People from countries where HIV is endemic make up a unique segment of the concentrated HIV/AIDS epidemic in Canada. This is the fi rst time PHAC has attempted to present evidence from a variety of sources in one document to better understand the impact of HIV and AIDS on this population. The report also highlights a number of gaps and identifi es opportunities for future policy and program development and research priorities.
Collecting and presenting relevant information regarding ethnicity in the surveillance data reported to PHAC presented several challenges. First, the categories for reporting ethnicity are quite broad and some individuals may not clearly fi t into any particular category, creating the potential for misclassifi cation. Second, there still remains a number of large gaps in the completeness of ethnicity data reported nationally for HIV cases. Although the heterosexual exposure sub-category entitled “origin from an HIV-endemic country” provides some information in P/T jurisdictions where ethnicity is not reported, it does limit assessment of the number of people from countries where HIV is endemic in other exposure categories, such as MSM and IDU. In addition, the defi nition of an “HIV-endemic country” inevitably changes over time as HIV and AIDS cases continue to affect a growing number of people from other regions in the world outside of Africa and the Caribbean and these changes will complicate the interpretation of trends.
The report has confi rmed that communities play a critical role in addressing the HIV/AIDS diagnosis, prevention, care, treatment and support needs of the population. However, the success of communitybased organizations, public health offi cials and other groups in lowering the number of new HIV infections in this population and in improving the quality of life of Black people living with HIV/AIDS is infl uenced by how well Canada as a country “addresses the factors that infl uence health, physical and social environments, which could facilitate decisions to achieve and maintain the highest state of health possible” . The evolution of the HIV situation in this population is linked to a variety of broad factors and determinants of health, which infl uence the population’s vulnerability to HIV/AIDS. Additional research and evidence will be required to analyze and understand some of these, including the incidence and prevalence of HIV in their countries of origin and in Canada, the population’s demographic evolution, its interaction with the immigration system, its biological or genetic endowment and its experience with racism, as well as sexual violence, and the complex interplay of these factors in relation to HIV/AIDS in this population. Comprehensive, coordinated efforts will be required to address the broader health inequities that infl uence the vulnerability of people from countries where HIV is endemic.
While the relationship between immigration and HIV/ AIDS has been the focus of some research, projects and community-based initiatives, the ability of HIV-positive immigrants to connect with, and benefi t from, health and HIV/AIDS services upon their arrival in Canada needs to be further examined. Areas in need of further attention also include the access to prevention, diagnosis, care, treatment and support services for migrant workers from countries where HIV is endemic and for individuals from this population moving to regions experiencing rapid economic growth, such as Alberta.
The experiences of Black people in Canada differ signifi cantly from those of African Americans in the USA or Black immigrants in European countries. Therefore, results from research conducted outside of Canada may not always be applicable to the Canadian context, and yet transnational issues affecting this population, such as the impact of frequent travel between countries where HIV is endemic and Canada on our domestic epidemic, have not received much attention from the Canadian research community. Genetic studies demonstrate that the predominant HIV virus strains found among people from countries where HIV is endemic living in Canada are similar to strains found in Africa and the Caribbean and are quite different to the strains commonly found among other populations affected by HIV/AIDS in Canada. The potential implications of this fi nding for HIV epidemiology in Canada and for prevention and care programs have not been well studied.
Barriers to accessing appropriate culturally sensitive health services and information still remain a problem for this population. The impact of racism, stigma and discrimination within the health system continue to affect the quality of life and health outcomes of Black people living with HIV/AIDS. The ongoing stigma and discrimination against AIDS and people living with HIV/ AIDS exercised by the Black community itself continues to hamper prevention efforts directed at this population.
Organizations involved in the delivery of the HIV/ AIDS response to the Black community have built solid networks, which have encouraged knowledge exchange and culturally relevant approaches to HIV/ AIDS. Strengthening their evaluation capacity will be important to determine whether current programs, interventions and activities adequately meet the prevention, care, treatment, and support needs of this population. Best practices for this population could assist the pan- Canadian response. As such, cross-sectoral and crossjurisdictional activities to share best practices, to increase partnerships among a wider range of stakeholders and to better use evidence in the development of strategies and interventions should be fostered and encouraged.
Canadian stakeholders involved in addressing HIV/AIDS among Black people of African and Caribbean descent from countries where HIV is endemic have demonstrated strong collective will and leadership. Their unwavering dedication to increase HIV/AIDS awareness and to reduce stigma and discrimination has contributed to a growing recognition among this population that the epidemic cannot be ignored and that they must continue to lead this response. This report acknowledges their important role, their successes and their ongoing quest to get ahead of, and reverse the spread of, HIV/AIDS in this population.
(1 ) Public Health Agency of Canada, The Chief Public Health Offi cer’s Report on the State of Public Health in Canada, Helping Canadians achieve the best health possible, 2008. Available from: http://www.phac-aspc.gc.ca/publicat/2008/cpho-aspc/ index-eng.php