Electronic Thesis and Dissertation Repository

Thesis Format

Integrated Article

Degree

Doctor of Philosophy

Program

Geography

Supervisor

Luginaah, Isaac (PhD)

2nd Supervisor

Arku, Godwin (PhD)

Co-Supervisor

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.

Summary for Lay Audience

Canada has recorded low HIV cases among the general population since the first diagnosis in 1981. However, some groups in the country are more at risk of HIV infection than others. For example, research shows that African, Caribbean, and Black (ACB) men with a straight sexual orientation are more at risk of HIV infection because of behaviors such as unprotected sex, multiple sexual partners, and poor use of HIV healthcare. Therefore, existing studies recommend behavioral change as a solution that can reduce ACB men’s HIV risk. However, missing from these studies is an examination of the contributory roles of health policies and services, as well as ACB men’s everyday challenges of living in Canada as a racial minority population.

Furthermore, we do not know from these studies if ACB men engage in activities that build their capacity to reduce their vulnerability to HIV. This dissertation was part of a larger study called weSpeak, which was implemented in four cities (i.e., Ottawa, Toronto, London, and Windsor) in Ontario from 2016 to 2020. The aim was to understand and explain to policy makers factors that contribute to ACB men’s increased risk to HIV. Specifically, this research was conducted in London to find out how factors like behaviors, health policies, and everyday challenges of ACB men come together to make them vulnerable to HIV infection. Overall, thirty-seven people participated in four focus groups and thirteen in-depth interviews. The study findings revealed that HIV risk for ACB men resulted from challenges they faced as a racial minority population as well as from risky behaviors that were intended to meet the larger societal expectation of ACB men’s masculinity.

Additionally, institutions such as AIDS service organizations were not actively engaging with ACB men. Therefore, some of them were not aware of their high HIV risk. It also emerged that ACB men resorted to their innate qualities, friends, families, and religious communities to improve their capacities and resilience to HIV. Health policy stakeholders can take advantage of ACB men’s willingness to reduce their risk of HIV and engage them in the design of policies specific to their needs.

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