Reaching Through the Cracks: An African, Caribbean, Black (ACB) LGBTQ+ Newcomer Sexual Health Co-Design Report
What is this project about?
This Access Alliance project is about making sexual health services better for African, Caribbean, and Black (ACB) newcomers who are also part of the 2SLGBTQI+ community in Toronto. Many of these individuals have lived experience with HIV/AIDS and face extra challenges due to stigma, discrimination, and barriers to care.
The project focused on peer-engaged co-designing a sexual health service model that addresses the unique needs of African, Caribbean, and Black (ACB) 2SLGBTQI + newcomers, particularly those with lived experience of HIV/AIDS. The research identified barriers to care and how to improve access to sexual health and HIV services for ACB 2SLGBTQI + newcomers who are often marginalized and underserved.
This project shows that when we listen to the people most affected and include them in the process, we can create better, more welcoming sexual health services for ACB 2SLGBTQI+ newcomers. The findings are a call to action for everyone: learn, adapt, and make sure no one is left behind.
What do you need to know?
Context and Relevance:
- The research is based on Access Alliance’s Among Friends 2SLGBTQI+ newcomer Program, which has provided support through workshops, arts programs, and resource connections since 2006. A 2020 survey revealed high concern about HIV/AIDS among program participants, with 100% expressing concern and 80% being “extremely concerned”.
- Previous research highlighted that precarious immigration status, housing insecurity, and poverty worsen sexual exploitation and violence for 2SLGBTQI+ newcomer women and gender-diverse individuals.
- The project is unique in its use of co-design, peer support, and body mapping methodologies, centering the lived experiences and agency of ACB 2SLGBTQI+ newcomers rather than imposing top-down solutions.
- The peer research team, drawn from the community, brought diverse lived and professional experience, and their involvement ensured the process was trauma-informed and inclusive.
- The body mapping methodology was originally developed in South Africa for women living with HIV/AIDS to help them process trauma through expressive arts and community focused research. The body mapping technique in this research provided rich qualitative data from ACB 2SLGBTQI+ Newcomers.
What did the researchers find?
Key Highlights and Themes:
Major gaps identified included service providers’ limited knowledge of ACB 2SLGBTQI+ newcomer needs, limited community knowledge about sexual health and HIV/AIDS, and urgent issues related to marginalization.
Service Providers Need More Knowledge
- Challenge: Health workers may not understand the unique needs of ACB 2SLGBTQI+ newcomers. Participants reported experiencing macro-aggressions and triggering questions during care.
- Issue: This can lead to uncomfortable or even harmful situations, such as being asked triggering questions during care.
- Recommendation: Service providers need easy-to-use resources and better training to offer trauma-informed, respectful care. There is also a clear need to move beyond a strictly clinical model of care and also consider wellbeing, joy, and even pleasure.
Community Needs More Information
- Challenge: Many newcomers don’t have enough accurate information about sexual health or HIV/AIDS.
- Reason: Stigma, fear, and trauma make it hard to talk about these topics.
- Recommendation: Community organizations should provide culturally relevant, clear information, and create safe spaces for discussion.
Marginalization Is a Big Problem
- Challenge: ACB 2SLGBTQI+ newcomers often feel left out and anxious about accessing health services.
- Result: Improving services can give them more comfort, peace of mind, and confidence to seek care.
- Recommendation: Services should focus on building trust, reducing stigma, and ensuring everyone feels welcome.
Digital Access Is Important, But Not Perfect
- Challenge: COVID-19 made it harder for newcomers to connect in person. There were digital inclusion challenges. Many newcomers are also worried about privacy and safety online.
- Recommendation: Health services should make sure digital tools are safe, private, and easy to use, but also keep in-person options available.
Peer Support and Community Voices Matter
- Highlight: The project brought together people with lived experience to help shape the services.
- Benefit: This made the project more effective, trauma-informed, and inclusive.
- Recommendation: Always include community members in planning and delivering health services.
How can you use this research?
For Service Providers:
- Use the findings to inform training and develop resources that improve understanding of ACB 2SLGBTQI+ newcomer needs and best practices for inclusive care.
- Incorporate trauma-informed, culturally sensitive approaches and shift beyond a strictly clinical medical model to consider wellbeing, joy, and pleasure in care delivery.
For Community Organizations:
- Develop and disseminate culturally relevant, stigma-reducing sexual health information and resources tailored to ACB 2SLGBTQI+ newcomers.
- Run campaigns and events to normalize HIV, reduce stigma, and foster a sense of belonging for ACB 2SLGBTQI+ newcomers living with HIV.
For Policymakers and Funders:
- Support initiatives that centre the voices and leadership of marginalized groups in program design and delivery.
- Address systemic barriers, including those related to immigration status and racism, through targeted policy and funding. This funding should include the creation of culturally relevant, stigma-reducing sexual health information and resources tailored to ACB 2SLGBTQI+ newcomers.
For Researchers:
- Researchers should embrace and use participatory and co-design approaches to ensure research, recommendations, and proposed solutions are grounded in lived experience.
- Future studies should explore the impact of digital access barriers and the effectiveness of peer-led interventions.
What did the researchers do?
Methods and Activities:
- Co-Design: A 12-session process involving a peer team of four ACB 2SLGBTQI+ newcomers, a coordinator, 10 community members, primary care providers, and an advisory committee. We recognize that our communities have unparalleled expertise and dedication to resolving the barriers faced in accessing sexual health and HIV services. Co-design principles require maximizing the personal agency of the ACB LGBTQ+ newcomers’ community in shaping program delivery and standards of care.
- Peer Support: Peer team members received training in peer support, co-design, and outreach, ensuring the process was inclusive and trauma informed.
- Body Mapping: Used as a narrative and expressive arts tool to generate qualitative data and facilitate discussion about needs and experiences.
- Stakeholder Engagement: Included facilitated group discussions with primary care providers to identify gaps and standards of care.
Related Access Alliance activities
Building Positive Spaces for Newcomer LGBTQ+ Women
This community-based research project explored the barriers to health and well-being experienced by LGBTQ+ newcomer women and other trans and gender non-conforming newcomers. It examined how LGBTQ+ newcomer women and other trans/gender non-conforming newcomers are marginalized simultaneously because of sexual orientation, gender, race, and immigration status. The research revealed numerous systemic and service barriers, leading to specific recommendations for government.
Among Friends
Access Alliance provides services to 2SLGBTQI+ newcomers in a positive and knowledgeable environment. In operation since 2007, Among Friends is dedicated to serving two-spirit, lesbian, gay, bisexual, transgender, queer and intersex (2SLGBTQI+) newcomers. We recognize the need for targeted and culturally appropriate programs and services that ensure all voices are heard and represented.