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Larcombe L, McLeod A, Samuel S, Samuel J, Payne M, Van Haute S, Singer M, Ringaert L, Meyers AFA, Kinew K, Keynan Y, MacDonald K, Antsanen J, Orr P. A Dene First Nation's community readiness assessment to take action against HIV/AIDS: a pilot project. Int J Circumpolar Health 2020; 78:1588092. [PMID: 30935345 PMCID: PMC6450605 DOI: 10.1080/22423982.2019.1588092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background: Among Indigenous people in Canada the incidence of HIV is 3.5 times higher than other ethnicities. In Manitoba First Nations, Metis and Inuit people are disproportionately represented (40%) among people who are new to HIV care. Northlands Denesuline First Nation (NDFN) identified the need to revisit their level of knowledge and preparedness for responding to the increasing rates of HIV. NDFN piloted a community readiness assessment (CRA) tool to assess its appropriateness for use in northern Manitoba. Methods: A First Nation and non-First Nation research team trained to administer the CRA tool at NDFN in Manitoba. Five informants were interviewed using the CRA tool and the responses were scored, analysed and reviewed at community workshops and with stakeholders to develop a 1-year action plan. Results: CRA training was best conducted in the community. Using the readiness score of 2.4 along with feedback from two workshops, community members, the research team and stakeholders, we identified priorities for adult education and youth involvement in programmes and planning. Conclusions: In response to the increasing incidence of HIV, a northern First Nation community successfully modified and implemented a CRA tool to develop an action plan for culturally appropriate interventions and programmes.
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Affiliation(s)
- Linda Larcombe
- a Max Rady College of Medicine , University of Manitoba , Winnipeg , Manitoba
| | - Albert McLeod
- b Two-Spirited Peoples of Manitoba , Winnipeg , Manitoba
| | - Sarah Samuel
- c Northlands Denesuline First Nation , Lac Brochet , Manitoba
| | - Jennifer Samuel
- c Northlands Denesuline First Nation , Lac Brochet , Manitoba
| | - Michael Payne
- d Nine Circles Community Health Centre/MB HIV Collective Impact Network , Winnipeg , Manitoba
| | | | - Matthew Singer
- a Max Rady College of Medicine , University of Manitoba , Winnipeg , Manitoba
| | | | - Adrienne F A Meyers
- f National HIV and Retrovirology Laboratories, JC Wilt Infectious Diseases Research Centre , Public Health Agency of Canada , Winnipeg , Manitoba
| | - Kathi Kinew
- g First Nation Health and Social Secretariat , Winnipeg , Manitoba
| | - Yoav Keynan
- a Max Rady College of Medicine , University of Manitoba , Winnipeg , Manitoba
| | - Kelly MacDonald
- a Max Rady College of Medicine , University of Manitoba , Winnipeg , Manitoba
| | - Joe Antsanen
- c Northlands Denesuline First Nation , Lac Brochet , Manitoba
| | - Pamela Orr
- a Max Rady College of Medicine , University of Manitoba , Winnipeg , Manitoba
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Barker B, Adams E, Wood E, Kerr T, DeBeck K, Dong H, Shoveller J, Montaner J, Milloy MJ. Engagement in Maximally-Assisted Therapy and Adherence to Antiretroviral Therapy Among a Cohort of Indigenous People Who Use Illicit Drugs. AIDS Behav 2019; 23:1258-1266. [PMID: 30269233 DOI: 10.1007/s10461-018-2226-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Throughout the world, Indigenous populations experience a disproportionate burden of HIV infection. Maximally-assisted therapy (MAT) is an interdisciplinary care intervention that includes ART dispensation to support individuals with a history of addiction and homelessness. This study sought to longitudinally evaluate the relationship between engagement in MAT and achieving optimal adherence using data from an ongoing cohort of HIV-positive individuals who use drugs in Vancouver, Canada, where HIV/AIDS treatment is offered at no cost. Between December 2005 and November 2016, 354 HIV-positive Indigenous participants were enrolled and data were analyzed using generalized mixed-effects (GLMM) and marginal structural modeling. In both multivariable analyses, engagement in MAT was independently associated with optimal adherence to ART (GLMM: AOR = 4.92, 95% CI 3.18-7.62; marginal structural model: AOR = 5.76, 95% CI 3.34-9.96). MAT-based programmes could be a part of a renewed evidence-base to elevated levels of preventable HIV/AIDS-associated morbidity, mortality and viral transmission among Indigenous peoples in Canada.
