Antabe Roger, Konkor Irenius, McIntosh Martin, Lawson Erica, Husbands Winston, Wong Josephine, Arku Godwin, Luginaah Isaac
The Department of Geography, University of Western Ontario, Social Science Centre, 1151 Richmond Street, London, Ontario, N6A 5C2, Canada.
Regional HIV/AIDS Connections (RHAC), 30-186 King Street, London, Ontario, N6A 1C7, Canada.
BMC Public Health. 2021 Feb 8;21(1):315. doi: 10.1186/s12889-021-10321-x.
In Canada, heterosexual African, Caribbean, and Black (ACB) men's heightened risk of HIV infection has been linked to behavioral characteristics, including practices of hegemonic masculinity that discourage the use of HIV preventive services. However, this framing is bereft of the role of structural factors that may be contributing to new HIV infections. This paper examined the underlying factors limiting access to health services among heterosexual ACB men in London, Ontario Canada.
A convenient sampling technique was used to recruit thirty-seven (n = 37) self-identified heterosexual ACB men and service providers. Four focus groups (FG) were conducted; three with ACB participants of similar age category (i.e., 16-24; 25-38; 39+), and one with service providers. The FGs focused on the barriers to using health services and interrogated the ease of access to HIV intervention programs by ACB men respectively. Recurring themes from the FGs were probed further using in-depth interviews (n = 13). FGs and in-depth interviews complemented each other in reducing uneven power dynamics, fact checking, and allowing for detail discussion of the topic under study. Data analyses were done in NVivo using a mixed inductive-deductive thematic analyses approach.
Most ACB men lacked information on HIV and were unaware of their increased risk of infection. Contrary to the notion that behavioral characteristics keep ACB men away from health services, we found that most ACB men were unaware of the availability of these services. Those that had some knowledge about the services reported that they were not appropriately tailored to their needs. In addition, stereotypes and stigma about the etiology of HIV among Blacks, and systemic neglect served as significant barriers to ACB men's use of services.
The findings suggest that, to enhance preventive health service use among heterosexual ACB men, there is the need to remove structural barriers. Engaging ACB men in the design and implementation of policies may be useful at improving access to HIV information, testing, and treatment services. Increased information dissemination to ACB men would create awareness of the availability of HIV services. Finally, service providers should be conscious of ACB men's concern about experiences of discrimination and racism at service centers.
在加拿大，异性恋的非洲、加勒比和黑人（ACB）男性感染艾滋病毒的风险较高，这与行为特征有关，包括霸权男性气质的行为模式，这种行为模式不鼓励使用艾滋病毒预防服务。然而，这种框架没有考虑到可能导致新的艾滋病毒感染的结构因素的作用。本文研究了加拿大安大略省伦敦市异性恋ACB男性获得医疗服务受限的潜在因素。
采用便利抽样技术招募了三十七名（n = 37）自我认定的异性恋ACB男性和服务提供者。进行了四个焦点小组（FG）讨论；三个小组由年龄相仿的ACB参与者组成（即16 - 24岁；25 - 38岁；39岁及以上），一个小组由服务提供者组成。焦点小组讨论聚焦于使用医疗服务的障碍，并分别探讨了ACB男性获取艾滋病毒干预项目的难易程度。通过深入访谈（n = 13）进一步探究焦点小组讨论中反复出现的主题。焦点小组讨论和深入访谈在减少权力动态不均衡、核实事实以及允许对研究主题进行详细讨论方面相互补充。使用混合归纳 - 演绎主题分析方法在NVivo中进行数据分析。
大多数ACB男性缺乏关于艾滋病毒的信息，并且没有意识到自己感染风险的增加。与行为特征使ACB男性远离医疗服务的观念相反，我们发现大多数ACB男性并不知道这些服务的存在。那些对这些服务有一些了解的人表示，这些服务没有根据他们的需求进行适当调整。此外，对黑人中艾滋病毒病因的刻板印象和污名化，以及系统性忽视，成为ACB男性使用服务的重大障碍。
研究结果表明，为了提高异性恋ACB男性对预防性医疗服务的使用，有必要消除结构障碍。让ACB男性参与政策的设计和实施可能有助于改善他们获取艾滋病毒信息、检测和治疗服务的机会。增加向ACB男性传播信息将提高他们对艾滋病毒服务可获得性的认识。最后，服务提供者应该意识到ACB男性对服务中心歧视和种族主义经历的担忧。
