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In this section, we discuss the main themes that emerged from our discussions with heterosexual (straight) Black men in Toronto and London, and illustrate the discussion with direct quotes from the participants.


Black men and heterosexuality

 

What it means to be heterosexual, or to be a heterosexual Black man


Focus group participants articulated their interpretation of ‘heterosexual’ and ‘heterosexual Black man’ in complex ways. On one level, they understood heterosexual men to have sexual relations (and accompanying emotional attachments) with women; for example, heterosexual Black man “means that as a black man, you are only attracted to a woman” (London). But some participants also understood ‘heterosexual’ in opposition to other forms of sexual relationships and sexual orientations, and demarcated a traditional or standard form of heterosexuality. For example, one Toronto participant identified heterosexual men as those who “eat from one plate” rather than trying to unreasonably “eat from different plates” (i.e., having sexual relationships with women and men).

In addition, they interpreted their heterosexuality in cultural terms—a traditional interpretation that they located in African culture, as opposed to new, emerging or different interpretations in ‘the west’.

“... over the years a lot of circumstances have arisen that the term heterosexual could move away from man and woman relationship to people who relate to men and also to women ... This is a new development. Having been in this part of the world for the past

20 years, I understand that culture has much to do in interpreting what it means. But there seems to be a clash and confusion of accepting what it actually means, practically, presently. But basically most men of African or Black background will look at it as man and woman.” (London)

If heterosexuality is understood differently in Africa than it is in Canada, then African men (or men of African descent from the Caribbean) may be ambivalent or uncertain about what it means for them to be (or to refer to themselves as) ‘heterosexual’ in Canada, or about whether the traditional “African” view of heterosexuality would be appreciated in contemporary Canada.

“... it means that relationship in the context with a female. But having said that, it is very broad; we’re talking about cultural diversity here and what those relationships look like, because theres many forms of relationships in that context again, between male and female ... So I think the question should also be, “what does it mean to me to be able to share my views or maintain that type of relationship in a world today?”, so its having that balance as well, with the understanding that others may not share that view.” (London)


Table 1. Heterosexual mens focus group participants: Toronto (N=7) and London (N=7)

(7 participants 50% were HIV-positive)

 

 

Number

%*

Place of birth

 

 

Africa

11

78.6

Caribbean

2

14.3

Other

1

7.1

Age

 

 

<30 years old

1

7.1

30-39

3

21.4

40-49

4

28.6

50 or older

6

42.9

Length of residence in Canada**

 

 

<3 years

2

20.0

3-5 years

1

10.0

>5 years

7

70.0

Annual income

 

 

<$20,000

10

71.4

$20,000-29,000

3

21.4

$30,000-39,000

1

7.1

Employment status

 

 

unemployed

3

21.4

working part time

2

14.3

working full time

2

14.3

self employed

2

14.3

student

2

14.3

on disability

3

21.4

Marital status

 

 

married/common law

8

57.1

single

2

14.3

divorced/separated

4

28.6

Highest level of education

 

 

less than high school

1

7.1

completed high school

2

14.3

some university or college

6

42.9

completed university or college

5

35.7

Parent***

 

 

yes

11

78.6

no

3

21.4

 

 

*percentages for each measure/variable add to 100; **only 10 participants responded to this question;

*** “yes” and “no” are the number (and percent) who reported having or not having children.


Women in the lives of heterosexual Black men

Participants’ sexual exclusivity with women defines them as heterosexual men:

“... a black man attracted to a black woman, emotionally and physically. Thats my own understanding.” (Toronto)

“... I think we’ll interpret the same as we do in Africa. Its a sexual relation between men and woman. Thats it. It is heterosexual or straight man.” (London)

Participants who were living with HIV also understood women as a source of support, appreciated women for their efforts to care for and support their men, and appeared to be more comfortable sharing some types of information with their female partner than with their doctor:

“For me the source of health like the people I can disclose to including my peers is my partner who is a woman. She is very supportive ... even if its a simple cold, you know, I talk to her. I tell her this, although honestly I dont usually go to a doctor for headaches or colds yet for her she does. But I can tell her and she will say You know what? Here is some Tylenol’ or You know, drink some juice. You didnt sleep enough.’ So shes a major support. But also when it is my appointment with a doctor I tell them ... I have limits with the doctor.” (Toronto)

Among men, womens involvement or interest in supporting their men could also be reified or naturalized as a feminine quality; that is, women are naturally pre-disposed to care-giving, and care- giving is synonymous with womanhood.