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Affiliation(s)
- Brittany Barker
- British Columbia Centre on Substance Use, Vancouver, Canada
- Interdisciplinary Studies Graduate Program, University of British Columbia, Vancouver, Canada
| | - Evan Adams
- First Nations Health Authority, BC Provincial Government, Vancouver, Canada
| | - Evan Wood
- British Columbia Centre on Substance Use, Vancouver, Canada
- Division of AIDS, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Thomas Kerr
- British Columbia Centre on Substance Use, Vancouver, Canada
- Division of AIDS, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Kora DeBeck
- British Columbia Centre on Substance Use, Vancouver, Canada
- School of Public Policy, Simon Fraser University, Vancouver, Canada
| | - Huiru Dong
- British Columbia Centre on Substance Use, Vancouver, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Jean Shoveller
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Julio Montaner
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - M-J Milloy
- British Columbia Centre on Substance Use, Vancouver, Canada.
- Division of AIDS, Department of Medicine, University of British Columbia, Vancouver, Canada.
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Flicker S, Wilson C, Monchalin R, Restoule JP, Mitchell C, Larkin J, Prentice T, Jackson R, Oliver V. The Impact of Indigenous Youth Sharing Digital Stories About HIV Activism. Health Promot Pract 2019; 21:802-810. [PMID: 30724108 DOI: 10.1177/1524839918822268] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION This article reports on the micro-, meso-, and macro-level impacts of sharing digital stories created by Indigenous youth leaders about HIV prevention activism in Canada. METHOD Eighteen participants created digital stories and hosted screenings in their own communities to foster dialogue. Data for this article are drawn from individual semistructured interviews with the youth leaders, audio-recordings of audience reflections, and research team member's field notes collected between 2012 and 2015 across Canada. Data were coded using NVivo. A content analysis approach guided analysis. RESULTS The process of sharing their digital stories had a positive impact on the youth themselves and their communities. Stories also reached policymakers. They challenged conventional public health messaging by situating HIV in the context of Indigenous holistic conceptions of health. DISCUSSION The impact(s) of sharing digital stories were felt most strongly by their creators but rippled out to create waves of change for many touched by them. More research is warranted to examine the ways that the products of participatory visual methodologies can be powerful tools in creating social change and reducing health disparities.
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Affiliation(s)
| | - Ciann Wilson
- Wilfrid Laurier University, Waterloo, Ontario, Canada
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- The Native Youth Sexual Health Network, Toronto, Ontario, Canada
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Miller RL, Reed SJ, Chiaramonte D, Strzyzykowski T, Spring H, Acevedo-Polakovich ID, Chutuape K, Cooper-Walker B, Boyer CB, Ellen JM. Structural and Community Change Outcomes of the Connect-to-Protect Coalitions: Trials and Triumphs Securing Adolescent Access to HIV Prevention, Testing, and Medical Care. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2017; 60:199-214. [PMID: 28851064 PMCID: PMC5678968 DOI: 10.1002/ajcp.12162] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Connect to Protect (C2P), a 10-year community mobilization effort, pursued the dual aims of creating communities competent to address youth's HIV-related risks and removing structural barriers to youth health. We used Community Coalition Action Theory (CCAT) to examine the perceived contributions and accomplishments of 14 C2P coalitions. We interviewed 318 key informants, including youth and community leaders, to identify the features of coalitions' context and operation that facilitated and undermined their ability to achieve structural change and build communities' capability to manage their local adolescent HIV epidemic effectively. We coded the interviews using an a priori coding scheme informed by CCAT and scholarship on AIDS-competent communities. We found community mobilization efforts like C2P can contribute to addressing the structural factors that promote HIV-risk among youth and to community development. We describe how coalition leadership, collaborative synergy, capacity building, and local community context influence coalitions' ability to successfully implement HIV-related structural change, demonstrating empirical support for many of CCAT's propositions. We discuss implications for how community mobilization efforts might succeed in laying the foundation for an AIDS-competent community.
