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“It’s for us –newcomers, LGBTQ persons,
and HIV-positive persons. You feel free to
be”: a qualitative study exploring social
support group participation among African
and Caribbean lesbian, gay, bisexual and
transgender newcomers and refugees in
Toronto, Canada
Carmen H. Logie
1,2*
, Ashley Lacombe-Duncan
1
, Nakia Lee-Foon
3
, Shannon Ryan
4
and Hope Ramsay
4
Abstract
Background: Stigma and discrimination harm the wellbeing of lesbian, gay, bisexual and transgender (LGBT)
people and contribute to migration from contexts of sexual persecution and criminalization. Yet LGBT newcomers
and refugees often face marginalization and struggles meeting the social determinants of health (SDOH) following
immigration to countries such as Canada. Social isolation is a key social determinant of health that may play a
significant role in shaping health disparities among LGBT newcomers and refugees. Social support may moderate
the effect of stressors on mental health, reduce social isolation, and build social networks. Scant research, however,
has examined social support groups targeting LGBT newcomers and refugees. The purpose of this qualitative study
was to explore experiences of social support group participation among LGBT African and Caribbean newcomers
and refugees in an urban Canadian city.
Methods: We conducted 3 focus groups with a venue-based sample of LGBT African and Caribbean newcomers
and refugees (n= 29) who attended social support groups at an ethno-specific AIDS Service Organization. Focus
groups followed a semi-structured interview guide and were analyzed using narrative thematic techniques.
Results: Participant narratives highlighted immigration stressors, social isolation, mental health issues, and
challenges meeting the SDOH. Findings reveal multi-level benefits of social support group participation at
intrapersonal (self-acceptance, improved mental health), interpersonal (reduced isolation, friendships), community
(reciprocity, reduced stigma and discrimination), and structural (housing, employment, immigration, health care)
levels.
(Continued on next page)
* Correspondence: carmen.logie@utoronto.ca
1
Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor
Street West, Toronto M5S 1V4, ON, Canada
2
Women’s College Research Institute, Women’s College Hospital, 790 Bay
Street, 7th Floor, Toronto M5G 1N8, ON, Canada
Full list of author information is available at the end of the article
© 2016 The Author(s). Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Logie et al. BMC International Health and Human Rights (2016) 16:18
DOI 10.1186/s12914-016-0092-0
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
(Continued from previous page)
Conclusions: Findings suggest that social support groups tailored for LGBT African and Caribbean newcomers and
refugees can address social isolation, community resilience, and enhance resource access. Health care providers can
provide support groups, culturally and LGBT competent health services, and resource access to promote LGBT
newcomers and refugees’health and wellbeing.
Keywords: Social support, LGBT, Refugee, Newcomer, Social determinants of health, SDOH, Mental health, Sexual
and gender minorities
Background
Pervasive sexual stigma and discrimination are chronic,
cumulative stressors that have deleterious health impacts
among lesbian, gay, bisexual and transgender (LGBT)
people [1–5]. Meyer’s minority stress model describes
the role of distal processes, such as enacted stigma,
whereby people experience acts of violence and unequal
treatment (e.g., harassment), and perceived stigma,
including concerns of rejection and negative treatment
by others because of actual or perceived LGBT identity,
in contributing to health disparities among LGBT people
[3, 5, 6]. LGBT people may migrate to a new country
due to sexual stigma, often including imprisonment,
abuse, and threat of execution [7].
Upon migration, marginalization of LGBT people may
be exacerbated for those experiencing intersecting
stigma associated with sexuality, race, gender, class, and
immigration status [8]. This intersecting marginalization
among LGBT newcomers and refugees contributes to
significant challenges in realizing the social determinants
of health (SDOH) including meeting basic needs, such
as secure housing and employment, and emotional well-
being, including social support. A SDOH framework
posits that the conditions necessary for health are
shaped by individuals’immediate, social, and political
environments [9]. Newcomers and refugees frequently
experience difficulties navigating Canada’s complex
immigration processes, adapting to cultural norms, [10,
11] and being denied access to healthcare [12]. LGBT
newcomers and refugees face additional challenges
related to social isolation due to intersecting oppression
based on race/ethnicity and LGBT identity, contributing
further to health and mental health disparities. Social
support may play a significant role in moderating the
effects of sexual stigma on health among LGBT people
[3, 5, 6], yet little attention has been afforded to strat-
egies that may build social support among LGBT new-
comers and refugees in the Canadian context.
