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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Executive Summary

The health of people from countries where HIV is endemic continues to be threatened by the high incidence of HIV/AIDS within this population.

The epidemiological term “People from countries where HIV is endemic” refers to a population that is largely composed of Black people of African and Caribbean descent. This group forms a diverse community, which largely came to Canada through the immigration waves of the last fi ve decades, although a number of Black Canadians trace their roots in Canada to the early 1600s and 1700s. Census data shows that the Black population is increasing faster than the overall population and that it is distributed among Canada’s largest provinces (Ontario and Quebec) and in major urban centres across the country. HIV infections and AIDS cases follow a similar distribution pattern, with newly diagnosed infections and reported cases concentrated in Ontario (Greater Toronto Area) and Quebec (Montreal), and to a lesser extent, in key urban centres across the country, such as Vancouver, Calgary and Ottawa.

HIV infections in the HIV-endemic subcategory of the heterosexual contact category are diagnosed at a younger age than in the general population and affect a high number of women. Surveillance data from Ontario shows signifi cant infection rates among Black men who have sex with men (MSM), however, little is known at this time about the overall number of Black MSM who are infected with HIV nationally. Similarly, rates of HIV infection among Black injecting drug users (IDU) and prison inmates and rates of hepatitis C co-infection are not well documented which limits effective planning of prevention, care, treatment and support activities.

Immigration alone cannot explain the high prevalence of HIV and AIDS in this population. Canada is now able to identify, through testing, immigrants and refugees who are HIV positive and link them with appropriate services. For those who are tested in Canada, surveillance data cannot identify whether HIV transmission occurred abroad or in Canada. Achieving a better understanding of the patterns and locations associated with the acquisition of infection could lead to better prevention, diagnosis, care, treatment and support services among people from countries where HIV is endemic.

Understanding factors, such as age, religious beliefs and cultural infl uences of immigrants from countries where HIV is endemic, whether 1st, 2nd or 3rd generation Canadians, affects our collective ability to provide effective and specifi c HIV/AIDS services. For instance, understanding and adapting to Canada’s cultural norms and practices is not always possible in the short term for some new immigrants recovering from traumatic experiences in their country of origin or trying to cope with and navigate Canada’s immigration system. These factors relegate HIV/AIDS prevention to a lower priority and, without proper support, may place them at even greater risk for HIV infection.

The determinants of health clearly infl uence the Black population’s vulnerability to HIV/AIDS. A person’s vulnerability increases or decreases based on income, education, unemployment, housing, early childhood development (e.g. history of child abuse), physical and social environments, access to health services, support networks, gender, a history of sexual violence, and, for this population in particular, having experienced racism and diffi culties with the immigration process. The report details the lived experience of the population in relation to these determinants and supports an approach that addresses the root causes of HIV/ AIDS. Culturally appropriate services can also help mitigate the impact of some of these determinants and contribute to developing coping skills and resiliency in individuals, which can lessen their vulnerability to HIV/AIDS. Not surprisingly, the majority of community projects reviewed for this report focus on improving the Black community’s or individual’s coping skills and resiliency, by building on the experiences, knowledge and skills found in Black communities across the country.

Some cultural practices and norms in the Black community increase this population’s vulnerability to HIV and constitute barriers to services for Black persons living with HIV/AIDS. Similarly, these individuals face stigma and racial discrimination from Canadian society in general.

Mirroring the Black population’s geographic distribution and the prevalence of HIV and AIDS across the country, HIV/AIDS services and activities for people from countries where HIV is endemic are concentrated in Canada’s larger urban centres. In smaller centres, community-based AIDS organizations are increasingly offering services to try to meet the needs of people from countries where HIV is endemic. The report found that beyond the services delivered through regular governmental public health and health and social services systems the following four types of organizations are delivering prevention, care, treatment and support services to the Black community in Canada: community-based HIV/AIDS organizations; ethnocultural HIV/AIDS organizations; broader ethnocultural organizations, and others such as community health centres. The response to HIV/AIDS in the Black population is consistent with classic community development models, which actively engage community members and affected populations in the development and implementation of projects and activities.

In Toronto, an unparalleled number of diverse organizations have built networks to meet the HIV/AIDS needs of the Black community and to ensure services are culturally appropriate. The model, promoted by the African Caribbean Council on HIV/AIDS in Ontario’s (ACCHO) Strategy to Address Issues Related to HIV Faced by People in Ontario from Countries Where HIV is Endemic emphasizes the importance of partnerships in building cultural competencies and meeting the needs of key populations. ACCHO’s efforts have led to the creation of additional stakeholder networks across the province and to the establishment of national and international networks.

While the report was able to map out where key activities are taking place across the country, very little research (including community-based research) and comprehensive evaluations have been conducted to determine their effectiveness in preventing new HIV infections or responding to the needs of those living with HIV/AIDS in this population. Such information is integral to developing future evidence-based interventions. However, research on this population is increasingly taking place in a number of urban centres such as Vancouver, Calgary, Edmonton, Winnipeg, Windsor, Hamilton, Toronto, Ottawa/Gatineau, Montreal, and Halifax and should inform future interventions and activities.

Communities across Canada have taken up the challenge and are doing their part to reduce the growing number of infections in this population and to meet the needs of Black people living with, or at risk for, HIV/AIDS in Canada. Despite these important and signifi cant efforts, much remains to be done. Effective and continued efforts in preventing the transmission and acquisition of HIV/AIDS and improving the quality of life of Black people living with HIV/AIDS are required to successfully address the epidemic among this population. Canada has the capacity and a strong foundation from which to act.

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