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Affiliation(s)
| | - Sarah J. Reed
- Medical College of Wisconsin, Department of Psychiatry and Behavioral Medicine
| | | | | | | | | | - Kate Chutuape
- Johns Hopkins University School of Medicine, Department of Pediatrics
| | | | - Cherrie B. Boyer
- University of California, San Francisco, Department of Pediatrics
| | - Jonathan M. Ellen
- Johns Hopkins University School of Medicine, Department of Pediatrics
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Woodgate RL, Zurba M, Tennent P, Cochrane C, Payne M, Mignone J. A qualitative study on the intersectional social determinants for indigenous people who become infected with HIV in their youth. Int J Equity Health 2017; 16:132. [PMID: 28732498 PMCID: PMC5521109 DOI: 10.1186/s12939-017-0625-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 07/10/2017] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Indigenous young people are currently highly overrepresented in the HIV epidemic in Canada, especially in the Prairie Provinces, such as Manitoba. Understanding HIV-vulnerability in Indigenous peoples must begin with understanding that social determinants are intersectional and linked to the historical legacy of European colonization. In this paper findings that detail the influence of the intersectional social determinants on Indigenous people who become infected with HIV in their youth are presented. METHODS The qualitative research design of phenomenology was used as it afforded the opportunity to understand Indigenous young people from their frames of reference and experiences of reality, resulting in a phenomenological understanding of their perspectives and experiences of the early years of living with HIV. A total of 21 Indigenous young people took part open-ended interviews. RESULTS The stories that the Indigenous young people shared revealed their deeply interconnected social worlds, and how social determinants including abuse, trauma, being part of the child welfare system, and housing and food security were connected throughout various stages of their lives. Such stages included childhood, adolescence and young adulthood (the time of HIV infection), and later adulthood for older participants with the social determinants having multiple influences on their health trajectories. CONCLUSIONS The findings highlight the need for policies and programs that are broadly focused, addressing multiple social determinants together. Overall, there needs to be more emphasis on the multiple social determinants in the life situations of all Indigenous youth. Reducing the health and social disparities in Indigenous youth is key to reducing the number of young Indigenous people diagnosed with HIV. The findings also shed light on the importance of listening to young Indigenous people who have experienced HIV diagnosis and life following diagnosis.
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Affiliation(s)
- Roberta L. Woodgate
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, 89 Curry Place, Winnipeg, MB R3T 2N2 Canada
| | - Melanie Zurba
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, 89 Curry Place, Winnipeg, MB R3T 2N2 Canada
| | - Pauline Tennent
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, 89 Curry Place, Winnipeg, MB R3T 2N2 Canada
| | - Carla Cochrane
- Assembly of Manitoba Chiefs, 200-275 Portage Ave, Winnipeg, MB R3B 2B3 Canada
| | - Mike Payne
- Nine Circles Community Health Centre, 705 Broadway Avenue, Winnipeg, MB R3G 0X2 Canada
| | - Javier Mignone
- Dept. of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, 307 Human Ecology Building, 35 Chancellors Circle, Winnipeg, MB R3T 2N2 Canada
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Konrad BP, Taylor D, Conway JM, Ogilvie GS, Coombs D. On the duration of the period between exposure to HIV and detectable infection. Epidemics 2017; 20:73-83. [PMID: 28365331 DOI: 10.1016/j.epidem.2017.03.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 03/02/2017] [Accepted: 03/08/2017] [Indexed: 11/16/2022] Open
Abstract
HIV infection cannot be detected immediately after exposure because plasma viral loads are too small initially. The duration of this phase of infection (the "eclipse period") is difficult to estimate because precise dates of exposure are rarely known. Therefore, the reliability of clinical HIV testing during the first few weeks of infection is unknown, creating anxiety among HIV-exposed individuals and their physicians. We address this by fitting stochastic models of early HIV infection to detailed viral load records for 78 plasma donors, taken during the period of exposure and infection. We first show that the classic stochastic birth-death model does not satisfactorily describe early infection. We therefore apply a different stochastic model that includes infected cells and virions separately. Since every plasma donor in our data eventually becomes infected, we must condition the model to reflect this bias, before fitting to the data. Applying our best estimates of unknown parameter values, we estimate the mean eclipse period to be 8-10 days. We further estimate the reliability of a negative test t days after potential exposure.
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Affiliation(s)
- Bernhard P Konrad
- Department of Mathematics and Institute of Applied Mathematics, University of British Columbia, Vancouver, BC V6T 1Z2, Canada
| | - Darlene Taylor
- British Columbia Centre for Disease Control, 655 W 12th Ave., Vancouver, BC V5Z 4R4, Canada
| | - Jessica M Conway
- Department of Mathematics, The Pennsylvania State University, University Park, PA 16802, USA
| | - Gina S Ogilvie
- British Columbia Centre for Disease Control, 655 W 12th Ave., Vancouver, BC V5Z 4R4, Canada
| | - Daniel Coombs
- Department of Mathematics and Institute of Applied Mathematics, University of British Columbia, Vancouver, BC V6T 1Z2, Canada.
