Criminal Code reform of HIV non disclosure is urgently needed : Social science perspectives on the harms of HIV criminalization in Canada

The criminalization of HIV non-disclosure represents a significant issue of concern among people living with HIV, those working across the HIV sector, public health practitioners, and health and human rights advocates around the world. Recently, the government of Canada began a review of the criminal law regarding HIV non-disclosure and invited feedback from the public about potential reforms to the Criminal Code. In light of this public consultation, this commentary examines social science research from Canadian scholars that documents the intersecting damaging effects of HIV criminalization. Canadian social scientists and other researchers have shown that HIV criminalization is applied in uneven and discriminatory ways, impedes HIV prevention efforts, perpetuates HIV stigma, and has a damaging impact on the daily lives of people living with HIV. We argue that there is an urgent need for reforms that will significantly restrict how the criminal law is applied to HIV non-disclosure

No Place Like Home: African Refugees and the Making of a New Queer Identity

For reasons of necessity, urgency, and sometimes choice, queer Africans cross borders and find their lives unfolding in diasporic spaces. Refugee claims based on sexual orientation and gender identity persecution make up 12% of all refugee cases in Canada, with queer African refugees constituting the largest group within this category. With this in mind, we now have to ask, “what kind of history will be written about the collision between queer Africans dislocated from post-colonial nations and the Canadian settler nation?” In this study, qualitative in-depth interviews were conducted to explore the individual lived experiences of queer African refugees, with a focus on the intricate realignment of sexual orientation, sexual identity, sexual politics, and sexual desire that inevitably emerges through forced migration and the refugee process in Canada. The deep meaning of life experiences is captured in the participants’ own words, providing detailed, in-depth insights into the complexities of their lives, their reflections, and their subsequent responses. These narratives call attention to the specific features of queer African refugees, who test the limits of the current homonational refugee apparatus. Participants’ experiences of resisting social roles, structures, identities, and expectations that limit queer African refugees and keep them “in their place,” both in their countries of origin and in Canada, are interrogated. The construction of boundaries that decide who belongs and deserves protection within Canada and who does not provides a foundation for engaging in research as a practice of freedom, in order to counter the global narrative of refugee life that excludes queer Africans. The findings in this research require us to look at practices of exclusion and inclusion in the Canadian refugee system and the tensions that emerge for queer African claimants. In the end, we are left with strategies for how to engage with the politics of knowledge production and advocate for an agenda of social justice and transformation for queer Africans globally.Ph.D

HEALTH DISPARITIES, SOCIAL DETERMINANTS OF HEALTH, AND SYSTEMIC ANTI-BLACK RACISM DURING COVID-19: A CALL TO ACTION FOR SOCIAL WORK

Systemic anti-Black racism is deeply rooted in the social, political, economic, ontological, and epistemological foundations of Canadian society. Driven by our code of ethics and the most recent call to reckon with anti-Black racism in society, the social work profession’s advocacy agenda requires reconceptualization to eradicate anti-Black racism and the creation of equitable environments within which Black communities can thrive. This article examines the anti-Black racism exhibited during the COVID-19 pandemic through the lens of health equity and health disparity. The interplay between health disparities, social determinants of health, and systemic anti-Black racism is highlighted and the urgency for social workers to respond to the causes of poor Black health outcomes is emphasized. Social workers are called upon to engage in a more intentional framework of Black health equity, which includes a practice that ensures the well-being and survival of Black people and their communities. The authors conclude that for the social work profession to reach its full potential, it must recognize and use its distinctive qualities to eradicate anti-Black racism.Le racisme systémique contre les personnes noires est profondément enraciné dans les fondations sociales, politiques, économiques, ontologiques et épistémologiques de la société canadienne. À partir de notre code d’éthique et des appels les plus récents nous encourageant à reconnaître le racisme contre les personnes noires, le travail social doit reconceptualiser ses objectifs de défense des droits pour viser à éradiquer le racisme contre les personnes noires et créer des environnements de travail au sein desquels les communautés noires peuvent s’épanouir. Cet article examine le racisme contre les personnes noires durant la pandémie de COVID-19 sous l’angle des iniquités de santé. Il met en évidence les interactions entre les iniquités en santé, les déterminants sociaux de la santé et le racisme systémique contre les personnes noires, et insiste sur l’importance pour les travailleuses sociales et les travailleurs sociaux d’attaquer les causes des mauvais résultats en matière de santé pour les personnes noires. Les travailleuses sociales et les travailleurs sociaux sont interpellé.e.s afin de s’engager de manière plus intentionnelle en ce qui a trait à l’équité en matière de santé pour ces personnes, y compris en pratiquant leur profession d’une manière permettant d’assurer le bien-être et la survie des personnes noires et de leurs communautés. Les auteur.e.s concluent que, pour atteindre son plein potentiel en tant que profession, le travail social doit reconnaître et utiliser ses caractéristiques distinctives pour éradiquer le racisme contre les personnes noires

