Multilevel Barriers to Access Health and HIV Care Among African, Caribbean, and Black Men and Youths in Ottawa, Ontario: A Qualitative Study

Abstract

Background: Ontario is home to the largest proportion of African, Caribbean, and Black (ACB) people living in Canada. This group isdisproportionately affected by the HIV pandemic. However, there is limited evidence on how multilevel barriersintersect and mutually reinforce each other to restrict access to health and HIV care. This paper examines multilevel barriers to access health and HIV carebased on the lived experiences of ACB people in Ottawa and Ontario. Method: We conducted community based qualitative study with selfidentified ACB men aged 16 and over, living in Ottawa. Our approach is informed by intersectionality theory and Socio-Ecological Model (SEM). A purposive sampling technique was used to recruit participants. We conducted six Focus Group Discussions and 16 In-depth Interviews. Sixty-three people participated in this study. N Vivo software was used for data management and thematic analysis. Results: Six major themes were identified including barriers to access health and HIV care among heterosexual ACB men in Ottawa and Ontario, which is the focus of this paper. This theme is discussed through three subthemes:( 1)individual level low economic, knowledge,and racial identity;(2) community-level lack of culturally responsive services, few community leaders and lack of neighbourhood resources;and (3) system-level embedded discriminatory policies and practices, anti-Black racism, and traumasand legacies of colonialism. Conclusion: Addressing health inequality and enhancing the accessibility and provision of healthcare for ACB populations in Ontario is critical for their health and well-being. An inter sectionality lens and SEM should be given priority to guide understanding of the causes of inequities and the complex ways multilevel barriers to access healthcare relates, intersects, and mutually reinforces one another. Multiple level strategies with strong emphasis at a systemic level, and culturally appropriate approaches are crucial to address barriers while enhancing collaboration among multilevel stakeholders including heterosexual ACB men’s and ACB organizations.