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Negin J, Aspin C, Gadsden T, Reading C. HIV Among Indigenous peoples: A Review of the Literature on HIV-Related Behaviour Since the Beginning of the Epidemic. AIDS Behav 2015; 19:1720-34. [PMID: 25731659 PMCID: PMC4551545 DOI: 10.1007/s10461-015-1023-0] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
From the early days of the HIV epidemic, Indigenous peoples were identified as a population group that experiences social and economic determinants-including colonialism and racism-that increase exposure to HIV. There are now substantial disparities in HIV rates between Indigenous and non-Indigenous peoples in some countries. We conducted a comprehensive literature review to assess the evidence on HIV-related behaviors and determinants in four countries-Australia, Canada, New Zealand and the United States-in which Indigenous peoples share important features of colonization and marginalization. We identified 107 articles over more than 20 years. The review highlights the determinants of HIV-related behaviors including domestic violence, stigma and discrimination, and injecting drug use. Many of the factors associated with HIV risk also contribute to mistrust of health services, which in turn contributes to poor HIV and health outcomes among Indigenous peoples.
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Affiliation(s)
- Joel Negin
- Sydney School of Public Health, University of Sydney, Edward Ford Building (A27), Sydney, NSW, 2006, Australia,
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8
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Taylor D, Durigon M, Davis H, Archibald C, Konrad B, Coombs D, Gilbert M, Cook D, Krajden M, Wong T, Ogilvie G. Probability of a false-negative HIV antibody test result during the window period: a tool for pre- and post-test counselling. Int J STD AIDS 2014; 26:215-24. [PMID: 25033879 DOI: 10.1177/0956462414542987] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Failure to understand the risk of false-negative HIV test results during the window period results in anxiety. Patients typically want accurate test results as soon as possible while clinicians prefer to wait until the probability of a false-negative is virtually nil. This review summarizes the median window periods for third-generation antibody and fourth-generation HIV tests and provides the probability of a false-negative result for various days post-exposure. Data were extracted from published seroconversion panels. A 10-day eclipse period was used to estimate days from infection to first detection of HIV RNA. Median (interquartile range) days to seroconversion were calculated and probabilities of a false-negative result at various time periods post-exposure are reported. The median (interquartile range) window period for third-generation tests was 22 days (19-25) and 18 days (16-24) for fourth-generation tests. The probability of a false-negative result is 0.01 at 80 days' post-exposure for third-generation tests and at 42 days for fourth-generation tests. The table of probabilities of falsely-negative HIV test results may be useful during pre- and post-test HIV counselling to inform co-decision making regarding the ideal time to test for HIV.
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Affiliation(s)
- Darlene Taylor
- British Columbia Centre for Disease Control, Vancouver, BC, Canada School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Monica Durigon
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | | | | | - Bernhard Konrad
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Daniel Coombs
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Mark Gilbert
- British Columbia Centre for Disease Control, Vancouver, BC, Canada School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Darrel Cook
- British Columbia Centre for Disease Control, Vancouver, BC, Canada BCCDC Public Health Microbiology and Reference Laboratory, Vancouver, BC, Canada
| | - Mel Krajden
- British Columbia Centre for Disease Control, Vancouver, BC, Canada BCCDC Public Health Microbiology and Reference Laboratory, Vancouver, BC, Canada Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Tom Wong
- Alberta Health Services, Edmonton, AB, Canada
| | - Gina Ogilvie
- British Columbia Centre for Disease Control, Vancouver, BC, Canada Family Practice, University of British Columiba, Vancouver, BC, Canada
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RETIRED: Chapter 5 First Nations, Inuit, and Métis Women’s Sexual and Reproductive Health. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2013; 35:S28-S32. [DOI: 10.1016/s1701-2163(15)30705-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Nelson K, Tom N. Evaluation of a substance abuse, HIV and hepatitis prevention initiative for urban Native Americans: the Native Voices program. J Psychoactive Drugs 2012; 43:349-54. [PMID: 22400468 DOI: 10.1080/02791072.2011.629158] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
Although many community-based prevention interventions are conducted in American Indian and Alaska Native (AI/AN) communities, few studies report the outcomes. This article is a mixed methods outcome evaluation of an HIV/AIDS, hepatitis, and substance abuse prevention intervention for an urban AI/AN community, Native Voices. The study group wascomposed of 100youth (ages 13 to 18) who lived in the San Francisco Bay Area. The outcome measures of interest were knowledge, perception of risk, sexual self-efficacy, ethnic identity, and sexual risk behavior. The findings indicate that knowledge, perception of risk, and sexual self-efficacy increased, while no change was shown in measures of ethnic identity and behavior. Findings extended prior research by evaluating the Gathering of Native Americans (GONA) curriculum, a promising intervention designed for AI/AN people.
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Affiliation(s)
- Kyle Nelson
- Quartz Valley Indian Reservation/Anav Tribal Health Clinic, Fort Jones, CA, USA.
