HIV risk perception and distribution of HIV risk among African, Caribbean and other Black people in a Canadian city: mixed methods results from the BLACCH study.

Background: African, Caribbean, and other Black (ACB) people are a priority population for HIV prevention in Canada. However, little is known about the epidemiology of HIV risk within this population. This study aimed to address this knowledge gap by presenting service providers' and ACB community members' perceptions of HIV risk among ACB populations, describing the distribution of HIV risk behaviours according to markers of social status and position, and comparing findings from these qualitative and quantitative analyses. Methods: The Black, African and Caribbean Canadian Health (BLACCH) Study used a mixed-methods design that included semi-structured interviews and a cross-sectional quantitative questionnaire to collect information about HIV and health from 188 ACB individuals living in London, Ontario, Canada. Qualitative content analysis was used to identify themes from the interviews, while weighted bivariate statistical analyses were conducted on the quantitative data. HIV risk behaviours were examined according to participants' sex, poverty status, immigration experience, and employment status. Results: Community members generally perceived themselves to be at low risk for HIV and primarily associated HIV risk with sexual behaviours. Participants expressed a need for greater access to information about HIV in Canada and for culturally appropriate HIV services. Service providers identified marital infidelity and cultural and religious attitudes toward condom use as barriers that limited women's ability to protect themselves from HIV. They also identified cultural norms, beliefs surrounding masculinity, and the underrepresentation of heterosexual ACB men within AIDS service organizations as barriers that prevented men from adequately protecting themselves. The quantitative findings showed few statistically significant differences in HIV risk behaviours between men and women. Participants living in poverty were more likely to report abstaining from sex (p = 0.006) and using condoms during the past year (p = 0.027). Individuals who had lived in Canada for a longer period reported higher prevalences of forced sex (p < 0.001), mixing alcohol or drugs with sex (p = 0.001), and previous sexually transmitted infection (STI) diagnoses (p = 0.032). Stable employment was associated with a higher prevalence of not using condoms during the past year (p = 0.005) and previous STI diagnoses (p = 0.018). Conclusions: The findings demonstrate that perceptions of HIV risk among ACB communities differ from actual reported risk behaviours, with individuals of higher social standing appearing to engage in behaviours associated with greater HIV risk. The study also highlights that the social determinants of health play an important role in shaping HIV epidemiology among African, Caribbean, and other Black populations in Canada.