“It’s for us –newcomers, LGBTQ persons, and HIV-positive persons. You feel free to be”: a qualitative study exploring social support group participation among African and Caribbean lesbian, gay, bisexual and transgender newcomers and refugees in Toronto, Canada

BACKGROUND: Stigma and discrimination harm the wellbeing of lesbian, gay, bisexual and transgender (LGBT) people and contribute to migration from contexts of sexual persecution and criminalization. Yet LGBT newcomers and refugees often face marginalization and struggles meeting the social determinants of health (SDOH) following immigration to countries such as Canada. Social isolation is a key social determinant of health that may play a significant role in shaping health disparities among LGBT newcomers and refugees. Social support may moderate the effect of stressors on mental health, reduce social isolation, and build social networks. Scant research, however, has examined social support groups targeting LGBT newcomers and refugees. The purpose of this qualitative study was to explore experiences of social support group participation among LGBT African and Caribbean newcomers and refugees in an urban Canadian city. METHODS: We conducted 3 focus groups with a venue-based sample of LGBT African and Caribbean newcomers and refugees (n = 29) who attended social support groups at an ethno-specific AIDS Service Organization. Focus groups followed a semi-structured interview guide and were analyzed using narrative thematic techniques. RESULTS: Participant narratives highlighted immigration stressors, social isolation, mental health issues, and challenges meeting the SDOH. Findings reveal multi-level benefits of social support group participation at intrapersonal (self-acceptance, improved mental health), interpersonal (reduced isolation, friendships), community (reciprocity, reduced stigma and discrimination), and structural (housing, employment, immigration, health care) levels. CONCLUSIONS: Findings suggest that social support groups tailored for LGBT African and Caribbean newcomers and refugees can address social isolation, community resilience, and enhance resource access. Health care providers can provide support groups, culturally and LGBT competent health services, and resource access to promote LGBT newcomers and refugees’ health and wellbeing

Exploring the State of Sexual Health Literacy among Young Black Gay and Other Men who Have Sex with Other Men in Toronto, Ontario, Canada

Despite advancements in diagnosis, treatment and prevention for HIV and other sexually transmitted infections (STIs), young Black gay and other men who have sex with men (YBGM) experience significantly higher HIV rates compared to other young gay and other men who have sex with men. While sexual health literature indicates various socio-structural factors (e.g., systemic racism, low income) contribute to these rates, research on YBGM’s sexual health literacy in Canada is sparse. I developed a qualitative study guided by intersectionality and the social-ecological model theoretical frameworks and methodologically informed by Charmaz’s constructivist grounded theory to begin addressing this scarcity. My primary research question was: what is the state of YBGM’s sexual health literacy? My sub-questions were: 1) what or who are YBGM’s sources of sexual health information?; 2) how do YBGM evaluate the information they gather from these sources? and 3) in what ways, if any, are YBGM applying this information in their everyday lives? Twenty-two YBGM aged 16 to 31 years underwent a socio-demographic survey and one-on-one semi-structured interviews. The first manuscript centered on YBGM’s pre-exposure prophylaxis (PrEP) knowledge. My findings revealed that YBGM’s limited PrEP knowledge was due to healthcare institutions’ inability to effectively disseminate PrEP information coupled with the impact of PrEP stigma and their social locations on this knowledge. Manuscript two explored YBGM’s approaches to evaluating the credibility of key sexual health information sources. My findings countered common narratives in the literature that identified sex-ed, same aged peers and family as key sources. Older Black peers were seen as a key source who used ‘testimonials’, a commonly used knowledge dissemination approach in the Black-African diaspora, to share their experiential sexual health knowledge with YBGM. My final manuscript explored the state of healthcare providers’ sexual health communication skills through the lens of YBGM. Participants’ accounts pointed to providers’ inadequate skills and to the healthcare system’s medicalization of YBGM whereby their race, sexual orientation and/or age automatically categorized them as needing HIV and other STI testing even when they sought non-sexual healthcare. We conclude with the study’s implications on sexual healthcare research, policy and practice.Ph.D

Everybody’s talking about equity, but is anyone really listening?: The Case for Better Data-Driven Learning in Health Systems