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Newman PA, Woodford MR, Logie C. HIV vaccine acceptability and culturally appropriate dissemination among sexually diverse Aboriginal peoples in Canada. Glob Public Health 2011; 7:87-100. [PMID: 21390966 DOI: 10.1080/17441692.2010.549139] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This study explored HIV vaccine acceptability and strategies for culturally appropriate dissemination among sexually diverse Aboriginal peoples in Canada, among those at highest HIV risk. We conducted four focus groups (n=23) with Aboriginal male (1) and female (1) service users, peer educators (1) and service providers (1) in Ontario, Canada. Transcripts were analysed with narrative thematic techniques from grounded theory, using NVivo. Participants' mean age was 37 years; about half (52%) were female, half (48%) Two-spirit or lesbian, gay or bisexual (LGB)-identified, 48% had a high-school education or less and 57% were unemployed. Vaccine uptake was motivated by community survival; however, negative HIV vaccine perceptions, historically based mistrust of government and healthcare institutions, perceived conflict between western and traditional medicine, sexual prejudice and AIDS stigma within and outside of Aboriginal communities, and vaccine cost may present formidable obstacles to HIV vaccine acceptability. Culturally appropriate processes of engagement emerged on individual levels (i.e., respect for self-determination, explanations in Native languages, use of modelling and traditional healing concepts) and community levels (i.e., leadership by Aboriginal HIV advocates and political representatives, identification of gatekeepers, and procuring Elders' endorsements). Building on cultural strengths and acknowledging the history and context of mistrust and social exclusion are fundamental to effective HIV vaccine dissemination.
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Affiliation(s)
- P A Newman
- Centre for Applied Social Research, Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada.
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Duncan KC, Reading C, Borwein AM, Murray MCM, Palmer A, Michelow W, Samji H, Lima VD, Montaner JSG, Hogg RS. HIV incidence and prevalence among aboriginal peoples in Canada. AIDS Behav 2011; 15:214-27. [PMID: 20799061 DOI: 10.1007/s10461-010-9792-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We examined incidence, prevalence, and correlates of HIV infection in Aboriginal peoples in Canada and found that among most risk groups both Aboriginal and non-Aboriginal participants showed similar levels of HIV prevalence. Aboriginal peoples who use illicit drugs were found to have higher HIV incidence and prevalence when compared to their non-Aboriginal drug-using peers. Aboriginal street youth and female sex workers were also found to have higher HIV prevalence. Among Aboriginal populations, correlates of HIV-positive sero-status include syringe sharing and frequently injecting drugs, as well as geographic and social factors such as living in Vancouver or having a history of non-consensual sex. This study is relevant to Canada and elsewhere, as Indigenous populations are disproportionately represented in the HIV epidemic worldwide.
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Affiliation(s)
- Katrina C Duncan
- Division of Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
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Devries KM, Free CJ. Boyfriends and booty calls: sexual partnership patterns among Canadian Aboriginal young people. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2011; 102:13-17. [PMID: 21485961 PMCID: PMC6974215 DOI: 10.1007/bf03404871] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2010] [Accepted: 08/20/2010] [Indexed: 05/30/2023]
Abstract
OBJECTIVES Sexual partnership patterns, forced sex, and condom non-use can contribute to STI risk, but little is known about these patterns among Aboriginal young people despite elevated STI risk in this group. We describe sexual relationship and condom use patterns among Canadian Aboriginal young people, and how these patterns relate to the socio-structural context as experienced by young people. METHODS We use data from in-depth individual interviews conducted in 2004 with 22 young people who reported ever having sex and who self-identified as Aboriginal in British Columbia, Canada. A thematic analysis is presented. RESULTS Young people described a range of partnership patterns, including 'on-off' relationships which could have high rates of partner turnover but could sometimes be viewed as acceptable contexts for pregnancy, precluding condom use. Contextual elements beyond individual control appeared to contribute to these patterns. Migration between geographic locations was linked with risky partnership patterns, especially if it was linked with family instability or substance use problems. CONCLUSION Sexual health interventions for this group must address partnership patterns in addition to promoting condom use. Survey research into 'migration' as a risk factor for STI transmission should consider reasons for migration. Interventions that address both individual level behaviour and the contextual elements that shape behaviour should be developed and tested.