Your woman partner could be very supportive and definitely she knows your status and all this. She could be very, very supportive and you are free to her. You can talk to her openly, and tell her everything, how you are feeling. She knows when you are very low and when you are in your normal self. You know women, I like to tell this to those who have sex with those like them, women are very understanding people. We all know that. When you want to be treated like a baby, she will treat you like a baby. And she knows exactly when to treat you like a baby.” (Toronto)

However, in the sphere of service provision and access to HIV-related services, Black men may find themselves in competition with (or in opposition to) Black women (and gay men). In other words, in the response to HIV from service providers, policy makers and even people living with HIV (PHAs), some iSpeak participants claimed to be disadvantaged precisely because they are Black, male and heterosexual:

“The services for straight men are very limited, very limited. And to me its annoying. We’re not saying that gay men shouldnt have services but have a balance. In the city, if its not white gay men, its women of colour, like you said there is special attention to woman or white gay folks and we are left trapped there in the middle.” (Toronto)


Health and access to services

Being healthy

Participants generally understood ‘health’ or ‘being healthy’ holistically:

“For me, healthy means generally to be healthy mentally, physically, spiritually and so on, everything healthy. As a person, you should be healthy.” (London)

However, some participants interpreted health and being healthy in broader but also more everyday terms, such as the characteristics or effect of ones neighbourhood, and the need to be happy:

“Like for me I live in Scarborough but I used to live at [neighbourhood] which is known to be kind of a crime area. Honestly, I dont think my mental health was okay in [neighbourhood]. I lost three bikes. And, I got better when I moved to Scarborough because, you know, the neighbourhood is fairly okay. You know you greet neighbours. So my mental health is okay. So I can get on the TTC even if its one hour to downtown, but my health is okay on top of, you know, going to see my doctor when appointment is there.” (Toronto)

You have to be very happy for you to be healthy. Because I believe that happiness plays a very big role in your mental health. Being happy.” (Toronto)

Participants who were living with HIV tended to interpret health and being healthy through the prism of HIV. Therefore, health and being healthy included going to the doctor, taking ones prescribed medications, regulating diet and exercise, and even regulating personal relationships as well.

“For me to be healthy is first, as he has said, to take my medication, to get enough appetite,

to eat enough and if possible to do some exercise outside, run or whatever.” (Toronto)

You are taking your drugs to put it back in time; you level up your systems a bit more ... You’re controlling it. But you cannot control it if you turn women at that corner and that corner then you cannot be healthy.” (Toronto)

Access to services

Participants in both Toronto and London acknowledged the availability of services that heterosexual Black men may access. Services may be accessible because some service providers make a conscientious effort to reach and engage service users.

“The other thing I wanted to mention is that there are some support workers at AIDS service organizations who treat you ... as if you are normal. And despite the fact that maybe you arrived five, ten minutes late and your appointment is only 30 minutes, they can go on for at least 45 minutes to an hour. And it shows that they care. They are connected with other services from legal, settlement, housing. I find that to be very, very good and informative. Some AIDS service organizations, not all.” (Toronto)

Nonetheless, sometimes Black communities may not have up-to-date information about available services.


“What I know is that service is available if you require it, and it has been for quite some time. So it is up to us. The opportunity to get tested is there if we want. One of the problems with our community is that we dont read anything, some of us ... So we cant blame other people; it has to be us. Its hard to mobilize the community but as far as it goes I see service is available and its how we fan out from here.” (London)

The above comments notwithstanding, focus group participants (particularly those living with HIV) were generally concerned that services were not sufficiently available or accessible to heterosexual Black men. They spoke of a lack of cultural competency which persists because of institutional racism.

“The first time that I moved to London, I went to visit, to see a doctor. You know black skin gets dry, especially in winter time, so if you dont use cream or something its dry. The doctor just took my hand because I was scratching and said “you must have cancer, skin cancer”. I was really I asked him, “Doctor how do you know I have cancer?” I think my question just touched him and he stopped That is just to show you how I am disappointed with services that I have received as a Black man here in London.” (London)

Participants who were HIV-positive remarked on the sense of exclusion and marginalization that they experienced in the realm of HIV service provision, which they attributed to a peculiar intersection of race, gender and sexual orientation, and a general belief that heterosexual Black men are socially advantaged because of their heterosexuality.

