Against the backdrop of the ongoing COVID-19 Pandemic, the global community has looked to the Canadian healthcare system as a shining example to follow for its ability to rapidly vaccinate its citizens, reaching over 80 percent of citizens have received a first dose. At the same time, First Nations, Inuit, and Métis peoples across the country continue to experience widespread health disparities, and yet little attention has been given to them. Among these disparities is the fact that Indigenous communities continue to struggle with an epidemic of HIV among its members. In 2018, 14% of new HIV infections were among Indigenous peoples, showing that Indigenous peoples as a demographic overrepresent HIV cases in Canada.
The colonization of North America, which involved stealing land from Indigenous communities and cultural genocide through the “Indian Residential School System”, has translated into a legacy of settler colonialism and systemic racism, the ills of which have impacted Indigenous peoples across generations, often referred to as “intergenerational trauma”. For example, Indigenous peoples experience a higher risk of alcohol abuse and drug addiction, physical abuse and violence, living in poverty, as well as housing insecurity and homelessness among other risks compared to their non-Indigenous counterparts.
For Indigenous peoples, intergenerational trauma is linked to an increased rate of HIV infection rates. For example, the leading cause of HIV transmission among Indigenous peoples is injection drug use. Meanwhile, addiction to opioids, crack, and methamphetamine, as well as prescription drugs such as morphine, oxycodone/OxyContin, and Ritalin surges in different Indigenous communities across Canada, so much so that some chiefs have deemed it a state of emergency. This puts Indigenous peoples at risk for HIV because of the sharing of needles, syringes, and other injection equipment among multiple users.
Among the Indigenous population, women bear a disproportionate risk of HIV infection compared to their female-non-Indigenous counterparts. While Indigenous women represent only 4 percent of the female population in Canada, between 1998 and 2012 they accounted for 47.3% of all new HIV infections. In Ontario, between 2016 and 2017, Indigenous women accounted for 44% of new HIV infections among Indigenous peoples. Indigenous women are also being diagnosed at later stages of disease progression – many at the AIDS stage. For them, the risk of HIV infection is even greater as intergenerational trauma also leads to high incidence of sexual abuse and involvement in sex work. Indigenous women make up 50% of street sex workers across Canada, which shows their overrepresentation in the trade compared to their male-Indigenous and non-Indigenous (both male and female) counterparts in the trade. This overrepresentation leaves them particularly vulnerable to infection through sexual contact with HIV-positive people.
Further, Indigenous women represent the fastest-growing prison population in Canada, representing 41% of all female prison populations. 97% of female-Indigenous federal offenders report having experienced substance abuse (particularly injection drug use) problems prior to their arrest compared to 71% of non-Indigenous federal offenders. It seems that high incarceration rates may relate to an increased risk of infection among this demographic prior to arrests.
What is clear is that while the Canadian health care system has been successful on some fronts such as vaccinating citizens, it is far from a model – it fails to protect those most socially vulnerable.
“We have been addressing the virus for many years,” said Margaret Kisikaw Piyesis, CEO of the Canadian Aboriginal Aids Network (CAAN), “but it is something we need to be mindful of in terms of how we are able to address it”. On this view, addressing the HIV epidemic among Indigenous peoples in Canada must reach beyond immediate treatment, as this would oversimplify the issues at hand. The solution must puncture the root of the problem – settler colonialism and systemic racism.
Tackling settler colonialism and systemic racism in this context requires reconciliation, which is highlighted in the Truth and Reconciliation Commission (TRC) report. For example, the TRC’s sections 18 and 19 call upon the federal government to recognize that Indigenous health disparities are the result of settler colonialism and to close those health care gaps.
Considering that the current Trudeau government continues to rave about its progress with Indigenous peoples across Canada, it follows that the government would have implemented sections 18 and 19 (as well as the other calls to action). However, the Trudeau government has only completed 10 of the TRC’s 94 recommendations.
If the government is serious about the TRC’s recommendations and reconciliation altogether, then it must take responsibility for this ongoing HIV epidemic. This would help to remove the stigma that surrounds high infection statistics by taking away blame that is designated toward Indigenous peoples. This would also help to encourage more Indigenous peoples to seek testing and treatment before the virus progresses to AIDS. Further, this would help increase access to health care in general. But this is just one step among a list of 94 recommendations. Eliminating the epidemic needs to be a continuous exercise until reconciliation is met.
In addition to the TRC, any proposed solution meant to prevent HIV among Indigenous communities must include the participation of Indigenous peoples. In doing so, communities are able to voice their community-specific struggle with the virus in regards to transmission. This may even lead to culturally specific intervention programs that can tackle the virus within those communities.
In more general terms, there is no doubt that action is needed — but any action taken must be tailored with and for Indigenous peoples.
Edited by Sarah St-Pierre
