Aboriginal HIV/AIDS
Attitudinal Survey 2006

Final Report

PDF Version (2,8 MB - 272 pages)

Table of Contents

Executive Summary

1. Introduction
   1.1 Context
   1.2 Methodology
   1.3 Limitations of the Survey

2. Results for First Nations People
   2.1 Knowledge and Awareness
   2.2 Distancing, Risk, and Treatment for HIV/AIDS
   2.3 Sexual Behaviour
   2.4 HIV/AIDS-Related Stigma
   2.5 HIV/AIDS-Related Discrimination
   2.6 Comfort with People Living with HIV/AIDS
   2.7 Information Sources
   2.8 Typology of First Nations People

3. Results for Métis People
   3.1 Knowledge and Awareness
   3.2 Distancing Risk, and Treatment for HIV/AIDS
   3.3 HIV/AIDS-Related Stigma
   3.4 HIV/AIDS-Related Discrimination
   3.5 Comfort with People Living with HIV/AIDS
   3.6 Information Sources
   3.7 Typology of Métis People

4. Results for Inuit
   4.1 Knowledge and Awareness
   4.2 Distancing, Risk, and Treatment for HIV/AIDS
   4.3 Sexual Behaviour
   4.4 HIV/AIDS-Related Stigma
   4.5 HIV/AIDS-Related Discrimination
   4.6 Discrimination Index
   4.7 Comfort with People Living with HIV/AIDS
   4.8 Information Sources
   4.9 Typology of Inuit

5. Summary

APPENDIX A: Questionnaire
APPENDIX B: Response Rates

Executive Summary

Introduction and Methodology

The Public Health Agency of Canada (PHAC) commissioned EKOS Research Associates to conduct this tracking survey in order to create an overall picture of Aboriginal peoples’ awareness and knowledge, as well as attitudes and behaviour related to HIV/AIDS, and to isolate patterns of sub-group differences, including demographic and attitudinal patterns. The purpose of the current survey is to help inform the communications and social marketing activities related to HIV/AIDS that are designed to educate the public, raise awareness levels and decrease the incidence of risk-related behaviours associated with contracting HIV. With the exception of only a few items, comparison points exist from the general public¹ for the same timeframe.

The survey included a total of 1,597 completed interviews with Aboriginal people over the age of 15, conducted by telephone in March of 2006. A total of 985 cases were collected with First Nations (513 with First Nations people living on a reserve and 472 with First Nations people living off-reserve); 408 with Métis and 204 with Inuit. The overall margin of error² for the First Nations sample is +/-3.2 per cent, while it is in the range of 4.3 to 4.9 per cent for the on-, and off-reserve sub-groups, as well as for the Métis sample. The Inuit sample carries an error rate of +/-6.9 per cent.

Knowledge and Awareness

As is the case in the broader general public³ , most Aboriginal people describe themselves as moderately knowledgeable or knowledgeable on the subject of HIV/AIDS, although self-rated knowledge is a fair bit lower among Inuit (where 28 per cent say that they are not knowledgeable about the disease). At least two in three Aboriginal people know that when a person has HIV/AIDS, their body is unable to defend itself against common illnesses, although some are not aware of this, and the proportion who are not aware is somewhat higher among First Nations people and Inuit. Just over half know that a person can have HIV for ten or more years without developing AIDS, although many are not aware of this. More than three in four Aboriginal people understand, however, that AIDS is deadly; realizing that HIV/AIDS cannot be cured.

For the most part, Aboriginal people are able to correctly identify how HIV is transmitted. Most Aboriginal people know, without prompting, that the HIV virus is spread through unsafe intercourse. Almost half the population also know - unprompted, that blood to blood contact (i.e., an open wound) is a way to transmit the virus, although this is lower among Inuit. When prompted, most Aboriginal people also realize that sharing drug needles and unsafe oral sex can put a person at risk of contracting HIV, that HIV can be transmitted from mother to child during pregnancy, or through tattoos or body piercing. Between one in ten and one in three Aboriginal people believe that HIV can be transmitted through kissing, from mosquito bites, from a sneeze or cough, or from casual contact or contact with objects such as fountains or toilets.

A vast majority of Aboriginal people can identify taking a blood test as a way to diagnose HIV/AIDS. Almost half of Aboriginal people believe, however, that HIV/AIDS can be diagnosed through a physical examination and one in five to one in seven also believe that self-diagnosis is possible.

From a top of mind perspective, Aboriginal people are not as likely as other members of the general public⁴ to identify any specific group as being “at-risk” of contracting HIV/AIDS. Although gay men and injection drug users are identified one in ten to one in five times, Aboriginal people and “everyone” are also as likely categories. Those having unprotected sex, sex trade workers, and youth are even less likely than other segments to be examples immediately thought of as groups that are at risk. Between one in three and one in two individuals were unable to identify any specific at-risk groups.

