Taking Action On HIV And AIDS In Black Communities In
Taking Action onHIV and AIDS inBlack Communitiesin Canada:A Resource for Moving AheadDA Falconer & Associates Inc.March 2008
Cataloguing in Publication ProgramTaking Action on HIV and AIDS in Black Communities in Canada:A Resource for Moving AheadText in EnglishISBN 978-0-9736976-3-61. DA Falconer & Associates Inc.2. HIV/AIDS-Black Communities-Canada-Resource.3. Interagency Coalition on AIDS and Development (ICAD).4. Title.Published by Interagency Coalition on AIDS and Development (ICAD)1 Nicholas Street, Suite 726Ottawa, ON K1N 7B7www.icad-cisd.comTranslation: Jean DussaultDesign: Frantz Brent-HarrisAll rights reserved.
Table of ional Steering CommitteeInformation Gathering GuideInformation Gathering MethodsStakeholder Participation22223.0Vancouver and British Columbia33.13.23.33.4DemographicsHIV and AIDS StatisticsKey Findings – VancouverTaking Action – Vancouver34454.0Calgary and Alberta64.14.24.34.4DemographicsHIV and AIDS StatisticsKey Findings – CalgaryTaking Action – Calgary67785.0Toronto, Ottawa and Ontario95.15.25.35.4DemographicsHIV and AIDS StatisticsKey Findings – Toronto & OttawaTaking Action – Toronto & Ottawa91010116.0Montréal and Québec136.16.26.36.4DemographicsHIV and AIDS StatisticsKey Findings – MontréalTaking Action – Montréal131414157.0Halifax and Nova Scotia177.17.27.37.4DemographicsHIV and AIDS StatisticsKey Findings – HalifaxTaking Action – Halifax171818198.0National Level208.18.28.3HIV and AIDS StatisticsKey Findings – NationalTaking Action – National2020219.0 Conclusion10.0 Summary of Suggested Actions –Municipal, Provincial and National LevelsAppendix A: National Steering Committee Termsof ReferenceAppendix B: Interview/ Focus Group QuestionsAppendix C: Interview ParticipantsAppendix D: Greater Involvement of People Living withHIV or Affected by HIV/AIDS (GIPA)Appendix E: References22232526282939
Taking Action on HIV and AIDS inBlack Communities in Canada:A Resource for Moving Ahead1.0 IntroductionHIV is at a crisis level in Black1 communities in Canada. Black people are over-representedin the number of new HIV infections and AIDS cases. In 2001, Black people represented2.2% of the Canadian population. In 2005, the Public Health Agency of Canada estimatedthe HIV infection rate among Black people to be at least 12.6 times higher than among otherCanadians.2 For 2006, Black people accounted for 12.9% of the positive HIV test reportsand 11.1% of the reported AIDS cases where ethnicity was known.3 While these numbersare significant in and of themselves, they are most likely understated due to factors such asunderreporting and a lack of ethnicity data.4The disproportionate number of Black people living with HIV and AIDS combined with anincreasing number of Black people presenting for services at AIDS service organizations(ASOs) across the country prompted action in 2005. The Springboarding a National HIV/AIDSStrategy for Black Canadian, African and Caribbean Communities project was implementedwith the objective of conducting preliminary research that would contribute to the developmentof a national HIV/AIDS strategy for Black Canadian, African and Caribbean communities.5This Phase I resulted in an environmental scan report6 and a consultation on a draft strategyframework and principles. A first of its kind in Canada, the environmental scan reportprovides: a snapshot of current programmatic and research activities and initiatives addressingHIV/AIDS and related issues in Black communities; statistical and demographic information on HIV/AIDS and Black people in Canada; an annotated listing of various reports produced with findings and/or recommendationsspecific to HIV/AIDS and the Black communities; and information on government responses to HIV/AIDS in Black communities.For Phase II, a resource was to be developed that can be used at the municipal, provincial andnational level to enable better planning and delivery of HIV and AIDS programs and servicesto Black communities. Taking Action on HIV and AIDS in Black Communities in Canada: AResource for Moving Ahead is that document. It is targeted to everyone who is interested orwilling to address HIV and AIDS in Black communities in Canada.The resource is organized into six key sections based on the cities in which interviews andfocus groups were conducted as well as a national overview. Each section generally containsselected demographic characteristics of the Black population, HIV and AIDS statistics specificto Black people, and key findings and suggested actions from the interviews and focus groups.The series of suggested actions are targeted to Black community members, including Blackpeople living with HIV; service providers; policy makers and researchers.1The term “Black” will be used throughout the document to refer to people of Black African descent regardless of country of origin. This includes Black Canadians, Africansand people from the Caribbean. Historically and at the time of writing, the epidemiological term “HIV-endemic” has generally referred to Black people.Public Health Agency of Canada. 