HIV and the Black community in Canada: A Scoping Review

Abstract

Background: The Black community in Canada is disproportionately burdened by HIV (human immunodeficiency virus). Factors at the downstream, midstream, and upstream levels contribute to this ongoing health challenge. The upstream (structural) factors are not well understood by policymakers and the Public Health Agency of Canada continues to request better research in this area. Examining the current research landscape on HIV and the Black community in Canada will identify the gaps and serve as the first step towards addressing them. Objective: The aim of this scoping review is to map existing health literature about HIV and the Black community in Canada and identify gaps that can be addressed in future research on this topic. This review also uses a scoping review methodology as a case to illustrate how this methodology can be used to identify literature gaps of a biomedical topic. Methods: This thesis follows the Joana Briggs Institute (JBI) Manual for Evidence Synthesis guidelines and was conducted through six major databases (MEDLINE, Embase, CINAHL, Web of Science, EBSCO, and Google Scholar). Studies were systematically screened using the inclusion criteria. Data was analyzed and presented using pre-determined and subsequently developed outcome categories. Results: Our initial search produced 3060 abstracts. After applying our eligibility criteria and screening all abstracts and full-texts, we retained 67 articles. We added 11 studies from a recently published review on a similar topic, which resulted in a total of 78 literature sources for this study. HIV outcomes addressed in this review include prevalence, incidence, knowledge about HIV, behaviours related to transmission, access to care, barriers/facilitators to care, use of HIV care, engagement/retention in care, initiation/adherence to treatment, CD4 count, HIV-related stigma, intersectionality, HIV prevention, testing, and resilience. The majority of studies were conducted in Ontario (n = 65, ~83.3%) and were either cross-sectional (n = 26) or qualitative (n = 14) designs. The most common outcomes reported were behaviours related to HIV transmission (n = 17), HIV-related stigma (n = 15), and access to HIV care (n = 14). Conclusion: Overall, research gaps were observed at all three levels. Notable gaps include: data from provinces and territories outside of Ontario, incidence and prevalence data that can be pooled, comparisons of HIV knowledge and access to HIV care between Black and non-Black communities, information on HIV transmission through needles, and identifying structural solutions to addressing the HIV burden.