Some studies suggest LGBT newcomers and refugees
may not anticipate experiencing marginalization based
on LGBT identity in Canada, as Canada is viewed as
having human rights and protections for LGBT people,
particularly compared to countries of origin where
LGBT people may face punitive laws against homosexu-
ality [13, 14]. Murray’s qualitative study with 54 LGBT
refugee claimants in Toronto, Ontario found LGBT
refugees’expectations of safety and freedom, versus the
realities of immigrating to Canada, including experien-
cing stigma and discrimination based on their LGBT
status and race/ethnicity, contributed to disappointment
and stress [14]. Addressing LGBT newcomer and refu-
gee expectations, facilitating access to the SDOH, and
reducing social isolation are important factors in opti-
mizing the health and wellbeing of LGBT newcomers
and refugees.
Social support and LGBT newcomers and refugees
Meyer’s minority stress model posits that social support
may buffer the effect of sexual stigma on LGB people’s
mental health [3]. Social support may also reduce isola-
tion, enhance feelings of belonging, and reduce the
effects of discrimination among newcomers and refugees
[15]. Social support groups can foster universality—the
understanding that others have similar experiences [16].
Support groups among LGBT people have been de-
scribed as creating environments that foster mentorship
and contribute to positive identity development [17].
Social support groups may be therefore be particularly
meaningful for African and Caribbean (AC) LGBT new-
comers and refugees who experience marginalization
based on LGBT identity, in addition to intersecting
factors such as race and immigration status. In one
study, social support was particularly critical in normal-
izing the intersection between ethno-racial and LGBT
identities and traumatic experiences [11]. Although not
LGBT-specific, studies with newcomers to Canada high-
light the potential for support groups to address social
isolation. Stewart et al. [15] explored social support
among Chinese and Somali newcomers to Canada. They
found that post-migration, newcomers faced challenges
establishing and maintaining social networks, and that
peers who had immigrated were an important source of
support [15]. Stewart et al.’s [18] qualitative study ex-
plored the benefits of a support group for Somalian and
Sudanese refugees [18]. Participants reported that the
group reduced isolation, provided a place to express
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frustrations about structural barriers to navigating new
systems, and fostered a kinship network [18].
Among scant research conducted with LGBT new-
comers and refugees conducted in the U.S., studies dem-
onstrate the importance of social support. A needs
assessment with LGBT newcomers and refugees in
Arizona highlighted a lack of LGBT competent health
services, housing insecurity, and legal concerns [19].
Kahn [20] qualitatively explored the development of so-
cial connections among gender non-conforming refugees
from Islamic countries seeking asylum in the U.S. due to
persecution. Her study found that many participants
were alienated from family and co-ethnic communities,
and that service providers often served as ‘transitional
kinship proxies’[20]. Further studies are necessary to
understand how social support groups may address
intersecting oppression and resultant health and well-
being disparities among LGBT newcomers and refugees,
particularly within a Canadian context.
Study objective
Scant studies have examined experiences of support
groups among AC LGBT newcomers and refugees in
Canada who may face intersecting forms of stigma and
marginalization. The study objective was to explore ex-
periences and perceived benefits of social support group
participation among LGBT African and Caribbean (AC)
newcomers and refugees in an urban Canadian centre.
Methods
Study design and sample
This study was a community-based partnership with an
ethno-specific AIDS service organization (ASO) serving
AC populations in an urban Canadian centre. The ASO
implements monthly peer support groups for AC new-
comers and refugees facilitated by a staff member. This
ASO is the only ethno-specific ASO serving the AC
community in the urban centre, providing services to
community members who experience increased vulner-
ability to HIV due to social and structural drivers such
as lack of access to adequate housing, financial, and so-
cial support, and intersecting stigma and discrimination.
The ASO also serves members of the AC community
who are living with HIV, although program attendance
is not limited by HIV status.
We used venue-based sampling to recruit LGBT new-
comers and refugees participating in at least one support
group held by this ASO. One (group A) was developed
for AC LGBT women, and a second (group B) for AC
LGBT newcomers and refugees. The support groups are
open for new members. Both group A and group B pro-
vide a space for informal discussions as well as organized
workshops held by organization staff or outside expert
facilitators that aim to address the SDOH, such as
employment, immigration, and housing from a new-
comer and refugee perspective, and LGBT health and
human rights such as adoption for same sex couples.
Both groups run monthly for a period of three hours.
Participants were recruited for the study by the lead in-
vestigator (CHL) during the support groups, through the
ASO’s email listserv, and word-of-mouth. Participants
were eligible if they had attended group A and/or B at
least once. A total of 29 participants participated in one
of three focus groups (FG#1: n= 8, FG#2: n= 13, FG#3:
n= 10) facilitated by trained doctoral students (ALD,
NLF). Focus groups lasted 60 to 90 min and were con-
ducted at the ASO. We held focus group sessions at the
ASO to provide participants with a comfortable, easily
accessible space where service providers were available
in the event participants had questions or concerns
about the topics discussed.
