The A/C Study- Key findings about HIV by Eunice Machuhi
A study developed to understand the factors that influence HIV among African, Caribbean and Black (ACB) People in Ontario has established that they routinely account for 25 per cent of new HIV diagnoses despite comprising of only 5 per cent of the population in the province.
A key finding on HIV infections revealed that participants with lower social status, based on social determinants of health, were more likely to test positive for HIV. The study also found that participants aged 50-59 years old were more likely to test positive for HIV than younger participants as well as people recruited from AIDS service organizations (ASOs).
The A/C study, a community-based research project, was developed by a team of mostly ACB researchers and service providers in Toronto and Ottawa and people from ACB communities.
Several focus group participants spoke about the high rate of poverty in ACB communities, especially among recent immigrants as one of the threats leading to an increase in the level of vulnerability to HIV. Other factors included poor housing, employment in precarious or low-wage jobs and lower levels of education which aggravate poor health in general and create barriers to accessing necessary health services.
The participants, however, identified the need for more integrated/ linked programs to ensure people living with HIV have access to preventive care, services that support their care, housing, and can lead sexually healthy lives.
HIV surveillance data routinely shows that, relative to other population groups, ACB
people have increased vulnerability to HIV due to systemic anti-Black racism and
social determinants of health, and not behavioural or biological factors.
Other findings similar to the A/C Study, have also demonstrated that lower
social and economic status is associated with higher rates of HIV infection in ACB
On sexual practices and health, the study found that while most participants did not exchange sex for drugs, money, goods, or services, factors that affect HIV risk included having multiple sex partners (both regular and casual) and low levels of condom use and substance (alcohol and marijuana) use during penetrative sex.
However, while sexual practices are individual-level factors that influence vulnerability to HIV infection, they do not occur in a vacuum. Evidence from other research shows that structural elements such as policies and institutional practices are more robust determinants of HIV infection rates at the population level than individual behaviours.
Additionally, evidence shows that the prevalence of HIV and STIs within one’s sexual network, and factors that impede the ability to achieve viral suppression, also play a role in HIV transmission.
Meanwhile, findings on HIV testing and counselling showed that most survey participants have tested for HIV at least once, and the vast majority were HIV-negative. Several individuals and structural factors (e.g.HIV stigma and fear, fear of deportation) were found to be related to lower levels of HIV testing.
For instance, 68.8 per cent of survey participants indicated they had ever tested for HIV, and 89.1 per cent were HIV-negative, while 30.8 per cent of the survey participants who have ever had an HIV test were tested in the last six months.
Also, 23.5 per cent of the participants revealed they have never tested for HIV and 5.4 per cent of survey participants overall (and 7.9 per cent of those who have ever had an HIV test) tested positive for HIV.
The study also revealed that among those ever tested for HIV, participants from Ottawa were more likely to have a positive HIV test result than those from Toronto. Those who were younger, those with part-time jobs, those born in Canada and those who had intercourse for the first time at older ages were less likely to get tested for HIV.
In line with these results, some of the actions recommended to enhance awareness include, increasing HIV knowledge among young African, Caribbean, and Black (ACB) people and those born in Canada as well as disseminating information about the lag time between HIV exposure and a positive test result in health/ HIV education curricula.
Others are promoting the benefits of early detection (early treatment, longevity, and reduction in HIV spread), including HIV counselling and testing as part of routine health check-ups and advocating for widespread dissemination of HIV self-tests in Canada.
The researchers observed that the results demonstrate that efforts to increase HIV testing in ACB communities must target individual and structural factors.
While increasing knowledge about HIV will lead to some increases in the uptake of testing, its effectiveness will depend on the availability of HIV testing services and how successfully structural barriers (e.g. HIV stigma and fear, fear about deportation, concerns about confidentiality, poor relationships with health care providers, etc.) are addressed.
The study notes that while more people should get tested, and testing should be more generally available, it is crucial to promote testing among younger people and those born in Canada. ACB people have many ideas about testing services and options for their communities, and these ideas should drive efforts to normalize HIV testing in these communities.