“A couple of years ago I worked in [neighbourhood]. I was doing HIV/AIDS work for an organization. And, I saw a huge gap because [neighbourhood] is one of the priority neighbourhoods but the few services that were there for youth HIV and AIDS services were for gay and bi youth of colour. So I asked, okay, this one caters for gay or bi youth of colour, how about services that are for straight youth of colour? There was nothing. I think the organizations not only in the city even outside like in [inner suburbs] there is a huge gap, huge gap for HIV services for Black straight men. I dont know what the reasons are… but one reason is systemic racism, because honestly if you count even the Black organizations we know… some still dont have services that cater for Black straight men, they are very limited.” (Toronto)

“All I got was being shut off in the cell phone (speaker banging the table for emphasis); and I never went there, I never went there again. I lost. But look at the girls, the way they get things here. Look at the gays they press any button. The gays they press any button. They win. I’m sorry to say that. Lets forget about it. Its very pathetic. Its paining, its really, really paining us. We dont get the resources we ought to. It should be 50/50 to everyone. We are falling under the same umbrella. Why the lie? Why the lie? Why the lie?” (Toronto)

These concerns precipitated talk about whether HIV-positive heterosexual Black men were “endangered” persons, based on their marginalization related to service provision combined with the growing threat of criminal prosecution for non-disclosure of HIV status to sexual partners.

We are being accused [referring to criminal prosecution] of spreading HIV. So when I say that the straight black man is an endangered person I mean exactly what I am saying, with a lot of bitterness.” (Toronto)


Privacy, secrecy and access to health information

Many participants spoke about discussing their health with immediate family (e.g., wives) and trusted

friends, and understood this as beneficial to their wellbeing.

“I feel very, very comfortable to discuss about health with my family, children and other people. Because sometimes like with checkups with physicians, Africans have many diseases like diabetes, high blood pressure; or sometimes we have diseases but we dont know. If we discuss with other people from back home, I have to check maybe unfortunately I may have this disease. For me its very important for me to discuss my health with another person.” (London)

They also noted, however, that African/Black men are reticent to discuss health issues, and were perhaps secretive about their personal health concerns or challenges (which is also generally attributed to men of various nationalities and cultures). Participants invoked reticence and secrecy about health as something located in African and diasporic cultures, and as something that helps to define manhood. Yet, they acknowledged that secrecy was a protection against gossip.

“Another problem for Black men, they show too much pride to find information ... Many times, if I have a problem I would say, I’m OK. Three months later, the guy died or feels really badly in the hospital. If you dont want to talk about things with people from the same community, you can’ find a physician or a person who has the ability to give you information, there is many, many services. The problem is finding it.” (London)

“But there are tendencies in African communities to hide issues because it is part of the way people like to gossip about others in our cultures. There is a need for us to be advised in this. So it would be nice if we had professional people who are qualified and trained and have experiences, who we can trust. We need to approach them so we can know because you cant sit down with disease in your body for years; it’ll kill you in the end.” (London)

On balance, participants recognized the harm that could result from secrecy, such as illness that could be avoided or prevented, the complications due to late diagnosis, and even death:

“My problem is sometimes I saw many, many guys from my community die, or went to the hospital late, because they did not see the physician to tell about their disease. Maybe because they feel like shy about their reputation. You know, you feel reserved. And then if they feel like very, very sick, no other choice or possibility, they have to go see the physician, but its late.” (London)

Focus group participants who were living with HIV appeared much more guarded and selective about discussing their health with others, due to the stigma and discrimination that could result from disclosing to others that they were HIV-positive.

“In most cases, we have difficulty to discuss it with our friends because you dont want to expose so much to someone whos not gonna help you. Thats why we chose to go to specialist or go your dietician, someone from medical field who gonna help you, advise you how to eat healthy and she or he is gonna keep you up confidentially. Because once I started disclosing to my friend, sometimes in a bar or in a party, they start running away from me.” (Toronto)


Participants also drew attention to various systemic barriers that affected Black peoples access to information about HIV and health. While acknowledging the barriers that may reinforce secrecy about health, some participants suggested that its in Black peoples interest to access appropriate information, and develop an infrastructure to ensure access.

“But when I talk generally about HIV and Black people in Canada ... we dont want to talk openly, we dont want to get open information Any barriers in getting information about HIV in Canada? There is no barrier, but my understanding is that White people say HIV is with Black people. So, even this is an obstacle towards getting information. If they dont have HIV, White people dont care about it. So how can I ask them for information. Its for me, a Black man. So I keep it a secret, I cant talk openly, thats a barrier for me.” (London)

“I think HIV remains an underground issue because its affecting Blacks. Because we have no megaphone, no media outlets, nothing ... Nobodys in a huge rush to provide us with information. Plus when we do have HIV, we dont reach out for information. If theres no demand for it, if its only affecting a minority group, then why would they ever do anything about it?” (London)

Given the rising population of Francophone Africans in southern and southwestern Ontario, the lack of resources in French was also cited as a barrier. As one participant in London stated, “my first barrier is the language barrier.” Still, focus group participants offered a few low-cost, straightforward suggestions for improving access to health information among ACB communities. One participant in London mentioned volunteering as a way to “keep[ing] current”. Another mentioned using the Internet as a way to start engaging relevant information about health and HIV.