Prior to the focus group, we collected socio-
demographic data including age, gender, sexual orienta-
tion, country-of-origin, immigrant/refugee status, and
social support group attended using a brief form. We
used a semi-structured focus group interview guide with
open-ended questions to explore lived experiences of
being a LGBT AC newcomer and/or refugee. We probed
for participants’experiences in the support groups, for
example exploring motivation for involvement, perceived
benefits, and recommendations. Sample questions in-
clude: “How did you hear about [group name]? What
made you decide to attend the support group? What
makes you keep coming to the support group? What
have you found helpful about attending [group name]?”
Focus group facilitators elicited feedback from all group
members to ensure that all voices were represented.
Participants received a $20.00 (CAD) honorarium for
time and travel.
Data analysis
Focus groups were digitally recorded and transcribed
verbatim. Three investigators (CHL, ALD, NLF) inde-
pendently analyzed transcripts using narrative thematic
analysis to explore, analyze, and report themes. Narrative
thematic analysis involves developing both inductive and
deductive themes [21, 22]. Thematic analysis was con-
ducted in a multi-step process that included multiple
readings of the transcripts, team meetings to discuss ini-
tial findings, developing first level codes, developing
themes by highlighting connections between codes, cre-
ating a thematic map, and finally refining themes and
situating them in prior literature. In particular, we drew
on a social ecological approach to develop overarching
categories under which particular benefits to social sup-
port group participation are situated. Social ecological
approaches recognize complex associations between
social (e.g., friendships), structural (e.g., immigration)
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Table 1 Focus Group Participant Socio-demographic Characteristics
Characteristic Mean (SD) or Frequency* (%)
Age (n= 26) 30.5 years (8.0)
Born in Canada (No) 100 %
Country of Birth (n= 27)
African region 8 (29.6 %)
Caribbean region 19 (70.4 %)
Immigration Status
Permanent resident 2 (6.9 %)
Visitor visa 1 (3.4 %)
Student visa 1 (3.4 %)
Refugee 23 (79.3 %)
Overstay (non-status) 2 (6.9 %)
Highest Level of Education (n= 28)
Less than high school 1 (3.6 %)
Completed high school 6 (21.4 %)
Some college 7 (25.0 %)
Some university 3 (10.7 %)
Completed university degree (Bachelors) 6 (21.4 %)
Completed graduate degree 5 (17.9 %)
Employment Status (n= 28)
Employed full-time 2 (7.1 %)
Employed part-time 2 (7.1 %)
Not employed: looking for work 5 (17.9 %)
Not employed: a student 2 (7.1 %)
Social assistance (ODSP, OW) 14 (50.0 %)
Unemployed 3 (10.7 %)
Annual Income (n= 16) $13, 493 ($6984)
Sexual Orientation (n= 28)
Heterosexual 1 (3.6 %)
Bisexual 12 (42.9 %)
Lesbian 5 (17.9 %)
Gay 9 (32.1 %)
Other 1 (3.6 %)
Gender Identity
Cisgender male 15 (51.7 %)
Cisgender female 11 (37.9 %)
Transgender 3 (10.3 %)
Support Group(s) Attended (n= 28)
Rainbow Sistahs 3 (10.7 %)
Foreign Integration 18 (64.3 %)
Both support groups 7 (25.0 %)
*All variables are for n= 29 unless otherwise noted due to missing data
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and intrapersonal (e.g., mental health) factors [23].
Trustworthiness of findings was established through
debriefing with ASO managers and presenting findings
at an ASO staff meeting for feedback [24].
Results
Focus group participant socio-demographics are pre-
sented in Table 1. Participants were a mean age of
30.5 years [SD 8.0]. Most participants (89.6 %) identified
as cisgender (non-transgender) men or women, with few
participants identifying as transgender women. Partici-
pants identified as bisexual (42.9 %), gay (32.1 %), and
lesbian (17.9 %). Notably, all participants from both
group A, not specific to newcomers and refugees and
group B, specific to newcomers and refugees, were born
outside of Canada, in either Africa (29.6 %) or the
Caribbean (70.4 %), and most came to Canada as refu-
gees (79.3 %). Participants attended group B (64.3 %),
group A (10.7 %) and both groups (25.0 %). Our analysis
identified multi-level benefits of social support group
participation at intrapersonal (self-acceptance, improved
mental health), interpersonal (reduced isolation, friend-
ships), community (reciprocity, reduced stigma and
discrimination), and structural (housing, employment,
immigration, health care) levels.
