“ The individualist approach to social problems is basically selfish .”
HR is not a moralistic concept which takes a stand on drug use but rather, it is a pragmatic solution to the very serious issues of HIV infection. In fact, Harm Reduction is intended to be a value neutral approach and makes no assumptions about drug use of persons who use drugs. The intention of Harm Reduction is to help drug users make informed decisions and empower themselves to reduce the risk of HIV infection. Canadian Aboriginal AIDS Network (CAAN) Service providers’ beliefs and attitudes can create barriers to access for the most vulnerable people in our communities. Harm Reduction asks us to look at ourselves and how we offer services. . .are we really open and accessible to those we want to reach. We need to take our social and moral beliefs out of the programs and services we offer Harm Reduction is a moral necessity and politically smart to do. Harm Reduction is needs based philosophy taking the individual and community into account.
How far can I push my own system of beliefs? Influences that impact First Nations Pain Colonialism - Loss of culture, language, traditions, ceremonies Residential Schools Changing gender roles Capitalism Justice system – RCMP killing Inuit dogs Resulted in a loss of balance and harmony and inflicted pain: Mental, Spiritual, Emotional and Physical. Breaking the cycle ... but not the circle. (campaign for &quot;harm reduction&quot; among aboriginal community) (need to control HIV and Hepatitis C) (Excerpt) Gender issues
Barlow, “ I know that our communities face many challenges. It is hard to tell a community that they need to deal with HIV/AIDS when their kids are killing themselves, or they don’t have running water, or their houses are run down, overcrowded and there is the violence against women and kids to contend with.”
&quot;Today we honour the indigenous people of this land, the oldest continuing cultures in human history. We reflect on their past mistreatment. We reflect in particular on the mistreatment of those who were Stolen Generations - this blemished chapter in our national history. The time has now come for the nation to turn a new page in Australia’s history by righting the wrongs of the past and so moving forward with confidence to the future. &quot;We apologise for the laws and policies of successive parliaments and governments that have inflicted profound grief, suffering and loss on these, our fellow Australians. We apologise especially for the removal of Aboriginal and Torres Strait Islander children from their families, their communities and their country. &quot;For the pain, suffering and hurt of these Stolen Generations, their descendants and for their families left behind, we say sorry. To the mothers and the fathers, the brothers and the sisters, for breaking up of families and communities, we say sorry. And for the indignity and degradation thus inflicted on a proud people and a proud culture, we say sorry. &quot;We the Parliament of Australia respectfully request that this apology be received in the spirit in which it is offered as part of the healing of the nation. For the future we take heart; resolving that this new page in the history of our great continent can now be written. Related Links Australia says sorry for 'stolen' Aborigines &quot;We today take this first step by acknowledging the past and laying claim to a future that embraces all Australians. A future where this Parliament resolves that the injustices of the past must never, never happen again. A future where we harness the determination of all Australians, Indigenous and non-Indigenous, to close the gap that lies between us in life expectancy, educational achievement and economic opportunity. A future where we embrace the possibility of new solutions to enduring problems where old approaches have failed. A future based on mutual respect, mutual resolve and mutual responsibility. A future where all Australians, whatever their origins, are truly equal partners, with equal opportunities and with an equal stake in shaping the next chapter in the history of this great country, Australia.&quot; Barlow “the election of the first African-American President in the US, but also the appointment of Canada’s first Aboriginal Health Minister, Leona Aglukkaq, and the apology by the federal government of Canada for the atrocities that were directed at the first peoples of this land.”