2007. HIV/AIDS Epi Update: HIV/AIDS in Canada Among Persons from Countries where HIV is Endemic. pi/pdf/epi2007 e.pdf3Public Health Agency of Canada. 2007. HIV and AIDS in Canada: Surveillance Report to December 31, ion/survreport/pdf/survrep1206.pdf4According to the Public Health Agency of Canada, “Two of Canada s largest provinces, Ontario and Quebec, do not provide ethnic information on positive HIV test reportsto the national level. This is a limitation for monitoring the epidemic among persons from countries where HIV is endemic, as the two provinces together account forover two-thirds of all positive HIV test reports; as well, they include two large urban centres, namely Toronto and Montreal, that contain large proportions of people fromcountries where HIV is endemic.” HIV/AIDS Epi Update: HIV/AIDS in Canada Among Persons from Countries where HIV is Endemic. pi/pdf/epi2007 e.pdf5The project was funded by the Public Health Agency of Canada through the Interagency Coalition on AIDS and Development and it was a partnership of the organizationsrepresented on the National Steering Committee: African and Caribbean Council on HIV/AIDS in Ontario (Toronto, ON); Centre de Ressources et d Interventions en Santéet Sexualité (Montreal, QC); Interagency Coalition on AIDS and Development (Ottawa, ON); James R. Johnston Chair in Black Canadian Studies, Dalhousie University(Halifax, NS); National Congress of Black Women Foundation (Vancouver, BC); Safeworks (Calgary, AB).6The Springboarding a National HIV/AIDS Strategy for Black Canadian, African and Caribbean Communities Project Environmental Scan Report is available at http://www.icad-cisd.com/pdf/publications/SNS EnviroScan Final Report 9 Dec 05.pdf.21
Taking Action on HIV and AIDS inBlack Communities in Canada:A Resource for Moving Ahead2.0 Process2.1 National Steering CommitteeTo initiate the project, the National Steering Committee from Phase I was re-engaged withresponsibility for providing guidance, direction, assistance with identifying key stakeholdersfor interviews and regionally-based focus groups, linkages to appropriate persons and/ororganizations, linkages to the Public Health Agency of Canada Status Report Working Group,technical advice and support, and feedback on draft documents (see Appendix A for theCommittee s Terms of Reference).2.2 Information Gathering GuideTo guide the interviews and focus groups, an information gathering tool was developed (seeAppendix B). It focused on the following areas:1. Current gaps to better planning and delivering HIV/AIDS programs and servicesto Black Canadian, African and Caribbean communities at the municipal, regional/provincial and national levels;2. Unique or specific regional/provincial issues when it comes to addressing HIV/AIDS inBlack Canadian, African and Caribbean communities;3. Needs of various stakeholders to enable better planning and delivery of HIV/AIDSprograms and services to Black Canadian, African and Caribbean communities, i.e.community members, Black people living with HIV/AIDS (PHAs), service providers,policy makers and researchers.2.3 Information Gathering MethodsInformation was collected through documentation reviews as well as interviews and focusgroups across the country (Vancouver, Calgary, Toronto, Ottawa, Montréal and Halifax) withBlack community members, including people living with HIV and researchers; service providers;and other key stakeholders (see Appendix C for interview participants). The interviews andfocus groups were conducted from June to September 2007.2.4 Stakeholder ParticipationA total of 95 individuals participated in the interviews and focus groups; 14% of whom wereBlack people living with HIV/AIDS. Table 1 summarizes the overall stakeholder participation.Table 1: Stakeholder ParticipationFocus Group ParticipantsCityInterviewParticipantsPHA ver15101 FemaleCalgary1170Toronto47102 Females / 3 MalesOttawa1571 FemaleMontréal511124 Females / 2 MalesHalifax1340TOTAL1332508 Females / 5 Males2
