Understanding the factors associated with HIV and STIs diagnosis among Black heterosexual men in Ottawa and Windsor, Ontario


Background: The African, Caribbean and Black (ACB) men living in Canada share a heightened risk of infection by Human Immunodeficiency Virus and other sexually transmitted illnesses (STIs) and the associated risky behaviours such as suboptimal use of family planning services such as condom use. The African, Caribbean and Black (ACB) heterosexual men living in Canada are disproportionately exposed to HIV and other sexually transmitted infections. The present paper aims to assess the relationship between knowledge, attitude and use of condom with diagnosis of HIV and STIs among ACB heterosexual men in Ontario.
Design and methods: This was a cross-sectional study on 430 participants consisting of black heterosexual men living two communities, Ottawa and Windsor in Ontario. The outcome variables were ever being diagnosed with HIV (Yes/No) and other STIs (Yes/No). Data were analysed using descriptive, and logistic regression techniques.
Results: Findings indicated that 70.20% did not have good knowledge of HIV, 68.10% had positive attitude towards condom use, and 62.82% were not regular condom user. Men who reported experiencing difficulty in accessing healthcare services had significantly higher odds of reporting HIV and STI diagnosis. Men with positive attitude towards condom use had lower odds of both HIV (odds ratio= 0.48, 95%CI=0.30,0.76) and STI diagnosis (odds ratio= 0.27, 95%CI=0.08,0.90). Similarly, condom users also had lower odds of both HIV and (odds ratio= 0.21, 95%CI=0.09,0.49) STI diagnosis (odds ratio= 0.62, 95%CI=0.39,0.99).
Conclusions: A large proportion of the sample with positive attitude to condom use was not a reflection of the large sample who did not have correct knowledge of HIV. Several factors were also found to be associated with heightened odds of being diagnosed with HIV and other STIs. The most notable of these factors were experiences of difficulty in accessing healthcare and utilisation of condoms.


Catie.ca [Internet]. The epidemiology of HIV in Canada. Available from: https://www.catie.ca/en/fact-sheets/epidemiology/epidemiology-hiv-canada

Haddad N, Li JS, Totten S, McGuire M. HIV in Canada-Surveillance Report, 2017. Can Commun Dis 2018;44:348-56 DOI: https://doi.org/10.14745/ccdr.v44i12a03

Government of Canada. HIV in Canada, 2017. Available from: https://www.canada.ca/en/public-health/services/reports-publications/canada-communicable-disease-report-ccdr/monthly-issue/2018-44/issue-12-december-6-2018/article-3-hiv-in-canada-2017.html

Haddad N, Robert A, Weeks A, et al. HIV in Canada – Surveillance Report, 2018. Can Commun Dis Rep 2019;45:304-12. DOI: https://doi.org/10.14745/ccdr.v45i12a01

Government of Canada. Chapter 13: HIV/AIDS Epi updates, April 2012 – HIV/AIDS in Canada among people from countries where HIV is endemic. 2014. Available from: https://www.canada.ca/en/public-health/services/hiv-aids/publications/epi-updates/chapter-13-hiv-aids-canada-among-people-from-countries-hiv-endemic.html

Zhabokritsky A, Nelson RE, Tharao W, et al. Barriers to HIV pre-exposure prophylaxis among African, Caribbean and Black men in Toronto, Canada. PloS One 2019;14:e0213740. DOI: https://doi.org/10.1371/journal.pone.0213740

Friedman SR, Cooper HLF, Osborne AH. Structural and social contexts of HIV risk among African Americans. Am J Public Health 2009;99:1002-8. DOI: https://doi.org/10.2105/AJPH.2008.140327

Blankenship KM, Smoyer AB, Bray SJ, et al. Black-White disparities in HIV/AIDS: The role of drug policy and the corrections system. J.Health Care Poor Underserved 2005;16:140-56. DOI: https://doi.org/10.1353/hpu.2005.0110

Canadian AIDS Society [Internet]. Canada sees its fourth consecutive year of increasing HIV rates. 2020. Available from: https://www.cdnaids.ca/canada-sees-its-fourth-consecutiveyear-of-increasing-hiv-rates/

Canadian HIV/AIDS Black, African and Caribbean Network (CHABAC) [Internet]. About. Available from: https://www.blackhivday.ca/about.html

da Costa Andrade SS, Lacet Zaccara AA, Souza Leite KN, et al. [Knowledge, attitude and practice of condom use by women of an impoverished urban area].[Article in Portuguese]. Rev Esc Enferm USP 2015;49:364-72. DOI: https://doi.org/10.1590/S0080-623420150000300002

Wongkongdech R, Chanthamath S, Wongkongdech A. Knowledge, attitude and prevention behavior related to HIV/AIDS among students of a college in Lao-PDR: a cross sectional study. F1000Res 2020;9:181. DOI: https://doi.org/10.12688/f1000research.22306.1

Espada JP, Morales A, Guill n-Riquelme A, et al. Predicting condom use in adolescents: a test of three socio-cognitive models using a structural equation modeling approach. BMC Public Health 2016;16:35. DOI: https://doi.org/10.1186/s12889-016-2702-0

