The Intersection of Racial Identity and Immigration Status on Patterns of Condom Use, HIV/STI Testing, and Concurrent Sexual Partnerships in Canada.

Immigrants and visible minority populations are at higher risk of HIV infection in Canada. To understand the contributory role of these identities on HIV infection, our study examined how the intersection of racial identity and immigration status is associated with patterns of condom use, testing for HIV and other sexually transmitted infections (STIs), and having concurrent sexual partners among females and males in Canada. We used a nationally representative dataset from the 2015-2016 Canadian Community Health Survey (CCHS) and applied multivariate modified Poisson regression analysis. Our findings revealed that compared to visible minority immigrant males, white Canadian-born (RR = 0.64, p < 0.001), visible minority Canadian-born (RR = 0.72, p < 0.001), and white immigrant males (RR = 0.80, p < 0.01) were less likely to have used a condom during their last sexual intercourse. Among females, only white Canadian-born respondents were less likely to report condom use (RR = 0.67, p < 0.001). For HIV testing, visible minority Canadian-born males remained less likely to have ever been tested (RR = 0.81, p < 0.05), whereas white Canadian-born (RR = 1.29, p < 0.001), white immigrant (RR = 1.23, p < 0.01), and visible minority Canadian-born females (RR = 1.18, p < 0.05) were more likely to have been tested. For lifetime STI testing, all comparison groups of males and females showed higher probability than visible minority immigrants, with the largest effects observed among white Canadian-born females (RR = 1.91, p < 0.001). Finally, although no significant differences were observed among males for reporting more than one sexual partner in the past 12 months, all comparison groups of females were more likely to report concurrent sexual partners, including white Canadian-born (RR = 2.19, p < 0.001), visible minority Canadian-born (RR = 1.89, p < 0.01), and white immigrant females (RR = 2.18, p < 0.01) relative to visible minority immigrants. We acknowledge that geopolitical events over the last decade have shaped immigration and health landscapes in Canada; hence, our findings may not adequately capture the current dynamics of HIV infection. We recommend developing population-specific interventions to reduce the risk of HIV infection in Canada.