Taking Action on HIV and AIDS inBlack Communities in Canada:A Resource for Moving Ahead3.0 Vancouver and British Columbia3.1 DemographicsUsing selected demographic characteristics taken primarily from the 2001 Census ofCanada7 , this section provides a profile of the Black community in Vancouver, in BritishColumbia and in Canada.Population Size The 2001 Census enumerated 662,215 Black people in Canada which represented2.2% of the country s population and a 31% growth in the Black population from 1991. The Black population of British Columbia was 25,460 which represented 0.7% of theprovince s population. The Black population of Vancouver was 18,400 which represented 0.9% of the city spopulation and a 20% growth in the Black population from 1991.Canadian-Born Blacks & Places of Birth for Black Immigrant Population In 2001, 45% of the Black population in Canada was Canadian-born. The top threeplaces of birth for the Black immigrant population were Caribbean and Bermuda, Africa,and Central and South America. In British Columbia, 51% of the Black population was Canadian-born. The top threeplaces of birth for the Black immigrant population were Africa, Caribbean and Bermuda,and United States of America. In Vancouver, 48% of the Black population was Canadian-born.AgeTable 2: Black population by age, Canada, 2001GeographicAreaUnder 5-54years(%)55-64years(%)65 yearsand 817.79.76.64.1Gender Women and female children were more than half (52%) of Canada s Black population in2001. In British Columbia, men and male children were more than half (53%) of the province sBlack population. In Vancouver, men and male children were more than half (53%) of the city s Blackpopulation.73Statistics Canada. 2001. Census of Canada. standard/themes/ListProducts.cfm?Temporal 2001&APATH 3&Theme 44&FREE 0
Taking Action on HIV and AIDS inBlack Communities in Canada:A Resource for Moving AheadLanguage Almost three-quarters (72%) of Canada s Black population was enumerated asspeaking English most often at home and 14% spoke French most often at home. Ninepercent (9%) spoke a non-official language most often at home. In British Columbia, 90% of the Black population spoke English most often at homewhile only 1% spoke French most often at home. Nine percent (9%) spoke a non-officiallanguage most often at home.Education Of the 2001 Canadian Black population 15 years and over, 28% had less than a highschool graduation certificate and 13% had a university degree. In British Columbia, 23% had less than a high school graduation certificate and 17%had a university degree.Income In Canada in 2000, the incidence of low income for the Black population was 33%. In British Columbia, the incidence of low income for the Black population was 27%.3.2 HIV and AIDS StatisticsAccording to the British Columbia Centre for Disease Control8 : In British Columbia, 4.4% (16/360) of the new HIV positive cases in 2006 were Blackpeople, of which 43.7% were women. From 2000-2006, Black people represented 4.6% (132/2849) of the total new HIVpositive cases. Women accounted for 43.2% of the new HIV positive cases in the Blackcommunity. In 2006, Black people represented 2.5% (2/79) of the total AIDS cases and both werewomen.3.3 Key Findings – VancouverThe Vancouver census metropolitan area had the 4th largest Black population in Canada in2001. The consultation revealed several key themes. The Black community is geographically scattered. There is no central hub where thecommunity gathers together and there is a sense of disconnection among communitymembers. The community appears to be growing, particularly in the number of Africanimmigrants. Fear, HIV stigma and discrimination are negatively affecting Black people comingforward for HIV prevention information, care and support. There is a perception thatas a small community, there is less confidentiality when people present for informationor support. Fear of disclosure, stigma and discrimination are significant contributorsto Black PHAs living in isolation and often not accessing available services that mayenhance their quality of life. There is a lack of visibility and prioritizing of HIV and AIDS in the Blackcommunity. Black people are often not visible in messages about HIV and AIDS andwhen they are, it tends to be in reference to the epidemic in Africa. This furthers theperception that HIV and AIDS are not an issue for the community in Canada. The8British Columbia Centre for Disease Control. 2007. HIV/AIDS Annual Report 2006. -AIDS%20Update%20Report 2006.pdf4
Taking Action on HIV and AIDS inBlack Communities in Canada:A Resource for Moving Aheadlimited availability of race-based HIV and AIDS statistics compounds the perception andinforms the lack of prioritizing of the issue in the Black community. There is no strongvoice in the Black community around HIV and AIDS. Priority for funding appears to be research, gay men and injection drug use.Concerns were raised that HIV funding, provincially, tended to be geared towards doingresearch versus supporting service delivery. There are many improvements that can be made to enhance HIV and AIDSprograms and services to the Black community. There are a number of barriers toaccess, including lack of childcare, translation, culturally and linguistically appropriatematerials and transportation. There is a concentration of HIV programs and servicesin Vancouver while the Black community is often in the suburbs. There are alsofew services for the Black community, especially at the provincial level. For manynewcomers, they lack information about existing