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A worrying trend

Ontario’s  Black  population  accounts  for  approximately  4%  of  the  total  provincial  population. However, among the estimated 27,420 people living with HIV in the province in 2009, 18.8% were ACB people infected through heterosexual contact.2    Men comprised a clear majority (60%) of the estimated number of ACB people living with HIV, though in recent years HIV has spread more rapidly among women—from 2004 to 2009, the estimated number of ACB women living with HIV increased by almost 80% (from 1,160 to 2,190 women), while the estimated number of men increased by 40% (from 2,190 to 3,075 men).  ACB men are also less likely than women to be diagnosed—in 2009, less than half (46.5%) of the estimated number of HIV-positive ACB men were diagnosed (the lowest proportion among all HIV-positive men), compared to almost two-thirds  (64.5%) of ACB women.3

Late diagnosis may result in poor health; also, HIV-positive people who are undiagnosed may be more likely to spread the virus than those who are diagnosed and receiving treatment.

 

Hope and struggle

With increasing demands on their agencies by the mid-1990s, ACB service providers began to strategize collectively about an appropriate response to HIV. Based on an epidemiological report that confirmed the  disproportionate effect  of HIV among ACB communities, the  initial group  of service

providers established the HIV Endemic Task Force (HETF) to develop a strategy on HIV for ACB communities in Ontario. The process to develop the strategy included research and consultation with community stakeholders, policy makers and researchers.  On completion of the Strategy in 2003, the expanded HETF emerged in 2005 as the African and Caribbean Council on HIV/AIDS in Ontario (ACCHO) to coordinate implementation, monitoring and renewal of the Strategy.4    Since 2005 the AIDS Bureau of Ontario’s Ministry of Health and Long-Term Care has been supporting the Strategy by funding ACCHO and a network of HIV prevention programs delivered through established AIDS service organizations (ASOs) in Ottawa, Durham Region, Toronto, Peel Region, Guelph, Kitchener, Waterloo, London and Windsor.

However, among ACB communities, the response to HIV from researchers, policy makers and community-based agencies has focussed mainly on gay and bisexual men, and women.  From a community-wide  perspective, it is important to acknowledge that (a) heterosexual contact is the leading mode of HIV transmission among ACB people in Ontario, (b) men comprise the majority of heterosexually-infected ACB people, and (c) heterosexual transmission of HIV can be halted only if prevention efforts include both men and women. In other words, HIV will continue to be a challenge for ACB communities if heterosexual men are not meaningfully engaged in the response, and if their needs, circumstances and priorities are not understood and addressed.  Indeed, one of the lessons from a recent study about HIV and health among women in Ontario (the Ontario Women’s Study) was that  “heterosexual men  need to be  more  aggressively targeted for HIV prevention.”5    That is, men and women share responsibility for halting the spread of HIV among ACB communities in Ontario.

 

iSpeak – cultivating hope, joining the struggle

The iSpeak research study, which is the basis of this report, was developed in response to the epidemiological, program and policy framework outlined above. The project was initially implemented in 2011, with the goal of engaging heterosexual Black men, service providers who work with ACB communities, and researchers in a dialogue to inform HIV research, programs and policy among ACB communities.  In particular, we wanted to understand the HIV-related needs, challenges and priorities of ACB heterosexual men, which would also help to assess their potential for greater involvement in organized responses to HIV among ACB communities.

The impetus  for  iSpeak originated  with  Africans in Partnership Against AIDS (APAA), a small community-based ASO in Toronto.  APAA is a founding member of ACCHO, and collaborates with the other ACCHO members and stakeholders to implement and monitor the strategy on HIV for ACB communities in Ontario.  In addition to APAA, the iSpeak partners included ACCHO, the AIDS Committee of Toronto (ACT), and the AIDS Bureau of the provincial Ministry of Health and Long-Term Care.  The partners also collaborated with the Regional HIV/AIDS Connection (RHAC) in London, Ontario.