Faust L, Yaya S. The effect of HIV educational interventions on HIV-related knowledge, condom use, and HIV incidence in sub-Saharan Africa: a systematic review and meta-analysis. BMC Public Health 2018;18:1254. DOI: https://doi.org/10.1186/s12889-018-6178-y

Tshitenge ST, Nlisi K, Setlhare V, Ogundipe R. Knowledge, attitudes and practice of healthcare providers regarding contraceptive use in adolescence in Mahalapye, Botswana. South Afr Fam Pract 2018;60:181-6. DOI: https://doi.org/10.1080/20786190.2018.1501239

Okawa S, Mwanza-Kabaghe S, Mwiya M, et al. Sexual and reproductive health behavior and unmet needs among a sample of adolescents living with HIV in Zambia: a cross-sectional study. Reprod Health 2018;15:55. DOI: https://doi.org/10.1186/s12978-018-0493-8

Abubeker FA, Fanta MB, Dalton VK. Unmet need for contraception among HIV-positive women attending HIV care and treatment service at Saint Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia. Int J Reprod Med 2019;2019:3276780. DOI: https://doi.org/10.1155/2019/3276780

Long JE, Waruguru G, Yuhas K, et al. Prevalence and predictors of unmet contraceptive need in HIV-positive female sex workers in Mombasa, Kenya. PLoS One 2019;14:e0218291. DOI: https://doi.org/10.1371/journal.pone.0218291

Kosugi H, Shibanuma A, Kiriya J, et al. Consistent condom use among highly effective contraceptive users in an HIVendemic area in rural Kenya. PLoS One 2019;14:e0216208. DOI: https://doi.org/10.1371/journal.pone.0216208

Rodger AJ, Cambiano V, Bruun T, et al. Risk of HIV transmission through condomless sex in serodifferent gay couples with the HIV-positive partner taking suppressive antiretroviral therapy (PARTNER): final results of a multicentre, prospective, observational study. Lancet 2019;393:2428-38. DOI: https://doi.org/10.1016/S0140-6736(19)30418-0

Schaalma H, Kok G, Peters L. Determinants of consistent condom use by adolescents: the impact of experience of sexual intercourse. Health Educ Res 1993;8:255-69. DOI: https://doi.org/10.1093/her/8.2.255

Ritchwood TD, Bishu KG, Egede LE. Trends in healthcare expenditure among people living with HIV/AIDS in the United States: evidence from 10 years of nationally representative data. Int J Equity Health 2017;16:188. DOI: https://doi.org/10.1186/s12939-017-0683-y

Fox MP, Rosen S, MacLeod WB, et al. The impact of HIV/AIDS on labour productivity in Kenya. Trop Med Int Health 2004;9:318-24. DOI: https://doi.org/10.1111/j.1365-3156.2004.01207.x

Taraphdar P, Guha RT, Haldar D, et al. Socioeconomic consequences of HIV/AIDS in the family system. Niger Med J 2011;52:250-3. DOI: https://doi.org/10.4103/0300-1652.93798

Konkor I, Lawson ES, Antabe R, et al. An intersectional approach to HIV vulnerabilities and testing among heterosexual African Caribbean and Black men in London, Ontario: Results from the weSpeak study. J Racial Ethn Health Disparities 2020;7:1140-9. DOI: https://doi.org/10.1007/s40615-020-00737-3

Konkor I, eAntabe R, Mkandawire P, et al. Knowledge of sexual partner’s HIV serostatus and the practice of safer sex among heterosexual men of African descent in London, Ontario. Ethn Health 2022;27:375-87. DOI: https://doi.org/10.1080/13557858.2020.1734776

Harling G, Subramanian S, B rnighausen T, Kawachi I. Socioeconomic disparities in sexually transmitted infections among young adults in the United States: examining the interaction between income and race/ethnicity. Sex Transm Dis 2013;40:575-81. DOI: https://doi.org/10.1097/OLQ.0b013e31829529cf

Farley T A. Sexually transmitted diseases in the Southeastern United States: location, race, and social context. Sex Transm Dis 2006;33:S58-64. DOI: https://doi.org/10.1097/01.olq.0000175378.20009.5a

Annang L, Walsemann KM, Maitra D, Kerr JC. Does education matter? Examining racial differences in the association between education and STI diagnosis among Black and White young adult females in the U.S. Public Health Rep 2010;125:110-21. DOI: https://doi.org/10.1177/00333549101250S415

Abra do-Lanza AF, Armbrister AN, Fl rez KR, Aguirre AN. Toward a theory-driven model of acculturation in public health research. Am J Public Health 2006;96:1342-6. DOI: https://doi.org/10.2105/AJPH.2005.064980

Rade DA, Crawford G, Lobo R, Gray C, Brown G. Sexual health help-seeking behavior among migrants from Sub-Saharan Africa and South East Asia living in high income countries: A systematic review. Int J Environ Res Public Health 2018;15:1311. DOI: https://doi.org/10.3390/ijerph15071311