Determinants of HIV vulnerability among heterosexual ACB men in Ottawa, Canada

Introduction
Although significant progress has been made in the fight against HIV/AIDS, structural factors continue to undermine this progress, especially among racialized populations in many countries. For instance, African, Caribbean and Black (ACB) men in Canada face barriers – such as unemployment, stigma, and racism – that increase their vulnerability to health-related events including HIV/AIDS. However, there is a paucity of culturally appropriate responses to address these factors within the ACB population in Canada. Hence, this paper sought to identify the structural barriers that increase the vulnerability of ACB heterosexual men to HIV, and the strategies for building resilience in response to HIV.

Material and methods
This paper is based on the qualitative findings from the weSpeak project, which was a mixed-methods study informed by community-based participatory research (CBPR). Qualitative data were collected from 63 participants in Ottawa, Canada through focus group discussions (FGD) and in-depth interviews (IDI). The participants included ACB heterosexual men, service providers, and policy/decision-makers. All interviews were recorded, transcribed verbatim and analysed using NVivo Version 11.

Results
The themes were: 1) systemic barriers to employment and income, 2) healthcare access and uptake, 3) stigma, discrimination and racism, 4) strategies for responding to HIV vulnerabilities. The participants highlighted the difficulties that new immigrants faced with recognition of their academic credentials, which then limits their income and job opportunities. Healthcare services were underutilized because of privacy issues, insufficient physicians and long waiting periods. Also, HIV-related stigma, anti-Black racism and stereotypes were factors that limited health and economic options for the participants. However, the participants acknowledged that health education, collaboration and engagement with faith-based leaders can reduce HIV vulnerabilities.

Conclusions
The study highlights the role of structural factors in increasing HIV vulnerability among ACB heterosexual men, and the need for multilevel interventions to foster better a HIV response within the ACB community.