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Anisnabe Kekendazone Network Environment for Aboriginal Health Research

1 Stewart Street, Room 319
Ottawa, Ontario K1N 6N5
Telephone: 1 613 562 5393
Fax: 1 613 562 5392
E-mail: neahr-iph@ciet.org

HIV and AIDS in Aboriginal communities

In Canada, Aboriginal people have higher HIV rates than non-Aboriginal populations. First Nations, Métis and Inuit make up roughly 3% of the Canadian population yet represent an estimated 6-12% of new HIV infections. Some 40% of all new infections among First Nations, Métis and Inuit are under 30 years of age. 

Moreover, Canada seems to be on the verge of an HIV epidemic in Aboriginal communities, where young women are being hit the hardest. This is the outlook from a three-country study that captured HIV diagnoses among indigenous and non-indigenous populations aged 15-64 from 1999 to 2008 in Australia, Canada and New Zealand.

There is also a well established connection between gender violence and HIV. A study involving northern Aboriginal communities showed that youth who had been sexually abused were more likely to have forced sex on someone else. The communities have responded with plans to support latent youth resilience in dealing with sexual violence and preventing its future occurrence.

AK and CIET are working to help build up Aboriginal youth resilience to sexually transmitted diseases and HIV. CIET first collaborated with the Assembly of First Nations in a study on youth resilience to HIV/AIDS in two rural locations in the James Bay region and two urban centres – Montreal and Winnipeg. The results showed that accurate knowledge of HIV/AIDS risks was considerably lower in remote communities.

Building on these experiences, and guided by the Alberta Treaty 8 ACRA Elders Advisory Committee, we have been laying the foundation for community-based studies on Aboriginal youth resilience to HIV/AIDS and related diseases with several Alberta Treaty 8 communities in rural Alberta.

In the Tlicho region of the Northwest Territories of Canada, a long-running partnership between communities and researchers is engaged in a sustainable effort for the prevention of HIV and sexually transmitted infections (STIs).

The following publications from AK investigators, fellows, grantees and collaborators cover different aspects of these initiatives. 

Publications

Shea B, Aspin C, Ward J, Archibald C, Dickson N, McDonald A, Penehira M, Halverson J, Masching R, McAllister S, Tuhiwai Smith L, Kaldor JM, Andersson N. HIV diagnoses in indigenous peoples: comparison of Australia, Canada and New Zealand. International Health 2011; 3: 193-198.
In industrial countries, a number of factors put indigenous peoples at increased risk of HIV infection. National surveillance data between 1999 and 2008 provided diagnoses for Aboriginal and Torres Strait Islanders (Australia), First Nations, Inuit and Métis (Canada excluding Ontario and Quebec) and Maori (New Zealand). Each country provided similar data for a non-indigenous comparison population. Direct standardisation used the 2001 Canadian Aboriginal male population for comparison of five-year diagnosis rates in 1999–2003 and 2004–2008. Using the general population as denominator, we report diagnosis ratios for presumed heterosexual transmission, men who have sex with men (MSM) and intravenous drug users (IDU). Age standardised HIV diagnosis rates in indigenous peoples in Canada in 2004–2008 (178.1 and 178.4/100 000 for men and women respectively) were higher than in Australia (48.5 and 12.9/100 000) and New Zealand (41.9 and 4.3/100 000). Higher HIV diagnosis rates related to heterosexual contact among Aboriginal peoples, especially women, in Canada confirm a widening epidemic beyond the conventional risk groups. This potential of a generalised epidemic requires urgent attention in Aboriginal communities; available evidence can inform policy and action by all stakeholders. Although less strik- ing in Australia and New Zealand, these findings may be relevant to indigenous peoples in other countries.

Andersson N, Nahwegahbow A. Family Violence and the Need for Prevention Research in First Nations, Inuit, and Métis Communities.   Pimatisiwin. 2010 Fall; 8(2): 9–33.
Existing sources produce widely varying estimates of family violence in First Nations, Inuit, and Métis communities; taken together, they imply a convincing if poorly quantified higher risk of family violence in Aboriginal communities, with the greater burden borne by women. With an accelerating HIV epidemic in some Aboriginal communities, prevention of domestic violence takes on even greater urgency. Five planks in a prevention research platform include: training emerging researchers from all Aboriginal groups to promote culturally specific research; systematic review of unpublished and published knowledge of interventions that reduce domestic violence; intervention theory development specific to each community; attention to the particular ethical issues; and methods development focused on interventions.

