Background: African, Caribbean, and Black (ACB) populations in Canada face significant systemic and socio-cultural barriers to HIV prevention and pre-exposure prophylaxis (PrEP) uptake. This systematic review synthesizes the barriers and facilitators identified in research on HIV prevention and PrEP among ACB communities to highlight intersecting challenges and areas for targeted intervention.
Methods: After conducting a comprehensive search across Medline, EMBASE, SCOPUS, CINAHL Plus, PsychINFO, and Google Scholar, 12 peer-reviewed studies published between 2007 and 2022 met the inclusion criteria and were analyzed thematically. Seven studies focused on HIV prevention, while five investigated PrEP adoption. Key dimensions analyzed included barriers and facilitators, with data further categorized to explore overlaps and distinctions in proposed solutions for HIV prevention versus PrEP uptake.
Results: Systemic barriers included structural violence, racism, economic marginalization, and provider biases, with both HIV prevention and PrEP studies highlighting the inequities embedded within healthcare systems. Stigma—rooted in homophobia, cultural norms, and religious beliefs—was a pervasive barrier, limiting access to both prevention and PrEP. Provider gaps such as insufficient cultural competency and inadequate engagement with ACB communities further compounded these challenges. Facilitators common to both areas included community-driven interventions, culturally relevant education, and peer-led programs. However, PrEP-specific barriers, including cost and provider neglect, highlighted the need for broader structural interventions such as subsidized programs and integrated care models. Youth-targeted campaigns emerged as critical across both domains, emphasizing the need for tailored outreach to address stigma and support risk reduction.
Conclusion: This comparative analysis demonstrates significant overlap in the barriers to HIV prevention and PrEP uptake, underscoring the need for integrated, culturally responsive interventions. Structural reforms, community engagement, and targeted education are critical for reducing health disparities. Nationally representative data, particularly from provinces beyond Ontario, is essential to inform equitable and evidence-based health policy for ACB populations across Canada.

Background: Consistent engagement in HIV care is essential for achieving viral suppression and improving health outcomes. Medication adherence, a key step in the HIV care continuum, is often disrupted by individual, systemic, and structural barriers. African, Caribbean, and Black (ACB) women living with HIV (WLWH) in Canada face unique challenges, including stigma, discrimination, socio-economic disparities, and mental health issues, such as depression and anxiety, which further impede adherence. This study examines the relationships between psychosocial vulnerabilities, mental health, and access to women-centered HIV/AIDS support services (WHSS).
Methods: A mixed-methods approach was employed, combining quantitative data from 415 participants in the Canadian HIV Women's Sexual and Reproductive Health Cohort Study (CHIWOS) and qualitative insights from 58 semi-structured interviews. Recruitment used purposive and snowball sampling, with data collection including demographic information and participant experiences with healthcare services. Quantitative analysis identified trends and relationships, while thematic content analysis explored barriers, facilitators, and policy recommendations.
Results: The ART adherence rate was 90% or more among 74.35% of participants, indicating successful HIV management. The study revealed significant links between psychosocial vulnerabilities and adherence to WHSS. Quantitative findings showed protective factors positively impacted adherence, while risk factors and depression had negative effects. Qualitative data identified systemic barriers, including geographic challenges, discrimination, and mental health concerns, affecting access to medication and services. Participants highlighted the value of personalized care, reliable healthcare systems, and supportive group environments, emphasizing the need for tailored interventions and policy changes to improve accessibility and mental well-being.
Conclusion: This research highlights the urgent need to address systemic barriers, stigma, and mental health challenges to improve medication adherence among ACB WLWH. Trauma-informed care, culturally sensitive interventions, robust community support, and policy reforms, including telehealth innovations, are critical for ensuring equitable access and better health outcomes for ACB women navigating the HIV care continuum.

