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. 2025 Apr;116(2):209-218.
doi: 10.17269/s41997-024-00983-6. Epub 2025 Feb 19.

HIV testing among heterosexual Black men in Toronto: What are the determinants?

Roger Antabe  1 , Yujiro Sano  2 , Egbe B Etowa  3 , Joseph Bertrand Nguemo Djiometio  4 , Mandana Vahabi  5   6   7 , Kenneth Po-Lun Fung  8 , Josephine Pui-Hing Wong  3 , Winston Husbands  9
Affiliations

HIV testing among heterosexual Black men in Toronto: What are the determinants?

Roger Antabe et al. Can J Public Health. 2025 Apr.

Abstract
in English, French

Objectives: African, Caribbean, and Black (ACB) men in Canada face a higher risk of HIV infection relative to other men. Despite this concern, these are nascent studies focused on the usage of HIV testing services among ACB men. To contribute to health policy in Canada, we seek to understand the prevalence and predictors of HIV testing among heterosexual ACB men living in Toronto.

Methods: We used a sample of 325 self-identified heterosexual Black men in Toronto, Ontario, who participated in the weSpeak study, which examined HIV vulnerability among ACB men. Guided by Andersen's framework of health services utilization, we fitted negative log-log regression models to cross-sectional data of ACB men 16 years or older.

Results: The findings indicate that (1) ACB men with secondary or lower levels of educational attainment (OR = 0.57, p < 0.1) were less likely to have ever been tested for HIV compared to their counterparts with a university education or higher, (2) foreign-born men were more likely to have ever been tested for HIV than their Canadian-born counterparts (OR = 3.14, p < 0.01), and (3) ACB men who report multiple sexual partners were more likely to have ever been tested for HIV compared to colleagues with one sexual partner (OR = 2.76, p < 0.01).

Conclusion: Based on these findings, we recommend further research to understand the barriers to HIV testing among non-priority risk groups and the design of a more nuanced population-based approach to HIV testing that incorporates case management or various incentives.

RéSUMé: OBJECTIFS: Les hommes africains, caribéens et noirs (ACB) au Canada sont confrontés à un risque plus élevé d’infection par le VIH par rapport aux autres hommes. Malgré cette préoccupation, il existe peu d’études centrées sur l’utilisation des services de dépistage du VIH chez les hommes ACB. Afin de contribuer à la politique de santé au Canada, nous cherchons à comprendre la prévalence et les facteurs prédictifs du dépistage du VIH chez les hommes hétérosexuels ACB vivant à Toronto. MéTHODES: Nous avons utilisé un échantillon de 325 hommes noirs hétérosexuels s’identifiant eux-mêmes à Toronto, en Ontario, qui ont participé à l’étude weSpeak, qui a examiné la vulnérabilité au VIH chez les hommes ACB. Guidés par le cadre d’utilisation des services de santé d’Andersen, nous avons ajusté des modèles de régression en log-log négatif aux données transversales des hommes ACB de 16 ans ou plus. RéSULTATS: Les résultats indiquent que (1) les hommes ACB ayant un niveau d’éducation secondaire ou inférieur (RC=0,57, p<0,1) étaient moins susceptibles d’avoir déjà fait un dépistage du VIH que leurs homologues ayant un niveau d’éducation universitaire ou supérieur, (2) les hommes nés à l’étranger étaient plus susceptibles d’avoir déjà fait un dépistage du VIH que leurs homologues nés au Canada (OR=3,14, p<0,01), et (3) les hommes ACB qui déclarent avoir plusieurs partenaires sexuels étaient plus susceptibles d’avoir déjà fait un dépistage du VIH que leurs collègues ayant un seul partenaire sexuel (OR=2,76, p<0,01). CONCLUSION: Sur la base de ces résultats, nous recommandons des recherches supplémentaires afin de comprendre les obstacles au dépistage du VIH chez les groupes non prioritaires à risque et la conception d’une approche de dépistage du VIH plus nuancée basée sur la population qui intègre la gestion des cas ou divers incitatives.

Keywords: African, Caribbean, and Black; Canada; HIV; Resilience; Vulnerability.

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Conflict of interest statement

Declarations. Ethics approval: The protocol for this study was originally approved by the REBs of Toronto Metropolitan University (TMU), formerly Ryerson University (the lead institution), and all affiliated universities and institutes, including Western University, University of Windsor, and University of Ottawa. Consent to participate: Informed consent was obtained from individual participants who were told they were free to leave the study at any time or request that their survey responses be removed from the study at a reasonable time after responding to the survey questionnaire. Consent for publication: Not applicable. Conflict of interest: The authors declare no competing interests.

References

    1. Andersen, R. (1968). A behavioral model of families’ use of health services. Center for Health Administration Studies, University of Chicago.
    1. Andersen, R. M. (1995). Revisiting the behavioral model and access to medical care: Does it matter? Journal of Health and Social Behavior,36(1), 1–10. - PubMed
    1. Antabe, R., Konkor, I., Mcintosh, M., Lawson, E., Husbands, W., Wong, J., Arku, G., & Luginaah, I. (2021a). “I went in there, had a bit of an issue with those folks”: Everyday challenges of heterosexual African, Caribbean and Black (ACB) men in accessing HIV/AIDS services in London, Ontario. BMC Public Health,21(1), 1–14. - PMC - PubMed
    1. Antabe, R., Miller, D., Kohoun, B., Okonufua, O., & Husbands, W. (2021b). Black resilience: A strategic asset for engaging heterosexual Black Canadian men in community responses to HIV. Journal of Racial and Ethnic Health Disparities,9, 756–766. - PubMed
    1. Bisaillon, L., & Ells, C. (2014). When doctoring is not about doctoring: An ethical analysis of practices associated with Canadian immigration HIV testing. Public Health Ethics,7(3), 287–297. 10.1093/phe/phu036

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