HIV Among Indigenous peoples: A Review of the Literature on HIV-Related Behaviour Since the Beginning of the Epidemic

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Abstract

From the early days of the HIV epidemic, Indigenous peoples were identified as a population group that experiences social and economic determinants—including colonialism and racism—that increase exposure to HIV. There are now substantial disparities in HIV rates between Indigenous and non-Indigenous peoples in some countries. We conducted a comprehensive literature review to assess the evidence on HIV-related behaviors and determinants in four countries—Australia, Canada, New Zealand and the United States—in which Indigenous peoples share important features of colonization and marginalization. We identified 107 articles over more than 20 years. The review highlights the determinants of HIV-related behaviors including domestic violence, stigma and discrimination, and injecting drug use. Many of the factors associated with HIV risk also contribute to mistrust of health services, which in turn contributes to poor HIV and health outcomes among Indigenous peoples.

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Strategic approaches to enhanced health service delivery for Aboriginal and Torres Strait Islander people with chronic illness: a qualitative study

Clive Aspin, Ngiare Brown, Tanisha Jowsey … (2012)

Background Aboriginal and Torres Strait Islander people with chronic illness confront multiple challenges that contribute to their poor health outcomes, and to the health disparities that exist in Australian society. This study aimed to identify barriers and facilitators to care and support for Aboriginal and Torres Strait Islander people with chronic illness. Methods Face-to-face in-depth interviews were conducted with Aboriginal and Torres Strait Islander people with diabetes, chronic heart failure or chronic obstructive pulmonary disease (n-16) and family carers (n = 3). Interviews were transcribed verbatim and the transcripts were analysed using content analysis. Recurrent themes were identified and these were used to inform the key findings of the study. Results Participants reported both negative and positive influences that affected their health and well-being. Among the negative influences, they identified poor access to culturally appropriate health services, dislocation from cultural support systems, exposure to racism, poor communication with health care professionals and economic hardship. As a counter to these, participants pointed to cultural and traditional knowledge as well as insights from their own experiences. Participants said that while they often felt overwhelmed and confused by the burden of chronic illness, they drew strength from being part of an Aboriginal community, having regular and ongoing access to primary health care, and being well-connected to a supportive family network. Within this context, elders played an important role in increasing people’s awareness of the impact of chronic illness on people and communities. Conclusions Our study indicated that non-Indigenous health services struggled to meet the needs of Aboriginal and Torres Strait Islander people with chronic illness. To address their complex needs, health services could gain considerably by recognising that Aboriginal and Torres Strait Islander patients have a wealth of cultural knowledge at their disposal. Strategies to ensure that this knowledge is integrated into care and support programs for Aboriginal and Torres Strait Islander people with chronic illness should achieve major improvements.

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Empowerment and Indigenous Australian health: a synthesis of findings from Family Wellbeing formative research.

Roxanne Bainbridge, Andrew Wilson, Komla Tsey … (2010)

This paper employs a thematic qualitative analysis to synthesise seven discrete formative evaluation reports of an Indigenous Australian family empowerment programme across four study settings in Australia's Northern Territory and Queensland between 1998 and 2005. The aim of the study, which involved a total of 148 adult and 70 school children participants, is to develop a deeper understanding of the contribution of community empowerment education programmes to improving Indigenous health, beyond the evidence derived from the original discrete micro evaluative studies. Within a context beset by trans-generational grief and despair resulting from colonisation and other discriminatory government policies, across the study sites, the participants demonstrated enhanced capacity to exert greater control over factors shaping their health and wellbeing. Evident in the participants' narratives was a heightened sense of Indigenous and spiritual identity, respect for self and others, enhanced parenting and capacity to deal with substance abuse and violence. Changes at the personal level influenced other individuals and systems over time, highlighting the ecological or multilevel dimensions of empowerment. The study reveals the role of psychosocial empowerment attributes as important foundational resources in helping people engage and benefit from health and other behaviour modification programmes, and take advantage of any reforms made within macro policy environments. A key limitation or challenge in the use of psychosocial empowerment programmes relates to the time and resources required to achieve change at population level. A long-term partnership approach to empowerment research that creatively integrates micro community empowerment initiatives with macro policies and programmes is vital if health gains are to be maximised.

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Risk factors for elevated HIV incidence among Aboriginal injection drug users in Vancouver.

Kevin Craib, Patricia M. Spittal, Evan Wood … (2003)

Because of established links between entrenched poverty and risk of HIV infection, there have long been warnings that HIV/AIDS will disproportionately affect Aboriginal people in Canada. We compared HIV incidence rates among Aboriginal and non-Aboriginal injection drug users (IDUs) in Vancouver and studied factors associated with HIV seroconversion among Aboriginal participants. This analysis was based on 941 participants (230 Aboriginal people) recruited between May 1996 and December 2000 who were seronegative at enrollment and had completed at least one follow-up visit. Incidence rates were calculated using the Kaplan-Meier method. The Cox proportional hazards regression model was used to identify independent predictors of time to HIV seroconversion among female and male Aboriginal IDUs. As of May 31, 2001, seroconversion had occurred in 112 (11.9%) of the participants, yielding a cumulative incidence of HIV infection at 42 months of 12.7% (95% confidence interval [CI] 10.3%-15.1%). The cumulative incidence at 42 months was significantly higher among the Aboriginal participants than among the non-Aboriginal participants (21.1% v. 10.7%, p < 0.001). This elevation in risk was present in both female and male Aboriginal IDUs. Among the female Aboriginal IDUs, frequent speedball (combined cocaine and heroin) injection (adjusted relative risk [RR] 3.1; 95% CI 1.4-7.1) and going on binges of injection drug use (adjusted RR 2.3; 95% CI 1.0-5.2) were found to be independent predictors of HIV seroconversion. Among the male Aboriginal IDUs, the independent predictors of seroconversion were frequent speedball injection (adjusted RR 2.9; 95% CI 1.0-8.5) and frequent cocaine injection (adjusted RR 2.5; 95% CI 1.0-6.5). In Vancouver, Aboriginal IDUs are becoming HIV positive at twice the rate of non-Aboriginal IDUs. Our findings emphasize the urgent need for an appropriate and effective public health strategy--planned and implemented in partnership with Aboriginal AIDS service organizations and the Aboriginal community--to reduce the harms of injection drug use in this population.

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Author and article information

Contributors

Joel Negin: +61-2-9114-0974 , joel.negin@sydney.edu.au

Journal

Journal ID (nlm-ta): AIDS Behav

Journal ID (iso-abbrev): AIDS Behav

Title: AIDS and Behavior

Publisher: Springer US (New York )

ISSN (Print): 1090-7165

ISSN (Electronic): 1573-3254

Publication date (Electronic): 3 March 2015

Publication date PMC-release: 3 March 2015

Publication date (Print): 2015

Volume: 19

Issue: 9

Pages: 1720-1734

Affiliations

[ ]Sydney School of Public Health, University of Sydney, Edward Ford Building (A27), Sydney, NSW 2006 Australia

[ ]Independent consultant, Sydney, Australia

[ ]School of Public Health and Social Policy, Faculty of Human and Social Development, University of Victoria, Victoria, Canada

Article

Publisher ID: 1023

DOI: 10.1007/s10461-015-1023-0

PMC ID: 4551545

PubMed ID: 25731659

SO-VID: 804210a7-6c78-4068-9049-60e8f8d01d32

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution License which permits any use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.