HIV prevention risks for Black women in Canada

The future availability of HIV vaccines can increase options available to Canadian Black women for risk reduction. However, current conceptual frameworks do not adequately address barriers to HIV prevention for this population, and may be inadequate to address challenges with vaccines. This study explored knowledge and attitudes regarding HIV vaccines and associated prevention methods to inform appropriate conceptual frameworks for their dissemination to Canadian Black women. We completed four 90-min focus groups with women (n = 26) of African or Caribbean origins, and six interviews with key informants providing health and social services in the Black communities of Toronto. The participants suggested that there were significant risks associated with seeking prevention information and attempting to reduce exposure to HIV infection. They described individual, familial, community and institutional domains of risk and predicted the same spectrum of risk for HIV vaccines. Participants advocated for education, empowerment and institutional change to create a supportive environment for vaccines and other HIV prevention methods. They further indicated that preparation for vaccine dissemination will need to prioritize building trust between women of the Black communities and institutions in the research, health and government sectors.Canada HIV/AIDS Prevention Vaccines Black women Trust

HIV prevention for Black women: structural barriers and opportunities

Copyright © 2008 Meharry Medical College. This article first appeared in Journal of Health Care for the Poor and Underserved, 19:3 (2008), 829-841. Reprinted with permission by Johns Hopkins University Press.Black women bear a disproportionate burden of HIV/AIDS in North America. The purpose of this investigation was to explore Black Canadian women's perspectives on HIV risk and prevention. Four 90-minute focus groups (n=26) and six key informant interviews were conducted in Toronto with Black women of African and Caribbean descent and low socioeconomic status. Data analysis revealed a number of potent barriers to existing HIV preventive interventions: stigma, cultural disconnections, lack of engagement of Black religious institutions, and multiple intersecting forms of discrimination. Recommended HIV prevention opportunities included the Black church, mainstreaming, health care providers, and ethno-specific agencies. HIV prevention strategies for North American Black women, rather than focusing on HIV and individual risk behaviors, may benefit from a primary focus on social and structural factors (e.g., promoting gender equality, economic opportunity, women-controlled prevention technologies and combating racism in health care) thereby integrating HIV prevention into the larger context of community health and survival.Funding for this project was provided by the Canadian Institutes of Health Research, Institute of Gender and Health. We thank our collaborator, Women’s Health in Women’s Hands Community Health Centre, whose engagement throughout the entire project was central to the research

“Going vaccine hunting”: Multilevel influences on COVID-19 vaccination among racialized sexual and gender minority adults—a qualitative study

ABSTRACTHigh levels of COVID-19 vaccine hesitancy have been reported among Black and Latinx populations, with lower vaccination coverage among racialized versus White sexual and gender minorities. We examined multilevel contexts that influence COVID-19 vaccine uptake, barriers to vaccination, and vaccine hesitancy among predominantly racialized sexual and gender minority individuals. Semi-structured online interviews explored perspectives and experiences around COVID-19 vaccination. Interviews were recorded, transcribed, uploaded into ATLAS.ti, and reviewed using thematic analysis. Among 40 participants (mean age, 29.0 years [SD, 9.6]), all identified as sexual and/or gender minority, 82.5% of whom were racialized. COVID-19 vaccination experiences were dominated by structural barriers: systemic racism, transphobia and homophobia in healthcare and government/public health institutions; limited availability of vaccination/appointments in vulnerable neighborhoods; absence of culturally-tailored and multi-language information; lack of digital/internet access; and prohibitive indirect costs of vaccination. Vaccine hesitancy reflected in uncertainties about a novel vaccine amid conflicting information and institutional mistrust was integrally linked to structural factors. Findings suggest that the uncritical application of “vaccine hesitancy” to unilaterally explain undervaccination among marginalized populations risks conflating structural and institutional barriers with individual-level psychological factors, in effect placing the onus on those most disenfranchised to overcome societal and institutional processes of marginalization. Rather, disaggregating structural determinants of vaccination availability, access, and institutional stigma and mistrust from individual attitudes and decision-making that reflect vaccine hesitancy, may support 1) evidence-informed interventions to mitigate structural barriers in access to vaccination, and 2) culturally-informed approaches to address decisional ambivalence in the context of structural homophobia, transphobia, and racism