Data collection, analysis, and data driven action cycles have been viewed as vital components of healthcare for decades. Throughout the COVID-19 pandemic, case incidence and mortality data have consistently been used by various levels of governments and health institutions to inform pandemic strategies and service distribution. However, these responses are often inequitable, underscoring pre-existing healthcare disparities faced by marginalized populations. This has prompted governments to finally face these disparities and find ways to quickly deliver more equitable pandemic support. These rapid data informed supports proved that learning health systems (LHS) could be quickly mobilized and effectively used to develop healthcare actions that delivered healthcare interventions that matched diverse populations' needs in equitable and affordable ways. Within LHS, data are viewed as a starting point researchers can use to inform practice and subsequent research. Despite this innovative approach, the quality and depth of data collection and robust analyses varies throughout healthcare, with data lacking across the quadruple aims. Often, large data gaps pertaining to community socio-demographics, patient perceptions of healthcare quality and the social determinants of health exist. This prevents a robust understanding of the healthcare landscape, leaving marginalized populations uncounted and at the sidelines of improvement efforts. These gaps are often viewed by researchers as indication that more data is needed rather than an opportunity to critically analyze and iteratively learn from multiple sources of pre-existing data. This continued cycle of data collection and analysis leaves one to wonder if healthcare has a data problem or a learning problem. In this commentary, we discuss ways healthcare data are often used and how LHS disrupts this cycle, turning data into learning opportunities that inform healthcare practice and future research in real time. We conclude by proposing several ways to make learning from data just as important as the data itself

Black feminist pedagogy as a tool for inclusive teaching and learning: critical reflections of Black women scholars

The global COVID-19 pandemic has led us to this current public health and political moment, bringing widespread attention to social and health inequalities and interconnecting racial discrimination faced by Black communities and other communities of colour. The pandemic has also precipitated a transition of the qualitative methodology classroom from physical to virtual spaces. At this juncture, an opportunity has emerged to amplify critical pedagogies challenging White, Eurocentric, hetero- and cis-normative epistemologies and introduce their practice into the ever-evolving classroom. Rooted within a genealogy of Black women’s political and intellectual activism, Black feminist pedagogy captures their unique intersectional experiences and presents a methodology for teachers and learners alike to promote equity in the classroom and our society. In this presentation, we discuss the ways in which Black feminist pedagogy can support reflection on the inherent relations of power shaping the pedagogical practices and knowledge production of/in the classroom. We hold that Black feminist pedagogy is not simply concerned with the instruction of, for, and about Black women. It additionally puts forth learning strategies informed by Black women’s historical experiences of race, gender, and class discrimination that can support the inclusion of diverse epistemological positionings and meaningfully represent the social and health inequities of marginalized communities. We affirm that a ‘standpoint epistemology' is foundational to Black feminist pedagogy and that those who experience marginalization are best positioned to make claims about its meanings and impacts. The presenters draw from their epistemological standpoint as Black women, graduate and postdoctoral scholars, and Black feminist thinkers. We center our own experiential knowledge as learners and teachers to reflect on the value of Black feminist pedagogy. A major learning from our experiences in this current moment has compelled us to advocate for integrating a critical reflexivity process. This process is undertaken by teachers and learners to assess how knowledge is being produced, legitimized and/or erased as a counter to the social and institutional power and authority constituting the classroom. We also discuss considerations for teaching theoretical and methodological approaches to intersecting oppressions as elemental to Black women’s experience and a cornerstone of Black feminist pedagogy. An intersectional approach supports us to take stock of the interlocking stigmas shaping health inequalities, ontologically and epistemologically (re)position the multiply marginalized communities they impact, and take up theories, methods, and practices that better align with our experiences. Intersectionality will be used to exemplify tensions as a ‘travelling theory’ and its strengths when rooted in a Black feminist pedagogy. At a time where Black feminist thought is at the forefront of public consciousness, we emphasize the dangers of taking up this tradition through white and patriarchal logics and pedagogies. As we rework the notion and formations of ‘the classroom’ in this current moment, it is important to not only recognize it as a place of intellectual advancement but also as a historical site of colonial, racial, and epistemic violence. Black feminist pedagogy holds that the experiential knowledge of racialized communities uniquely positions them for the teaching of ontologies and epistemologies characterizing their social realties and the methodological approaches employed to interpret them. To this end, redressing academic violence unequivocally requires the meaningful engagement and inclusion of Black (feminist) scholars in academic institutions and actively creating an environment that supports this pedagogical practice as an ethic and praxis towards decolonizing the classroom and qualitative health research more broadly. In this presentation, we aim to represent Black feminist thinking as a pedagogical tool to emphasize the intellectual, experiential, and cultural contributions of Black scholars to knowledge production and to help practitioners meaningfully approach teaching-learning and conducting qualitative health research in a (post-)COVID-19 reality