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Affiliation(s)
- Karen M Devries
- Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
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Nowgesic E. Addressing HIV/AIDS among Aboriginal People using a Health Status, Health Determinants and Health Care Framework: A Literature Review and Conceptual Analysis. CANADIAN JOURNAL OF ABORIGINAL COMMUNITY-BASED HIV/AIDS RESEARCH 2010; 3:35-46. [PMID: 27398110 PMCID: PMC4935527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVES (1) To describe the Human Immunodeficiency Virus (HIV) infection among Aboriginal populations using a mixed methods approach (i.e. quantitative and qualitative methods); (2) to examine the individual-level and community-level relationships between HIV/AIDS, health determinants, and health care (e.g. diagnosis, access to treatment and health services planning); and (3) to explore innovative solutions to address HIV/AIDS among Aboriginal populations based upon research and infrastructure (e.g. partnerships, data sources and management, health indicators and culture) and policy (i.e. self-determination of Aboriginal Peoples). METHODS Literature review and conceptual analysis using a health status, health determinants and health care framework. RESULTS In comparison to non-Aboriginal persons, HIV infection is higher among Aboriginal persons, is more directly attributable to unique risk factors and socio-demographic characteristics, and yields more adverse health outcomes. Culture, poverty and self-determination are determinants of health for Aboriginal populations. Aboriginal people have inadequate primary care and, in particular, specialist care. It is necessary to include traditional Aboriginal approaches and culture when addressing Aboriginal health while understanding competing paradigms between modern medicine and Aboriginal traditions. CONCLUSION There is a need for self-determination of Aboriginal Peoples in order to improve the health of Aboriginal communities and those living with HIV/AIDS. Research and policy affecting Aboriginal people should be of the highest quality and based upon Aboriginal community relevance and involvement.
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Mill JE, Edwards N, Jackson RC, MacLean L, Chaw-Kant J. Stigmatization as a social control mechanism for persons living with HIV and AIDS. QUALITATIVE HEALTH RESEARCH 2010; 20:1469-1483. [PMID: 20663937 DOI: 10.1177/1049732310375436] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Stigmatization contributes to inequity by marginalizing persons living with HIV and AIDS (PHAs). In this study we examined the stigmatizing practices in health care settings from the perspectives of PHAs and health care providers (HCPs). A qualitative design, using a participatory action research approach, was used. Interviews and focus groups were completed with 16 aboriginal and 17 nonaboriginal individuals living with HIV (APHAs and PHAs) and 27 HCPs in Ottawa and Edmonton, Canada. We present findings to support the premise that stigmatization can be used as a social control mechanism with PHAs. Participants described both active and passive social control mechanisms: shunning and ostracizing, labeling, and disempowering health care practices. Forgiving behavior, balancing disclosure, practicing universal precautions, bending the rules, shifting services, and reducing labeling were strategies to manage, resist, and mitigate social control. The findings illustrate the urgent need for multilevel interventions to manage, resist, and mitigate stigma.
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Affiliation(s)
- Judy E Mill
- Faculty of Nursing, University of Alberta, 7-90 UniversityTerrace, Edmonton, AB, Canada.
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16
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Devries KM, Free C. 'I told him not to use condoms': masculinities, femininities and sexual health of Aboriginal Canadian young people. SOCIOLOGY OF HEALTH & ILLNESS 2010; 32:827-842. [PMID: 20456685 DOI: 10.1111/j.1467-9566.2010.01242.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Gendered power imbalances in heterosexual relationships are a key target of gender-sensitive STI risk reduction interventions. Gendered aspects of sexual behaviour have not been explored among Canadian indigenous young people, who are at elevated risk for STI relative to other young Canadians. We used data from in-depth qualitative interviews with 15 male and 15 female indigenous young people to explore gendered sexual behaviour and its implications for STI reduction. There was a pervasive 'double standard' where young men were expected to be sexually aggressive and young women were expected to resist sexual advances; but we also observed 'alternative' or non-hegemonic behaviours. Specifically, young women were often very active participants in sexual negotiations, could refuse condom use and sometimes pressured their male partners to not use condoms. Young men also described being the object of coerced sex, and did not always perceive female sexual desire in negative terms, and were not always receptive to sex. The gendered sexual attitudes and behaviours in our sample were much more complex than usually described in the literature. Intervention work needs to take more realistic account of the sexual interactions that occur between young people.
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Affiliation(s)
- Karen M Devries
- Health Policy Unit, London School of Hygiene and Tropical Medicine, London.