Intrapersonal benefits
Self-acceptance
Participants experienced increased acceptance of their
LGBT identity and their rights as an LGBT person in
Canadian society over the course of participating in
groups. Self-acceptance was connected to participants’
experiences of feeling “welcomed”,“a part of something”,
and being “treated like a human being”. A participant
articulated the emotional process of being able to be
open about their sexuality:
“I was shocked and really emotional. You are gay. You
are lesbian. And you feel free to say that. It was my
first, first, first experience here in Canada. And I think
Canada is a free country because, back home, in
Africa, it’s a big problem. You can never even open
your mouth and say ‘I’m a lesbian’. Your family is
going to kill you. The government is going to put you
into prison”.
Another participant discussed meeting LGBT parents
for the first time at a workshop held at the support
groups, and how this expanded their understanding of
possible family structures:
“Coming from a culture where gays don’t have certain
rights, I never considered having a family or even
going through the process of, let’s say, adopting.
When I actually attended that workshop, you had a
gay couple. It actually changed my mind about how I
look at parenting.”
These narratives note the intersectional forms of
discrimination (e.g., sexual orientation, class and gender)
participants encountered in their own countries and
how immigration to Canada not only enhanced their
self-acceptance but ability to view themselves as having
equal rights and opportunities as heterosexuals.
Improved mental health
Many participants described how their mental health
improved after they began attending the support groups.
One narrative reflected increased hope: “I love [the
ASO]. The day I came, it was everything that was dead
in me, it revived again. I started singing.”Others dis-
cussed attending groups more frequently to help them
cope with challenging times: “there were times in my
life, in those rough times, where I was frequent in those
groups. I was really coming from a really bad situation”.
Another participant discussed the benefits of having a
community place that was always open to come to when
feeling depressed:
“The community room that is open every day, all day,
that is so innovative and useful…There were days I
was really depressed and really lonely and can’tdo
anything. And you’re in bed all day. And you get out,
you come here.”
Interpersonal benefits
Reduced isolation
Many participants explicitly discussed that participating
in the support groups reduced their isolation: “when you
come to meetings, you see that you’re not really alone.
You hear different people’s different stories and you can
relate to it”. Others discussed feeling a sense of belong-
ing and kinship in Canada after attending the support
groups:
“It’s sort of finding a family. When I came here, it was
winter time. Everybody was in their own house. It was
like, oh, there is no life. But the day I met [group A],
it was like chatting, laughing. It made me feel
welcome in Canada.”
Friendships
Friendships developed through support group participa-
tion extended beyond the ASO to churches and the
community-at-large. A participant noted: “I’ve met new
friends here. I’ve strengthened relationships, as well, be-
cause I’m an LGBT refugee claimant. Many of us, we go
to the same church.”Another narrative reflects the
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strength of the connections developed in the support
groups:
“When you get out from [organization] and you walk
to the subway and ride in a train with two or three
people who have been to the session, that is when you
hear what is going on in their lives and you get an
understanding of what they are facing. A lot of times,
you are able to help. I have ridden the train to the
opposite direction of where I need to go, beyond
where I need to get off, just talking.”
Community
Reciprocity
Reciprocity, sharing knowledge and skills with others,
stretched beyond the groups to the broader newcomer
and refugee communities. For example, participants
discussed sharing their transit-related knowledge with
others—even strangers. In particular, many newcomers
did not understand the public transportation transfer
system:
“That is a thing that confuses a lot of people a lot of
times. So, you need to explain to them and show
them how to use the transfer because, sometimes,
they get in conflict with the driver because the driver
may not explain it. They just speak abruptly and the
person feels mistreated. There are people that are not
knowing the directions of the city. I’ve shown people
how to get around the city and how to read the map.
That takes some time. So, leaving this session and
realizing what a person’s needs are, you jump in and
you help them. People have done that to me and
helped me. I do the same.”
This narrative reflects helping people in the larger
community as a way of giving back. Moreover, partici-
pants indicated that group involvement motivated them
to volunteer at the ASO and share their knowledge:
“Simple things like you want to find out how to do a
work permit or how to get something off the
computer or how to fax something or how to email
something, you can ask one of these volunteers. You
can come and ask us.”
Reduced stigma
Participants explained that the groups provided a safe
space without fear of judgement based on sexual orien-
tation, gender identity or HIV serostatus:
“It’s for us, as newcomers, to settle in because coming
from our different countries, it accommodates
LGBTQ persons as well as HIV [positive] persons.
And you feel free to be among females, your peers.
You don’t really have anybody being scornful of you if
you are HIV. They interact with you just like you are
a normal person and make you feel welcome. So, that
is a good environment that you want to participate in
or be a part of.”
Having a space free from stigma and discrimination
was particularly important for people who never had a
chance to learn about LGBT issues in their country of
origin:
“Where I’m coming from there is no formal setting to
educate a person within the LGBTQ community.
