“The Medical System Is Not Built for Black [Women’s] Bodies”: Qualitative Insights from Young Black Women in the Greater Toronto Area on Their Sexual Health Care Needs

Abstract

While often framed as historical or ‘post’colonial, the pervasive legacies of anti-Black racism, rooted in the afterlives of slavery and the dehumanization of African, Caribbean, and Black (ACB) voices, continues to shape the health experiences of young ACB women in Ontario, Canada. Using an intersectional framework, this qualitative study utilized focus groups (n = 24) to understand factors influencing access to sexual and reproductive health services for young ACB women in southern Ontario. The findings reveal that fostering ACB youth engagement in the design and facilitation of healthcare programs will be vital for creating more responsive spaces to fully express sexual health concerns. It also demonstrates that Eurocentric biomedical frameworks continue to obscure young ACB women’s needs, emphasizing the necessity for culturally relevant care. Lastly, the findings indicate that internalized colonial narratives around health practices perpetuate intergenerationally, further complicating young ACB women’s access to adequate sexual and reproductive healthcare. This examination illuminates the need to address the colonial legacies within healthcare systems that continue to pathologize and hypersexualize young ACB women’s bodies. The study concludes by advocating for intersectional, youth-centered, and culturally competent approaches to dismantling the barriers young ACB women face in accessing sexual and reproductive health services.

1. Introduction

African, Caribbean, and Black (ACB) Canadians in cities across Ontario, Canada are experiencing an alarming rise in anti-Black racism. These experiences of racial discrimination have a prevalent influence on education, employment, and other socio-economic outcomes (Mensah and Williams 2022). This is also the case for sexual and reproductive health (SRH), as demonstrated by the disproportionately high rates of sexually transmitted infections (STIs) among ACB Canadian communities. Although ACB communities comprise roughly 5% of Ontario’s population, after considering factors including age, sex, and city of residence, the prevalence of HIV among ACB residents in Ontario was reported as 7.5% in a 2022 survey report (Mbuagbaw et al. 2022). Yet, there remains a critical gap in the scholarship addressing how the intersections of race, gender, age, and sexuality shape the SRH experiences of young ACB women in Ontario. Young ACB women, who are already subjected to racial and gender-based discrimination, often face experiences of age-based marginalization and culturally inadequate care that further silences their voices within the healthcare system. The long-term implications from the research gaps that have been identified are significant, as these unaddressed health inequities compromise the overall well-being of young ACB women, undermining their autonomy to make informed choices about their bodies. This study therefore seeks to urgently address this gap by uncovering barriers to accessing and maintaining culturally safe SRH care. By centering the experiences of young ACB women, this research aims to reimagine SRH in a manner that dismantles pervasive structures of medical and social violence in order to affirm their agency and right to adequate care.

Importantly, this project was led by two Black identifying women, one who is a first-generation immigrant to Canada from the Caribbean. She is an Associate Professor and Canada Research Chair. The other is a first-generation immigrant to Canada from continental Africa, and emerging scholar. The larger project team consists of Black, racialized, and allied researchers, community leaders, healthcare and frontline service providers, all of whom have an invested interest and track record of work in tackling sexual and reproductive health inequities across North America.

1.1. Genealogies of Anti-Black Racism in Canada

The roots of anti-Black racism in Canada can be traced back to histories of colonialism, imperialism, globalization, and slavery—many of which continue to significantly shape the social, economic, and political landscape of the country. Ongoing colonial processes include the displacement and genocide of Indigenous peoples and their land, as well as the enslavement and exploitation of African peoples brought forcibly to the continent (Warren 2016). Slavery played a significant role in the economic development of Canada; therefore, current-day Canada can be conceptualized as being built on the backs of African slaves (alongside otherwise colonized subjects forcibly brought to the country for settler-capitalist exploitation) (Easterbrook and Aitken 1988; Mackey 2010; Warren 2016). The abolition of slavery in Canada occurred gradually, with Upper Canada (now known as Ontario) passing legislation to abolish slavery in 1834 (Winks 1997). However, this abolition process did not result in immediate freedom or full rights for formerly enslaved individuals.

The post-emancipation period saw the emergence of discriminatory practices and policies aimed at restricting the rights and freedoms of Black Canadians. This included the implementation of segregationist policies in schools, housing, hospitals, and other public spaces, as well as the enactment of laws that denied Black individuals the right to vote, own property, or pursue certain professions (Maynard 2017; Kendi and Blain 2021); these practices catalyzed experiences of racial segregation throughout the nation and reinforced a homogenizing view of Blackness that reduced diverse Black experiences to a singular, marginalized category. One instance of this can be seen in the case of Viola Desmond, who was arrested in 1946 for sitting in the “whites only” section of a theater (Backhouse 1994). Contemporarily, ACB Canadians continue to face anti-Black racism, systemic discrimination, and dehumanization. Racial profiling, police violence, and disproportionate rates of incarceration further exacerbate the marginalization and disenfranchisement of ACB communities (Maynard 2017). A review by DasGupta et al. (2020) noted 4 key areas where anti-Black racism can be felt most prominently across Canada: children and youth development; job opportunities and income support; health and community services; and policing and the justice system. In particular, this review found that ACB women in Ontario are widely underscreened for cervical cancer (DasGupta et al. 2020). When reviewing these statistics, it becomes critical to understand its root causes. The pervasive nature of anti-Black racism in Canada reproduces eugenic violence and discrimination against ACB peoples, leading to experiences of stigma, alienation, and microaggressions in everyday life (Jean-Pierre and James 2020). The ongoing lack of attention to ACB Canadian experiences in these interconnected systems perpetuates racial inequities in access to employment, education, housing, and social mobility.

1.2. Sexism and Gender-Based Discrimination in Canada

Sexism and gender-based discrimination in Canada are deeply intertwined with settler colonialism, cis-heteropatriarchy, and hegemonic ideals of gender roles and norms. Since European colonization of North America, Canadian society was forcibly structured around patriarchal systems that relegated women to subordinate roles within the family, economy, and public sphere (Johnson 2005). This hierarchical division served to maintain the binary status quo of white male privilege and female inferiority, perpetuating systemic inequalities that would persist for centuries. Throughout the 19th and early 20th centuries, Canadian women began to organize for their rights, demanding greater autonomy, suffrage, and access to education and employment opportunities (Sangster 2018; McCammon 2003). Throughout this period (and afterwards), ACB women’s roles in feminist movements were often sidelined, with their distinct struggles and contributions being ignored within mainstream feminist organizing (Shorter-Bourhanou 2024). The post-World War II era saw a shift towards liberal feminism, which focused on legal and political equality within existing structures, while the rise of second-wave feminism in the 1960s and 1970s brought attention to systemic issues such as reproductive rights, gender-based violence, and workplace discrimination (Molony 2017). Legislative reforms, such as the introduction of the Canadian Human Rights Act in 1977 and the Charter of Rights and Freedoms in 1982, provided legal frameworks for addressing gender-based discrimination and advancing women’s rights (Boyd and Sheehy 1986); however, Canadian feminist organizing continued to center whiteness (Salem 2018). As such, despite these legal changes, systemic inequities continue to persist, particularly for ACB, Indigenous, and racialized gender and sexual minorities, as well as folks with dis/abilities (Kia et al. 2020; Siller and Aydin 2022).