“It’s for us –newcomers, LGBTQ persons, and HIV-positive persons. You feel free to be”: a qualitative study exploring social support group participation among African and Caribbean lesbian, gay, bisexual and transgender newcomers and refugees in Toronto, Canada

From publisher: Background: Stigma and discrimination harm the wellbeing of lesbian, gay, bisexual and transgender (LGBT) people and contribute to migration from contexts of sexual persecution and criminalization. Yet LGBT newcomers and refugees often face marginalization and struggles meeting the social determinants of health (SDOH) following immigration to countries such as Canada. Social isolation is a key social determinant of health that may play a significant role in shaping health disparities among LGBT newcomers and refugees. Social support may moderate the effect of stressors on mental health, reduce social isolation, and build social networks. Scant research, however, has examined social support groups targeting LGBT newcomers and refugees. The purpose of this qualitative study was to explore experiences of social support group participation among LGBT African and Caribbean newcomers and refugees in an urban Canadian city. Methods: We conducted 3 focus groups with a venue-based sample of LGBT African and Caribbean newcomers and refugees (n = 29) who attended social support groups at an ethno-specific AIDS Service Organization. Focus groups followed a semi-structured interview guide and were analyzed using narrative thematic techniques. Results: Participant narratives highlighted immigration stressors, social isolation, mental health issues, and challenges meeting the SDOH. Findings reveal multi-level benefits of social support group participation at intrapersonal (self-acceptance, improved mental health), interpersonal (reduced isolation, friendships), community (reciprocity, reduced stigma and discrimination), and structural (housing, employment, immigration, health care) levels. Conclusions: Findings suggest that social support groups tailored for LGBT African and Caribbean newcomers and refugees can address social isolation, community resilience, and enhance resource access. Health care providers can provide support groups, culturally and LGBT competent health services, and resource access to promote LGBT newcomers and refugees’ health and wellbeing.The study was funded by the Canadian Institutes of Health Research (CIHR) and the Social Sciences and Research Council of Canada (SSHRC)

“It’s for us –newcomers, LGBTQ persons, and HIV-positive persons. You feel free to be”: a qualitative study exploring social support group participation among African and Caribbean lesbian, gay, bisexual and transgender newcomers and refugees in Toronto, Canada

Abstract Background Stigma and discrimination harm the wellbeing of lesbian, gay, bisexual and transgender (LGBT) people and contribute to migration from contexts of sexual persecution and criminalization. Yet LGBT newcomers and refugees often face marginalization and struggles meeting the social determinants of health (SDOH) following immigration to countries such as Canada. Social isolation is a key social determinant of health that may play a significant role in shaping health disparities among LGBT newcomers and refugees. Social support may moderate the effect of stressors on mental health, reduce social isolation, and build social networks. Scant research, however, has examined social support groups targeting LGBT newcomers and refugees. The purpose of this qualitative study was to explore experiences of social support group participation among LGBT African and Caribbean newcomers and refugees in an urban Canadian city. Methods We conducted 3 focus groups with a venue-based sample of LGBT African and Caribbean newcomers and refugees (n = 29) who attended social support groups at an ethno-specific AIDS Service Organization. Focus groups followed a semi-structured interview guide and were analyzed using narrative thematic techniques. Results Participant narratives highlighted immigration stressors, social isolation, mental health issues, and challenges meeting the SDOH. Findings reveal multi-level benefits of social support group participation at intrapersonal (self-acceptance, improved mental health), interpersonal (reduced isolation, friendships), community (reciprocity, reduced stigma and discrimination), and structural (housing, employment, immigration, health care) levels. Conclusions Findings suggest that social support groups tailored for LGBT African and Caribbean newcomers and refugees can address social isolation, community resilience, and enhance resource access. Health care providers can provide support groups, culturally and LGBT competent health services, and resource access to promote LGBT newcomers and refugees’ health and wellbeing