With [group B], it is more of a formal setting. So, in
that case, the information that you’re getting is from
persons who actually live openly without feeling
discriminated against. And so, you feel a little bit
more accepted as to how it is that you, as an LGBTQ
person, can actually integrate into this new lifestyle
that you get on coming to Canada.”
These narratives highlight the groups as a forum
where participants can learn from others how to navi-
gate and overcome past experiences of stigma and dis-
crimination based sexual orientation and/or gender
identity. Learning how to navigate sexuality and gender
identity with others sharing similar experiences contrib-
uted to participants feeling more accepted in Canadian
society.
Structural
Participants described how the groups increased their
knowledge of, and access to, a range of resources and
opportunities spanning from housing to health:
“Being new to Canada, you would want to come to a
gathering to get information so that you can navigate
through your new life, being a part of Canadian
culture. A lot of things I have learned while coming to
[group B], whether it be for housing, navigating the
immigration process, health-related things as it relates
to LGBTQ. And those things are things that affect us
on a whole.”
This knowledge was an incentive for participation:
“Each time, I keep coming, it’s like I’m getting know-
ledge and I’m learning more stuff. This makes me come
back, back, back, back, back.”
Housing
Participants’reported acquiring knowledge of housing
rights: “There are some trouble landlords. You may not
know your rights. This is what I’m supposed to do if my
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landlord acts this way. So, they made us understand our
rights.”Another participant discussed a session on hous-
ing at one of the support groups that contributed to
attaining stable housing: “I was in a shelter. I got a
place.…I got that from the session about the housing.”
Employment
Participants discussed how the support groups offered
volunteer opportunities and employment workshops that
helped them attain employment in Canada. One of the
participants volunteered at the ASO described: “Through
my volunteering here, I was able to get job references
for the job that I have now. And even through their
employment workshop, that also helped me pick up the
job I have right now.”Participants were also offered op-
portunities to participate in an HIV training certification;
this could be included on the their resume and used as a
skillset for future employment applications: “they did a
workshop with us. And because of the content, the facil-
itators said that we can actually get certificates for it,
which we did, and which I used to get me the job that I
have right now. So, it was really helpful in that way.
Immigration
Participants reported receiving both emotional support
as well as informational support to facilitate navigating
the immigration process. A participant narrative articu-
lated how emotional support helped reduce the stress of
refugee claimants: “Those that have gone through [a
refugee hearing] are usually a great encouragement to
those who have not gone through it yet. And I can say,
those who have not gone through are usually extremely
stressed.”The support groups also provided information
about the immigration process and connected partici-
pants with professionals such as immigration lawyers
who could answer immigration-related questions: “they
talk about different services, that we can acquire differ-
ent services, that we can get into …they provide ther-
apy, very good help, with ensuring that you have all the
right information you need for your immigration
process.”
Healthcare
Participants discussed the complexity of navigating the
healthcare system as a newcomer to Canada. Partici-
pants noted the difficulties understanding what health
care costs are covered in a universal healthcare system
and how to gain access to physician services, medication
and dentists. The groups helped clarify some of the
questions around this complexity, enhancing partici-
pants’ability to access healthcare:
“Whether you are a refugee claimant or a protected
person, health is important. Maybe, come in and
speak to persons who are new to Canada to say
exactly how it is the benefits work in some cases,
there are co-payments, there are coinsurance. There
are little terminologies that we probably don’t
understand or are probably different from where we’re
coming from. So, in terms of health on a whole, and
how it works here in Canada, I think that’s important,
not just on STI and STDs, but health on a whole and
how it is that health insurance helps to alleviate some
of the costs.”
Others discussed being able to learn about LGBT
sexual health issues at the groups: “We talk about sexual
health, relationships between female and female, trans”.
Discussion
African and Caribbean LGBT newcomers and refugees
in an urban Canadian setting experience numerous
stressors, including challenges navigating immigration
and refugee processes, social isolation, and difficulties
acquiring employment. Our findings suggest that social
support groups tailored for LGBT AC newcomers and
refugees can address social exclusion and help people
meet the SDOH. Utilizing a combination of peer support
and psycho-education, support groups tailored for AC
LGBT newcomers and refugees can facilitate peer sup-
port and knowledge sharing that helps to build friend-
ships, challenge stigma, and provide strategies for
negotiating legal, employment, housing and health is-
sues. Group participation revealed structural and social
level benefits can contribute to improved intrapersonal
factors, such as self-acceptance and mental health. While
the ASO does not directly offer healthcare services, sev-
eral participants discussed how the support groups pro-
vide individuals with the information needed to
effectively navigate and access healthcare services. The
groups’provision of safe spaces enabled participants to
discuss and learn about sensitive topics such as sexual
health and healthy LGBT relationships under the guid-
ance of trained service providers. Support groups also
provide a space where individuals learn about their ten-
ant rights and gain certifiable skills, thereby enhancing
their SDOH (e.g., housing and employment).
