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REFLECTION, IMPLICATIONS, ACTION Print

 

 

We have demonstrated that, to a notable degree, heterosexual Black men may not conform to familiar renditions of Black masculinity.   For example, Black men care about their health and wellbeing, and the wellbeing of their communities.   Black men do engage their vulnerability in meaningful ways.  However, Black men are complex, in that they also attempt to resolve their vulnerability in ways that are unproductive.  For example, though our participants spoke at length about how they engage their spouses and partners about their health, they sometimes appear to naturalize women as caregivers. The Black men who participated in our focus groups also do not have access to the resources that are more broadly available to White men, and which allow certain classes of White men to engage their vulnerabilities in ways that are socially approved, even if destructive.   And, though many focus group participants understood ‘heterosexual’ in a very conventional way, others articulated the complexity associated with this identity or orientation.

The implications of iSpeak may be far-reaching, but we offer a few fairly practical ideas on the next steps.

Though our participants spoke approvingly about the health-related services that are generally available, they also harbour deep reservations about the ability and willingness of service providers to productively engage them.   This raises a few questions: to what extent do their reservations influence   their  willingness  to  engage community-based health  agencies and  service providers? To what  extent do  their  reservations influence  their  health  behaviours?  How should community- based health agencies and service providers (particularly ASOs) address Black men’s reservations? These questions may be research issues. However, the third question could be the subject of an intervention.   For example, on the basis of consultations with Black men and other relevant stakeholders  throughout  Ontario,  ACCHO or  another  competent  organization  may  (a) identify and  prioritize specific outreach or engagement initiatives,  (b) undertake the  required feasibility assessments, and (c) design, implement and evaluate the preferred initiative as an intervention among heterosexual Black men in the province.  In addition, respective ASOs may engage advisory committees of stakeholders (including Black men, and structured to ensure that heterosexual men’s voices are not overwhelmed) in reviewing their program descriptions, promotional materials, board recruitment practices and board composition  to determine whether those crucial aspects of the organization may be facilitating or impeding accessibility and, where necessary, recommend specific improvements.

There is also a rhetoric of blame that circulates among many community stakeholders, which holds that men are to blame for HIV among Black communities while women are disempowered victims of men’s bad  behaviour.  This oversimplified perspective  is an injustice  to Black men  and  women. What may be required among researchers and  service providers is critical reflection  on gender and sexism which strengthens women’s agency while also recognizing men’s legitimate claims for better access to various services.

Heterosexual Black men who participated in iSpeak are concerned about the wellbeing of Black communities, and are willing to be more involved in the community response to HIV. Some service providers suggested that Black men ought to be encouraged to demonstrate leadership in the response to HIV. This is an interesting suggestion.  Currently, throughout Ontario there are 12 ACB Strategy Workers (i.e., positions in ASOs funded by the AIDS Bureau, Ministry of Health and Long- Term Care, to work on HIV prevention or support with local ACB communities), only two of whom are men.  Hence, it is possible that Black men’s needs, challenges and potential may not receive a level of attention that compares well with other ACB groups or issues.  We are suggesting that the Strategy Workers  may benefit  from recruiting  and  supporting men  to advise and  assist in engaging their counterparts around HIV prevention.

HIV-positive Black men are concerned by the tide of criminal prosecutions for non-disclosure of HIV status to sexual partners, and the likely over-representation of Black men in media renditions of non-disclosure charges.  This issue was raised by one participant in the Toronto focus group. Media reports may help to fuel the more long-standing inhospitable view that Black men are out of control, and destroying themselves and Black communities.  This situation raises a few questions that may be explored in new research: How does the climate of criminal prosecution affect the lives of Black men?  What impact does the climate of criminal prosecution, and the way in which cases are reported in the media, have on Black men’s behaviours related to HIV?

