The A/C Study: A cross-sectional study of HIV epidemiology among ACB People in Ontario By Eunice Machuhi

A cross-sectional study of HIV epidemiology among African, Caribbean and Black (ACB) people in Ontario has revealed that some patients have difficulties in accessing HIV medication. In contrast, others are not able to afford them.

Other patients claimed that they did not need the medication yet, while another group said they did not have a doctor to attend to them. These are some of the reasons that participants in the study asked why they were not taking the HIV infection prescription.

Based on some of these responses, the study established that financial barriers threaten that access to HIV medication for People Living With HIV (PLWHs) and access to treatment will lead to viral suppression and, therefore, less risk of transmission.

Therefore, all people living with HIV should have access to HIV care and medications.

This community-based research was conducted in the two major Ontario cities – Toronto and Ottawa between November 2018 and September 2020.

The A/C leadership comprised Prof Josephine Etowa, Suzanne Obiorah, Wangari Tharao, Winston Husbands, Lawrence Mbuagbaw and LaRon Nelson.

The final report titled ‘AC Study: A community report on HIV/AIDs among ACBs’ was presented virtually to CADHO members by Dr Bagnini Kohoun and Dr Charles Dabone.

In an earlier presentation, Prof Etowa stated that the study aimed to monitor HIV prevalence and facilitate an improved understanding of associated behaviours, knowledge, community/structural factors, health care access, and utilization among ACB people in Ontario.

The study's primary objectives focused on describing include prevalence and testing behaviour for HIV and behaviours associated with transmission of HIV and care and treatment.

Others are the history of HIV, core knowledge related to HIV transmission and acquisition and key individual and structural factors that affect vulnerability to HIV.

The secondary objectives are to estimate the incidence of HIV and to assess the utilization of health care services.

In Ottawa, statistics indicate that currently taking medication was 83.3 per cent and 92.3 per cent in Toronto. An estimated 5.6 per cent in Ottawa and 5.1 per cent in Toronto were not taking the medication.

Other key findings that the study revealed were that 87 per cent of PLWHs were under the care of a health professional while 88 per cent were taking medication for HIV infection.

It also emerged that a total of 82.7 per cent of the participants were diagnosed two or more years before the study. Seven per cent were diagnosed within the last year, 4 per cent within six months before the study, 2.7 per cent were diagnosed seven to 12 months before the study, and another 2.7 per cent knew of their diagnosis one or two years before the study.

According to Prof Etowa, these statistics suggest that ACB communities are disproportionately infected by HIV in Ontario because they constitute only 5 per cent of the population of Ontario yet account for 25 per cent of new diagnoses of HIV.

Some of the key actions that the study recommended include conducting more research on the clinical effectiveness and social impacts of pre-exposure prophylaxis (PrEP)/ post-exposure prophylaxis (PEP) on ACB communities, particularly ACB women.

Others are promoting PrEP/ PEP as an HIV prevention tool for ACB people, removing socio-economic barriers to accessing PrEP/ PEP, collecting or synthesizing existing data to assess how ACB communities are doing along the 90-90-90 cascade and guaranteeing access to HIV care and treatment regardless of residency status or other factors.

There is also a need to increase access to community-led information and education, implement anti-Black racism training, increase access & eliminate barriers to health care, foster partnerships and collaboration, increase opportunities, and build capacity for ACB research.