Andersson N, Ledogar RJ. The CIET Aboriginal Youth Resilience Studies: 14 Years of Capacity Building and Methods Development in Canada. Pimatisiwin. 2008 Summer; 6(2): 65–88.
CIET started supporting Canadian Aboriginal community-based researchers of resilience in 1995. An evolving approach to Aboriginal resilience used a combination of standard instruments and questionnaires of local design. Over the years, CIET measured personal assets like sense of coherence, spirituality, knowledge, pride in one's heritage, mastery or self-efficacy, self-esteem, low levels of distress, involvement in traditional ways and activities, church attendance. Other indicators reflected the social dimension of resilience: feeling supported; parental care and support; parental monitoring, attitudes, and example; peer support; and support from the wider community. Pride in one's heritage, self-esteem, low distress, and mastery were measurable personal assets of resilient Aboriginal youth in a variety of cultures and circumstances. Early efforts to link resilience with specific features of culture or spirituality did not meet with success - largely reflecting failure to ask the right questions. Parental care and support, parental monitoring, parental attitudes, and parental example clearly supported the resilient Aboriginal youth in most settings. But peers are an even stronger influence, critical in relation to different types of behaviour from smoking to drinking to substance abuse to violence, unsafe sex, and suicidal tendencies. More generally, having someone to confide in, to count on in times of crisis, someone to give advice and someone who makes one feel cared for are important factors in youth resilience and something that communities can help to provide even where the family is not the support it should be and where peers are more of a hindrance than a help. CIET currently supports three resilience research projects involving Aboriginal youth in Canada: suicide prevention, reduction of HIV risk, and reduction of domestic violence. The latest resilience measurement tools include enculturation and revised approaches to Aboriginal spirituality.

Andersson N, Shea B, Archibald C, Wong T, Barlow K, Sioui G. Building on the Resilience of Aboriginal People in Risk Reduction Initiatives Targeting Sexually Transmitted Infections and Blood-Borne Viruses: The Aboriginal Community Resilience to AIDS (ACRA).  Pimatisiwin. 2008 Summer; 6(2): 89–110.
There is evidence that Aboriginal people may be at increased risk of HIV infection; they also experience higher rates of other blood-borne viral (BBV) and sexually transmitted infections (STI). This project will provide insights into the role of resilience and its impact on the health and well-being of Aboriginal youth, especially as it relates to sexual and injecting behaviour. The primary recipients of this information will be agencies that provide risk education related to BBVs and STIs. The project involves several phases. First, the framework for the research will be established, with Aboriginal leadership and involvement at every level. Next, both qualitative and quantitative methodologies will be used to identify factors that protect Aboriginal youth against blood-borne viral and sexually transmitted infections and their transmission within local communities. Finally, results from this project will be used to develop interventions and appropriate frameworks for their evaluation in Aboriginal communities. An important component of this project will involve the building of capacity within participating communities, with the goal of identifying strategies related to resilience that can be incorporated into public health and clinical practice. The project will run for five years.

Edwards K, Mitchell S, Gibson NL, Martin J, Zoe-Martin C. Community-coordinated Research as HIV/AIDS Prevention Strategy in Northern Canadian Communities.  Pimatisiwin. 2008 Summer; 6(2): 111–127.
The Tłįchǫ Community Services Agency's (TCSA) Healing Wind Strategy identifies a number of activities and interventions to address the prevention of STI/HIV/AIDS in the Tłįchǫ region of the Northwest Territories of Canada. As a part of this strategy, the TCSA and CIET facilitated research to develop a foundation for interventions targeting sexually transmitted infections. The project recruited and trained community-based researchers who conducted a research survey on sexual health attitudes and behaviours in the four Tłįchǫ communities, covering 65% of the population above 9 years of age. The research process, outcomes, and the strategic plan that arose from the research findings produced a clear framework for interventions that are grounded in the community, but could also influence national and territorial policy. The approach may be relevant in other settings.

Nicholls S. & Giles A.R. Sport as a tool for HIV/AIDS education: A potential catalyst for change. Pimatisiwan: Sport, Recreation, and Physical Activity: Intersections with Aboriginal Health 2007; 5(1), pp. 51-85.
This paper seeks to bring to the foreground the potential use of sport as a tool for HIV/AIDS in Canada with the hope of stimulating further dialogue as to the concerns, challenges, and possibilities of building on international initiatives. It also highlights the potential of sports to make a lasting, culturally appropriate contribution to stemming the tide of HIV infection in Aboriginal populations within Canada. Starting with an examination of the international movement of sport for development to situate the discussion of the role of sport for development in Canada, this paper will discuss the Euro-Canadian colonial legacy of domination as well as postcolonial thought and the potential for its use within the realm of sport, physical activity, and health. In particular, colonial legacies will be connected to a historical understanding of the HIV/AIDS crisis facing Aboriginal peoples today. After illustrating how the Aboriginal sport movement has been successful in resisting colonial expressions of domination, we provide insight into potential uses of sport to tackle the issues outlined above. Specific examples of how sport has been used in the global context and a sampling of these programs’ results will be provided. Finally, Canadian strategies to address the HIV/AIDS crisis will be discussed, and potential links between the health, sport, and development sectors will be proposed in order to ascertain the potential use of sport for HIV/AIDS education in Canada.