1.3. Intersectional Considerations for Black Women’s Sexual and Reproductive Health in Canada

Rooted in Black feminist organizing and the foundational work of The Combahee River Collective (2014), as well as the works of the likes of Bell Hooks (1984) and Audre Lorde (1984), Kimberlé Crenshaw’s (2013) work on intersectionality, as well as Hill Collins’ work on the Matrix of Domination (Collins 1990), provides a critical framework for understanding the interconnected nature of oppression and privilege based on differing identities, such as race, ethnicity, gender, class, religion, sexuality, and dis/ability. This key framework highlights how multiple social locations intersect to shape individuals’ access to resources, opportunities, and power. Thus, the term “common oppression” is a false notion that does not consider the social complexities and the realities of young ACB women (Hooks 1984). Within the context of SRH, young ACB women in Ontario face intersecting forms of sexism, gender-based discrimination, ageism, and anti-Black racism that exacerbate gaps in access to healthcare, reproductive rights, and sexual autonomy (Woodly et al. 2021; Darko 2020). From medical racism to a lack of access to comprehensive sexual education, ACB Canadian women are often forced to navigate a plethora of systemic barriers, biases, and discrimination that undermine their bodily agency, health outcomes, and overall well-being (Roberts 2014).

Another key consideration of intersectionality is religiosity, which is deeply entangled with the legacies of colonialism and its attendant systems of power. Religion, in its institutionalized Eurocentric form, has served as a mechanism of colonial control and cultural regulation (Tarusarira 2020). This process involved the systematic erasure and delegitimization of traditional African spiritualities, which often celebrated holistic and community-centered approaches to health and well-being. In contrast, colonially entrenched Christian ideologies imposed rigid, hierarchical frameworks that prioritized heteronormativity, chastity, and reproductive labor within patriarchal family structures (Lugones 2007; Tarusarira 2020). Natarajan et al. (2022) studied how the rhetoric and practice of purity culture has caused harm to women’s sexuality and sexual expressionIn particular, they found that the prevailing notions surrounding celibacy and abstinence are a product of white evangelicalism and have distinct ramifications on women of color’s romantic and sexual relationships in ways that differ from white women due to their experiences at intersecting forms of oppression (Natarajan et al. 2022). These ideologies continue to shape contemporary framings of morality, sexuality, and bodily autonomy, reinforcing gendered and racialized notions of respectability politics as it pertains to (sexual) healthcare. As such, the framework of intersectionality thereby becomes a crucial theoretical underpinning of this study to illustrate the nuanced access and healthcare needs at this nexus of race, religion, age, gender, as well as other social locations and identities.

1.4. Sexual and Reproductive Health Service Provision in Canada

While Canada is often known for its “free” healthcare, many Canadians frequently report barriers to accessing necessary SRH care, including limited hours of operation, service costs, and lack of person-centered care (Cram et al. 2016; Vass et al. 2022). In Ontario, residents are covered by the Ontario Health Insurance Plan (OHIP), which includes visits to family doctors, medically necessary hospital services, and certain procedures, including abortion services (Government of Ontario 2024). However, this coverage does not fully address the needs required for long-term SRH care and support. For example, non-prescription medications such as over-the-counter pain relievers, as well as birth control and other contraceptives would not be supported with coverage from OHIP (Government of Ontario 2024). Thus, this prompts financial barriers for individuals who require access to extended SRH services and care.

The World Health Organization’s (WHO) definition of sexual health goes beyond the traditional disease model to encompass one’s mental health and well-being (Douglas and Fenton 2013). Despite this definition, ACB youth in Toronto have reported a lack of holistic SRH care, advocating for culturally responsive resources and healthy conversations about sexuality and pleasure (Larkin et al. 2017; Toronto Teen Survey 2010a). Furthermore, Two-Spirit, lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (2S/LGBTQ+)-identifying ACB youth from this study noted that topics surrounding sexual and gender diversity were not discussed in their sexual health education, leading to their needs not being acknowledged or addressed (Larkin et al. 2017). From this, it becomes clear that while Canada’s “free” healthcare covers a range of services, it faces significant challenges related to SRH care for ACB communities.

Existing literature on reproductive care highlights a significant lack of race-based data on reproductive services in Canada (Maxwell et al. 2024). Post-secondary students across Ontario who advocate for disaggregated race-based health data have noted that this absence perpetuates ongoing issues within healthcare spaces (James and Turner 2017; Toronto Teen Survey 2010b). Despite these efforts, a persistent gap remains in the collection and use of such data.

1.5. The Effects of COVID-19 on Virtual Care in Ontario

Virtual healthcare, which is commonly defined as health services delivered using technological means, became pivotal during the COVID-19 pandemic (Bhatia et al. 2021). Bhatia et al. (2021) describes the COVID-19 pandemic as the catalyst of the virtual care revolution. In Ontario, many healthcare professionals transitioned to virtual services to reduce virus transmission and exposure (Bhatia et al. 2021). During the pandemic, the demand for healthcare services exceeded the number of resources available (Barrett et al. 2020). Before the pandemic, the Ontario Telemedicine Network was the only funded virtual service in the province (Bhatia et al. 2021). In March 2020, telecommunication services, such as Skype, Zoom, FaceTime, and telephone calls, were included as the services that would be reimbursed (Bhatia et al. 2021). With the increase in requests for healthcare services and the limitations on in-person contact, telehealth services became an essential method of healthcare delivery (Virtual Care Task Force 2022).

The federal government responded to COVID-19 by investing significantly in the delivery and advancement of virtual health services (Virtual Care Task Force 2022). According to the Canada Health Infoway data, the rates of virtual care increased from 10% to 20% in 2019, peaking at 60% in April 2020 (Virtual Care Task Force 2022). Nayyar et al. (2022) reported that patients found virtual services more convenient in alleviating some barriers to care. However, they also highlighted barriers in virtual care, noting variable effectiveness and challenges in building patient–provider rapport (Nayyar et al. 2022). Meanwhile, other scholars have raised ethical concerns such as issues of surveillance, confidentiality, and informed consent when it comes to the use of virtual healthcare services (Abdillahi 2024). Whilst there is a body of literature that explores the impacts of virtual care on different marginalized groups in Canada (Brennan et al. 2020; Shaw et al. 2021; Abdillahi 2024), there is minimal research consisting of disaggregated empirical data that explore the outcomes and experiences related to specific intersections of identities. In addition, there is a gap in the literature that looks at the distinct experiences of SRH care for ACB youth in Canada during the pandemic. In acknowledging the historical and ongoing legacies of slavery, racism, sexism, and discrimination, there is a need for culturally specific data that addresses young ACB women’s experiences with SRH care in Southern Ontario, and outcomes and experiences related to specific intersections of identities. In addition, there is a gap in the literature that looks at the distinct experiences of SRH care for ACB youth in Canada during the pandemic. In acknowledging the historical and ongoing legacies of slavery, racism, sexism, and discrimination, there is a need for culturally specific data that addresses young ACB women’s experiences with SRH care in Southern Ontario.