An eHealth Intervention for Promoting COVID-19 Knowledge and Protective Behaviors and Reducing Pandemic Distress Among Sexual and Gender Minorities: Protocol for a Randomized Controlled Trial (#SafeHandsSafeHearts)

BackgroundExisting data on COVID-19 disparities among vulnerable populations portend excess risk for lesbian, gay, bisexual, transgender (LGBT) and other persons outside of heteronormative and cisgender identities (ie, LGBT+). Owing to adverse social determinants of health, including pervasive HIV and sexual stigma, harassment, violence, barriers in access to health care, and existing health and mental health disparities, sexual and gender minorities in India and Thailand are at disproportionate risk for SARS-CoV-2 infection and severe disease. Despite global health disparities among LGBT+ populations, there is a lack of coordinated, community-engaged interventions to address the expected excess burden of COVID-19 and public health–recommended protective measures. ObjectiveWe will implement a randomized controlled trial (RCT) to evaluate the effectiveness of a brief, peer-delivered eHealth intervention to increase COVID-19 knowledge and public health–recommended protective behaviors, and reduce psychological distress among LGBT+ people residing in Bangkok, Thailand, and Mumbai, India. Subsequent to the RCT, we will conduct exit interviews with purposively sampled subgroups, including those with no intervention effect. MethodsSafeHandsSafeHearts is a 2-site, parallel waitlist-controlled RCT to test the efficacy of a 3-session, peer counselor–delivered eHealth intervention based on motivational interviewing and psychoeducation. The study methods, online infrastructure, and content were pilot-tested with LGBT+ individuals in Toronto, Canada, before adaptation and rollout in the other contexts. The primary outcomes are COVID-19 knowledge (index based on US Centers for Disease Control and Prevention [CDC] items), protective behaviors (index based on World Health Organization and US CDC guidelines), depression (Patient Health Questionnaire-2), and anxiety (Generalized Anxiety Disorder-2). Secondary outcomes include loneliness, COVID-19 stress, and intended care-seeking. We will enroll 310 participants in each city aged 18 years and older. One-third of the participants will be cisgender gay, bisexual, and other men who have sex with men; one-third will be cisgender lesbian, bisexual, and other women who have sex with women; and one-third will be transfeminine, transmasculine, and gender nonbinary people. Participants will be equally stratified in the immediate intervention and waitlist control groups. Participants are mainly recruited from online social media accounts of community-based partner organizations. They can access the intervention on a computer, tablet, or mobile phone. SafeHandsSafeHearts involves 3 sessions delivered weekly over 3 successive weeks. Exit interviews will be conducted online with 3 subgroups (n=12 per group, n=36 in each city) of purposively selected participants to be informed by RCT outcomes and focal populations of concern. ResultsThe RCT was funded in 2020. The trials started recruitment as of August 1, 2021, and all RCT data collection will likely be completed by January 31, 2022. ConclusionsThe SafeHandsSafeHearts RCT will provide evidence about the effectiveness of a brief, peer-delivered eHealth intervention developed for LGBT+ populations amid the COVID-19 pandemic. If the intervention proves effective, it will provide a basis for future scale-up in India and Thailand, and other low- and middle-income countries. Trial RegistrationClinicalTrials.gov NCT04870723; https://clinicaltrials.gov/ct2/show/NCT04870723 International Registered Report Identifier (IRRID)DERR1-10.2196/3438