infection and AIDS. Vulnerability is defi ned as a variety of social and economic factors that increases a person’s susceptibility to HIV infection, including stigma and discrimination, gender inequity, poverty, human rights violations, and lack of HIV/AIDS awareness and access to education, health and other services [2]. When these factors are present, individuals may engage in behaviours such as unprotected sex or use contaminated needles that put them at higher risk of becoming infected with HIV. In this context, risk is not certain, but based on probability. Therefore, not everyone who is exposed to these factors will experience adverse outcomes [3].

It is important to note that an individual, a group or community can successfully adapt to vulnerabilities through their innate capacity for resiliency, which operates best when resiliency-building conditions that contribute to healthy coping skills are present [4]. According to Mangham et al (1995), the term “resiliency” has been traditionally used to describe an individual’s ability to manage or cope with signifi cant adversity or stress in ways that are not only effective, but also may result in increased ability to respond to future adversity [3].

Characteristics of resilient individuals have been studied in populations exposed to war, poverty, and chronic illness. Balancing stress and adversity with ability to cope and access support mechanisms produces resilient behaviour. While this balance is ideal, it may not exist forever. When stress becomes overwhelming, even individuals who have displayed resilience in the past may suffer consequences that increase vulnerability. It has been noted that during times of transition when stress accumulates, resiliency is even more important [3]. This may be particularly relevant to this report as many have had to cope and recover from major shocks or trauma related to their experiences with war, violence, refugee camp conditions and the immigration process. The community response outlined in Chapter 6 of this report includes several examples of projects that illustrate the resiliency of the Black population.

1.2 Methodology

To support the development of this status report, PHAC contracted DA Falconer & Associates Inc.ix , and established an expert working group comprising non-governmental organizations, community representatives, population representatives, researchers, and policy and program experts. Community representatives were selected from the national steering committee for Springboarding a National HIV/AIDS Strategy for Black Canadian, African and Caribbean Communities, which offered its support for the development of this status report. The expert working group acted as an advisory body and provided guidance and feedback on the report process, themes and drafts.

The methodology for each chapter was designed to ensure that the most current and relevant evidence was summarized and presented. Development of the report took place between January 2007 and July 2008. Demographic and research data were extracted from various sources including Statistics Canada (2001 and 2006 Census). Data and information on HIV/AIDS and vulnerability were extracted from PHAC, published research from the Canadian Institutes of Health Research (CIHR), the Ontario HIV Treatment Network (OHTN), Citizenship and Immigration Canada (CIC), Health Canada, the provinces and territories, non-governmental organizations, and universities. Input was also provided directly from key experts in this fi eld. Epidemiologic information and surveillance data were gathered from published reports by PHAC, provinces and territories, UNAIDS and other existing published data. Provincial estimates were also collected through published reports and further analysis of Ontario data was provided by Dr. Robert Remis.

Research and response data were collected from peerreviewed publications and grey literature published from January 1, 2002, to January 1, 2008, using the following search terms: “HIV,” “AIDS,” “Canada,” “Black,” “African,” “Caribbean,” “endemic,” and the names of African and Caribbean countries where HIV is endemic (see Appendix B for the list of key words, databases and principal Internet sites searched). Both quantitative and qualitative information was gathered and analyzed.

An information-gathering template was developed (see Appendix C) and circulated to PHAC, the Canadian AIDS Society (CAS), the Interagency Coalition on AIDS and Development (ICAD) and the Canadian HIV Trials Network (CHTN). Through their respective listservs, the template was sent to approximately 250 organizations, individuals and researchers involved in the HIV/AIDS response in Canada, who in turn circulated the template within their own networks. Twelve weeks after the initial launch of the template, 28 responses were received, primarily from organizations working with Black communities, including fi ve from PHAC. Responses were also received from British Columbia, Alberta, Saskatchewan, Manitoba, Ontario, Quebec and Nova Scotia. PHAC approached the Federal/Provincial/Territorial Advisory Committee on HIV/AIDS (F/P/T/AIDS) and received more specifi c information from all provinces and territories. A detailed analysis of PHAC national and regional HIV/AIDS funding programs was also conducted to obtain information about projects supported to address HIV/AIDS and people from countries where HIV/AIDS is endemic. More information on how the analysis was conducted can be found in Chapter 6.

Information included in this status report was drawn from public sources and published data. Limitations due to the paucity of data specifi c to the health of Black people in Canada [5] hindered the fi nal analysis. Furthermore, specifi c data analyses from the 2006 Census of Canada relating to this population were not released in time to be included in this status report, save for a few exceptions.

1.3 References

(1) Public Health Agency of Canada. HIV/AIDS Epi Update. Ottawa: Surveillance and Risk Assessment Division (SRAD), Public Health Agency of Canada (PHAC); 2007 Nov.

(2) UNAIDS [website]. Key Populations. Geneva: UNAIDS. Available from: Populations/default.asp [cited 2008 Jun]; 2008.

(3) Public Health Agency of Canada. Risk, Vulnerability, Resiliency - Health System Implications. Ottawa: Public Health Agency of Canada (PHAC) [website]. Available from: [cited 2008 Jul]; 1997 Feb.

(4) Resiliency in Action. What is Resiliency? Ojai: Resiliency in Action [website]. Available from: [cited 2008 Jun]; 2006.

(5) Calgary Health Region. Healthy Diverse Populations: Health and Black Canadians. Calgary: Calgary Health Region [website]. Available from: diversity_resources/health_div_pops/black.htm [cited 2008 Jun]; 2008 May.

viii Prevalence: The total number of people with a specifi c disease or health condition living in a defi ned population at a particular time; i.e. the total estimated prevalence of people currently living with HIV/AIDS in Canada to the end of 2005 is 58,000.

ix Team members were Dionne A. Falconer, Keisa Campbell and Alexander Lovell.

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