1.6. The Current Study

The data presented in this paper comes from the Sista2Sista project, which was a pilot project focused on adapting the Health Improvement for Teens (HIPTeens) Intervention (Morrison-Beedy et al. 2024) from the American to the Canadian context. HIPTeens is an evidence-based sexual health risk reduction intervention for adolescent girls that enhances knowledge, increases motivation, and teaches the behavior and skills needed to reduce pregnancy, HIV, and STI risk (Morrison-Beedy et al. 2013). Through conversations with young ACB women (n = 24) across two focus groups, the research team hoped to garner a better understanding of how young ACB women in Toronto, Ontario, Canada navigated sexual decision-making and sexual healthcare access. The logic here is that a better understanding of the barriers and facilitators for sexual health among local ACB youth would help to inform the tailoring stage of the HIPTeens intervention for adaptation from the American to the Canadian context and thus enhance the intervention’s efficacy and uptake locally. While the larger study focused on the components of an intervention adaptation, the focus of the current manuscript is to elucidate the barriers and facilitators to sexual healthcare identified by young ACB women in the focus group data.

2. Materials and Methods

2.1. Sampling and Recruitment

Throughout 2019 and 2020, the Sista2Sista project recruited young ACB-identifying women between the ages of 16 and 24 who lived in Toronto and its surrounding regions, otherwise known as the Greater Toronto Area (GTA), and were interested in participating in focus group discussions. The Sista2Sista project was vetted and garnered ethical approval from Wilfrid Laurier University’s institutional research ethics board and provided with approval number 5862. We opted for young ACB women who were 16 years of age or older, as 16 is the age of consent in Ontario (Government of Canada 2023). Furthermore, we recruited participants who identified as women to leave room in these discussions for the experiences of not only cisgender women but transgender women as well. Posters were distributed electronically via email listservs, and social media platforms such as Facebook, as well as at local community organizations (i.e., Black Coalition for AIDS Prevention), community events (i.e., Afrofest), and in-person at local health centers, community centers, high schools, and shopping malls. The research team also tapped its network of collaborating community organizations to promote the project so that the youth can access their services.

In total, 40 young women were interested in joining the focus groups and participating in the study. However, six people were excluded because they did not meet the age requirements. Another three people were excluded from participation because they did not reside in the GTA. One participant was excluded because they did not identify as a cisgender or transgender woman. Six other participants had a variety of scheduling conflicts and could not join the focus groups. The final sample consisted of 24 young ACB women who completed a brief demographic survey (see Figure A1) and took part in either of two focus groups. The first focus group had 13 participants (n = 13), and the second had 11 (n = 11). The mean age of our sample was 24 years. Of the 24 participants, 23 participants identified as heterosexual (n = 23), and one participant identified as bisexual (n = 1). All participants identified as cisgender women. The full details on participant demographics can be viewed in

Table 1. Participant Demographic Survey Information.

Characteristics	Total Sample N = 24 n (%)	FG1 N = 13 n (%)	FG2 N = 11 n (%)
Age range	16–29	22–29	16–26
Age mean and SD	M = 24.2 SD = 3.2	M = 25.7 SD = 2.1	M = 22.6 SD = 3.5
Ethnicity
African	12 (50.0)	7 (53.4)	5 (45.4)
Caribbean	8 (33.3)	4 (30.8)	4 (36.4)
Black-Canadian	1 (4.2)	0 (0)	1 (9.1)
Mixed	1 (4.2)	0 (0)	1 (9.1)
Other	2 (8.3)	2 (15.4)	0 (0)
Sexual Orientation
Heterosexual	24 (95.8)
Bisexual	1 (4.2)
Region of Residence
City of Toronto	11 (45.8)	4 (30.8)	7 (63.6)
Durham Region	3 (12.5)	0 (0)	3 (27.3)
Peel Region	4 (16.7)	3 (23.1)	1 (9.1)
York Region	6 (25.0)	6 (45.2)	0 (0)

.

Participants were compensated $30 plus the cost of transportation for their time, and culturally appropriate food was provided at the start of each focus group as a means for facilitating rapport amongst facilitators and participants. Further, offering this culturally appropriate food was important to honor cultural traditions and foster a sense of belonging and safety amongst those involved in the focus groups. The focus groups were facilitated by authors N.D. and C.W., who both have experience as youth program coordinators.

2.2. Methodology

At the start of each focus group, the project facilitators explained the informed consent form to ensure there were no outstanding questions or concerns from participants before commencing the discussions. In the informed consent process, participants were informed that participation was voluntary, and that they can withdraw from the study at any time. However, participants were notified that because the audio-recorded discussions were occurring within the context of a group conversation, the project team could not excise their specific statements from the recording within the context of that larger discussion. That being said, our project team did express a commitment to excising any mention of their name and/or pseudonym should they voluntarily withdraw. Furthermore, to encourage the respective confidentiality within each focus group, participants were strongly encouraged to refrain from disclosing the names and identities of other focus group participants outside of the focus group. Participants then signed off on the consent forms, followed by completing a brief demographic survey. The survey was written in an accessible and jargon-free manner for participant engagement.

The focus group discussions started by establishing ground rules for engaging in the shared discussion, which included principles such as ‘listen when someone is talking’, ‘respect different perspectives’, and ‘withhold judgment of others with different lived experiences’. This is done to cultivate a safe environment of mutual respect and empathy for participants to feel comfortable sharing their experiences. The focus groups lasted approximately 90 min and were aimed at unpacking the experiences of young ACB women in accessing sexual health services, resources, and information across the GTA. Towards this end, participants were asked to comment on how they define their sexual health, the state of sexual healthcare and education in Ontario, their preferred modalities for accessing sexual health information and resources, as well as other barriers and facilitators to their overall sexual health. Due to the sensitive nature of sexual health and HIV, participants were encouraged not to share any personal information they did not feel comfortable disclosing publicly (i.e., HIV status) with others in these sessions. The guide of the focus group discussions focused on identifying key factors influencing service access, evaluating the effectiveness of existing resources, and gathering insights to improve tailored interventions. The full guide can be viewed in

Table A1. Focus Group Guide.

Section/Question	Discussion Prompt	Probes
Preparation	Create comfortable environment.
Introduction	Introduction of Research Coordinator
Introduction	Welcome participants.
Introduction	Overview of the topic.
Introduction	Ground rules.
Q1	When I say the word sexual health, what comes to mind? What does sexual health mean to you? What does your sexual health include?
Q2	What are the most important sexual health issues facing young, Black women in the GTA? What are the pressing issues?	Probe: Can you explain why these issues might be occurring? What is at play?
Q3	When you think about safe spaces, places and people to talk about sexual health—who/where/what is included in that list?
Q4	Where do you go to discuss your sexual health?
Q5	When you think about safe spaces, places and people to talk about sex?	Probe: School, friends, parents?
Q6	What about STIs and HIV/AIDS?
Q7	What sexual health programming is available to you to discuss these issues of sex, sexual, STI’s etc.?
Q8	Where do you go for sexual health services?	Probe: Why do you go there? What prevents you from going to certain places?
Q9	How would you improve the state of sexual health programs available to Black youth? What would you change/include etc.? What kind of sexual health programs or campaigns would be useful for Black youth like yourself?
Q10	About HIPTeens Intervention—describe HIPTeens and probe about what would be useful and NOT useful about such an intervention. What needs to change to improve it to make it relevant to Black youth?
Q11	How would you like to receive information on sexual health?
Q12	What is the best way to engage ACB youth and get them involved in sexual health issues?
Q13	Any final comments about sexual health and how it affects us as Black women?