From a program development and advocacy perspective, it is important for organizations to maintain or even strengthen current efforts to ensure a measured and nuanced application of criminal prosecution by criminal justice authorities. However, many PHAs still struggle with disclosure in a variety of different contexts. There are also strategic considerations about how and where people disclose aspects of their background—disclosing  anything about oneself depends on what’s at stake. Certainly, organizations should give serious thought to developing programs and interventions that build people’s ability, confidence and consciousness to assess how, when,  where  and to whom to disclose their HIV status.

iSpeak is perhaps the fourth study in which new immigrants from Africa claimed to be initially unaware of HIV in Canada, or bemoaned the lack of public acknowledgement and discourse about HIV in Canada.20   Throughout much of sub-Sahara Africa and the Caribbean, people are exposed to various ongoing health promotion  and social marketing campaigns about HIV prevention.   In Canada, however, there is relatively little public discussion of HIV, and campaigns tend to be restricted to a few neighbourhoods and agencies.  This means that new immigrants may not be sufficiently cognisant of their personal stake in HIV prevention as would have  been the case in their home countries.  In response, ACCHO, together with its community partners, related agencies, and provincial and municipal health authorities may develop a resource to apprise newcomers about HIV trends and HIV risk in Ontario, and provide an annotated list of immigration, settlement and health agencies where newcomers could access HIV-related services or receive more information.  This resource could be made available to its intended audiences as part of the immigration and settlement process, but also through physicians’ offices,  ASOs and other community-based agencies. It would help to engage new immigrants about HIV in Ontario, promote HIV prevention, and help to improve access to appropriate information and services.

A related issue concerns HIV transmission in Canada among African and Caribbean people. Despite popular opinion that immigrants from so-called HIV-endemic countries in Africa and the Caribbean are bringing HIV to Canada, there have been no studies to examine transmission in Canada versus prior infection in Africa or the Caribbean and, for those infected after arrival in Canada, the main drivers of transmission. This new research will not only address an important gap in the knowledge base about HIV transmission, but may also inform new perspectives on HIV prevention among African and Caribbean people in Ontario.

iSpeak participants articulated their interest in and potential for greater involvement in community responses to HIV in Ontario.   They also spoke about the relative lack of attention from service providing institutions.   All groups of participants (heterosexual Black men, service providers and researchers) indicated  that  issues related to  Black  men’s  health and wellbeing  are somewhat overlooked.   This situation calls for renewed community engagement and research efforts related to health and HIV.  Though the iSpeak research study was principally concerned with HIV, efforts to engage communities in the response to HIV are not just about HIV.  There is a broader health imperative at stake, which situates health and wellbeing in relation to the social determinants of health,  and  supports community action  that  is informed  by critical reflection  on their vulnerabilities and their strengths.21 It is also worth remembering that stigma associated with HIV is still pervasive. Consequently, from a community engagement perspective, it is prudent to address HIV in the context of health and wellbeing, rather than as an isolated condition that ails Black communities.

In the spirit of thinking anew about what we claim to know, we hope that iSpeak may be a platform for the emergence of new, informed perspectives on sex, sexuality, and masculinity related to Black men, how we (communities, service providers  and researchers) understand the spread of HIV among Black communities in Canada, and how to mount an appropriately informed response to HIV. Traditionally, African and Caribbean peoples have been reluctant to entertain meaningful, public discourses on sex and sexuality. Since  slavery,  this silence has  been filled by prejudiced discourses on Black men’s alleged hypersexuality and destructive masculinity.  These peculiar discourses have even been taken up by Black communities—some Black men understand themselves as “saga boys” and “players”, while Black women lament  their men’s abundant irresponsibility. But why would Black men join a movement or avail themselves of services in an environment where they are considered suspect and blameworthy?  Whose interests are served by the one-dimensional identity of the wild Black man versus the suffering, aggrieved Black woman? How we answer these questions may well shape how we emerge from the HIV epidemic.

iSpeak was never intended to answer all the questions related to heterosexual Black men and HIV.  In this  regard the  project appears to have  fulfilled its promise by: (a) challenging us  and  our colleagues to re-evaluate what we think we know about Black men, and to think creatively about Black men in relation to health and HIV; (b) engaging heterosexual Black men and listening to their stories and perspectives on HIV and health; (c) showing that  Black men are more caricatured than understood in Canadian society; (d) pointing to the need to strengthen research on health and wellbeing among Black communities (particularly among Black men), and perspectives to guide that work; and (e) identifying opportunities to strengthen heterosexual Black men’s involvement in community responses to HIV, and build the knowledge base to inform those efforts.