Storying with First Nations People Living with HIV and AIDS
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Published by Te Rau Ora, 2021 Colonisation, suicide, and resilience: Storying with First Nations people living with HIV and AIDS Volume 6 | Issue 2 traumas, and stigma experienced following their HIV diagnosis as well as their desire to re-engage Article 1, August 2021 and revitalize their connection to culture and Sean Hillier community, demonstrating their unwavering York University resilience. Following the interviews, participants produced recommendations requesting funding Eliot Winkler for HIV and AIDS treatment and programming Ontario HIV Treatment Network in First Nations communities, a government commitment to address issues surrounding Lynn Lavallée poverty, stable housing, clean drinking water and Ryerson University perpetual trauma for northern Indigenous Peoples, and a need for accessible, culturally Abstract based treatment programs and services at HIV service organizations. The impact and trauma of colonisation persists among Indigenous Peoples in Canada, where Keywords: Indigenous, suicide, colonisation, they face a disparate burden of HIV diagnoses trauma, prevention, resilience and suicide compared to the general population, yet still demonstrate tremendous resilience. In He Mihi – Acknowledgements: We are order to elucidate the issues facing First Nations grateful for the support of Canadian Institutes of people living with HIV and AIDS, 29 participants Health Research which provided funding for this partook in traditional storytelling to share their research through a priority doctoral award in the experiences, resulting in 27 major themes. area of Indigenous Peoples living HIV/AIDS of Participants shared the negative coping $105,000. mechanisms, suicidal ideations, historical 2 Volume 6 | Issue 2 | Article 1 – Hiller et al. We are thankful to the Indigenous Peoples living AIDS epidemic in Canada, facing a 13% with HIV who have generously shared their time, incidence increase in HIV infection between the experiences, and bodies for the purposes of this years 2014 and 2016 (CATIE, 2019). The research. Much of the fight against HIV/AIDS province of Saskatchewan has the highest rates of relies upon people living with HIV to continue HIV infection in the country, mainly focused in putting themselves forward. This research, and First Nations communities (Woroniuk, 2017). our fight against HIV/AIDS, is forever indebted Indigenous Peoples living with HIV on to our generous community partners, past and combination antiretroviral therapy have a lower present. We also acknowledge the many other life expectancy at age 20 compared to non- organisations who helped with recruitment and Indigenous Canadians (Patterson et al., 2015). offered space and resources whenever needed. Furthermore, the mortality rates of Indigenous We wish to acknowledge the traditional Peoples living with HIV is higher than for other territories on which this research took place. This ethnicities in Canada (Benoit et al., 2017). land helped to ground the knowledge we gained Though the rates of HIV among Indigenous through this process, and we will be forever Peoples in the United States, Australia, and New grateful. Zealand are not substantially higher than non- Indigenous Peoples in said countries, Conflict of Interest: The authors declare no colonization and inequitable social determinants conflict of interest. place these populations at risk of a future HIV Informed Consent: Consent was sought and epidemic currently being seen in Canada (Negin obtained from all participants within this et al., 2015). Perhaps one of the most pervasive research. This research was approved by the impacts of colonialism still felt today is the Ryerson University Research Ethics Boards disproportionate rate of suicide in Indigenous (REB 2015-343). communities in Canada, particularly among Indigenous youth. Young Indigenous people living with HIV who use drugs in British Introduction Columbia are 12.9 times more likely to die Colonisation has supressed Canada’s Indigenous compared to Canadians of the same age, with Peoples for hundreds of years and has played a suicide being one of the leading causes of death significant role in the power structure of (Jongbloed et al., 2017). This research shares the Canadian society, placing social, political, and stories of 29 First Nations people living with HIV economic inequalities upon Indigenous Peoples. and AIDS in Ontario; how their lives have been These inequalities have caused unfavourable, shaped by colonial trauma, HIV, self-harm and intermediate, and proximal determinants suicide, and their undeniable will to keep living. (Reading & Wien, 2009), which have led Indigenous Peoples to suffer the worst social, economic, and health conditions in all of Canada Background (MacDonald & Altaran, 2007). Striking health Indigenous Peoples in Canada disparities exist amongst Indigenous Peoples in Canada’s Indigenous population is comprised of Canada and have been well documented for First Nations (status and non-status), Métis