Aboriginals and
HIV/AIDS The number of Aboriginals who are diagnosed with HIV is increasing at an alarming rate. "The number of Aboriginal people with HIV is growing every year, and health professionals fear it could reach epidemic proportions if measures aren't taken to prevent the spread of the deadly virus" (Calgary Herald, Jan 17, 1999.) In addition to a predominance of high-risk behaviours, the spread of HIV/AIDS amongst the Aboriginal problem is exacerbated by several fundamental factors: the general social conditions in which significant numbers of Aboriginals live, the frequent movement of significant numbers of Aboriginals between urban centres and reserves, response to HIV/AIDS within the Aboriginal community and cross-cultural issues. The Numbers Statistics released by Health Canada in November, 1998, draw a harrowing portrait of Aboriginals and HIV/AIDS:
More alarmingly, it is estimated that these numbers may be an under-representation of the actual numbers because ethic background information is not collected in as many as 40 % of HIV tests. A more accurate profile may be provided by the following statistics:
In the Aboriginal population, the number of females who are diagnosed with HIV is proportionately higher than in the general population. For example:
In the Aboriginal youth population HIV infection is proportionately more higher than in the general population. Aboriginals are infected at a earlier age than non-Aboriginals. "Over three quarters of reported Aboriginal AIDS cases fall between the ages of 20 and 39 years, Because the onset of AIDS can happen as late as 12 years after infection with HIV, this means that most Aboriginals are infected during their adolescence" (The Changing Face of AIDS.) Means of Transmission: According to Health Canada (November,1998) the means of transmission of HIV among the 213 male aboriginal AIDS cases were as follows:
Among the 42 female Aboriginal AIDS cases, exposure categories were as follows:
Injection drug use accounts for 18.8%% of the AIDS cases among Native men and 47.6% of those among Native women. By comparison, in the non-Native community injection drug use accounts for only 3.5% of the AIDS cases among men and 18.1% among women (Health Canada as cited in Canadian Aboriginal AIDS Network.) The predominant mode of HIV infection in the Native and non-Native community is sex between men. However, heterosexual sex is also a significant method of HIV transmission in the Aboriginal community. According to case studies conducted in Alberta and British Colombia heterosexual contact accounts for 30% of the reported AIDS cases among Native women" (Canadian Aboriginal AIDS Network.) Social Conditions The social conditions in which many Aboriginals live have a strong contributory factor to the susceptibility to HIV and AIDS. "A large number of Aboriginal people with HIV are living in sub-standard housing. Not even their most basic needs are being met" (The Changing Face of AIDS.) As a result, most basic preventative measures, such as education, risk-behaviour awareness, and good general health are out of reach for a significant portion of the Aboriginal population. Kevin Barlow, head of the Canadian Aboriginal AIDS Network, notes that "mainstream society does not appreciate the extent of the poor health conditions experienced by First Nations people and Inuit." These adverse social conditions only exacerbate the problems of Aboriginal people with HIV/AIDS (APHAs.) As a result, the maintenance of good physical health after contraction of HIV becomes more difficult for the Aboriginal population than for the population as a whole. Also, due to the prevalence of poverty and economic hardship, treatment drugs are difficult to obtain. Additionally, the prevalence of dependencies such as alcohol and drugs further diminishes the APHAs ability to maintain physical health. Mobility of Population Mobility between inner city and rural/reserve counties is an important factor in the introduction and spread of HIV from infected individuals. It is not uncommon for individuals to import the HIV virus to reserves from urban centres. According to the CAAN survey "as many as 79% of Aboriginal IDUs visit their reserve with some frequency. While on the reserve, they may share needles or have unprotected sex with community members." (Canadian Aboriginal AIDS Network.) Travel to and from these areas by Aboriginal people increases the chance that diseases will be introduced to previously unexposed populations. Aboriginals will inhabit one or more of three communities: the reserve, the urban centre and prison. Aboriginals are over-represented in prison populations, while in prison inmates often "engage in high risk activity such as injection drug use, sexual activity and tattooing, without taking appropriate protective measures" (The Changing Face of AIDS.). According to a CAAN survey, as many as 87% of Aboriginal IDUs have been incarcerated. This high incarceration rate has the potential to be the catalyst or a rapid spread of HIV. "Drug use in