The study ASO is the among the only organizations in
the city that provide culturally relevant HIV prevention
services made specifically for, and by AC populations.
This specificity is necessary as the ASO support groups
not only address the social contexts that contribute to
disproportionate HIV infection rates among AC people
in Canada—including racism—but also the challenges
that AC LGBT newcomer/refugees may face navigating
the refugee processes and sexual stigma. Its location is
easily accessible by public transit and there were no age
restrictions for attending the ASO support groups for
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ACB LGBT newcomers and refugees. These factors
enhance accessibility for individuals of a wide age rage
and from various parts of the city to attend; this also
enabled our focus groups to include diverse participants
and perspectives.
A conceptual framework that incorporates our analytic
themes is illustrated in Fig. 1. We categorized the themes
and sub-themes within the social ecological model, reflect-
ing intrapersonal (self-acceptance, improved mental
health), interpersonal (friendships, reduced social isola-
tion), community (reciprocity, reduced stigma) and struc-
tural (housing, employment, immigration, health care)
domains. This model illustrates complex associations
between social (e.g., friendships), structural (e.g., immigra-
tion) and intrapersonal (e.g., mental health) factors [23].
Findings highlight the utility of applying both social eco-
logical analyses as well as Meyer’sminoritystressmodel
to understand benefits of social support groups for AC
newcomers and refugees. Findings suggest social support
groups can positively influence mental health as proposed
by Meyer’s minority stress model. The processes by which
social support groups benefit mental health and wellbeing
are complex, mapping onto the social ecological model’s
multiple levels. Social support appears to influence intra-
personal wellbeing by promoting self-acceptance that
reduces internalized stigma; interpersonal benefits such as
reduced isolation and friendships contribute to wellbeing.
Community building and reducing perceived stigma
through providing a safe space also improves mental
health [3]. Our findings illustrate multifaceted benefits of
social support groups that extend beyond intra/interper-
sonal domains to enhanced resource access. This model
may be useful for future research and interventions
focused on improving the SDOH among LGBT new-
comers and refugees.
The current findings corroborate prior research that
support groups with AC newcomers and refugees in
Canada can reduce isolation, provide information, and
build social networks [15, 18]. Similar to prior studies,
participants described finding “family”and “universality”
at the support groups [18, 20]. Our findings reflect
research that consistently demonstrates the need to
Fig. 1 Conceptual model of a social ecological approach to understanding social support group benefits for African and Caribbean LGBT
newcomers and refugees
Logie et al. BMC International Health and Human Rights (2016) 16:18 Page 8 of 10
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address SDOH for newcomers and refugees, including
employment-oriented support [18–20]. Findings are also
supported by work that highlights LGBT support groups
can positively impact self-acceptance [17]. Most research
on AC newcomers and refugee support groups has
therefore focused on social and structural dimensions,
while LGBT support groups have largely focused on
intra/interpersonal dimensions. We build on this litera-
ture by demonstrating that support groups tailored for
AC LGBT newcomers and refugees can address the
intersection of needs and priorities associated with being
a newcomer/refugee as well as needs of AC LGBT
people. For example, AC LGBT newcomers and refugees
face unique structural barriers related to newcomer/
refugee status (e.g., barriers to accessing housing and
healthcare) as well as sexual stigma (e.g., challenges with
self-acceptance).
Strengths and limitations
Limitations of the study include the focus group (FG)
design, possibility of response bias, and sample. First,
some participants may not have been comfortable speak-
ing and sharing about their personal experiences in the
FG setting [25]. Second, while FG co-facilitators were
not associated with the ethno-specific ASO, participants
may have responded more positively regarding the sup-
port groups due to the FG being located at the agency,
and having other group participants present. To reduce
response bias, the co-facilitators probed for divergent
opinions and reinforced that responses were confiden-
tial. Finally, FG participants were connected to an
ethno-specific ASO, which may have biased our sample
in two ways. First, we may have under sampled LGBT
immigrants and refugees who are most marginalized, ev-
idenced by lack of attachment to an ASO. Although the
ASO is the only service for AC people, some immigrants
and refugees may have been averse to seeking services
from an ethno-specific ASO due to HIV-related stigma.
