Increased mortality among Indigenous persons in a multisite cohort of people living with HIV in Canada

Helping Others Facilitates Well-Being for Indigenous Peoples Living With HIV/AIDS in Canada

Research has found that helping others facilitates well-being for Indigenous peoples living with HIV and AIDS, but limited research exists that investigates the mechanism(s) underlying this relationship. Indigenous perspectives posit that helping others facilitates well-being through the development of an individual's spiritual, physical, emotional, and mental aspects (four aspects). Similarly, self-determination theory posits that helping others facilitates well-being by satisfying basic psychological needs. In the present study, we examined if helping others facilitates well-being through the fulfillment of the spiritual, physical, emotional, and mental aspects among Indigenous peoples living with HIV and AIDS. We used a convergent parallel mixed methods design, coupled with a community-engaged approach grounded in the United Nations Greater Involvement of People Living with HIV and AIDS principles and Indigenous and decolonizing research methodologies. Survey (n = 117) and interview data (n = 9) collected by an Indigenous-led HIV/AIDS organization in Canada were employed to examine the relationship between helping, the four aspects, and well-being. Participants were primarily First Nations leaders and mentors who live with HIV/AIDS, with some Métis and Inuit. A parallel multiple mediation model and reflexive thematic analysis were used to analyze the relationship between helping, the four aspects, and well-being. Mixed-methods findings support the idea that helping others promotes well-being by fulfilling the emotional and mental aspects. Qualitative findings demonstrated this relationship for all four aspects. This research may facilitate the development of programs to support Indigenous peoples living with HIV/AIDS well-being and contribute to the literature on integrating Indigenous perspectives and methodologies within psychological research.

Indigenizing our research: indigenous community leadership in HIV epidemiology research

The use of data intensive health research has allowed for greater understandings of population health. When conducting data intensive health research, engaging and involving the community is essential for conducting meaningful research that is responsive to the public's needs. Particularly, when engaging Indigenous communities in research, there is a need to understand historical and ongoing impacts of colonialism and recognize the strengths in Indigenous Peoples' knowledges and experiences while supporting Indigenous leadership and self-determination in research. This article describes the approach our research team/organization used to engage and involve Indigenous people living with HIV in three research projects using large, linked datasets and looking at HIV outcomes of Indigenous populations in Canada. The foundation of these projects was simultaneously: 1) supporting Indigenous people living with HIV to be involved as research team members, 2) developing research questions to answer with available datasets, and 3) integrating Indigenous and Western ways of knowing. We have identified important considerations and suggestions for engaging and involving Indigenous communities and individuals in the generation of research ideas and analysis of linked data using community-based participatory research approaches through our work. These include engaging stakeholders at the start of the project and involving them throughout the research process, honouring Indigenous ways of knowing, the land, and local protocols and traditions, prioritizing Indigenous voices, promoting co-learning and building capacity, and focusing on developing longitudinal relationships. We describe keys to success and learnings that emerged. Importantly, the methodology practiced and presented in this manuscript is not  a qualitative study design whereby research subjects are surveyed about their experiences or beliefs. Rather, the study approach described herein is about engaging people with living experience to co-lead as researchers. Our approach supported Indigenous people to share research that addresses their research priorities and responds to issues relevant to Indigenous Peoples and communities.

Successful Aging: Indigenous Men Aging in a Good Way with HIV/AIDS

Les traitements associés au VIH ayant progressé au cours des 30 dernières années, le nombre de personnes âgées vivant avec le VIH s’est accru. Ce phénomène est particulièrement important chez les peuples autochtones du Canada, compte tenu de la surreprésentation chronique de cette population dans les diagnostics de VIH. Toutefois, peu de données sont disponibles sur l’expérience des Autochtones séropositifs plus âgés. Une approche fondée sur les forces a permis d’explorer comment les hommes autochtones plus âgés vivant avec le VIH conçoivent le vieillissement réussi. La recherche a été menée en partenariat avec le Réseau canadien autochtone sur le sida. Des hommes des Premières nations, Inuits et Métis, âgés de 43 à 63 ans et séropositifs depuis 10 à 29 ans, ont participé à des groupes de discussion et à des entrevues. Une approche analytique ouverte a été utilisée pour étudier le contenu des transcriptions. Les codes ont été développés en collaboration, par un processus inductif et itératif. Nous présentons l’analyse des points communs entre les groupes autochtones, ainsi que nos réflexions sur l’application du modèle de vieillissement réussi aux hommes autochtones plus âgés ayant le VIH.