“One program that could improve health in this neighbourhood is ____?” using concept mapping to engage communities as part of a health and human services needs assessment

Abstract Background This paper presents the findings of a rapid needs assessment conducted at the request of the local health authority responsible for health care services, the Toronto Central Local Health Integration Network (Ontario, Canada), to inform health and social service planning. Methods We utilized concept mapping methodology to facilitate engagement with diverse stakeholders–more than 300 community members and service providers–with a focus on hard to reach populations. Key informant interviews with service providers were used to augment findings. Results Participants identified 48 unique services or service approaches they believed would improve the health of residents in the area, including those addressing health care, mental health and addictions, youth, families, people experiencing homelessness, seniors, general social services, and services targeting specific populations. While service providers consistently identified a critical need for mental health and addiction services, community members placed greater importance on the social determinants of health including access to housing, job placement supports and training and service accessibility. Both groups agreed that services and programs for seniors and people experiencing homelessness would be highly important. Conclusion Our study provides a unique example of using concept mapping as a tool to aid a rapid service gap analysis and community engagement in a metropolitan area. The findings also reinforce the importance of working cross-sectorally, using a Health in All Policies approach when planning services for underserved populations

Barriers and facilitators to HIV testing among young men who have sex with men and transgender women in Kingston, Jamaica: A qualitative study

From publisher: Introduction: Young men who have sex with men (MSM) in Jamaica have the highest HIV prevalence in the Caribbean. There is little information about HIV among transgender women in Jamaica, who are also overrepresented in the Caribbean epidemic. HIV-related stigma is a barrier to HIV testing among Jamaica’s general population, yet little is known of MSM and transgender women’s HIV testing experiences in Jamaica. We explored perceived barriers and facilitators to HIV testing among young MSM and transgender women in Kingston, Jamaica. Methods: We implemented a community-based research project in collaboration with HIV and lesbian, gay, bisexual and transgender (LGBT) agencies in Kingston. We held two focus groups, one with young (aged 18–30 years) transgender women (n = 8) and one with young MSM (n = 10). We conducted 53 in-depth individual semi-structured interviews focused on HIV testing experiences with young MSM (n = 20), transgender women (n = 20), and community-based key informants (n = 13). We conducted thematic analysis to identify, analyze, and report themes. Results: Participant narratives revealed social-ecological barriers and facilitators to HIV testing. Barriers included healthcare provider mistreatment, confidentiality breaches, and HIV-related stigma: these spanned interpersonal, community and structural levels. Healthcare provider discrimination and judgment in HIV testing provision presented barriers to accessing HIV services (e.g. treatment), and resulted in participants hiding their sexual orientation and/or gender identity. Confidentiality concerns included: clinic physical arrangements that segregated HIV testing from other health services, fear that healthcare providers would publicly disclose their status, and concerns at LGBT-friendly clinics that peers would discover they were getting tested. HIV-related stigma contributed to fear of testing HIV-positive; this intersected with the stigma of HIV as a “gay” disease. Participants also anticipated healthcare provider mistreatment if they tested HIV positive. Participants identified individual (belief in benefits of knowing one’s HIV status), social (social support) and structural (accessible testing) factors that can increase HIV testing uptake. Conclusions: Findings suggest the need for policy and practice changes to enhance confidentiality and reduce discrimination in Jamaica. Interventions to challenge HIV-related and LGBT stigma in community and healthcare settings can enhance access to the HIV prevention cascade among MSM and transgender youth in Jamaica.We would like to thank the Canadian Institutes of Health Research for funding [grant id: 0000303157; fund: 495419; competition: 201209]