Urban, rural, and off and on reserve both have an extremely high rate of aboriginal homelessness, poverty, racism, and NIMBYism (not in my back yard). In addition, policies of exclusion abound in each community. &quot;Basically clients accessing HR services are seen as at the end of services. They've tried treatment, it didn't work, and they tried counseling it didn't work. So just give them the Methadone and keep them safe, just give them needles. It's almost like they are written off.&quot; (wardman) Another barrier for clients identified by participants was the fear of a lack of confidentiality when they access these services. Whether this fear is real or not is unclear but some clients are reluctant to access services within their community for fear of being identified. &quot;The Aboriginal community is small so they don't want aboriginal staff who they'll likely know, and then they'll know that they are an IDUer.“ One potential approach for First Nation communities considering HR services may be to present educational information with the acknowledgement that cultural differences exist. Communities will then be in a more informed position to decide whether HR services should be established. If a community is reluctant to consider HR services, it may be unwise to proceed. A disregard for one's personal and healing beliefs could impact that person's attitude towards HR (and other services), as well as his or her understanding of and compliance with therapeutic regiments
Knowledge in and of itself does not translate into behaviour change, and more knowledge, therefore, does not translate into more behaviour change. The goal is to look beyond traditional prevention and awareness campaigns and actively engage youth in the development of tools that are familiar and accessible. It is important to value the youth and consider culturally competent health strategies to address the social determinants of sexual health Human development, health promotion and prevention need to be supported. Disease specific policies and programs are a barrier 3 Legged wobbly stool
Racial origin does not make anyone automatically more or less susceptible to HIV infection, so there must be other reasons for this imbalance. Poverty may be one factor which explains the increased HIV prevalence amongst African American populations. Studies have found an association between higher AIDS incidence and lower income AIDS is a preventable disease, but to avoid HIV infection people need more than just factual information. In First Nations communities TB rates are 8 to 10 times higher than overall Canadian rates. In First Nations HIV rates are 6 times higher than overall Canadian rates.
Applause crackled and tears flowed in city squares and parks across Australia yesterday as the country united to embrace its original inhabitants with an apology most Aborigines never thought they would hear. The yellow, black and red of the Aboriginal flag fluttered from buildings, including the Sydney Harbour Bridge, as the Prime Minister delivered an apology on behalf of Parliament and the Government for the pain and suffering inflicted on tens of thousands of indigenous people taken from their families. In his first parliamentary speech as the nation's leader, Kevin Rudd urged Australians to “turn a new page” by “righting the wrongs of the past”. Aborigines in the public gallery, including Cathy Freeman, the Olympic gold medallist, Evonne Goolagong Cawley, twice the Wimbledon singles winner, and members of the “stolen generations”, wept and hugged amid a prolonged standing ovation. Related Links 'For 13 years all I knew was fear' Australia apologises to 'stolen generations' Australia's stolen generation to accept apology “ The stolen generations are not intellectual curiosities, they are human beings. Human beings who have been damaged deeply by the decisions of parliaments and governments. But, as of today, the time for denial, the time for delay is at last come to an end,” Mr Rudd said. Amid the tears and cheers there were also jeers as Brendan Nelson, the opposition leader, spoke in support of the formal apology. “We formally offer an apology, we say sorry to those Aboriginal people forcibly removed from their families through the first seven decades of the 20th century,” Dr Nelson said. But he added: “Our generation does not own these actions nor should it feel guilt for what was done in many, but certainly not all cases, with the best of intentions.” As his speech was being televised, some in Parliament's Great Hall, outside the chamber, turned their backs on the large screen. The controversy intensified as it emerged that two of Mr Rudd's media advisers had joined the protesters in their gesture. Wilson Tuckey, an outspoken conservative politician known as Ironbar for his uncompromising views, walked out of Parliament before the apology, saying it would do little for Aborigines. Five others boycotted the debate. While the apology itself was generally warmly greeted across the ethnic divide, most agreed it was only the start of a longer reconciliation process.Patrick Dodson, often called the father of reconciliation, was among several Aboriginal leaders to issue fresh calls for the Government to compensate victims financially - something Mr Rudd has rejected. In an effort to create further momentum, the Prime Minister said that he and Dr Nelson would take the unprecedented step of co-chairing a new bipartisan “war cabinet” to address disadvantage among Aborigines, focusing initially on housing and constitutional recognition. Mr Rudd committed to halving the gap in infant morality rates between indigenous and non-indigenous children and to close the 17-year life expectancy gap. “None of this will be easy,” he said.