.

2.3. Data Analysis

The qualitative data produced from the discussions were audio-recorded, transcribed verbatim, and stored in a password-protected Microsoft OneDrive digital folder on the Wilfrid Laurier University server. To ensure qualitative reliability and validity, a codebook for the thematic analysis was co-created by the two project leads (N.D. and C.W.) and vetted by the larger project team before being used to qualitatively analyze the data. Furthermore, ongoing team discussions allowed for iterative feedback on the codebook throughout the coding process. Trained by C.W., the transcripts from the focus groups were analyzed by N.D., G.R., and J.R., with specific attention to an intersectional framework of analysis, for common themes about ACB youth sexual healthcare needs using NVivo 11 software. This inductive process was completed using Braun and Clarke’s (2006) six-step process.

2.4. Limitation

Both of the facilitators of the focus groups identified as cisgender, heterosexual Black women. Early on in the recruitment process, it became clear that, despite language on our flyers indicating openness to gender and sexually diverse ACB women, the lack of sexually diverse representation among the project team limited our ability to recruit for such diversity. As such, the project leads tapped one of the queer-identifying youth collaborators on the larger project to assist with recruitment in the hopes that their greater visibility at the forefront of the project would yield a more gender and sexually diverse sample. Unfortunately, these efforts were not sufficient to increase diversity along these intersectional axes, as only one participant identified as being a sexual minority and the entire sample identified as cisgender women. While the cultivation of social, educational, and health spaces for cis-gendered Black women is essential and coveted space, the homogeneity of our sample in terms of orientation, gender identity and expression marks a limitation in our study findings, which capture the sexual health needs of a predominantly heterosexual, cisgender sample of young ACB women. This limitation reflects a broader issue within health research, wherein visible representation is vital for building trust among subgroups within communities that have been historically marginalized. We will also note here the importance of the effort to garner insight from sexually and gender-diverse young Black people in informing any SRH intervention, as sexuality within youth communities tend to be fluid, as young people are more open to exploring the fullness of who they are. Future research should engage queer and trans Black youth and the service providers who serve their diverse needs from the start of the project in order to best inform a research design that prioritizes queer and trans youth realities—which was not the exclusive focus of this larger project.

3. Results

After undergoing a rigorous qualitative analysis of the data presented by the focus group participants using NVivo qualitative data analysis software, 6 themes emerged: Barriers to care; Healthcare provider competency; Virtual care and pandemic adaptations; Intergenerational beliefs about sex, sexuality, and sexual health; Centering ACB youth; and Comfortable space.

3.1. Barriers to Care

This first theme encapsulates mentions of obstacles that impede their access to, or utilization of, sexual health services. This theme comprises three sub-themes: anti-Black stigma, lack of resources and information, and service inaccessibility.

3.1.1. Anti-Black (Sexual) Stigma

A prominent area of discussion among respondents was how forms of anti-Black stigma significantly impeded their ability to access sexual health services. In particular, they noted that the internalization of such stigma manifested in the inhibition of individuals from seeking necessary contraceptive methods. One respondent noted that their peer’s stigmatization of taking the over-the-counter contraceptive pill known as Plan B hindered their desire to continue with this form of contraception:

“Like sometimes the stigma of being called a slut or being hyper-sexualized, actually prevents you from taking steps to better your sexual health. Like there was one time when… like one of my friends, straight up got angry at me, hung up the phone on me, for taking plan B too many times. That’s not how it works. So, it’s just like all these stigmas… prevent you from actually taking care of yourself”.

(FG1)

Additionally, another respondent indicated that prevalent anti-Black racism within health settings deterred them from seeking, or continuing to seek, care:

“And you look at the fact that there’s anti-Black racism, in accessing services, there’s the impact that anti-Black racism has on you, … we’re often asked to be stronger, and, and we’re forced to be resilient when it comes to facing certain barriers. And … some of that is a cultural stigma that keeps us from recognizing that, but then also, the medical system itself is not built in a way where it understands Black bodies”.

(FG2)

These quotes demonstrate how entrenched cultural biases and the structural anti-Blackness embedded within the medical system coalesce to produce an exclusionary and hostile healthcare environment. Within this framework, young ACB women encounter systemic deterrents that obstruct their access to essential and equitable SRH services.

3.1.2. Lack of Resources and Information

Respondents also identified a lack of access to essential SRH information regarding where they can access such resources. This, in turn, was discussed as impacting their ability to maintain pre-existing care or access care in the first place. For instance, a participant spoke about how a combination of barriers to equitable resources structurally impeded their ability to seek out necessary care through school counseling services:

“As Black students, there’s often a lack of adequate services provided. And so if, for example, it’s unaffordable, to access those mental health services, or there’s no guidance counsellor at your school, who has any sort of, or who doesn’t have relevant lived experience, or who has inadequate training, then that makes it a lot more difficult”.

(FG2)

At the post-secondary level, one respondent noted how the lack of adequate information posed challenges to their sexual safety:

“But even in university [it is] always about consent but never the steps or ways to stay safe while doing it. You see, it’s kind of funny because it’s like they want to promote safeness so they offer condoms, but they don’t explain other things that you need to do”.

(FG2)

Further, if they are able to access these resources, respondents stated that the information provided to them is not culturally responsive to meet their specific needs. This lack of cultural responsiveness means that the care they receive may overlook socio-cultural or historical factors that shape their healthcare experiences, further impacting their ability to seek out adequate sexual health knowledge that is attuned to their lived realities:

“I see white gatekeepers engaging with Black community members or Indigenous community members or other racialized folks. And, they expect this very sort of western frame of sexuality, that doesn’t include spirituality for example, and often in sexual health services you’ll find that’s completely devoid of any conversation”.

(FG1)

Participants here largely highlighted how inadequate services, such as unaffordable or undertrained counseling, hindered their ability to maintain or initiate necessary care. Additionally, the information available to students and individuals lacked cultural responsiveness. This absence of culturally relevant care, rooted in Western-centric frameworks, marginalized the socio-cultural and historical experiences of ACB communities, further exacerbating inequities in SRH access and outcomes.

3.1.3. Service Inaccessibility

The final barrier discussed was the inability of young ACB women to access necessary healthcare services. One aspect that influenced this inaccessibility was geographic distance, or location-related factors. Some respondents pointed to a lack of sexual health service provision for ACB sexual and gender minorities in rural and suburban regions, and this was particularly marked in the GTA which is less infrastructurally developed than Toronto (i.e., bus routes and public transport options; healthcare spaces, etc.). The GTA also happens to be where many Black and racialized communities reside, as the metropolis of Toronto is relatively expensive, marking a class as well as race dynamic:

“We need more than just sexual health clinics in the suburbs… like in rural areas and there might not necessarily be like large populations of LGBTQ+ Black youth that are in many of those spaces. Those are hugely underserved areas… And there needs to be more access to things like, … contraception, and kind of medication for STIs, for HIV, and for pregnancies”.

(FG2)

Another key area of concern regarding accessibility mentioned by respondents was how a lack of financial resources further impeded their ability to seek out adequate sexual health services:

“I think one big issue is that there aren’t free or low-cost options that are reasonable. Like I remember really sitting there, having a serious conversation with myself about whether birth control would show up as a name on my parent’s insurance documents, and whether it was worth going through that, or you know what, let me just work a few extra shifts, and handle that myself”.

