A Comparative Analysis

Strengthening Ties – Strengthening Communities

An Aboriginal Strategy on HIV/AIDS in Canada for First Nations, Inuit and Métis People – CAAN July 2003 and Leading Together, Canada Takes Action on HIV/AIDS 2005-2010

and

Leading Together
Canada Takes Action on HIV/AIDS 2005-2010

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Preface

It is important that before any comparison is attempted between an Aboriginal Strategy to address HIV/AIDS and one adopted by the federal government that the context for the comparison be articulated.

The Aboriginal Reality

The National Aboriginal Council on HIV/AIDS (NACHA) uses the phrase Aboriginal reality to reflect the context within which the Council addresses the challenges faced by the Aboriginal community with respect to HIV/AIDS. The results of colonization, the residential school era, the loss of language and land base, the lack of economic opportunities are well known in the Aboriginal community and are becoming known in Canada generally. The negative impacts of these losses are strongly felt in the transgendered, gay, lesbian, intersexed, bisexual and two spirited Aboriginal community due to the stigma attached to sexual orientation that was ingrained in Aboriginal people generally by colonizers. Before the arrival of newcomers to Canada, all Aboriginal people were embraced regardless of their sexual orientation and were valued for their gifts and talents alone. They were not judged by others but participated fully in an inclusive society.

Sadly the Aboriginal reality of today is far different and has resulted in:

• Lower educational attainment, compared to other Canadians
• Unemployment rates that mirror third world countries
• Living conditions that are below acceptable standards including the lack of housing, safe drinking water, appropriate sewage disposal, adequate sources of heat etc.
• Poor nutrition
• High rates of Fetal Alcohol Spectrum Disorder (FASD)
• High rates of suicide, substance abuse, homelessness, mental illness
• High rates of disease including, but not limited to, HIV/AIDS, Diabetes, TB etc.
• High rates of the Aboriginal population are housed in federally run institutions.(While Aboriginal people make up 2.8% of the Canadian population they represent 18% of the federally incarcerated population)
• Aboriginal people make up a large percentage of street workers and those involved in the sex trade
• Aboriginal women and children suffer from emotional, sexual and physical abuse at alarming rates
• Lower life expectancy of Aboriginal people compared to Canadians generally.
• Homophobia and internalized racism etc.

In addition to these realities, Aboriginal people experience disparities between the access that on-reserve and off-reserve populations have to resources such as, health care, post secondary education and housing.

Aboriginal people experience the reality of always being subservient and dependent on governments to “do the right thing”. Experience has demonstrated that when Aboriginal people are in a position to make decisions for themselves and to design and implement their own solutions, they are more likely to succeed. This too is the Aboriginal reality.

It is important to understand that the Aboriginal population in Canada is very diverse in terms of political structures, social / cultural structures, language, geographical location and sexual orientation. One thing all have in common is the history of colonization, assimilation attempts and the general “disruption of the peace” Aboriginal people once enjoyed and treasured.

Aboriginal World View

When designing a Strategy to address HIV/AIDS in the Aboriginal community it is important to understand the Aboriginal world view and the fundamental differences between how mainstream Canadians and Aboriginal people perceive the affect/impact of the disease.

Aboriginal people value the interconnectedness of all life. The Commissioners of the Royal Commission on Aboriginal Peoples in 1996, came to understand the Aboriginal world view as follows:

"Culture we understand to be a whole way of life of a people…Aboriginal languages, relationship with the land, spirituality, and the ethics or rules of behaviour by which Aboriginal peoples maintained order in their families, clans, communities, nations and confederacies. Spirituality, in Aboriginal discourse, is not a system of beliefs that can be defined like a religion; it is a way in which people acknowledge that every element of the material world is in some sense infused with spirit, and all human behaviour is affected by, and in turn has an effect in, a non-material, spiritual realm. Ethics or rules guiding conduct of human beings toward one another and with other creatures and elements of the world, are more than rational codes that can be ignored. The rules are embedded in the way things are; they are enforced, inescapably, by the whole order of life, through movement and response in the physical world and the spiritual realm.”¹

HIV/AIDS cannot be viewed in isolation from everything else and treated in isolation from the Aboriginal reality. The disease has an impact or affect on everything within the Aboriginal family, community and world. If this world view is ignored in favour of mainstream thinking the result can be devastating. The Royal Commission on Aboriginal Peoples noted the following:

“If the circumstances in which Aboriginal people express their world view are controlled by persons with a different view of reality, and those in control are unwilling to acknowledge or accommodate Aboriginal ways, the scene is set for conflict or suppression of difference.”²

Aboriginal AIDS Service Organizations and others have repeatedly said that they must develop their own methods to treat and prevent the spread of HIV/AIDS, methods that are respectful of the Aboriginal world view and the importance of a family-based or kinship focused approach. Some of these ideas are reflected in the ASHAC as well as regional Aboriginal HIV/AIDS Strategies, the Inuit Action Plan and First Nations Plans of Action and are beginning to emerge in Leading Together: Canada Takes Action on HIV/AIDS, particularly in its population specific yet holistic response to the epidemic.

Distinction between the Canadian Aboriginal AIDS Network (CAAN) and the National Aboriginal Council on HIV/AIDS (NACHA)

At the national level, there are two bodies that address HIV/AIDS in the Aboriginal community. NACHA is a body comprised of representatives from the Métis, First Nations, Inuit and “Aboriginal HIV Community” (AASOs, CAAN etc). NACHA’s mandate is to provide policy advice to the Public Health Agency of Canada (and federal partners) on issues related to Aboriginal people and HIV/AIDS.