Further, some individuals may avoid the ASO for fear of
having their sexual orientation and/or sexual identity
‘outed’by accessing ASO services or by having contact
with other ASO clients. Alternately, we may have over-
sampled AC LGBT newcomers and refugees experien-
cing life and immigration challenges such that they
sought out support from a service agency. It is possible
LGBT immigrants and refugees not seeking support
from the ASO may have their social support needs met
within their family, community and/or another
organization. However, the validity of our findings is
supported by the congruency between this study’s find-
ings and prior research with LGBT people, newcomers
and refugees. Moreover, given our small sample size we
were unable to assess differences in experience with or
benefits of social support groups for individuals based
on differences in sexual and/or gender identities. Future
studies should seek to understand the distinct benefits
among diverse identities.
Despite these limitations, to our knowledge this is
the first study to explore the benefits of social sup-
port group participation among AC LGBT newcomers
and refugees. We develop a comprehensive under-
standing of the salience of support groups to the
wellbeing of LGBT newcomers and refugees. Applying
the social ecological model provides insight into the
interactions between dimensions: support groups can
have ripple effects that span from internal processes
to resource acquisition. This study also provides re-
searchers with a template which they can use to apply
the minority stress model and social ecological ap-
proaches with diverse ethno-racial populations to bet-
ter understand how social support groups can
influence individuals, the SDOH, mental and overall
health as well as their social and structural environ-
ments. Future research could use quantitative, longi-
tudinal designs to explore the relationships between
frequency and duration of support group participation
and social, health and structural outcomes.
Conclusions
Previous explorations of support groups among LGBT
people, and newcomers and refugees, have fruitfully doc-
umented the positive impacts on health promotion,
social networks, and acquisition of information [15, 17,
18]. Scant attention has examined support groups
tailored for LGBT newcomers and refugees. This study
expands on this literature to suggest that support groups
may be particularly important for AC LGBT newcomers
and refugees who often have limited family support, little
exposure to other LGBT people, and experience inter-
secting forms of marginalization. The friendships devel-
oped in the groups can also act as alternate source of
support and information that extend beyond the ASO
monthly support group meetings. The conceptualization
of reciprocity—wanting to give back support and know-
ledge to others—suggests support groups may play a role
in building community resilience [26]. There may be a
cyclical relationship between acquiring support that
helps oneself adapt to challenges, and wanting to pro-
vide support to others experiencing similar adversities.
Data from this study and others highlight an urgent
need for interventions to provide social support, and
improve health services access, among LGBT new-
comers and refugees [19, 20]. Social work and other ad-
vocates can provide emotional and information support
during the immigration and refugee processes, and advo-
cate for more just and humane practices [27]—and
health care for refugee claimants. Health practitioners
can support AC LGBT newcomers and refugees through
Logie et al. BMC International Health and Human Rights (2016) 16:18 Page 9 of 10
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
providing access to support groups, culturally and LGBT
competent mental health services, information and
resources to realize justice and meet the SDOH.
Abbreviations
AC, African and Caribbean; LGBT, lesbian, gay, bisexual, transgender; SDOH,
social determinants of health
Acknowledgements
The authors thank each of the participants and the Black Coalition for AIDS
Prevention (BlackCAP) for their generosity and support and time.
Funding
The study was funded by the Canadian Institutes of Health Research (CIHR)
and the Social Sciences and Research Council of Canada (SSHRC). The
funding bodies played no role in the design of the study and collection,
analysis, and interpretation of data or writing the manuscript.
Availability of data and materials
The qualitative data from this study is not publicly available. Data will not be
made available in order to protect the participants’identity.
Authors’contributions
CHL, SR, and HR conceived of the study; CHL led study design and was the
principal investigator. CHL led writing of the manuscript and ALD
contributed significantly to writing the manuscript. CHL, ALD, and NLF
participated in data collection and analysis. All authors (CHL, ALD, NLF, SR,
HR) participated in manuscript preparation and approve of the manuscript as
submitted.
Competing interests
The authors declare that they have no competing interests.
Consent for publication
Not applicable.
Ethics approval and consent to participate
We obtained written informed consent from participants directly prior to
conducting the focus groups. Participants received a $20.00 (CAD)
honorarium for time and travel. The study was approved by the Research
Ethics Board at the University of Toronto (REB # 30131).
Author details
1
Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor
Street West, Toronto M5S 1V4, ON, Canada.
2
Women’s College Research
Institute, Women’s College Hospital, 790 Bay Street, 7th Floor, Toronto M5G
1N8, ON, Canada.
3
Dalla Lana School of Public Health, University of Toronto,
155 College Street, Toronto M5T 3M7, ON, Canada.
4
Black Coalition for AIDS
Prevention, 20 Victoria Street, 4th Floor, Toronto M5C 2N8, ON, Canada.
Received: 18 July 2015 Accepted: 28 June 2016
References
1. Frisell T, Lichtenstein P, Rahman Q, Langstrom N. Psychiatric morbidity
associated with same-sex sexual behaviour: influence of minority stress and
familial factors. Psychol Med. 2010;40(2):315–24.