(FG1)

The excerpts throughout this theme illuminate how the medical system, coupled with entrenched cultural stigma, obstructs young Black women’s access to essential sexual and reproductive health (SRH) resources, particularly contraceptive methods. Respondents further identified structural barriers, including insufficient information regarding resource availability and geographic marginalization that renders SRH services difficult to access in suburban and rural areas. Additionally, the absence of culturally responsive care demonstrates a broader institutional failure to account for the socio-cultural and historical dimensions of Black communities’ health needs. This epistemic and structural neglect signals a critical gap within institutional consent education, which, although formally promoted, lacks substantive guidance and counseling on SRH, thereby reinforcing systemic inequities in reproductive autonomy.

3.2. Healthcare Provider Competency

The second theme discusses the proficiency, skills, and capabilities that healthcare professionals possess in delivering care to patients. This theme comprises two sub-themes: misogynoir and Western health practices.

3.2.1. Misogynoir

Misogynoir refers to the intersection of misogyny (prejudice against women) and anti-Black racism. Many respondents noted challenges with their healthcare provider due to ingrained biases rooted in white cis-heteropatriarchy. Notably, respondents pointed to their experiences of hypersexualization and objectification within healthcare settings. They reported that their quality of care was negatively impacted by healthcare providers holding beliefs rooted in misogynoir:

“Black women are stigmatized to be viewed as women that are very sexually active, and I guess sexually expressive, and they’re comfortable with pregnancy. And, these types of STDs and STIs are common within our group. So, when you go to a doctor’s office, and you present to them certain symptoms that you may be facing, they’ll automatically right way assume are you pregnant, you have an STD because of their experiences, and the things that they see outside of the world with regards to Black women”.

(FG2)

They also noted how their experiences of misogynoir caused their concerns to be institutionally ignored or silenced, further eroding their overall quality of care:

“I’ve read a couple of studies about how Black women are silenced. So, let’s say you’re in birth and you’re like I’m feeling this pain, they [health providers] kind of don’t really take your pain seriously. So, it’s like you can be addressing certain things or like voicing certain issues that you’re having but they’re just like pushing those things to the back burner, and those things can actually develop into something that’s actually serious. So, … a lot of Black women, they actually have like higher risk of dying during childbirth because they’re not actually listening to like ‘my back is hurting’ or like ‘I need this”.

(FG1)

The above quotes discuss the lived experiences of young ACB women navigating healthcare systems, particularly emphasizing the pervasive manifestations of discrimination and anti-Black sexism within these spaces. Such practices significantly undermine the efficacy and medical integrity of the care provided to young ACB women.

3.2.2. Eurocentric Health Practices

Respondents highlighted Western healthcare practices that prioritize Eurocentric perspectives, beliefs, and standards as another integral aspect of the lack of healthcare provider competency. One respondent in particular mentioned the importance of cultural relevance in receiving adequate care:

“I would say the lack of Black practitioners and or perhaps, practitioners that understand Black health… I do see it being a thing where, you know, you’re having practitioners who don’t necessarily have a cultural understanding. And are oftentimes, applying Eurocentric methodologies and Eurocentric ways of knowing as it relates to health care to the Black body in mind. And that in itself, can be devastating, or have devastating effects” (FG2). However, it is important to note that this perspective assumes empathy solely based on shared racial background, which may not be the case when additionally considering biases related to gender and sexuality that are ingrained within ACB cultures.

The prevalent use of Eurocentric strategies when treating a diverse population of young ACB women highlights the lack of holistic care that is currently provided and can exacerbate harm rather than promote healing.

Participants largely spoke to how pervasive discrimination based on both race and gender contributes to the medical marginalization of Black women and directly impacts the quality of care they receive. Misogynoir, as illustrated through respondents’ experiences of hypersexualization, objectification, and silencing, demonstrates how healthcare providers’ biases often lead to the dismissal of serious health concerns, which can have dire SRH consequences. Additionally, the dominance of Western, Eurocentric healthcare practices further alienates young ACB women from receiving appropriate care. By analyzing these dual challenges, it becomes clear how institutionalized racism and the failure to acknowledge diverse cultural health needs directly undermine the efficacy of medical care for young ACB women.

3.3. Virtual Care and Pandemic Adaptations

In this theme, respondents provided insights into their opinions about virtual sexual healthcare delivery, particularly in response to the COVID-19 pandemic. Both positive and negative experiences were explored.

3.3.1. Benefits

Some respondents highlighted positive experiences associated with virtual care services, noting that the accessibility of such services was significantly enhanced through virtual access to care:

“With online, in some ways, it’s actually a good thing as well, because I think here geographically things are so it’s very hard to access certain services, and commuting and things like that. So yeah, just kind of acknowledging that there is a need and getting more service providers to recognize that and then going from there in terms of providing more services here”.

(FG1)

Additionally, another respondent highlighted the benefits of obtaining information through a trusted health influencer during the pandemic. They also noted that the influencer’s audience contributed to the creation of a community that addressed pertinent health topics:

“Like I’m getting my information from an influencer, who is really outspoken about sexual health and everything, where to get smear tests, STIs, anything surrounding that information. So, this is a nice place to meet other women and just discuss how it affects me and get that knowledge that I did not get growing up”.

(FG1)

In the quotes above, the participants noted the advantages of virtual care, emphasizing its facilitation of more accessible and immediate information regarding healthcare-related inquiries. Additionally, participants noted the value of engaging in dialogs and fostering connections within a virtual community of individuals sharing similar concerns and questions.

3.3.2. Drawbacks

On the other hand, some participants expressed negative experiences with virtual sexual health services.

Participants highlighted the limitations of virtual care service accessibility, particularly with regard to structural and material barriers beyond their control. While participants noted barriers in reliable internet, they also identified the lack of confidential spaces as a limitation to accessing necessary virtual care. One respondent noted the significance of housing circumstances and housing environment where youth may not have the resources to connect in a confidential and safe space.

“A lot of youth that we work with, especially those who come from very underserved communities or who are not housed and they’re living in shelter spaces… Not sure if they actually have the resources they need to connect, or the space, the privacy, that kind of thing”.

(FG1)

From respondents’ narratives, virtual sexual healthcare during the COVID-19 pandemic became a contested site of both expanded accessibility and deepened inequities. While some participants noted the increased reach of care through virtual methods, particularly in geographically isolated areas, others emphasized the limitations imposed by unreliable internet access and challenges with housing environments. The influence of material and socio-economic constraints on digital health infrastructures expressed by participants suggest that the reality of virtual care simultaneously enables and forecloses care at intersecting axes of privilege and marginalization.

3.4. Intergenerational Beliefs About Sex, Sexuality, and Sexual Health

This next theme encapsulates discussions of participant’s perceptions of the term ‘sexual health’, as well as the pervasive influence of parental, cultural, or religious beliefs and values on their sexual practices. This theme comprises three sub-themes: fear of sex/uality, HIV/STI stigma, and intergenerational influence on sexual education.