decades (Kurtz et al.. Indigenous Peoples in (registered and non-registered) and Inuit people Canada experience ill health at rates far higher and represents 4.9% of Canada’s total than in the non-Indigenous population across population. Almost half (48%) of the 181,524 virtually every facet of health (National Collaborating Centre for Aboriginal Health, 2013). These gaps are paving the way for some of the shortest life expectancy rates of any one identifiable group within Canada (Government of Canada, 2017). Along with these disparities, Indigenous communities are at the heart of an HIV and 3 Published by Te Rau Ora, 2021 registered Indian1,2 population in Ontario lives on Ontario in 2016 and 2017 (Ontario HIV 207 reserves3 and there are 126 bands4, with over Epidemiology Surveillance Initiative, 2019b). 23,000 speakers of Indigenous languages in the Modes of exposure for women are mainly from province (Government of Canada, 2018a). sexual contact with men (at 59% of infections) and exposure through injection drug use (35% of HIV and AIDS infections). For men, the greatest risks are from The Human Immunodeficiency Virus (HIV) and injection drug use (32%), sexual contact with men Acquired Immune Deficiency Syndrome (AIDS) (28%), and exposure through combined drug use disproportionately impact Indigenous Peoples in and sexual contact with men (20%); only 16% Canada. There is limited data on the true impact reported transmission via sexual contact with of HIV and AIDS on this population, given women (Ontario HIV Treatment Network, significant issues with HIV data collection and 2014). reporting. Of the estimated 63,100 people living with HIV in Canada at the end of 2016, 9.6% Suicide in Indigenous Populations (6,055) were Indigenous, representing a 5% Between 2011 and 2016, suicide rates in First increase from the 2014 estimate (5,760). The Nations individuals were three times higher than estimated HIV prevalence rate for Indigenous in non-Indigenous people (Kumar & Tjepkema, Peoples in Canada in 2016 was 362 per 100,000 2019). In a study by Cain et al. (2011), of 72 population: two times higher than in the general Indigenous participants living with HIV population (Public Health Agency of Canada, interviewed across Canada, 35 described 2019). In 2017, Indigenous Peoples continued to thoughts of killing themselves or attempts to die be disproportionately represented, making up by suicide. Similarly, in a British Columbian less than 5% of the population in Canada, but cohort of 605 Indigenous participants, 53% accounting for more than 20% of new HIV considered taking their own life and 37% had diagnoses (Haddad et al., 2018). attempted suicide (Moniruzzaman et al., 2009). Inuit Peoples, particularly Inuit youth, have some Indigenous women are more likely to be of the highest suicide rates in the country, dying diagnosed with HIV than the general population, from suicide at a rate of 40% compared to 8% with up to 40% of new infections occurring in across Canadians (Kral, 2016; Webster, 2016). It this group (Haddad et al., 2018). In 2017, is currently estimated that suicide rates are 5 to 7 Indigenous women in Canada accounted for times higher for Indigenous youth compared to 30.9% of new HIV cases in women compared non-Indigenous youth, and 11 times higher in with Indigenous men, who accounted for 16.3% Inuit youth (Government of Canada, 2018b). of new cases in men (Haddad et al., 2018). In About 1 in 20 to 1 in 10 off-reserve First Nations, Ontario specifically, the percentage of new HIV Métis, and Inuit young adults reported having diagnoses in Indigenous men increased from had suicidal thoughts in the previous 12 months 1.4% in 2014-15 to 2.8% in 2016-17 while the and about 1 in 5 to 1 in 4 reported ever having percentage of new HIV diagnoses for Indigenous had suicidal thoughts in their lifetime (Kumar & women increased from 5.2% in 2014-15 to 6.9% Nahwehgabow, 2016). in 2016-17 (Ontario HIV Epidemiology Surveillance Initiative, 2019a). This may be Heightened suicide rates among Indigenous attributed, in part, to the fact that the number of Peoples in Canada can be tied to historical HIV tests increased across all health regions in trauma, poverty, family and community abuse or 1 “Indian people are one of three cultural groups, along requirements for determining who is an Indian for the with Inuit and Métis, recognized as Aboriginal people purposes of the Indian Act” (Government of Canada, under section 35 of the Constitution Act. There are 2012, Para. 11). legal reasons for the continued use of the term Indian. 3 “A reserve is a tract of land, the legal title to which is Such terminology is recognized in the Indian Act and held by the Crown, set apart for the use and benefit of is used by the Government of Canada when making an Indian band” (Government of Canada, 2012, Para. reference to this particular group of Aboriginal 25). people” (Government of Canada, 2012, Para. 10). 4 A “Band”, or “Indian Band,” is a governing unit of 2 “Status Indian is a person who is registered as an Indians in Canada instituted by the Indian Act, 1876.