2. Logie CH, James L, Tharao W, Loutfy MR. "We don't exist": a qualitative
study of marginalization experienced by HIV-positive lesbian, bisexual, queer
and transgender women in Toronto, Canada. J Int AIDS Soc. 2012;15(2):
17392.
3. Meyer IH. Prejudice, social stress, and mental health in lesbian, gay, and
bisexual populations: conceptual issues and research evidence. Psychol Bull.
2003;129(5):674–97.
4. Logie CH. The case for the World Health Organization's commission on the
social determinants of health to address sexual orientation. Am J Public
Health. 2012;102(7):1243–6.
5. Herek GM. Confronting sexual stigma and prejudice: theory and practice. J
Soc Issues. 2007;63(4):905–25.
6. Meyer IH. Minority stress and mental health in gay men. J Health SocBehav.
1995;36(1):38–56.
7. Pepper C. Gay men tortured on the basis of homosexuality: psychodynamic
psychotherapy and political asylum advocacy. Contemp Psychoanal. 2005;
41(1):35–54.
8. Logie CH, James L, Tharao W, Loutfy MR. HIV, gender, race, sexual
orientation, and sex work: a qualitative study of intersectional stigma
experienced by HIV-positive women in Ontario. Canada PLoS Med. 2011;
8(11), e1001124.
9. Mikkonen J, Raphael D. Social determinants of health: the Canadian facts.
Toronto: York University School of Health Policy and Management; 2010.
10. AIDS 2006, African/Black Diaspora Stream: Bringing the hidden epidemic to
an international audience [http://www.abdgn.org/files/pdfs/
ACCHO%20AIDS%202006%20report.pdf]. Accessed 1 Jul 2015.
11. Reading R, Rubin LR. Advocacy and empowerment: Group therapy for LGBT
asylum seekers. Traumatol. 2011;17(2):86–98.
12. Pollock G, Newbold B, Lafreniere G, Edge S. Discrimination in the doctor's
office: immigrants and refugees experiences. Critical Social Work. 2012;13(2):
60–79.
13. Jenicek A, Wong AD. Dangerous shortcuts: representations of sexual
minority refugees in the post-9/11 Canadian press. Can J Commun. 2009;
34(4):635–58.
14. Murray D. The (not so) straight story: queering migration narratives of sexual
orientation and gendered identity refugee claimants. Sexualities. 2014;17(4):
451–71.
15. Stewart M, Anderson J, Beiser M, Mwakarimba E, Neufeld A, Simich L, Spitzer
D. Multicultural meanings of social support among immigrants and
refugees. Int Migr. 2008;46(3):123–59.
16. Yalom ID, Leszcz M. The theory and practice of group psychotherapy. New
York: Basic Books; 2005.
17. Dietz TJ, Dettlaff A. The impact of membership in a support group for gay,
lesbian and bisexual students. J College Stud Psychother. 1997;12(1):57–72.
18. Stewart M, Simich L, Shizha E, Makumbe K, Makwarimba E. Supporting
African refugees in Canada: insights from a support intervention. Health Soc
Care Community. 2012;20(5):516–27.
19. Chávez KR. Identifying the needs of LGBTQ immigrants and refugees in
Southern Arizona. J Homosex. 2011;58(2):189–218.
20. Kahn S. Cast out: “Gender role outlaws”seeking asylum in the West and the
quest for social connections. J Immigr Refug Stud. 2015;13(1):58–79.
21. Attride-Stirling J. Thematic networks: an analytic tool for qualitative research.
Qual Res. 2001;1(2):385–405.
22. Braun V, Clark V. Using thematic analysis in psychology. Qual Res Psychol.
2006;3:77–101.
23. Baral S, Logie C, Grosso A, Wirtz AL, Beyrer C. Modified social ecological
model: a tool to guide the assessment of the risks and risk contexts of HIV
epidemics. BMC Public Health. 2011;13:482.
24. Drisko JW. Strengthening qualitative studies and reports: standards to
promote academic integrity. J Soc Work Educ. 1997;33(1):185–97.
25. Kruger KA, Casey MA. Focus groups: a practical guide for applied research.
Los Angeles, CA: Sage Publications; 2009.
26. Norris FH, Stevens SP, Pfefferbaum B, Wyche KF, Pfefferbaum RL.
Community resilience as a metaphor, theory, set of capacities, and strategy
for disaster readiness. Am J Community Psychol. 2008;41(1–2):127–50.
27. Heller P. Challenges facing LGBT asylum-seekers: the role of social work in
correcting oppressive immigration processes. J GayLesbian Soc Serv. 2009;
21(2–3):294–308.
Logie et al. BMC International Health and Human Rights (2016) 16:18 Page 10 of 10
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