An allied research paradigm for epidemiology research with Indigenous peoples

Background

There is no shortage of epidemiology research describing the ill health of Indigenous peoples in Canada and globally and many of these studies have had negative repercussions on Indigenous communities. However, epidemiology can also be a helpful tool for supporting the health and health services of communities. This paper challenges the reader to consider the harms of epidemiology which essentialize Indigenous communities as sick and in need of help. It then discusses, from the perspective of a settler physician and clinical epidemiology student, how we may be able reconcile the field of epidemiology research with the needs of Indigenous communities. In doing so, it describes an allied research paradigm for epidemiology.

Results

Although qualitative research has been substantially informed by critical feminist theories, uptake in quantitative research has been sparser. It is even more rare for Indigenous methodologies to be used to inform quantitative research. This paper is written from a personal perspective, reflecting on the author's prior experiences as well as existing literature on critical feminist theory and Indigenous methodologies, to describe an allied research paradigm. This allied research paradigm follows an ontology that explores the subjectivity within epidemiology and the influence of the positionality of the researcher. It follows an epistemology that understands that knowledge can be generated through many ways including, but not limited to statistical analyses. It follows an axiology that research aims to affect social change and improve the lives of the communities participating in the research. It follows a methodology that is participatory and empowers community partners to meaningfully contribute to statistical research. This allied research paradigm, which makes no claims to universality, describes several important principles: reconciliation, relationships, perspective, positionality, self-determination and accountability.

Conclusion

Researchers who wish to engage in research in allyship with Indigenous communities must understand the colonial history embedded in health research, commit to a process that honours meaningful relationships with community partners, and carefully consider the implications of their work.

Experiences of the HIV Cascade of Care Among Indigenous Peoples: A Systematic Review

Indigenous leaders remain concerned that systemic oppression and culturally unsafe care impede Indigenous peoples living with HIV from accessing health services that make up the HIV cascade of care. We conducted a systematic review to assess the evidence related to experiences of the HIV care cascade among Indigenous peoples in Australia, Canada, New Zealand, and United States. We identified 93 qualitative and quantitative articles published between 1996 and 2017 reporting primary data on cascade outcomes disaggregated by Indigenous identity. Twelve involved data from Australia, 52 from Canada, 3 from New Zealand and 26 from United States. The majority dealt with HIV testing/diagnosis (50). Relatively few addressed post-diagnosis experiences: linkage (14); retention (20); treatment initiation (21); adherence (23); and viral suppression (24). With the HIV cascade of care increasingly the focus of global, national, and local HIV agendas, it is critical that culturally-safe care for Indigenous peoples is available at all stages.

A comparison of virological suppression and rebound between Indigenous and non-Indigenous persons initiating combination antiretroviral therapy in a multisite cohort of individuals living with HIV in Canada

BACKGROUND

This study compared time to virological suppression and rebound between Indigenous and non-Indigenous individuals living with HIV in Canada initiating combination antiretroviral therapy (cART).

METHODS

Data were from the Canadian Observational Cohort collaboration; eight studies of treatment-naive persons with HIV initiating cART after 1/1/2000. Fine and Gray models were used to estimate the effect of ethnicity on time to virological suppression (two consecutive viral loads [VLs] <50 copies/ml at least 3 months apart) after adjusting for the competing risk of death and time until virological rebound (two consecutive VLs >200 copies/ml at least 3 months apart) following suppression.

RESULTS

Among 7,080 participants were 497 Indigenous persons of whom 413 (83%) were from British Columbia. The cumulative incidence of suppression 1 year after cART initiation was 54% for Indigenous persons, 77% for Caucasian and 80% for African, Caribbean or Black (ACB) persons. The cumulative incidence of rebound 1 year after suppression was 13% for Indigenous persons, 6% for Caucasian and 7% for ACB persons. Indigenous persons were less likely to achieve suppression than Caucasian participants (aHR=0.58, 95% CI 0.50, 0.68), but not more likely to experience rebound (aHR=1.03, 95% CI 0.84, 1.27) after adjusting for age, gender, injection drug use, men having sex with men status, province of residence, baseline VL and CD4⁺ T-cell count, antiretroviral class and year of cART initiation.

CONCLUSIONS

Lower suppression rates among Indigenous persons suggest a need for targeted interventions to improve HIV health outcomes during the first year of treatment when suppression is usually achieved.