African, Caribbean and Black (ACB) people are disproportionately impacted by HIV infection as a result of intersecting social determinants of health and stigma.1,2,3,4
The A/C Study
The A/C Study is a two-phase community-based research initiative to promote understanding of HIV among ACB communities in Ontario to inform policy development and other responses to HIV.4
Phase one of the study (discussed here) looked at the prevalence of HIV and factors associated with HIV risk in ACB people. The study took place in Toronto and Ottawa from January to December 2019. Participants were first- and second-generation ACB people who were 15 to 64 years old and were recruited by peers for participation in a survey and optional HIV testing. The survey collected information on sociodemographic characteristics, sexual behaviour, substance use, history of blood donation, access to and use of health systems and services, and access to and use of HIV testing, care and treatment services. Dried blood spot (DBS) testing was used to determine the HIV status of participants who consented to testing.4,5
Phase two of the study included a two-day online workshop with ACB adults and those providing service to ACB people in the Greater Toronto Area and Ottawa. During the workshop, phase one results were shared and discussed among 12 focus groups.4
Phase one of the study included 1,380 people who participated in a survey, of whom 834 (60.4%) agreed to an HIV DBS test. Of the 1,380 people who participated in the survey, 61.9% were from Toronto, 63.4% were female, 63.8% reported ever having had a sexually transmitted infection (STI) test and 74.6% reported ever having had an HIV test.
Among the 834 people who agreed to an HIV DBS test, 8.0% tested positive for HIV (HIV prevalence). After the results were weighted for age, the estimated HIV prevalence in the adult population (15–49 years) was 6.6% and after the results were weighted for age, sex and city of residence, the overall HIV prevalence among ACB people in Ontario was estimated to be 7.5%.
According to the survey results, 82.5% of those with a positive HIV test self-reported their positive HIV status, which means they already knew their HIV status. This means that 17.5% of people who completed both the DBS test and the survey did not know they were living with HIV, although self-reported HIV status may be underreported because of stigma.
In an analysis that adjusted for demographic, socioeconomic and behavioural factors, the following people were significantly more likely to have a positive HIV test result:
- older people (2.80 times more likely) compared with younger people
- people born outside of Canada (4.70 times more likely) compared with those born in Canada
- people who completed the survey in French (9.83 times more likely) compared with English
- people who were unemployed (1.85 times more likely) or part-time employed (4.64 times more likely) compared with those who were employed
- people who reported substance use during sex (1.66 times more likely) compared with those who did not
- people who identified as homosexual (19.68 times more likely) or bisexual (2.82 times more likely) compared with people who identified as heterosexual
The following people were significantly less likely to have a positive HIV test:
- people with a high school (99% less likely), college (100% less likely) or university education (100% less likely), compared with people with less than a high school education
- people who reported a more adequate housing situation (15% less likely) (housing adequacy was self-reported as not adequate, barely adequate, fairly adequate or very adequate)
- people with a higher social capital index score (39% less likely), which was estimated from self-reported levels of agreement or disagreement with individuals’ perceptions about their neighbourhood
- people who reported ever having an STI test (60% less likely) compared to not having an STI test
What does this study tell us?5
In addition to providing HIV prevalence estimates for ACB people in Ontario, this study highlights factors that are linked to HIV prevalence, which can help inform decisions about areas to prioritize for intervention. Examples of possible areas of focus for program and policy response mentioned by the study authors include:
- focusing on the protective role that community and family support can play in lowering HIV risk and increasing resilience among ACB people
- considering how to address social determinants of health for ACB immigrants (e.g., income- and employment-related factors) that could help to lower HIV risk
- considering and addressing the potential barriers that are being faced by French-speaking ACB linguistic monitories in Ontario
Overall, interventions that seek to remove structural barriers and improve the socioeconomic well-being of ACB people are needed to increase levels of HIV testing, improve treatment and care, and increase access to HIV prevention approaches.
- Ontario HIV Treatment Network. African, Caribbean and Black communities. Toronto: OHTN; 2018. Available from: https://www.ohtn.on.ca/research-portals/priority-populations/african-caribbean-and-black-communities/
- Ontario HIV Epidemiology and Surveillance Initiative. HIV diagnoses in Ontario, 2020. Toronto: Ontario HIV Treatment Network; August 22, 2022. Available from: https://www.ohesi.ca/wp-content/uploads/2022/08/HIV-diagnoses-in-Ontario-2020-REPORT-FINAL.pdf
- Canadian HIV/AIDS Black, African and Caribbean Network. CHABAC Awareness Day. CHABAC; 2018. http://www.blackhivday.ca/awareness_day_fact_sheet_2018_EN_final.pdf
- Baidoobonso S, Kihembo M, Nare H et al. A/C Study community report: HIV among African, Caribbean, and Black people in Ontario. December 2020. Available from: https://acstudy.ca/wp-content/uploads/2021/02/A_C_report2020.pdf
- Mbuagbaw L, Husbands W, Baidoobonso S et al. A cross-sectional investigation of HIV prevalence and risk factors among African, Caribbean and Black people in Ontario: the A/C Study. Canadian Communicable Disease Report. 2022;48(10):429-37. https://www.canada.ca/content/dam/phac-aspc/documents/services/reports-publications/canada-communicable-disease-report-ccdr/monthly-issue/2022-48/issue-10-october-2022/ccdrv48i10a03-eng.pdf
About the author(s)
Amanda Giacomazzo is CATIE’s manager, community programming. She has a master’s degree in health science with specialised training in health services and policy research and previously worked in knowledge translation and public health at the provincial level.
Externally reviewed by: Dr. Lawrence Mbuagbaw