In Ontario, new HIV diagnoses continue to remain highest among individuals who identify as gay, bisexual, or men who have sex with men (GBM), as well as persons of African, Caribbean, or Black (ACB) ethnicities. To address the disproportionate impact which HIV has on these sub-populations, and to encourage greater rates of HIV testing and, consequently, greater rates of HIV care, GetaKit, an internet-based service allowing for individuals to acquire a free HIV self-test (HIVST) partnered with the Black Coalition for AIDS Prevention (BlackCAP), an AIDS service organization in Toronto, Ontario, to provide tailored, culturally relevant, access to HIVST. As part of a larger mixed methods study, this work builds upon the quantitative data we have already published upon with the aim to explain the testing behaviors of ACB GBM. Using a focus group of nine individuals recruited from BlackCAP, this study further supports what is already known about HIVSTs and culturally sensitive public health interventions to empower and support community resiliency and liberation. However, the findings also demonstrate that there exist several issues which threaten to undermine the fecundity of HIVST as a resiliency building tool for ACB GBM, including the population’s concerns around trust, privacy, and the misaligned, at times apotropaic, beliefs around the test itself. To address these potential pitfalls, we call for a greater commitment to culturally relevant care and a renewed effort regarding programming aimed at addressing the sexual health literacy of ACB GBM.

Introduction: Black and Indigenous men in Canada experience a disproportionate burden of new HIV infections. PrEP is effective in preventing new HIV infections; however, there are barriers to awareness and uptake of PrEP in key populations. The purpose of this study was to understand racial differences in PrEP awareness and uptake among White, Black and Indigenous men in Canada.

Methods: We performed secondary analysis (n=4,294) of cross-sectional data from the I’m Ready national HIV self-testing program collected from June 2021 to December 2023. Prior to receiving a free HIV self-test, participants filled in a pretest survey asking about sociodemographic characteristics and PrEP awareness and uptake. Binary logistic regression was used to assess racial differences in PrEP awareness and uptake.

Results: Out of those who were PrEP eligible, 62% of participants were aware of PrEP and out of those who were aware, 19% had ever received PrEP. For race, participants identified mostly as White (56%), Black (36%), and Indigenous (8%). Black participants who identified as gbMSM, aged 18-45, living in urban or rural areas, and who were PrEP-eligible were all less likely to be aware of PrEP than the White reference group (OR=0.27-0.41, p<0.05). Indigenous participants aged 18-45, living in rural communities, and who were PrEP-eligible were also less likely to be aware of PrEP (OR=0.15-0.62, p<0.05). For PrEP uptake, Black participants aged 18-45, living in rural communities, and who were PrEP-eligible were less likely to be on PrEP than White participants (OR=0.44-0.62, p<0.05). Lastly, Indigenous men living in urban areas were more likely to be on PrEP White participants (OR=1.65, p<0.05).

Conclusion: Black and Indigenous communities in Canada experience significant racial differences in PrEP awareness and uptake. To maximize the potential benefits of PrEP for HIV prevention, more equitable PrEP access and a national PrEP strategy is urgently needed.

Background

HIV disparities persist among African, Caribbean, and Black (ACB) women in Canada, exacerbated by systemic racism, stigma, and inadequate access to culturally responsive healthcare services (Etowa et al., 2022). Despite a dramatic increase in national Pre-exposure Prophylaxis (PrEP) use, which rose 21-fold from 460 to 9,657 users between 2014 and 2018 (Public Health Agency of Canada, 2023), women remain underrepresented in PrEP uptake. Women account for only 2% of PrEP users in Canada (Public Health Agency of Canada, 2023). This disparity is particularly concerning, given that ACB women represent 26.4% of new HIV diagnoses in Canada (Public Health Agency of Canada, 2022).

Methods

We employed a qualitative approach, using focus group discussions as our data collection tool. Two focus groups were conducted with a diverse group of ACB women, trans and non-binary individuals from the Greater Toronto Area (GTA). Participants were recruited through collaborative efforts with organizations that serve the target population. Eligibility criteria included identifying as African, Caribbean, or Black, being a woman (cis and trans), non-binary or gender non-conforming, living in the GTA, and being at least 16 years of age.

Results

We gathered nuanced, contextual data that helped understand complex factors influencing ACB women and community members' decisions about PrEP uptake. Barriers to PrEP uptake included lack of awareness and knowledge of PrEP, affordability, and provider confidence. Facilitators to PrEP uptake included visibility, choice, and developing culturally sensitive awareness-raising campaigns.

Conclusion

ACB women and community members need equitable access to HIV biomedical prevention strategies that account for their unique needs and experiences. The focus group discussions highlighted the importance of developing culturally tailored PrEP interventions. Building an accessible and sustainable PrEP intervention empowers women and individuals in making informed choices and has the potential to reduce the disproportionate impact of HIV in ACB communities in Canada.