Electronic Thesis and Dissertation Repository

Degree

Doctor of Philosophy

Program

Epidemiology and Biostatistics

Supervisor

Greta Bauer

Abstract

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. The overall goal of this thesis is to guide HIV prevention interventions for ACB communities. It focuses on social factors that impact HIV vulnerability.

This research used data from the Black, African, and Caribbean Canadian Health Study—a mixed methods study that used 30 semi-structured interviews, and a cross-sectional survey using a structured, self-administered quantitative questionnaire to collect information about HIV and health from 188 ACB people.

The first manuscript compares risk perceptions to the social epidemiology of HIV risk. ACB people generally perceived their personal HIV risk to be low and they focused on sexual risks. Service providers’ perceptions about HIV risk behaviours were sometimes inconsistent with ACB people’s experiences. Quantitative results confirmed that HIV risk was mainly sexual. There were few gender-based differences in risk behaviours. Those living in poverty were more likely to be abstinent and use condoms. Born Canadians had the highest prevalences of forced sex, mixing alcohol or drugs with sex, and past STI diagnoses. Stable employment was associated with higher prevalences of not using condoms and past STI diagnoses.

The second manuscript identified social and proximate determinants of HIV testing in the past year. Approximately 20% of ACB people had tested for HIV in the past year. Testing for HIV was independently associated with higher education, stable immigration classes, living in Canada foryears, and gender and ethnicity combined. Proximate determinants mediating these relationships included: lower English language proficiency, greater HIV knowledge, and higher numbers of lifetime and past-year sex partners.

The third manuscript ascertains social and proximate determinants of the frequency of condom use. About 20.5% of sexually active ACB adults used condoms consistently. Male gender, wealth, unstable immigration classes, and less secure employment statuses status were independently associated with the frequency of condom use. Proximate determinants mediating these relationships included: not having a cohabiting regular partner, not disliking condoms, having one lifetime sex partner, and having a history of unwanted sex.


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