the penal system is a fact of life, but there is no program for providing clean needles in prison. Thus while in prison, Aboriginal IDUs are unable to protect themselves against HIV infection" (Calgary Herald, Jan 17, 1999.): When the individuals are released back into the general population, they have the potential to introduce HIV to whichever community they return to. Given the mobility of Aboriginal intravenous drug users (IDUs) the entire Aboriginal community from the reserve, to the streets, to prisons needs to pull together and implement programs to reduce the risk of HIV infection to Aboriginal IDUs and prevent an epidemic within the greater Aboriginal community. (CAAN.) Often the migration from an urban centre to their reserve, there exists a gap in the provision of education, treatment and prevention services. Presently, "only urban agencies have developed programs to reduce HIV transmission by injection drug use and sex" (Aidslaw.) APHAs who leave the city to return to the reserve will not have access to the same services as are available in the urban environment. "There is no continuum of care for Aboriginals with HIV who tend to move frequently between urban centres and First Nations communities and who access service in both places" (The Changing Face of AIDS.) Community Response There are many factors within the Aboriginal community that further compound the already onerous difficulties of APHAs. For many Aboriginals with HIV/AIDS, the virus is a Very, very lonely disease, since patients are often shunned from their communities" (Aboriginal communities in Canada face AIDS epidemic.) This may be due to the continued perception that HIV/AIDS is a white mans disease, homophobic preconceptions of the disease, or because for many rural/reserve Aboriginals consider it to be an urban problem, one which they do not want to have imported by part-time reserve residents. Within the Aboriginal community there is often insufficient education, funding or political will to develop support services. There is often a general reluctance to address the issue of AIDS, being associated with the issue of sexuality as it is. Furthermore, "very few Reserves in Canada have condom distribution and/or needle exchange programs Education about HIV/AIDS remains low on many Reserves" (Canadian Aboriginal AIDS Network.) For many APHAs the necessary physical, emotional and spiritual support may not exist. "Aboriginal people with HIV receive little or no support from their First Nations Communities" (The changing Face of AIDS.) Often APHAs encounter strong disapproval in the native community (AEGIS, AIDS Daily Summary.) Many Aboriginal people living with HIV/AIDS do not have access to an Aboriginal AIDS organisation. "[As of 1995] There are no Aboriginal AIDS organisations in a number of cities with significant Aboriginal populations, including Ottawa, Calgary and Saskatoon" (Aidslaw, p. 4.) There is then a growing need for a HIV/AIDS prevention programs that address the specific need of Canadian Aboriginal communities in a culturally accepted manner. Culture Differences between Aboriginal and mainstream cultures can add to the problems of APHAs. The Aboriginal population holds cultural norms and customs which differ significantly from other populations in which AIDS prevention programs have been implemented. "The special customs and structure of Indian society need to be understood by service providers in order to select prevention strategies which will be meaningful and credible in the Indian culture. For example, the elders hold a revered position within the Indian communities and function as transmitters of values to Indian youth This line of transition implies that elders should be an integral part of any prevention program which is founded on behavioural change related to values" (DePoy and Bolduc, 1992: 54.) There are other cultural factors at work as well. According to Dr. David Des Jardins, executive Director of the Feather of Hope Aboriginal AIDS Prevention Society of Edmonton and Calgary, "Natives are reluctant to talk about sex and sexuality It brings up old wounds since many were abused sexually as children" (AEGIS, AIDS Daily Summary.) Calgary Urban Aboriginal Outreach Project The Calgary Urban Aboriginal Outreach Project has been developed over the last 6-7 months as a way of addressing HIV/AIDS issues at a local level in the Calgary urban centre and the Treaty Seven region, which encompasses southern Alberta. The Project is a two-year pilot project. A pan-agency, multi-managed community project the UAOP is targeting the urban Aboriginal population and those transient to and from the Treaty 7 Area Reserves, with the objective of:
AIDS Calgary is working as the broker for the Project and, as such, the Project is sub-leasing its resource centre/ office in the space adjoining the new AIDS Calgary office. They will also be relying on AIDS Calgary for administrative assistance such as invoicing and financial management. the project will undertake to provide important linkages between the Aboriginal and non-Aboriginal communities, so that Aboriginals will have access to as many community resources and services as possible. To that end, the Project is working with numerous service providers within the community, including: the Calgary HAS Coalition Aboriginal Leadership Cluster, the Calgary Aboriginal Health Council, the Safe Works Needle Exchange, Aboriginal Hospital Representatives, the Canadian Red Cross, Feather of Hope, the Southern Alberta Clinic, the Calgary Native Disabled Society, the Treaty 7 Aboriginal CHR AIDS Committee and the CHRA. The Project is funded by the Medical Services Board, Alberta Health and Health Canada. The Urban Aboriginal Outreach Project will be initially comprise a staff of three employees, including full-time Project Leader, Tamara Hunt, and two part-time street-level outreach workers, with the expectation that the outreach staff will expand to include two full-time and two part-time workers. The Resource Centre will be a multi-faceted site, providing a resource library and a computer terminal with Internet capability to provide APHAs and their families access to information and education regarding HIV/AIDS issues, services, treatments, developments, etc. Additionally, the resource centre will provide APHAs and their families access to resources on traditional medicines and healing and will serve as a centralised social support centre. Tamara states that she envisions the resource centre as a "relaxed, inviting, safe, secure healing place." To that end, the walls will be decorated with Native art and education about traditional practices will be available. According to Tamara, the "cultural component needs to be at the centre of the service delivery model." Aboriginals base their traditional healing on the teachings of the Medicine Wheel, which takes into account and addresses the four aspects of an individual: the mental, emotional, physical and spiritual. These basic principals are the philosophical foundation of the Calgary Urban Aboriginal Outreach Project. According to Tamara, "APHAs, when they come to their last stages, tend to look very deeply into their native spirituality." However, "not all of them practice native spirituality, we need to be respectful of all spiritual needs, this can take on many faces but we need to support them whatever their spiritual choice is." In order to facilitate this, the Project is working with the Native Friendship Centre to match up APHAs and their families with tribal Elders who play an important role in traditional practices. According to the Urban Aboriginal Outreach proposal, there are currently "no existing organisations or projects in the Calgary urban area that offer Aboriginal with, or at risk for, HIV/AIDS infection support services. Because there are no services available, we have seen many Aboriginal who are HIV-positive leave the city and the surrounding reservations to go to other urban areas that can offer the support they need. This is not a healthy situation for a community that is already challenged on so many fronts. Furthermore, understanding the culture of the reserves and native family systems is crucial to developing the necessary communications with Aboriginals. It is hoped that the Project will create a more efficient tracking system for transient Aboriginal people in Calgary, thereby allowing better opportunity for follow up services. As Tamara explains, APHAs usually return to their reserves at some point in their illness. "When they go home, we need to ensure that they receive a continuum of services we need to establish links to promote connections with health directors and service providers on the reserves. We need to ensure that their needs are being met when they go home." Ultimately, the long-range overall objective is to have fewer Calgary area Aboriginals contracting HIV/AIDS, ensuring that those with HIV/AIDS are able to get the help they need and that those without it know how to stay healthy. To this end, Aboriginals will be more informed about risk behaviours, how to protect themselves and how to access the appropriate health and social services. Optimally, this will reduce incidence of HIV/AIDS within the Aboriginal population, in both urban and reserve settings. It is hoped and expected that the linkages developed between many different social services will result in increased awareness among service providers, improved coordination of services for Aboriginals and increased access to services for Aboriginal people in the Calgary area. Tamara concluded by stating that she is "excited to bring the Aboriginal and non-Aboriginal communities together so that they can support and learn from each other," and she looks forward to them coming together, sharing commonalities and unity." I want to thank Tamara for taking the time in this busy period to speak with me about this fascinating and important project and, on behalf of everybody at AIDS Calgary, wish her and her team a great deal of success. |
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