HIV Risk Perceptions and the Distribution of HIV Risk among African, Caribbean and Other Black People: Mixed-Methods Results from the BLACCH Study

BACKGROUND: African, Caribbean and other Black people (ACBP) are a priority group for HIV prevention efforts in Canada. ACBP and service providers’ (SP) perceptions about HIV risk impact the uptake and delivery of prevention messages. These perceptions may not reflect actual risk among ACBP, so it is important to assess them and identify groups for which they may be valid. Emerging evidence from Sub-Saharan Africa shows that social determinants of health (SDOH) impact the distribution of HIV risk. However, SDOH are context-specific, and to date, virtually no research has explored their impact on HIV risk among ACBP in North America. OBJECTIVE: Compare ACBP’s and SP’s perceptions about HIV risk among ACBP to a corresponding quantitative risk profile. METHODS: Using a community-based approach, a purposive sample of eight SPs and 22 ACBP were recruited for qualitative interviews. They were asked questions about HIV, and their responses are being analyzed using qualitative content analysis to identify themes. Following the interviews, a convenience sample of 188 ACBP completed a quantitative questionnaire covering HIV-related risk behaviours. Quantitative data were analyzed to describe the distribution of HIV risk behaviours according to the following SDOH: gender, poverty status, educational attainment, immigration experience, ethnicity and employment status. Qualitative and quantitative data were compared using concurrent triangulation. RESULTS: Interview participants mainly discussed sexual behaviours related to HIV risk, and the survey results showed that much of the community’s risk is sexual in nature. Risk behaviours acknowledged by ACBP and SP that showed statistically significant variation according to the SDOH include: forced sex, condom use, sex while drunk or high, and abstinence. It appears as though individuals with higher social status (based on SDOH) are at higher risk than those of lower social status. DISCUSSION: Further analyses including statistical weights need to be performed before these results can be finalized