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Studies demonstrate that people living with HIV who adhere to antiretroviral therapy can achieve viral suppression or undetectability, which is fundamental for optimizing health outcomes, decreasing HIV-related mortality and morbidity, and preventing HIV transmission. African, Caribbean, and Black (ACB) communities in Canada remain structurally disadvantaged and bear a disproportionate burden of HIV despite biomedical advancements in HIV treatment and prevention. This institutional ethnography orients to the concept of \u2018structural violence\u2019 to illuminate how inequities shape the daily experiences of ACB people living with HIV across the HIV care cascade. We conducted textual analysis and in-depth interviews with ACB people living with HIV (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u200920) and health professionals including healthcare providers, social workers, frontline workers, and health policy actors (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u200915). Study findings produce a cumulative understanding that biomedical HIV discourses and practices ignore structural violence embedded in Canada\u2019s social fabric, including legislation, policies and institutional practices that produce inequities and shape the social world of Black communities. Findings show that inequities in structural and social determinants of health such as food insecurity, financial and housing instability, homelessness, precarious immigration status, stigma, racial discrimination, anti-Black racism, criminalization of HIV non-disclosure, health systems barriers and privacy concerns intersect to constrain engagement and retention in HIV healthcare and ART adherence, contributing to the uncertainty of achieving and maintaining undetectability and violating their right to health. Biomedical discourses and practices, and inequities reduce Black people to a stigmatized, pathologized, and impoverished detectable viral underclass. Black people perceived as nonadherent to ART and maintain detectable viral loads are considered \u201cbad\u201d patients while privileged individuals who achieve undetectability are considered \u201cgood\u201d patients. An effective response to ending HIV\/AIDS requires implementing policies and institutional practices that address inequities in structural and social determinants of health among ACB people.\n                  <\/jats:p>","DOI":"10.1186\/s12939-022-01792-4","type":"journal-article","created":{"date-parts":[[2023,2,16]],"date-time":"2023-02-16T21:02:42Z","timestamp":1676581362000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["Structural violence and the uncertainty of viral undetectability for African, Caribbean and Black people living with HIV in Canada: an institutional ethnography"],"prefix":"10.1186","volume":"22","author":[{"given":"Apondi J.","family":"Odhiambo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia","family":"O\u2019Campo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"La Ron E.","family":"Nelson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"Forman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Grace","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2023,2,17]]},"reference":[{"issue":"5","key":"1792_CR1","doi-asserted-by":"publisher","first-page":"847","DOI":"10.1177\/10497323221082958","volume":"32","author":"AJ Odhiambo","year":"2022","unstructured":"Odhiambo AJ, Forman L, Nelson LE, O'Campo P, Grace D. 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