Structural and Social Disadvantage and Post-Migration HIV Vulnerability among African, Caribbean, and Black Communities in Ontario

Background. African, Caribbean, and Black (ACB) communities in Canada experience a disproportionate burden of HIV, and a considerable share of infections among ACB immigrants is acquired after arrival in Canada. Yet how ACB people themselves understand the structural circumstances surrounding post-migration acquisition remains underexamined. This study asked how intersecting structural and social disadvantages shape post-migration HIV vulnerability among ACB communities in Ontario. Methods. We conducted an interpretive secondary thematic analysis of 44 in-depth interviews from the MSAFIRI Study, read through intersectionality and structural-vulnerability lenses. Interviews were coded inductively and deductively by two analysts, with consensus adjudication and community review of the thematic structure. Results. Five structural conditions organized participants accounts: racism as a structural condition of settlement; immigration precarity and the work of settling alone; economic precarity, including insecure work, poverty, and unstable housing; ruptured kin networks and isolation under migration; and gendered violence and homophobia. These conditions compounded one another, so that disadvantage in one domain deepened vulnerability in another. Conclusion. Post-migration HIV vulnerability among ACB communities is produced by intersecting structural disadvantages encountered in the receiving country context. Equitable HIV prevention requires structural and community-led responses that address immigration precarity, economic and housing insecurity, gendered violence, homophobia, and anti-Black racism, alongside biomedical and individual-level prevention. Keywords: HIV; African, Caribbean, and Black communities; migration; structural vulnerability; intersectionality; social determinants of health; Canada