Local, as well as global research, indicates that HIV follows patterns of inequity with marginalized groups most at risk. Globally, Indigenous peoples are more likely to be economically disadvantaged, displaced from their lands, have lower educational attainment and have poorer health outcomes than their non-Indigenous counterparts.Locally, these outcomes can be linked directly to historical and ongoing systemic oppression. Factors facing Aboriginal people in Canada including racism, assimilation, the legacies of the residential schools, persistent economic inequality and cultural and social isolation. As a result, Aboriginal peoples are disproportionately affected by many social and behavioural factors that increase their vulnerability to HIV infection, including higher rates of substance abuse, (sexual and physical) violence, sexually transmitted infections, and limited access to, or use of, health care services.
While most HIV prevention approaches tend to focus on individual behaviors, an active engagement with the social, political and historical determinants of health (e.g. colonialism) that shape these behaviors may be crucial to reaching Aboriginal youth. Learning to cope with hardships such as poverty, violence and racism as a result of colonialism puts youth at risk.Common coping mechanisms are associated with high risk behaviours such as trading sex for food, shelter or drugs; alcohol and substance abuse; inconsistent condom use; sex with multiple partners; and sharing needles or other drug equipment. In order to address HIV, prevention and education strategies need to consider the socioeconomic and systemic factors that put youth at risk in the first place. Furthermore, as Indigenous scholar Linda Tawai Smith writes, in many Aboriginal communities, research is a bad word. In the name of science, enlightenment and colonization, Western researchers have abused and violated indigenous communities, often causing way more harm then good. As a result, many communities are positively weary of most institutions that want to reach out to reverse some of these trends.
According to a UNAIDS report released this summer, globally “young people are leading the prevention revolution by taking definitive action to protect themselves from HIV... [as a result], HIV prevalence among young people is falling in 16 of the 21 countries most affected by HIV” . The report shows that for the first time, reductions in HIV prevalence among young people have coincided with a change in sexual behaviour. UNAIDS attributes these shifts to policy changes that have lead to the implementation of a set of comprehensive programmes that put young people’s leadership at the centre of national responses and “provide rights-based sexual and reproductive health education and services,” including access to HIV testing and prevention. Here in Canada however, we have not experienced this positive trend. In fact, for Aboriginal youth – the situation is getting worse: The proportion of positive HIV test reports among youth identified as Aboriginal has shown a generally increasing trend, from 28.8% of positive HIV test reports in 1998 to 40.9% in 2008.Neverthless, there is much to learn from these international examples. The first lesson I hear is that (1) changing the course of the epidimic is not only theoretically possible – but we have evidence that it absoluetely can be done! (2) It will take a concerted effort at all levels to make it happen. (3) We need to continue to invest in youth and young people.
As a research team, we were very committed to being part of the response! We are a group of university based researchers, students and community activists who have come together to try and develop and think about new methods and decolonizing approaches to respond to these trends. Our approach is steeped in historical understandings of ongoing structural violence, a deep respect for self-determination principles, a desire to help youth connect with their traditional knowledge and teachings while building on the strengths and resilience of Aboriginal youth.Our project is called Taking Action! Building Aboriginal leadership in HIV prevention using arts-based methods. The picture you see here is of the side of a swimming pool change facilities located centrally in Khanawake – a reserve outside of Montreal. The graffitti installation was done by youth involved in our project.
This is a three year study funded by the CIHR and OHTN done in partnership with CAAN, NYSHN and Pauktitit.
Hire a local coordinatorDevelop weekend long Taking Action workshops in partnership with communitiesFind creative dissemination toolsFollow-up with participants following the workshopsRepeat with six communities
And once again we are back to the mural. I want to return here to talk about analysis.Analysis is ongoing and tricky. There is so much richness to these data sets. The art itself, presents us with endless possibilities for analysis. We are knee deep in the thick of it. We are asking questions like what does each piece tell us about how youth link colonization with HIV? What do these new insights offer us in terms of thinking about prevention? Can these pieces be used to promote dialogue or is it the process that is important.We can compare across art forms, communities, gender and cultural heritage. With a dataset this large, the possibilities are endless. But I would like to take a moment to look into a closer reading of this place and space. What do you notice about this image?And so, in this one image, we have the contradictions – of youth yearning for their history and culture while they redefine it and create a new way forward. These pieces live online, in youth’s peer networks and families, and many of them are alive in very public places in the community.And so, as we try to understand the links and relationship between community, culture, colonization and HIV… we are also in the process of changing it!
Background<br />Aboriginal people in Canada:<br />3% of population<br />9% of new HIV infections<br />contract HIV approximately 10 years younger.<br />Significant gaps in Aboriginal youth HIV prevention services, capacity and resources.<br />
Some are well…<br />The people crying represent people with HIV. They are mostly red people, Aboriginal people. Black, white and yellow (Asian) people are doing better. They are not crying…<br />
The Pain (KP) <br />My life - is a shitload of pain. There ain’t no gain from the shit I do man<br />All I can do is smoke like a train I’m soo high I feel like a plane<br />I ain’t no bitch. I don’t need to carry no gat or a vest. People see me in the hood and turn the other away and run like a bitch.<br />We need hope – no more dope.<br />Sometimes we feel like we gotta run away. But we know we gotta stand and fight the pain. Show everyone how we run this place. First Nation people. It’s like we got slapped. Straight across the face. See us. You know. We were here first. <br />
Acknowledgements<br />CIHR - HIV/AIDS Community Based Research Branch <br />Indigenous Health Research Development Program <br />The Ontario HIV Treatment Network<br />Join our Facebook group by searching: <br />Taking Action: Art and Aboriginal Youth 4 HIV Prevention<br />Thanks to all our community partners, youth, artists & students!<br />