Structural and Social Disadvantage and Post-Migration HIV Vulnerability among African, Caribbean, and Black Communities in Ontario
Year: 2026
Type: preprint
Abstract: Background. African, Caribbean, and Black (ACB) communities in Canada experience a disproportionate burden of HIV, and a considerable share of infections among ACB immigrants is acquired after arrival in Canada. Yet how ACB people themselves understand the structural circumstances surrounding post-migration acquisition remains underexamined. This study asked how intersecting structural and social disadvantages shape post-migration HIV vulnerability among ACB communities in Ontario. Methods. We conducted an interpretive secondary thematic analysis of 44 in-depth interviews from the MSAFIRI Study, read through intersectionality and structural-vulnerability lenses. Interviews were coded inductively and deductively by two analysts, with consensus adjudication and community review of the thematic structure. Results. Five structural conditions organized participants accounts: racism as a structural condition of settlement; immigration precarity and the work of settling alone; economic precarity, including insecure work, poverty, and unstable housing; ruptured kin networks and isolation under migration; and gendered violence and homophobia. These conditions compounded one another, so that disadvantage in one domain deepened vulnerability in another. Conclusion. Post-migration HIV vulnerability among ACB communities is produced by intersecting structural disadvantages encountered in the receiving country context. Equitable HIV prevention requires structural and community-led responses that address immigration precarity, economic and housing insecurity, gendered violence, homophobia, and anti-Black racism, alongside biomedical and individual-level prevention. Keywords: HIV; African, Caribbean, and Black communities; migration; structural vulnerability; intersectionality; social determinants of health; Canada
Source: medRxiv
Authors: Wangari Tharao, Thabani Nyoni, Elsie Amoako, Danilia Nellie Takang Fombang, Adrianna Perryman, Amrita Daftary, Mary Ndungu, Jenna MacNeily, Sandra Bullock, Soraya Blot, Valerie Pierre-Pierre, Mona Loutfy, Rubert Kaul, Darrell Tan, Anita Rachlis, Curtis Cooper, Irving Salit, Henry Luyombya, Shannon Thomas Ryan, Liviana Calzavara, MSAFIRI Study Team
Institutions: Women's Health In Women's Hands, Dalhousie University, York University, University of Toronto, Maple Leaf Medical Clinic, University Health Network, Toronto General Hospital, St. Michael's Hospital, Sunnybrook Health Science Centre, University of Ottawa, Ottawa Hospital, Toronto General Hospital Research Institute
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7225145552