3.4.1. Fear of Sex/Uality

Respondents noted their parents were reluctant to have conversations surrounding sexual behaviors with their children. Some discussed how this reluctance largely stems from their Christian upbringing, wherein religious teachings predominantly promote sexual aversion. One respondent, in particular, spoke to how these internalized Catholic beliefs are opposed to African and Afro-diasporic cultures:

“And, so, we come to this space, we talk about the fear of sex in our cultures, and in our communities, and also the fear of you know queer members of our communities as well, and the stigma around that as a direct result of Christianity right. And, I think like really acknowledging for me anyways and always is to acknowledge that you know not too long ago, our cultures were not nested in rampant homophobia, and this fear of children, and the fear of sex, and viewing all of these things as a- these are very Christian ideals. These are not the origins of African cultures or diaspora cultures for that matter”.

(FG1)

Other respondents brought up how this apprehension stemmed from their parent’s concern about them, as ACB women, being overly sexualized or exposed to sexual content at a young age.

“I find that too, it comes from a place of fear, and like any way shape or form, like women, like Black women especially are sometimes hyper-sexualized. So, I think my mom specifically is very like cautious about like what are you wearing, what are you saying, who are you talking to, because people are not just going to paint you as a sexual person. They’ll paint you as a sexual Black woman, and that is somehow worse”.

(FG1)

From the quotes above, respondents discussed how their Christian upbringing fostered a fear of sexual expression, which stands in contrast to pre-colonial Afro-diasporic practices. Furthermore, they noted that concerns about hypersexualization manifest in their parents’ protective behaviors, aimed at shielding them from being stereotyped as sexualized figures due to their race and gender.

3.4.2. HIV/STI Stigma

Intergenerational beliefs were also found to (re)produce prejudice about HIV/STIs, as stated by respondents. Specifically, one respondent highlighted their parent’s misconceptions regarding HIV/AIDS as being solely associated with homosexuality, altering their beliefs of safe sexual practices and reinforcing the stigma surrounding the virus:

“I’m Jamaican background, where you want to think about AIDS, I think about the homosexual community, and they were the only ones who could catch that the and you know, and bring it around out, you know, so I used to hear that growing up, so when I growing up, I used to assume that you like, like, as long as you’re not gay you’re not catching that. But you know, it turns out later on in my life that you know, that affects everyone, right?”.

(FG2)

The respondent here reflected on how intergenerational beliefs contribute to the perpetuation of HIV/STI stigma, influencing their early understanding of sexual health and reinforcing the broader stigma. This illustrates the enduring impact of cultural narratives in shaping individual and collective perceptions of HIV/STIs and sexual health more broadly.

3.4.3. Intergenerational Influence on Sexual Education

Concerning sexual education, respondents brought up how intergenerational stigmas related to sex hinder familial discussions of safe sex practices with their children. One respondent noted how the intersections of cultural and gender biases manifested themselves in gendered assumptions of sexual practices:

“[M]y parents are of an African background too, and well, my dad no, but with my mom, it was always just don’t have sex. It was never, why, this is how, it was always just don’t do it, don’t get pregnant type of thing. I do remember one instance where she spoke to my brother and she was asking him if he knew about condoms and stuff and where to get it. So, I think a lot of it too is the double standards, where it’s okay for a boy child, a male, it’s okay as long as he is using condoms but like daughters cannot like you know. So, that’s kind of like, that was my experience growing up”.

(FG1)

Another respondent shared their experience of prolonged gynecological pain due to a lack of sexual education in their youth. They discussed how this resulted in feelings of shame and discomfort surrounding sexual health conversations with their parents:

“And, there was one day, when I was like burning. I was like what’s going on? Turns out, it was just a yeast infection, everybody gets them, but I didn’t know that. So, I was walking around for literal weeks, just like in pain … There was one day when I just got tired, I was like Mom, listen, look, something is happening, I don’t know what it is, and she’s like well, what do you think it is?, … alluding to the fact that maybe it’s an STI … And, like even (if) it was, I shouldn’t be ashamed to talk, and to figure out if it is, and to get it treated but instead, I was just walking around for weeks in pain, over a simple yeast infection that you just go to the store and take a pill”.

(FG1)

This theme highlighted how intergenerational beliefs are entangled with colonial, religious, and cultural ideologies that regulate Black women’s sexual subjectivities. Respondents articulated how the Christian doctrine has engendered a moral panic around sex, queerness, and bodily autonomy, supplanting Afro-diasporic understandings of sexuality that were not inherently bound to shame or repression. Simultaneously, they noted how parental apprehensions and anxieties were further shaped by the hypervisibility and hypersexualization of Black women. As one participant noted, the regulation of dress and behavior by parents was not merely about sexual propriety but about negotiating the precarious racialized landscape in which Black femininity is surveilled and pathologized. These intergenerational transmissions of silence and stigma obscure access to critical sexual health knowledge and sustain cycles of shame that deter young Black women from engaging with SRH services.

3.5. Centring ACB Youth

Another prominent theme focused on the benefits of centering the needs of ACB youth in sexual health program creation, development, and implementation. The two subthemes are as follows: building community and increasing ACB youth leadership.

3.5.1. Building Community

Respondents noted the importance of having spaces that connect ACB youth in their community. One respondent mentioned how involving young ACB women in their programming facilitated meaningful relationships, thereby alleviating experiences of isolation during the pandemic:

“We created lots of different series, and workshops throughout the year that help to support with building that sense of community, supporting the capacity of young Black woman connecting them with their women their age, and just being able to reduce some of the isolation that often happens, both in a physical sense, and in a more personal sense, because as folks are navigating some really difficult and challenging times, … And so I know, it’s been really affirming for a lot of the young people to be able to connect with one another and see that I’m not alone in this struggle”.

(FG2)

This quote illustrated how the creation of youth-involved spaces, especially during the COVID-19 pandemic, provided affirming experiences, allowing community members to realize they were not alone in their struggles. This emphasis on community-building demonstrates the critical role of social networks in mitigating personal and collective challenges as well as fostering a strong sense of belonging.

3.5.2. Increasing ACB Youth Leadership

Many respondents emphasized the need to increase the involvement of ACB youth in leadership positions. One respondent stressed the importance of increasing the representation of young ACB women in leadership positions to build capacity in their communities:

“So what peer programs are really helpful, right, in terms of giving that, that freedom, that leeway, that leadership, that community capacity building, where we know that young people are experts, so let’s … let them have the conversation”.

(FG1)

In particular, some respondents discussed how ACB youth can be involved in leadership positions through their engagement in developing sexual health initiatives tailored to their communities’ needs. They noted how this involvement is crucial in fostering trust, as it values the importance of their lived experiences:

“Kind of co-developing curriculum to really offer what, what young people are asking for, and developing curriculum around their needs, and building trust and relationships that way and introducing, introducing other issues that they might not be speaking about, or asking for, but based on like, you know, the climate what’s happening in the neighbourhood”.

(FG1)

The respondents’ insights across this theme highlighted how fostering spaces of connection mitigates isolation brought on by the COVID-19 pandemic among young ACB individuals, reinforcing the importance of relationality in well-being. Simultaneously, they noted that increasing ACB youth leadership disrupts traditional hierarchies of knowledge production, positioning young people as active agents rather than passive recipients of programming. By embedding their lived experiences within program development, these leadership opportunities reconfigure approaches to sexual health education to ensure that they are responsive, co-created, and reflective of community needs.