However, as we shall explore in the next section, HIV-positive participants developed their own networks of support where they could freely discuss issues and exchange information related to their health and wellbeing.

Men supporting men

The participants in one focus group were affiliated with a loosely structured network of HIV-positive men supported by an ASO. The men met from time to time but, unlike a formal support group, they were free to participate in meetings without necessarily committing to a strict regime of attendance. The camaraderie among group members was recognized as a source of strength.

“For me I dont find it an issue, discussing HIV with any of my peers. Whether its men or women or they are mixed, I get a lot of strength from them and I think everybody in this group discuss HIV openly. We have a society of our own, very close knit society where we know each other ... But I find myself very, very comfortable because even when we started meetings as a group of men, as straight men when we sit down we discuss all these kinds of issues. We share jokes. We tell each other, You look as if you’re going to expire”, these kinds of jokes (laughter). We are very free with each other. This kind of support, the support that we give each other is very, very therapeutic. I dont think this kind of support you get from this kind of a group you can get it from any doctor.” (Toronto)

The equanimity among the group meant that serious issues pertaining to members’ health could be

discussed in a way that inspired confidence and hope, and promoted health.


“If I need a doctor, we discuss ‘oh you dont have a doctor, go to this doctor’ ‘oh we went

to this one, No, lets try this one’, ‘this one definitely.’ And even the resources that we get

‘this resource is no good. Try this one. We go to it. Lets try this one’. You go to it. We all need to back each other up ... You come in here sad but you move out laughing ... As for me I come here sick and I move out happy ... And I win all the time.” (Toronto).

Getting heterosexual Black men more involved in HIV issues

Focus group participants offered their perspectives on how Black communities, heterosexual men in particular, may become more involved in the response to HIV and be better served by the organized response among service providers and policy makers. Their varied actions and strategies for inserting heterosexual Black men into programs, policy and research were premised on the requirement that those actions and strategies should be championed by an alliance of stakeholders, with PHAs playing a leadership role. For example, advocating for policy that is informed by research would mean that “we work as a team, the researchers, academics and us straight Black men ... to increase the services for folks who are like us” (Toronto). But “the voices of PHAs on these boards [of directors or trustees] should be key to telling the organizations that straight Black men matter” (Toronto). In London, one participant suggested an advocacy effort focussed on Local Health Integration Networks (LHIN) as a way of trying to ensure that programs were appropriately funded.

Participants identified various ways of mobilizing PHAs and Black men more generally as a force to press for change. For example, participants in Toronto mentioned mass demonstrations or rallies, organizing a Pride-like event for Black and/or heterosexual people, and writing letters to the appropriate government ministries. In London, one participant used the idea of the focus group to speak about organizing meetings and forums to share experiences and ideas that can be passed on to “service-givers”. As one participant in London stated, “No information, no good community, no good family.”

In London, participants spoke at some length about the importance of mobilizing ACB communities though infrastructures that may already exist.

Well, I am familiar with the organization here; even when they are doing their BLACCH [Black African and Caribbean Canadian Health] study, the health research. They should try to come up with a good testing program that will go to the community through the community organizations and the churches, not just making it a government program, but that we’ll be able to speak to the community leaders so people can come voluntarily and come and get tested. That is the only way.” (London)

“... the government has already taken a preventative approach; its already in place. What we need to do [with] the information already provided is how we’re able to take that to the community to mobilize them to participate ... So again its to tap into all these organizations and structures that they already have and have them develop the outreach pieces and its how we communicate that to the rest of the community and how we mobilize them.” (London)


However, some London participants cautioned that community engagement efforts must be sensitive to the circumstances of the communities in question. One participant framed this perspective as looking for the “least intrusive way”.

“I am looking at our community, we are looking at the hiding. Thats a barrier right there. People say things like, “we dont have that [HIV], just those folks have that”. So how do you get that to them in the least intrusive way? I am not being critical but culture sensitive. But I am talking about the least intrusive route to effect change.” (London)

Though community engagement efforts should be sensitive to the respective communities, how those efforts may be designed or implemented depends on their purpose. For example, one London participant advised that condom distribution is very important in ACB communities because “some people cannot afford condoms”. However, another participant located the promotion of condoms within a wider process of community engagement.

We’re talking about the issue of culture and community because in Africa we respect the elders. There are some words that you cannot go to an older person and tell him or her. Its not that its not important, its because that is the culture. Will I go out and ask people to put condoms? I am not against it but I will not distribute them. I would rather educate the people about the importance of not having unprotected sex ... I would be willing to get the conversation, the committees, get to know who they are and whos in charge and what are the problems, so you can promote and educate them about the scourge of AIDS; why it happens, how it happens, and not necessarily only saying “here, take condoms”. (London)