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Long R, Boffa J. High HIV-TB co-infection rates in marginalized populations: evidence from Alberta in support of screening TB patients for HIV. Canadian Journal of Public Health 2010. [PMID: 20737809 DOI: 10.1007/bf03404374] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Heretofore we have not seen strong evidence of synergy between HIV and tuberculosis (TB) in Canada. This may simply reflect a lack of concurrent surveillance for the two diseases. To date, the goal of universal HIV testing of TB patients (> 80% tested) in Canada has not been achieved, despite the existence of two national advisories recommending universal HIV testing of TB patients. In response to these advisories, we recently undertook to demonstrate the feasibility of using an 'opt-out' approach to achieve universal HIV testing of TB patients in Alberta--see the Canadian Journal of Public Health 2009;100(2):116-20. In the present commentary, we add two more years of data (2007-2008) to our earlier report and demonstrate for the first time that HIV co-infection is significantly greater in middle-aged (35-64 years) compared to young adult (15-34 years) TB patients and in Aboriginal and sub-Saharan African, compared to Canadian-born non-Aboriginal and foreign-born 'other' TB patients. Our findings underscore the need for universal concurrent testing as well as greater interaction between TB and HIV programs.
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Affiliation(s)
- Richard Long
- Tuberculosis Program Evaluation and Research Unit, Department of Medicine, University of Alberta, Edmonton, AB.
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18
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Worthington C, Jackson R, Mill J, Prentice T, Myers T, Sommerfeldt S. HIV testing experiences of Aboriginal youth in Canada: service implications. AIDS Care 2010; 22:1269-76. [DOI: 10.1080/09540121003692201] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Catherine Worthington
- a Faculty of Social Work , University of Calgary , 2500 University Drive NW, Calgary , AB , T2N 1N4 , Canada
| | - Randy Jackson
- b School of Social Work , McMaster University , Hamilton , ON , Canada
- c Canadian Aboriginal AIDS Network , Vancouver , BC , Canada
| | - Judy Mill
- d Faculty of Nursing , University of Alberta , Edmonton , AB , Canada
| | - Tracey Prentice
- e Institute of Population Health , University of Ottawa , Ottawa , ON , Canada
| | - Ted Myers
- f HIV Social, Behavioural and Epidemiological Studies Unit , University of Toronto , Toronto , ON , Canada
| | - Susan Sommerfeldt
- d Faculty of Nursing , University of Alberta , Edmonton , AB , Canada
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19
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Ndlovu U, Ion A, Carvalhal A. "My children and my home": the most recent and challenging stressors of HIV-positive women. Arch Womens Ment Health 2010; 13:215-22. [PMID: 20182756 DOI: 10.1007/s00737-010-0148-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2009] [Accepted: 01/08/2010] [Indexed: 11/24/2022]
Abstract
Because of negative health consequences and differences in exposure and vulnerability to stressful encounters, it is important to examine and understand the stressful experiences faced by women living with HIV. The goal of this study was to examine the most recent and challenging stressors faced and coping strategies adopted by a sample of women living with HIV. Using mixed methodology, narratives of six women's most recent and stressful experience and answers to the Ways of Coping questionnaire were collected and analysed. Two main themes arose from the stressor narratives: child-related concerns and housing issues. To address these stressors, each woman used a variety of coping strategies, the most common being seeking social support even when stressors were analysed separately according to their main themes. Implications of these findings within service provision are discussed.
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Affiliation(s)
- Uitsile Ndlovu
- The Ontario HIV Treatment Network, 600-1300 Yonge Street, Toronto, ON M4T 1X3, Canada.
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20
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Long R, Boffa J. High HIV-TB co-infection rates in marginalized populations: evidence from Alberta in support of screening TB patients for HIV. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2010; 101:202-4. [PMID: 20737809 PMCID: PMC6973978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/21/2009] [Accepted: 02/05/2010] [Indexed: 07/26/2024]
Abstract
Heretofore we have not seen strong evidence of synergy between HIV and tuberculosis (TB) in Canada. This may simply reflect a lack of concurrent surveillance for the two diseases. To date, the goal of universal HIV testing of TB patients (> 80% tested) in Canada has not been achieved, despite the existence of two national advisories recommending universal HIV testing of TB patients. In response to these advisories, we recently undertook to demonstrate the feasibility of using an 'opt-out' approach to achieve universal HIV testing of TB patients in Alberta--see the Canadian Journal of Public Health 2009;100(2):116-20. In the present commentary, we add two more years of data (2007-2008) to our earlier report and demonstrate for the first time that HIV co-infection is significantly greater in middle-aged (35-64 years) compared to young adult (15-34 years) TB patients and in Aboriginal and sub-Saharan African, compared to Canadian-born non-Aboriginal and foreign-born 'other' TB patients. Our findings underscore the need for universal concurrent testing as well as greater interaction between TB and HIV programs.
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Affiliation(s)
- Richard Long
- Tuberculosis Program Evaluation and Research Unit, Department of Medicine, University of Alberta, Edmonton, AB.