Resiliency models focus on positive aspects to living. Focusing on disease and medical models focus too much on negative outcomes of behaviours. We need to look at life and the way we interact with each other from a more balanced way of functioning. Youth need to be given choices and need to take responsibility for actions and need to learn respect for themselves, others, and this can only be enhanced from a First Nations/Aboriginal cultural perspective. First Nations struggle for autonomy is very similar to the struggle of people living with HIV today. The challenge for Health Care providers will be to listen, in a non-judgmental way, to create a balanced approach to service delivery that takes the needs of the health care consumer into perspective.
Restoring balance through harm reduction
Restoring Balance through Harm Reduction Sex, Health, Wellness and HIV Monday November 24 th , 2008 The Norwood Hotel Greg Riehl Canadian Association of Nurses in AIDS Care
Objectives <ul><li>To broaden the understanding of Harm Reduction from an Aboriginal perspective </li></ul><ul><li>To describe current trends in Harm Reduction programs on-reserve </li></ul><ul><li>To discuss what puts people at risk and in harms way </li></ul><ul><li>To identify the unique challenges faced by Aboriginal peoples </li></ul>
Restoring Balance through Harm Reduction <ul><li>North American culture looks at problems of substance abuse as individual problems rather than looking at the larger societal picture. </li></ul><ul><li>In individualistic societies we blame the individuals, often missing the larger patterns and forces at work. </li></ul><ul><li>Most social ills are seen as the result of actions by people who are “bad”. </li></ul><ul><li>The individualistic perspective frequently narrows the ethical discussions to consideration of individual rights rather that collective goals and responsibilities. </li></ul><ul><li>We are far too focused on individual behaviour to see the larger context that encourages people to act ethically. </li></ul><ul><li>“ The individualist approach to social problems is basically selfish .” </li></ul>
Restoring Balance through Harm Reduction <ul><li>Strong social expectations are not good reasons for making a particular ethical decision </li></ul><ul><li>Collective cultures, like First Nations, have been impacted by colonialism, residential schools, changing gender roles, capitalism, and a foreign justice system, to name a few. </li></ul><ul><li>The loss of culture, language, traditions, and ceremonies has resulted in an imbalance to traditional ways of living. </li></ul><ul><li>The resulting loss of balance and harmony has resulted in pain: Mental, Spiritual, Emotional and Physical. </li></ul>
How they define Harm Reduction <ul><li>HR is not a moralistic concept </li></ul><ul><li>HR is a pragmatic solution to the very serious issues of HIV infection. </li></ul><ul><li>HR is intended to be a value neutral approach and makes no assumptions </li></ul><ul><li>The intention of HR is to help people make informed decisions and empower them to reduce the risk of HIV infection. </li></ul><ul><li>(Canadian Aboriginal AIDS Network (CAAN)) </li></ul>
Cycle of Pain and Trauma and Harm TREATMENT THERAPY JUSTICE STI’s HIV HCV PRISON ADDICTION RISKY BEHAVIOUR METHODS TO DECREASE OR HIDE PAIN PAIN TRAUMA -Introduction of Stigma and Discrimination -Loss of Balance -Goal is to restore balance -The path out of conflict begins at the center -There is calm and power at the center -Honesty not loyalty with all interactions -Medicine wheel
Medicine Wheel <ul><li>The Medicine Wheel shows the path out of conflict begins at the center </li></ul><ul><li>There is calm and power at the center - where honesty is considered more important than loyalty. </li></ul><ul><li>Stigma and Discrimination can be addressed with a goal to restore balance. </li></ul><ul><li>“ Addiction is the product of a poisoned environment that kills the spirit . . . And causes illness of the mind and body” Lucy Barney </li></ul>
WISDOM CLARITY OF PURPOSE COMMUNITY PEOPLE Law Justice Access to Care Treatment & Support Harm Reduction Prevention Pain SYSTEMS ORGANIZATIONS REFLECTION ASSESSMENT