services, including where to accessHIV testing. It was noted that Black people are visible in prisons but get little attention. Capacity building of the Black community to respond to HIV and AIDS is criticallyneeded. There is a lack of appropriate people with relevant knowledge and skills toaddress HIV and AIDS in the Black community.3.4 Taking Action – VancouverIn order to address the gaps, barriers and obstacles to better planning and delivery of HIVand AIDS programs and services to the Black community in Vancouver, several actions wereidentified. Build community. Opportunities and mechanisms should be created to betterconnect and facilitate working together among members of the Black communityaround HIV and AIDS issues. This will require working with community leaders andcommunity institutions, particularly religious ones such as churches and mosques. Thiswill also require better utilization of people within the community as there are untappedresources, including Black PHAs. Attention should be paid to building capacity within theBlack community such that there are more Black researchers and service providers towork with the community. Make addressing HIV and AIDS in the Black community a funding priority. Policymakers should become more aware of the HIV and AIDS issues affecting the Blackcommunity. They also should work with community members and service providersbefore developing policy. Community members should participate in opportunities toinfluence decision-making. Increase visibility of HIV and AIDS in the Black community. Multiple strategiesshould be used to raise awareness; promote prevention, care and support; encouragetesting; and address stigma, discrimination and homophobia. Efforts should be madeto get needed race-based statistics. A strong voice around HIV and AIDS in the Blackcommunity should be nurtured. Enhance availability, access and quality of HIV and AIDS programs and servicesto the Black community. Links should be made with settlement services to bridgeHIV, AIDS and settlement issues. For existing services, the diversity of staff, volunteersand Board members should be enhanced and coupled with skills training to betterwork with different communities. Cooperation, collaboration and communication shouldbe enhanced among service providers. More community-based research should beconducted to determine needs and support better programs and service delivery.5
Taking Action on HIV and AIDS inBlack Communities in Canada:A Resource for Moving Ahead4.0 Calgary and Alberta4.1 DemographicsUsing selected demographic characteristics taken primarily from the 2001 Census ofCanada9 , this section provides a profile of the Black community in Calgary, in Alberta and inCanada.Population Size The 2001 Census enumerated 662,215 Black people in Canada which represented2.2% of the country s population and a 31% growth in the Black population from 1991. The Black population of Alberta was 31,390 which represented 1.1% of the province spopulation. The Black population of Calgary was 13,700 which represented 1.4% of the city spopulation and a 34% growth in the Black population from 1991.Canadian-Born Blacks & Places of Birth for Black Immigrant Population In 2001, 45% of the Black population in Canada was Canadian-born. The top threeplaces of birth for the Black immigrant population were Caribbean and Bermuda, Africa,and Central and South America. In Alberta, 49% of the Black population was Canadian-born. The top three places ofbirth for the Black immigrant population were Africa, Caribbean and Bermuda, andEurope. In Calgary, 45% of the Black population was Canadian-born.AgeTable 3: Black population by age, Canada, 2001GeographicAreaUnder 15years rs(%)55-64years(%)65 yearsand .22.2Gender Women and female children were more than half (52%) of Canada s Black population in2001. In Alberta, men and male children were more than half (51%) of the province s Blackpopulation. In Calgary, men and male children were slightly more than half (50.5%) of the city sBlack population.9Statistics Canada. 2001. Census of Canada. standard/themes/ListProducts.cfm?Temporal 2001&APATH 3&Theme 44&FREE 06
Taking Action on HIV and AIDS inBlack Communities in Canada:A Resource for Moving AheadLanguage Almost three-quarters (72%) of Canada s Black population was enumerated asspeaking English most often at home and 14% spoke French most often at home. Ninepercent (9%) spoke a non-official language most often at home. In Alberta, 87% of the Black population spoke English most often at home while 2%spoke French most oft
3.4 Taking Action – Vancouver 5 4.0 Calgary and Alberta 6 4.1 Demographics 6 4.2 HIV and AIDS Statistics 7 4.3 Key Findings – Calgary 7 4.4 Taking Action – Calgary 8 5.0 Toronto, Ottawa and Ontario 9 5.1 Demographics 9 5.2 HIV and AIDS Statistics 10 5.3 Key Findings –
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