Increased Experiences of Multiple Forms of Discrimination in Healthcare Settings During the COVID-19 Pandemic Among African, Caribbean, and Black (ACB) People Across Canada: A Cross-Sectional Survey

Background: In Canada, racialized communities, including African, Caribbean, and Black (ACB) people, are disproportionately affected by HIV and COVID-19. Experiencing multiple forms of discrimination in healthcare settings compromises care engagement and health outcomes. The objective of this study was to assess the various forms of discrimination experienced by ACB people during the COVID-19 pandemic, changes in the levels of discrimination experienced before and during the pandemic and the demographic factors associated with increased experience of discrimination among ACB people when accessing healthcare services during the pandemic. Methods: Data were collected via an online survey co-led by the Public Health Agency of Canada, University of Ottawa, ACB community leaders and researchers across Canada. Participants were recruited via email contact. Eligibility criteria included living in Canada at the time of the survey, aged 18 years or older, ability to read English or French, and self-identifying as African, Caribbean or Black. The survey queried access to health services, and experiences of multiple forms of discrimination when accessing healthcare services before and during the COVID-19 pandemic. Multivariable logistic regression was used to identify factors associated with discrimination. Results: Of 1,556 participants, 39.6% were aged 25-39, 42.7% were resident in Ontario, and 63.2% were of African origin. Prior to the COVID-19 pandemic, 75% experienced at least one form of discrimination in a healthcare setting. During the COVID-19 pandemic, over 66% experienced at least a form of discrimination, with 25% reporting a perceived increase in the frequency with which they experienced discrimination. The perceived increase in the frequency of discrimination was 10.8%, 15.3%, 15.9%, 17.0%, 18.1%, 18.7%, and 31.2% among participants who experienced sexual orientation, gender, substance use, disability, age-based, economic status, and race-based discrimination, respectively. In the multivariate logistic regression, the odds of experiencing discrimination in participants aged 50 and above was 0.38 times (95%CI:0.21, 0.69) that in participants who were 31-40 years of age. Conclusion: The proportion of participants with perceived increased experience of discrimination when accessing healthcare services during the COVID-19 pandemic was high. Although there is variation in levels of experienced discrimination, the different forms of discrimination participants experienced (race, gender, sexual orientation, substance use, economic status, disability and age-based discrimination) are alarming. This underscores the need for concerted efforts to address multiple forms of discrimination in healthcare settings to improve care engagement and health equity among ACB communities. There was a significant association between perceived increased experience of discrimination and only one sociodemographic factor - older age (50 and above), other factors that could possibly contribute to participants perceived increased experience of discrimination when accessing healthcare services needs to be explored.