Post-arrival HIV acquisition patterns: Insights from African, Caribbean, and Black immigrant communities in Canada.

Objectives: This mixed methods study examines post-migration HIV acquisition patterns and sexual health behaviours among African, Caribbean, and Black (ACB) immigrant men who have sex with men (MSM), as well as heterosexual men and women in Ontario, Canada.

Methods: Data were collected from the MSAFIRI Study, including a cross-sectional quantitative survey (n = 108) and in-depth semi-structured interviews (n = 44). Participants were recruited from the Ontario HIV Treatment Network Cohort Study (OCS) through a purposive sampling of individuals who contracted HIV after migration. Data collection occurred between 2015 and 2017. Quantitative analyses using Fisher's exact tests examined associations between gender and HIV acquisition patterns, while qualitative content analysis identified themes around sexual relationships, HIV disclosure, and health decision-making.

Results: Findings highlighted gender and orientation-specific differences in HIV acquisition and associated behaviours. Quantitatively, a higher proportion of men than women could not identify their likely source partner (LSP), frequently describing these relationships as casual. Qualitative insights revealed that LSPs often concealed their HIV status, resulting in unintentional post-diagnosis disclosures. Inconsistent condom use was common, with gendered rationales: heterosexual women often cited partner disapproval or relationship exclusivity, while heterosexual men and MSM cited personal aversion and focus on sexual satisfaction.

Conclusion: These findings underscore the distinct post-migration HIV acquisition risks among ACB immigrants in Canada. They suggest the need for culturally responsive public health interventions that consider gender-specific barriers, address stigma, and support health decision-making for ACB migrant communities navigating the complex intersections of migration, health, and relationships.