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 forms of discrimination ACB people experienced during the COVID-19 pandemic, discrimination levels experienced before and during the pandemic and the demographic factors associated with the increased experiences 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. To be eligible, a participant had to be living in Canada, be aged 18 years or older, be able to read English or French, and self-identify as an ACB individual. The survey captured information on access to health services and experiences of multiple forms of discrimination before and during the pandemic. We used multivariable logistic regression to identify factors associated with discrimination. Results: Of 1556 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, 62.1% reported having experienced at least one form of discrimination in a healthcare setting. During the COVID-19 pandemic, over 66% reported having 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 reported having experienced sexual orientation-, gender-, substance use-, disability-, age-, economic status-, and race-based discrimination, respectively. In the multivariate logistic regression, the odds of reporting increased experiences of discrimination in participants aged 50 and above were 0.38 times (95%CI: 0.21, 0.69) those in participants who were 31–40 years of age. Conclusions: The proportion of participants who reported an increased experience of discrimination during the pandemic was high. Although there is variation in levels of experienced discrimination, the different forms of discrimination (race-, gender-, sexual orientation-, substance use-, economic status-, disability- and age-based discrimination) that participants experienced 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 contributing to participants’ perceived increased experience of discrimination when accessing healthcare services need to be explored.