Perceptions of Personal Risk

Results suggest that Aboriginal people are aware that HIV/AIDS can affect anyone. Between one in ten and one in three Aboriginal people believe that HIV/AIDS is mostly a third world disease, a gay person’s disease or a drug user’s disease. An overwhelming majority of Aboriginal people believe that HIV/AIDS is still a somewhat or very serious problem in Canada today. In particular, Aboriginal people are increasingly aware that Aboriginal youth (women in particular, according to the Inuit) are an at-risk group for HIV/AIDS. A strong majority of Aboriginal people rate their own personal risk of contracting HIV as low, although the perception of being at-risk is moderately higher among Inuit specifically (compared with other Aboriginal people).

As with the general public, most Aboriginal people report having been sexually active in the past 12 months. Of those who were sexually active, a large majority had only one partner, although roughly one in five engaged in sexual activity with two or more partners, which is marginally higher than found in the general public, and higher numbers (one in four to one in five) have had involvement with casual partners.

Knowing Someone with HIV/AIDS

The proportion of Aboriginal people who know or have known someone with HIV/AIDS is higher than found in the general public (52 per cent compared with 37 per cent in the general public), although this is not the case among the Inuit, where 35 per cent report knowing someone with HIV/AIDS. About half of those who know or have known someone with HIV/AIDS believe that this knowledge had little or no impact on their behaviour towards this person. Of those who do report a change in behaviour, relatively few report negative changes in their behaviour towards individuals they know with HIV/AIDS and most report positive changes, such as increased sympathy, increased awareness of HIV/AIDS, or increased support of that person.

Tolerance

Although Aboriginal people believe that they would be highly supportive of someone with HIV/AIDS, this support weakens in more distant relationships, and particularly, where a child is involved. More Aboriginal people believe that they would react in a supportive manner if they found out that a close friend had HIV/AIDS, which is higher than the support reported for a co-worker. A student attending the same school as their own child or a grocery store owner could expect to receive support from just over half of the population. In each case supportiveness is about ten to fifteen percentage points lower than found in the general public⁵. Roughly half of Aboriginal people agree that people with HIV/AIDS should be allowed to serve the public in positions such as hairstylists, and roughly one-third agree that people with HIV/AIDS should be permitted to work in positions such as dentists, and even fewer among First Nations. Furthermore, over half of the Aboriginal population would feel somewhat or very uncomfortable if a close friend or family member dated someone with HIV/AIDS and more than one-third would feel uncomfortable working in an office where someone developed HIV/AIDS or shopping at a small neighbourhood grocery store where the owner has HIV/AIDS.

Only a minority, however, agree that they could not remain or become friends with someone with HIV/AIDS or believe that people who get HIV/AIDS through sex or drug use have gotten what they deserve. Furthermore, although Aboriginal people demonstrate mixed feelings in terms of their tolerance of direct contact with people living with HIV/AIDS, few hold strong negative feelings towards those living with HIV/AIDS: most Aboriginal people feel no fear, anger or disgust towards people living with HIV/AIDS.

Of a range of factors examined, the fact that HIV/AIDS is a fatal disease is seen as having the greatest impact on the level of public discomfort with this disease (64 to 72 per cent identify this as having a strong influence). Other factors identified as having a strong influence on public discomfort levels by over half of Aboriginal people include the association between HIV/AIDS and certain behaviours, such as casual/promiscuous sex (62 to 69 per cent), intravenous drug use (65 to 55 per cent), and the association between HIV/AIDS and or the association with homosexual sex (50 to 52 per cent). Aboriginal people are only slightly less likely to think that people are uncomfortable with HIV/AIDS because they associate HIV/AIDS with certain groups, such as drug users or gay men, or influences by fear of infection through casual contact.

Aboriginal people believe that intolerance and stigma associated with HIV/AIDS have significant repercussions for people living with HIV/AIDS: most Aboriginal people believe that people would be unwilling to tell others they have HIV/AIDS; about half to two-thirds believe that people living with HIV/AIDS experience difficulty obtaining housing, health care or employment; and half agree that people are unwilling to be tested for HIV due to the stigma associated with this disease.