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21
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Abstract
The world's almost 400 million Indigenous people have low standards of health. This poor health is associated with poverty, malnutrition, overcrowding, poor hygiene, environmental contamination, and prevalent infections. Inadequate clinical care and health promotion, and poor disease prevention services aggravate this situation. Some Indigenous groups, as they move from traditional to transitional and modern lifestyles, are rapidly acquiring lifestyle diseases, such as obesity, cardiovascular disease, and type 2 diabetes, and physical, social, and mental disorders linked to misuse of alcohol and of other drugs. Correction of these inequities needs increased awareness, political commitment, and recognition rather than governmental denial and neglect of these serious and complex problems. Indigenous people should be encouraged, trained, and enabled to become increasingly involved in overcoming these challenges.
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Affiliation(s)
- Michael Gracey
- Unity of First People of Australia, Perth, WA, Australia.
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Mill JE, Jackson RC, Worthington CA, Archibald CP, Wong T, Myers T, Prentice T, Sommerfeldt S. HIV testing and care in Canadian Aboriginal youth: a community based mixed methods study. BMC Infect Dis 2008; 8:132. [PMID: 18840292 PMCID: PMC2573888 DOI: 10.1186/1471-2334-8-132] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2008] [Accepted: 10/07/2008] [Indexed: 12/03/2022] Open
Abstract
Background HIV infection is a serious concern in the Canadian Aboriginal population, particularly among youth; however, there is limited attention to this issue in research literature. The purpose of this national study was to explore HIV testing and care decisions of Canadian Aboriginal youth. Methods A community-based mixed-method design incorporating the Aboriginal research principles of Ownership, Control, Access and Possession (OCAP) was used. Data were collected through surveys (n = 413) and qualitative interviews (n = 28). Eleven community-based organizations including urban Aboriginal AIDS service organizations and health and friendship centres in seven provinces and one territory assisted with the recruitment of youth (15 to 30 years). Results Average age of survey participants was 21.5 years (median = 21.0 years) and qualitative interview participants was 24.4 years (median = 24.0). Fifty-one percent of the survey respondents (210 of 413 youth) and 25 of 28 interview participants had been tested for HIV. The most common reason to seek testing was having sex without a condom (43.6%) or pregnancy (35.4%) while common reasons for not testing were the perception of being low HIV risk (45.3%) or not having had sex with an infected person (34.5%). Among interviewees, a contributing reason for not testing was feeling invulnerable. Most surveyed youth tested in the community in which they lived (86.5%) and 34.1% visited a physician for the test. The majority of surveyed youth (60.0%) had tested once or twice in the previous 2 years, however, about one-quarter had tested more than twice. Among the 26 surveyed youth who reported that they were HIV-positive, 6 (23.1%) had AIDS at the time of diagnosis. Delays in care-seeking after diagnosis varied from a few months to seven years from time of test. Conclusion It is encouraging that many youth who had tested for HIV did so based on a realistic self-assessment of HIV risk behaviours; however, for others, a feeling of invulnerability was a barrier to testing. For those who tested positive, there was often a delay in accessing health services.
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Affiliation(s)
- Judy E Mill
- Faculty of Nursing, University of Alberta, 7-50 University Terrace, Edmonton, Alberta, Canada.
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Gesink Law D, Rink E, Mulvad G, Koch A. Sexual health and sexually transmitted infections in the North American Arctic. Emerg Infect Dis 2008; 14:4-9. [PMID: 18258070 PMCID: PMC2600166 DOI: 10.3201/eid1401.071112] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
STI rates reported for the Arctic are much higher than those reported for their southern counterparts. Our objective was to describe the basic epidemiology of sexually transmitted infections for Arctic and sub-Arctic regions of North America. We summarized published and unpublished rates of chlamydial infection and gonorrhea reported from 2003 through 2006 for Alaska, Canada, and Greenland. In 2006, Alaska reported high rates of chlamydial infection (715 cases/100,000 population) compared with the United States as a whole; northern Canada reported high rates of chlamydial infection (1,693 cases/100,000) and gonorrhea (247 cases/100,000) compared with southern Canada; and Greenland consistently reported the highest rates of chlamydial infection (5,543 cases/100,000) and gonorrhea (1,738 cases/100,000) in the Arctic. Rates were high for both men and women, although the highest incidence of infection was predominantly reported for young women in their early twenties. We propose that community-based participatory research is an appropriate approach to improve sexual health in Arctic communities.
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Affiliation(s)
- Dionne Gesink Law
- Department of Public Health Sciences, University of Toronto, 155 College Street, Toronto, Ontario, Canada.
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