3.6. Comfortable Space

The last theme focuses on the ways in which respondents believed a comfortable space could be created, maintained, and evolved. The three sub-themes are: cultural safety and relevance, holistic care, as well as anonymity and confidentiality.

3.6.1. Cultural Safety and Relevance

Respondents offered pathways for the creation of an environment wherein folks feel validated and respected based on their multiple identities. In particular, they mentioned how representation can aid in creating a more affirming environment. One respondent noted how this representation could take the form of aligning the facilitator’s identities with those of the community:

“Just as we Black women have you the facilitator, a Black person speaker, I’m pretty sure the LGBTQ+ [community] would also want someone they can relate to, sort of providing this information. It doesn’t come across the same way, when you have a heterosexual person standing here, telling you things that you feel are only specific to you”.

(FG2)

Other respondents also discussed the importance of digital representation through communication materials in increasing one’s sense of comfortability:

“I think it has to be culturally relevant. Um, you know, simple things like the images. It seems simple, but it’s really not. The imaging that you use in your presentations, in your posts, the colours, you know? That makes a difference, because, at the end of the day, it has to be something that people want to come to”.

(FG2)

Beyond representation, some respondents spoke about how another crucial aspect of cultural safety is the ability to allow patients to make healthcare decisions for themselves after being provided with the necessary education. One respondent, in particular, noted how affirmed they felt after being provided with all the necessary information for contraceptive care:

“Like I haven’t seen my family doctor for over a decade, and then, I mentioned that I need to get my IUD replaced… with the ones that I used to see on campus, when I had my first IUD inserted, it was just like, it was the best pathway of care. They were so, they sat down with me and went through all the contraceptive methods… I went with an IUD in the end but they were just like so nice and approachable”.

(FG1)

Throughout all discussions on the role of cultural safety in enabling comfortable spaces, respondents pointed out the importance of remaining flexible when developing sexual health services. This involves not only listening to the community’s concerns but also adapting programs to meet their evolving needs.

3.6.2. Holistic Care

Many respondents expressed a need for sexual health programs to include discussions of emotional, mental, and spiritual health. Specifically, one respondent spoke about the importance of taking a harm reduction approach to recognize the interconnectedness of health across multiple levels in order to protect communal well-being:

“To me, it just means, you know, overall, physical, sexual, even mental well-being, and taking care of yourself and doing what you know, taking whatever steps you need to take to protect yourself and protect your loved ones. That includes, you know, education, that includes taking, like a harm reduction approach, whereas it relates to sexual engagement, whether you have one partner or several partners, and that also includes protecting yourself”.

(FG2)

The respondent above highlighted the critical need for sexual health programs to go beyond physical health and address sexual, emotional, mental, and spiritual well-being. Specifically, they advocated for a harm reduction approach, emphasizing the interconnectedness of these health dimensions. This approach, thereby, stresses the importance of creating spaces that recognize the distinct challenges and cultural contexts that shape the sexual health experiences of young ACB women.

3.6.3. Anonymity and Confidentiality

Respondents also discussed how the inclusion of anonymous practices can enable more comfortable spaces. In particular, they offered suggestions to increase confidential processes, enabling them to access health services without feeling exposed or judged:

“I hate having to enter the clinic, and then have to exit the same way. I feel like maybe they create something where like you come and then you could like exit through the back or something, where they have like another exit. So, like you know, you don’t have to worry about … who is going to see me coming out of this clinic”.

(FG2)

Another practice that was proposed by another respondent is the implementation of a system wherein service users are able to anonymously ask questions or seek information, empowering individuals to engage with healthcare resources more openly:

“Maybe having systems put into place where people can anonymously question or ask things because not everyone in this day and age is comfortable walking into a place and asking a question… So, making things a little bit more privatized so that people… can access it in a private way that they feel they’re keeping their anonymity”.

(FG2)

Many respondents who spoke on the importance of confidentiality as a way to increase feelings of comfortability within health services also spoke about how these anonymous practices help build trust among service users who are otherwise hesitant to interact with the system:

“What we do is … like anonymous surveys or questionnaires just to kind of, you know, hear from people, because some people might not be comfortable, you know, to speak up in a group about, you know, their experience, so we try to do anonymous surveys, just to kind of test the temperature of what people’s impression of the groups are, and, and how we can better support or improve the delivery of these programs”.

(FG1)

Having spaces where there is anonymity encourages young people to obtain important healthcare information and SRH services. It increases feelings of trust and safety, which is imperative as young Black women navigate the intersectionalities in social structures discussed previously.

The participants’ reflections on the conditions necessary for a comfortable space point to the ways in which cultural safety, holistic care, and anonymity function as constitutive mechanisms of affirmation, agency, and trust within sexual health services. The emphasis on cultural safety and relevance highlighted how representation, whether physical, material, or otherwise, can transform clinical environments into spaces of recognition. Similarly, holistic care emerged from the discussions as an essential integrated approach that acknowledges how SRH services must attend to the entanglements of physical, emotional, spiritual, sexual, and psychosocial well-being. Meanwhile, the demand for anonymity and confidentiality illustrated how privacy functions as a critical mode of safety for those negotiating heightened stigma and surveillance. Together, these insights reveal the imperative for sexual health services to move toward structurally embedded, responsive, and community-informed paradigms of care.

4. Discussion

4.1. Religiosity, Colonialism, and the Policing of ACB Sexual Cultures

From our study, it is evident that colonial encounters have deeply imposed themselves onto ACB sexual cultures, particularly through the violent propagation of Christianity (Barnes 2024). While exploitative colonization provoked resistance to cultural change in many regions of Africa, Northeast Africa, particularly in the region now known as Ethiopia, was among the earliest area to adopt Christianity through gradual conversion (Phillips and Tribe 2025). Yet, the broader matrix of colonial power has sought to assert control over Afro-diasporic bodies, which is inherently tied to the regulation of sexuality across gender, sex, and race (Barnes 2024). By forcibly intertwining Christian doctrine with the governance of ACB lives, colonizers have continued to deploy a heteronormative, patriarchal framework on sex/uality that continue to dictate sexual norms and practices (Barnes 2024). The ongoing failure to name and interrogate these colonial legacies sustains contemporary experiences of systemic oppression (Lorde 1984). As noted by our participants, such framings have imposed a White settler gaze onto young ACB women’s bodies, resulting in others hypersexualizing them.

Our respondents also noted the erasure of pre-colonial African sexualities, cultures, and kinship systems that embraced non-normative identities. Differences are necessary polarities that allow for creativity, growth, and community (Lorde 1984); however, through hegemonic religiosity, sexual repression has been weaponized to dismantle African ontologies that prioritize fluidity and spiritual connectivity (Tarusarira 2020). This process was part of the broader Christian mission, wherein African bodies and sexual practices were cast as ‘sinful’ (Tarusarira 2020). As pointed out by our participants, the intergenerational internalization of such messages has contributed to the ongoing perception of sexuality and sexual health as taboo among ACB communities in Canada.

Contemporarily, the afterlives of slavery (Hartman 2019) persist in the ongoing stigmatization of young ACB women’s sexual expression. Young ACB women across the diaspora continue to grapple with the legacies of Christian morality, which often limits their capacity to express their sexuality. Further, heteropatriarchal framings of Christianity continue to influence ACB parental attitudes toward sexual practices. Our participants noted that the taboo surrounding sexuality has created this double standard wherein young ACB men’s sexual expression is encouraged while young ACB women’s sexuality is suppressed. These cultural stigmas remain tied to the imperial logics that continue to inhibit the sexual agency of ACB communities in Canada.

