HIV vulnerability and resilience among heterosexual African, Caribbean and Black men in London Ontario, Canada
Abstract
Since Canada’s first HIV diagnosis in 1981, prevalence rates have remained below endemic levels. This, however, tends to mask realities of HIV infection among sub-populations like heterosexual men of African, Caribbean, and Black (ACB) descent, who experience increased risk of infection compared to other groups. Research to unpack ACB men’s vulnerability to HIV has prioritized behavioral risk factors, including the endorsement of traditional masculinity, partner concurrency, condomless sex, and poor use of preventive health services. As such, recommendations from these studies have centered on behavioral changes, which understate the role of structural risk factors in ACB men’s HIV vulnerability. Furthermore, knowledge from these studies under-represents ACB men’s agency and overly simplifies their vulnerabilities and resilient trajectories in relation to HIV. In advancing knowledge in this area, the weSpeak research project was implemented in four cities in Ontario (i.e., Ottawa, Toronto, London, and Windsor) from 2016 to 2020 to provide a holistic account of HIV vulnerability and resilience among heterosexual ACB men. This dissertation is drawn from the weSpeak project. It specifically focused on unpacking the HIV vulnerability and resilience of heterosexual ACB men at the nexus of behavioral and structural risk factors in London, Ontario, using a qualitative approach. Through snowball and random sampling, thirty self-identified heterosexual ACB men and seven service providers participated in four focus groups (n=24) and thirteen (n=13) in-depth interviews.
Analyzing the data using NVivo 12 revealed the overarching role of structural factors in ACB men’s HIV risk. For instance, the perception that masculinity is a sexual performance factor was limited to younger ACB men who had internalized stigmatized and stereotyped Black masculinities. Most ACB men practiced resourceful masculinities that allowed them to engage with their health. Furthermore, some ACB men had limited understanding and awareness of their high-risk of HIV mainly because they were disconnected from institutions providing HIV services. Aside from these hidden vulnerabilities, the research also revealed the high resilience of ACB individuals to HIV. Most ACB men demonstrate resilience by drawing on intrapersonal and interpersonal resources, including friends, families, and religious communities. Health policymakers and stakeholders can leverage these findings to engage ACB men in designing interventions targeted at their HIV needs. Overall, the removal of race-based discrimination in access to health resources will ultimately contribute to HIV risk reduction among ACB men and, therefore, improve their health and wellbeing in Canada.