Imbalance Creates Illness <ul><li>Aboriginal peoples are infected at a younger age than non-Aboriginal persons. </li></ul><ul><li>Further research is needed on the pattern of HIV/AIDS and HIV testing among Aboriginal peoples to increase our understanding of the specific impact of HIV on Aboriginal peoples to guide prevention and control strategies. </li></ul><ul><li>“ Learning how to cope with a lack of survival skills groomed me to become a victim and feel vulnerable to mainstream society.” Ken Ward </li></ul><ul><li>“ We are sitting on a powder keg and decisions about what is needed must come from the people, who must take ownership of the issue.” Ken Ward </li></ul>
The War on Drugs <ul><li>The war on drugs has become a war on sick people, a war on patients, and advocates and caregivers are often caught in the crossfire. </li></ul><ul><li>In Canada, the window on Harm Reduction is either closed or very nearly closed </li></ul><ul><li>The most current strategy on drugs is an Anti-Drug Strategy </li></ul><ul><li>Disease specific policies and programs can be a barrier; likewise, a one size fits all solution can also be a barrier </li></ul>
HIV/AIDS <ul><li>Holistic approach to address issues and factors that impact HIV/AIDS targeting not just the disease, but also the social determinants of health and economic circumstances. </li></ul><ul><li>It is recognized that the whole family (broadly defined) is as impacted by the disease and needs healing just as the individual with HIV/AIDS needs care, treatment and support. </li></ul>
Cultural and Community Relevance: <ul><li>A culturally competent Harm Reduction program supports culturally and linguistically appropriate community-based interventions </li></ul><ul><li>Designed and delivered by First Nations people to meet the needs of their community members. </li></ul><ul><li>In particular, good Harm Reduction programs strongly support the participation of those living with HIV/AIDS in the process. </li></ul>
Harm Reduction Strategies <ul><li>People need empowerment to negotiate safe and responsible sexual relationships; gender inequalities must be confronted; and those who choose to have sex need access to condoms. </li></ul><ul><li>Needle exchanges should be encouraged, as they have proven highly effective at preventing HIV and HCV transmission among injecting drug users. </li></ul>
Challenges <ul><li>Need to challenge First Nations with new concepts and ways of dealing with new harms and disease processes. </li></ul><ul><li>HR new to First Nations, concepts need to be culturally appropriate and incorporate language, beliefs, and traditions </li></ul><ul><li>Leaders hold the power to help. The community has been lulled into inaction. </li></ul><ul><li>The problematic use of drugs is not the “problem”, it is a symptom of much broader social problems that face First Nations, Inuit and Métis in Canada </li></ul>
“ Ultimately we know deeply that the other side of every fear is a freedom.” Marilyn Ferguson
Thank you for your time and attention. Please feel free to Greg at: <ul><li>Greg Riehl </li></ul><ul><li>Canadian Association of Nurses in AIDS Care </li></ul><ul><li>Phone: 306.352.1045 </li></ul><ul><li>E-mail: [email_address] </li></ul><ul><li>The Spirit of HIV/AIDS Nursing : </li></ul><ul><li>Culture and Caring 17th Annual Conference </li></ul><ul><li>APRIL 25 – 28, 2009 Delta Bessborough Hotel 601 Spadina Avenue East, Saskatoon SK </li></ul>
References: <ul><li>Harm reduction services for British Columbia's First Nation population: a qualitative inquiry into opportunities and barriers for injection drug users. http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1618833 </li></ul><ul><li>Reducing the Harm Associated with Injection Drug Use in Canada. http://www.hc-sc.gc.ca/hl-vs/pubs/adp-apd/injection/approach-demarche_e.html </li></ul><ul><li>Joining the Circle: An Aboriginal Harm Reduction Model. http://www.healingourspirit.org/pdfs/publications/joincircle.pdf </li></ul><ul><li>Tories plan get-tough national drug strategy. http://www.cbc.ca/canada/story/2007/09/29/drug-strategy.html </li></ul><ul><li>Harm Reduction: Questions and Answers. http://www.soros.org/initiatives/health/focus/ihrd/articles_publications/publications/qa_20041123/harm_qa_english.pdf </li></ul><ul><li>Flexibility of Treaty Provisions as Harm Reduction Approaches. http://www.tni.org/drugsreform-docs/un300902.pdf </li></ul><ul><li>Beware the Middle Ground Susan Rosenthal November 23, 2007 http://canadawatch.org/index.php?option=com_content&task=view&id=574&Itemid=95 </li></ul>