Further, the trauma of enslavement and the brutality of historical practices such as buck breaking—wherein ACB men were sexually assaulted in public—have systematically dehumanized ACB bodies and sexualities associating queerness with moral corruption (Tarusarira 2020; Bennett 2019). One respondent discussed the parental perception that HIV/AIDS was solely regarded as a consequence of homosexuality. This ideology intertwines notions of religious morality with queer-phobia, enacting forms of sexual violence onto ACB 2S/LGBTQ+ individuals. By framing queerness as an ‘unnatural’ threat, colonial legacies of (sexual) control continue to reinforce the belief that non-normative sexual identities are shameful within many ACB Canadian communities today (Barnes 2024). This forbidden-ness of ACB 2S/LGBTQ+ sexual expression discourages healthy conversations surrounding safe sexual health practices. Such a denial of open conversation is directly rooted in colonial violence that continues to silence the autonomy of diverse young ACB individuals in Canada.

4.2. Resisting Institutionalized Anti-Blackness in Health and Social Service Sectors Through Community-Led Mechanisms

The ongoing legacies of anti-Blackness give rise to contemporary manifestations of misogynoir that are profoundly visible within the social and health(care) service sectors (Tarusarira 2020; Maxwell et al. 2024). These manifestations can be seen in the form(s) of uncomfortable encounters, microaggressions, medical gaslighting, and/or pathologizing of Blackness (Boakye et al. 2024; Alhassan et al. 2024). The colonial rhetoric of ACB women’s bodies as hypersexual and deviant continues to reinforce structures of sexual violence. Notably, participants expressed ACB these sectors are steeped in white supremacist ideologies that overpathologize young ACB women’s sexuality and impede access to equitable care. Misogynoir functions in these systems to render them both invisible in health discourse yet hypervisible in ways that further entrench them as subjects of scrutiny rather than care. Within these systems, it is evident that there is a lack of understanding and acknowledgment of the intersectionalities which can be detrimental to young women’s health and overall well-being (Alhassan et al. 2024). In thinking of the health(care) sector specifically, entrenched Eurocentrism can be seen as an institutional form of anti-Blackness such that Western health practices were and are not meant to treat ACB (as well as other racialized) communities. Such coloniality within health spaces positions Eurocentric medical knowledge as superior to non-Western epistemologies, refusing to integrate African ontologies and spiritualities.

Participants largely noted a lack of culturally specific information, service navigation, and resources attuned to their distinct livelihoods. The inaccessibility of services in both sectors can be viewed as a symptom of this institutionalized anti-Blackness and misogynoir, as it demonstrates a systematic disregard for their healthcare needs. As a way to combat the systemic devaluation of their lives, respondents offered methods to enable more culturally safe spaces with which to navigate their healthcare. For instance, increased representation of diverse identities within services allows for encouraging and open conversations due to shared lived experiences. This can help foster an environment where young Black women feel heard and understood (Boakye et al. 2024). Additionally, participants expressed how increased anonymity and confidentiality would increase feelings of safety, as they are more empowered to engage within sexual health services and systems. Participants discussed the consolidation of internalized stigma on sexual health practices, and to navigate these challenges, participants identified that anonymity and confidentiality aided them in developing a sense of safety and trust with service users. Further, increasing young ACB women leadership within sexual health programming and services was identified as another site of empowerment for individuals to feel more secure in expressing their full sexuality with their care providers and communities at large.

4.3. Affirming ACB Women’s Full Humanity Within Sexual Healthcare

Current Western sexual health practices operate under a reductionist paradigm that often casts young ACB women’s bodies as sexually deviant and risky (Tarusarira 2020). This framework of racialized (over)pathologization denies young ACB women their full autonomy, leading to ongoing experiences with limited and inadequate access to sexual health services. Respondents largely pushed back against such narrow biopolitical logic, yearning for a more holistic approach that recognizes a multidimensional approach to sexual care. In our discussions, participants advocated for sexual health services that engaged them as full human beings, acknowledging the often-overlooked emotional, mental, and spiritual dimensions that are necessary for culturally adequate SRH care. Aligning with Sylvia Wynter’s reconceptualization of humanness amidst the aftermath of colonial violence (McKittrick 2015), the (re)vision put forth by participants aims to affirm their embodied subjectivity within their circle of care.

4.4. ACB (Digital) Kinship as Sexual Health Promotion

ACB community building functions as a crucial strategy for enhancing sexual health experiences and care, particularly amidst the isolation brought about by the COVID-19 pandemic (Thorpe et al. 2023). Although access to care increased during the pandemic, participants highlighted the challenges of accessing affordable and culturally safe sexual healthcare in rural and remote regions, especially with the frequent limited access to internet services in these areas to support virtual care. However, ACB communities across the diaspora have long practiced forms of holistic community care (Ifekwunigwe 2018). Our participants were acutely aware of this, expressing the importance of meaningful connections during the pandemic through (sexual) health programming. In rural and remote regions, in particular, the fostering of ACB kinship networks can be seen as vital due to increased experiences of isolation. To this end, participants discussed how digital community care was essential during the pandemic to access culturally relevant sexual health information and build networks of care.

In fostering affirming relationship, efforts must be made to help young ACB women overcome alienation from one another and unlearn internalized biases (Hooks 1984). The various means of relationship-building identified during participant discussions arose as mechanisms through which community concerns could be amplified. These networks also facilitate conversations surrounding sexual health, including HIV/STI testing in the face of reduced SRH services during the pandemic, to provide ACB individuals with adequate SRH information to inform their own decisions. In this way, the generative possibilities of ACB kinship and community building function to cultivate spaces of resistance against institutionalized anti-Blackness and persisting SRH inequities. For instance, strengthening community ties can foster collective advocacy efforts toward policy changes that address structural barriers (e.g., affordability, limited internet) that continue to impede access to comprehensive SRH care for young ACB women in rural and remote regions.

5. Conclusions

This qualitative study aimed to explore the current SRH needs of young ACB women in southern Ontario, in facilitating and informing a sexual health intervention adaptation from the American to the Canadian context. Our findings emphasize the influence of Christian coloniality on the contemporary sexual cultures of young ACB women. Specifically, this study explored how anti-Blackness operates within the medical system, as well as how misogynoir functions within familial structures to further experiences of hypersexualization and reinforce cultural taboos surrounding sexual practices. These interconnected dynamics, rooted in heteropatriarchy, collectively restrict access to culturally safe and comprehensive care, further marginalizing the sexual sovereignty of young ACB women. Additionally, the study highlighted strategies for increasing cultural safety in SRH, including increasing young ACB women leadership within service provision and ensuring confidentiality when accessing spaces of care. By advocating for a more holistic and culturally responsive approach to SRH, this research calls for transformative changes to SRH service delivery and design that look beyond a reductionist view of health to incorporate spiritual, mental, social, and emotional wellness. Through vast community-led mechanisms and (digital) networks of care, young ACB women in Ontario are likely to become more empowered to not only navigate oppressive colonial health systems, but also to envision and enact transformative futures of healing and possibility.