CAAN has a much broader mandate in that it develops policy, develops and delivers programs, undertakes research and advocacy, capacity building and communications and social marketing. Both groups play important roles in addressing the epidemic within the Aboriginal population.

Introduction

In 2003, The Canadian Aboriginal AIDS Network (CAAN) developed a Strategy (ASHAC) Strengthening Ties – Strengthening Communities, to help to focus efforts aimed at responding to the HIV/AIDS epidemic specifically within the First Nations, Métis and Inuit population in Canada. The need to develop such a Strategy was based on existing epidemiological evidence that identified alarming increases of infection within the Aboriginal population and the need to develop and implement Aboriginal-specific approaches to address HIV/AIDS and those infected and affected by it, including holistic and integrated approaches. In fact, in 1997, CAAN provided projections on where the epidemic would be over five years within the Aboriginal population and these proved “right on the mark”. There was also a realization that Aboriginal AIDS Services Organizations in various parts of the country and community-based health/social service providers would benefit from strategic approaches to confronting the epidemic from an Aboriginal viewpoint. The ASHAC was developed with 173 Aboriginal individuals and organizations across the country. It was intended to be a document that would guide the broader Aboriginal HIV/AIDS movement (without interfering with successful community-based approaches) and inform government officials of what was needed to help curb the Aboriginal HIV/AIDS epidemic.

At the same time, it should be noted that because no substantial prevention investment was made into the Aboriginal population under the former National AIDS Strategy I & II (later the Canadian Strategy on HIV/AIDS and now the Federal Initiative), that this has resulted in the epidemic taking a firm foothold in a population which already experienced poorer health and distressed social conditions.

In 2004, the federal government released, The Federal Initiative to Address HIV/AIDS in Canada (Strengthening Federal Action in the Canadian Response to HIV/AIDS) also known as the “FI”. The document indicates that the “epidemic has gained a foothold in vulnerable populations including Aboriginal people, inmates [where Aboriginal people are over-represented], injection drug users [the leading factor in HIV infections amongst the Aboriginal population], at risk youth and women, and people from countries where HIV is endemic.” In October 2005, the Canadian Public Health Agency (PHAC) released, Leading Together (Canada Takes Action on HIV/AIDS), a five year blueprint that outlines a coordinated response to the disease and sets a benchmark of 2010 when Canada hopes to see, “the end of the epidemic in sight.” Leading Together notes the unique differences and challenges faced by the Aboriginal community in the face of HIV/AIDS:

“Strengthening Ties – Strengthening Communities: An Aboriginal Strategy on HIV/AIDS in Canada, along with strategies for Aboriginal people in British Columbia, Quebec , Alberta and Ontario) is on HIV as part of the larger challenge of building healthy communities. Within Aboriginal communities, HIV prevention initiatives must target women and two-spirit men as well as the underlying issues of poverty, lack of employment, stigma within the Aboriginal community, substance use and low self-esteem. Effective approaches will be led by Aboriginal people and grounded in Aboriginal culture, healing and the intertwining of body, mind and spirit. They will also be integrated with other urgent Aboriginal health issues, such as diabetes and the use of tobacco and alcohol, and encourage people to value and take care of themselves. Leadership, innovation and a long-term commitment will be vital.”³

Over the more than 20 years since HIV/AIDS has been recognized as a threat to the health of Aboriginal people and their communities, Aboriginal organizations, agencies and groups have struggled to keep on top of the ever evolving needs of APHAs and those affected by HIV/AIDS.

“The absence of an Aboriginal HIV/AIDS Strategy has been felt for sometime. In its place the federal strategy guided actions, but several factors complicated efforts to effectively reach Aboriginal populations. Some were systematic weaknesses found in the federal funding, as many Aboriginal AIDS Service organizations were quite late in getting started. In the first and second phases of the federal strategy, the main source of funds that could be accessed by Aboriginal groups were known as "special projects", which meant they were time-limited. Medical Services Branch (now called First Nations & Inuit Health Branch) also offered funding for On-reserve and Inuit communities, but again, these funds did not support organizational structures. Other factors experienced, included the fact that, as with main-stream populations, HIV/AIDS first began affecting Two-Spirited (gay) males, and also occurred mostly in larger urban centers. Thus, many Aboriginal political leaders, and even health portfolios did not heed the warnings being raised. Today, we know that HIV/AIDS is being spread through unprotected sex and injection drug use among all people, irregardless if they are heterosexual, homosexual, bisexual, women, babies develop HIV from HIV+ mothers, youth, or older individuals." ⁴

Both the Federal Initiative and Leading Together recognize the need to support Aboriginal organizations to develop and deliver programs and services within Aboriginal populations. The purpose of this document is to closely examine the degree to which strategies are aligned and where there may be gaps. It is important to lay out the similarities and differences so that when progress is measured, the unique circumstances of Aboriginal people with respect to HIV/AIDS, is clearly understood by all stakeholders.

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¹ James Dumont, Royal Commission on Aboriginal Peoples (RCAP) 1996, Chapter 15, Rekindling the Fire p.3

² RCAP 1996, Chapter 15 p.11

³ Leading Together, PHAC 2005 p.33

⁴ Strengthening Ties – Strengthening Communities CAAN, 2003 p.4