Critical analysis of peer engagement in HIV testing and prevention within Black, African, and Caribbean communities in Manitoba, Canada
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African, Caribbean, and Black (ACB) populations are overrepresented among new Human Immunodeficiency Virus (HIV) and Sexually Transmitted and Blood-Borne Infection (STBBI) cases in Canada. Manitoba has the second-highest rate of new HIV diagnoses in Canada. Peers have become increasingly important in the context of the HIV care cascade, serving to connect individuals and communities to HIV prevention, treatment, and related services. They play a crucial role in addressing disparities in HIV testing, prevention, and treatment access for communities by supporting individuals in navigating the healthcare system and overcoming bureaucratic obstacles and access barriers. Many studies have explored the impact of peer navigation in engaging communities in HIV prevention and treatment. However, no research has examined the acceptability of peer navigation among ACB communities in Canada and the power dynamics in the relationship between peer navigators and community members seeking HIV services. This Master of Social Work thesis focuses on peer navigation within the context of HIV among ACB communities in Manitoba. The study explored the discourses surrounding peer navigation and the power dynamics between peer navigators and ACB community members in Manitoba. The study utilized a qualitative community-based participatory research approach and harnessed the insights of ACB community members through the Community Guiding Circle (CGC), consisting of ten ACB community members. The research included a secondary analysis of data from the Ubuntu-Pamoja study, with participants recruited through agencies serving ACB communities, social media, and word-of-mouth. Thirty-three interviews were analyzed to identify key themes and fulfill the established research objectives. Data analysis employed thematic analysis using critical, intersectional-feminist, and Afrocentric theories. The methodology included two member checks to ensure the research process remained relevant to the needs of ACB communities in Manitoba. The ACB community's perspectives on peer support in HIV services uncovered a complex interplay of trust, knowledge, professionalism, culture, lived experiences, and gender dynamics. These elements influence the community's preferences for peer navigators in HIV-related services. The findings underscored the importance of integrating well-trained, culturally aligned peer navigators within the community. The study also revealed that power dynamics between peer navigators and community members seeking HIV services are nuanced and complex, involving trust, expertise, shared identity, and lived experiences. Attention must be given to the perspectives and experiences of ACB community members concerning peer navigation and the power dynamics between peer navigators and those seeking HIV services. This consideration is crucial for policy reforms and future research within Black communities in Manitoba. This study enhances our understanding of sexual health service delivery for Manitoba's ACB communities. It supports developing a more inclusive HIV response plan/policy and health promotion efforts. Additionally, it establishes a solid platform for health agencies to promote and enhance strategies for HIV prevention and testing within ACB communities.