Volume 12, numéro 3, 2021

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Objectives: In Canada, and elsewhere, Indigenous people who use illicit drugs and/or alcohol (WUID/A) experience a disproportionate burden of HIV-related harm. This study examined HIV risk perceptions and behaviours among Indigenous people WUID/A living in the Downtown Eastside (DTES) and the policies and practices that shape inequities and vulnerabilities for them in HIV testing and treatment. Further, we aimed to situate the vulnerabilities of Indigenous people WUID/A in HIV care within the context of wider structural inequality and generate recommendations for culturally relevant and safe HIV treatment options.

Methods: This research employed an Indigenous-led community-based participatory approach using talking circles to explore experiences of Indigenous people living with HIV. Under the participatory research framework, community researchers led the study design, data collection, and analysis. Talking circles elicited participants’ experiences of HIV knowledge, testing, and treatment, and were audio-recorded and transcribed. Data were coded line-by-line and codes were organized into themes. 

Results: Five key themes were identified via the talking circles: evolving HIV risk perceptions (e.g., HIV knowledge and testing, and “intentional exposure”); research as an avenue for HIV testing; HIV treatment and discussions about grief and loss; HIV-related stigma and discrimination; and the importance of culturally-relevant and safe HIV treatment options for Indigenous people WUID/A.

Discussion: Our work reveals that Indigenous people WUID/A do not have adequate access to HIV knowledge and education, often limiting their ability to access HIV testing and supports. Participant stories revealed both internalized and community stigma and discrimination, which at times compromised connection with participants' home communities. Further, our findings point to a failure in the public health system to deliver accessible HIV information to Indigenous Peoples, hence, many participants have solely relied on participation in community-based research studies in the Downtown Eastside (DTES) for HIV education and knowledge. There is an urgent need for accessible, culturally safe, and community-based education and treatment options for Indigenous people WUID/A within HIV care.

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Many First Nations homes in Canada do not have adequate water services.  This issue is unlikely to be resolved without public pressure on the government.  Thus, we investigated one strategy to increase non-Indigenous Canadians’ support for government action: framing water as a human right.  Informed by a partnership with Indigenous community members and multidisciplinary collaborators, we conducted seven experiments that sampled non-Indigenous Canadian community members (N = 584) and university undergraduates (N = 274).  Overall, framing water as a human right increased public support, relative to control conditions.  Further, the human rights frame indirectly increased support for government action through increases in perceived suffering (physical and financial) and empathy.  We discuss policy implications and end with a call for action.

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Indigenous governance systems within the Eastern African nation of Ethiopia are often dismissed by Western political elites as undemocratic. We assessed the nature of and level of democracy in Indigenous governance systems in Ethiopia by focusing on the Yejoka Qicha of the Gurage people. We found that, while the Yejoka Qicha system includes democratic elements that can support national efforts to consolidate democracy, it also marginalizes some groups, such as women, from political and economic benefits. As such, we recommend the implementation of policies that eliminate the oppressive aspects of the Yejoka Qicha system, while also recognizing the role that these Indigenous governance systems can have in promoting democracy within Ethiopia.

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Social assistance and related programs are an important part of life in the 13 Mi’kmaq communities of Nova Scotia. Given the substantive importance of social assistance and related programs in Mi’kmaq communities, it is surprising how little research has been conducted on the subject. This research aims to understand the origins of economic dependence and the related emergence of social assistance among the Mi’kmaq in Nova Scotia. We identify key historical periods and processes that have shaped the current policy landscape. A defining characteristic of social policy on reserve has been the fact that First Nations themselves have had very little say in how programs such as social assistance are designed and delivered. There is hope that a more self-determined and holistic approach may emerge.

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The San’yas Indigenous Cultural Safety Training Program is an Indigenous-led, policy-driven, and systems-level educational intervention to foster health equity and mitigate the effects of systemic racism experienced by Indigenous people in health and other sectors. Currently, San’yas is being scaled-up across Canada. This article focuses on the following: (a) the pedagogical underpinnings of San’yas grounded in transformational learning principles and Indigenous knowledges; (b) the scope, reach, and scale-up of San’yas as an explicit anti-racism educational intervention; (c) its unique program delivery approaches; and (d) program evaluation trends. We discuss the insights gained from implementing San’yas over the past decade, which will be relevant for leaders and policy-makers concerned with implementing anti-racism educational interventions as part of broader system transformation.

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This article describes a model that maps Indigenous communities’ journeys from the cycle of violence arising from colonization to the circle of wellness through relational determinants of health. This model emerged from learning with Indigenous communities participating in research on violence prevention programming with the Canadian Red Cross. Indigenous communities have shown us that they are returning to a place of thriving by restoring relationality with land, culture, ceremony, and language. Therefore, the relational determinants of health comprise the foundational relationships that contribute to wellness. The Community Journey of Change model represents actions that communities can undertake in moving to wellness. The model has implications for policies, programs, and services for Indigenous communities as they begin to restore health and wellness.