There is a strong appreciation for the potential for stigma related to HIV/AIDS. Close to two-thirds of Aboriginal people agree that the shame felt by some people living with HIV/AIDS is often also felt by their children or others close to them. Over one-third agree that if they were diagnosed with HIV/AIDS they would not want others in their community or on their reserve to know, and an equal proportion would seek treatment off-reserve or outside their community to reduce the chance that others find out. One-quarter agree that people living with HIV/AIDS are pressured to leave the community or reserve. Similarly, two in ten First Nations people living on-reserve agree that those who leave the reserve and return with HIV/AIDS are not welcomed back. Finally, two in ten First Nations people agree that people who have left their reserve often return with HIV/AIDS.

Many Aboriginal people believe that they do not receive the same quality of medical treatment for HIV/AIDS as other Canadians do. Just over four in ten First Nations people agree that First Nations people living on a reserve are less likely to get the right medical treatment for HIV/AIDS. Somewhat fewer believe that Aboriginal people living off-reserve are subject to sub-standard medical treatment for HIV/AIDS.

Rights and Responsibilities of People Living with HIV/AIDS

The vast majority of Aboriginal people believe that people living with HIV/AIDS have the same right to health care and housing as they do. Most also believe that people living with HIV/AIDS have the same right to employment as they do, which stands in contrast to the fact that many do not believe that those living with HIV/AIDS should be able to serve the public in positions such as dentists.
Most Aboriginal people do not believe that people living with HIV/AIDS should be legally quarantined from others to protect public health, or that names of people with HIV/AIDS should be made public so that others can avoid them. Aboriginal people are divided, however, on whether persons living with HIV/AIDS should have the right to be sexually active. Most Aboriginal people believe that people living with HIV/AIDS should shoulder the responsibility of protecting others from their disease, and believe that they have a responsibility to tell others about their condition.

Information Sources

Television in general and advertisements are the two primary sources where Aboriginal people say that they have recently heard about HIV/AIDS, followed by newspaper articles and television news in the Métis population and among First Nations living off-reserve. All other sources are cited by fewer than one in seven.
When asked where they would go if they were actively seeking information about HIV/AIDS today, most Aboriginal people cite the Internet, followed by nurses and other health care professionals, and doctors. Other sources were cited considerably less frequently, by one in ten or less.

Reliability of and Comfort with Information Sources

Aboriginal people consider a clinic, nursing station or their family doctor or another health care professional to be the most reliable information source about HIV/AIDS, followed by the FNIHB, or a pharmacist. About half consider the federal government to be a reliable source, as is also the case with a person living with HIV/AIDS. The media, friends and family are considered to be the least reliable information sources by Aboriginal people despite the fact that mass media is the most frequently cited source of information on HIV/AIDS.

Aboriginal people would feel most comfortable seeking information on HIV/AIDS from their family doctor or another health care professional, nursing station or an AIDS organization, pharmacist or clinic, particularly among Métis in the case of the latter. Two in three to three in four Aboriginal people say that they would feel comfortable seeking information from a person living with HIV/AIDS.

In terms of effective ways to provide people with information about HIV/AIDS, Aboriginal people point most often to schools and public education announcements on television and the radio, with the exception of First Nations people in the case of the latter. This is followed by informing elders and community workers. Information sharing in traditional Aboriginal ceremonies or activities is the least popular approach.

Typology of Aboriginal People

In addition to the basic analyses cited throughout the report, a typology of Aboriginal people was created. The typology groups Aboriginal people into segments of people with similar knowledge levels and attitudes regarding HIV/AIDS. This was carried out using factor and cluster analyses, as well as reliability analyses.

• Well Informed Liberal-Minded: This segment typically represents the second largest share of Aboriginal people between 17 and 28 per cent). They are the most knowledgeable and comfortable with people with HIV/AIDS, are the least likely to hold stigmatizing and discriminatory views, and the least likely to distance themselves from the issue (as a disease that only happens to others). They are more likely to perceive HIV/AIDS to be a serious issue, and one that is not diminishing with time. Typically they are more likely to know someone with HIV/AIDS and express high levels of support and sympathy around people with HIV/AIDS. They tend to rely on newspapers, television, magazines, work, and the Internet for information and would consult the Internet to obtain further information. They place considerable confidence in health professionals, AIDS service organizations and authorities as reliable information sources. This segment is most apt to report post-secondary education. Women and individuals between the ages of 25 to 44 are also over-represented in this segment.
• Informed Liberal-Minded: This segment represents the largest portion of Aboriginal people (from 27 per cent to 33 per cent). They have the second highest knowledge scores and are moderately comfortable with people living with HIV/AIDS. They generally do not hold stigmatizing or discriminating attitudes towards people with HIV/AIDS and are less likely than many other Aboriginal people to distance themselves from the issue (as a disease that only happens to others). They tend to see HIV/AIDS as a serious issue that is not declining over time. This group is more likely to know someone with HIV/AIDS and together with the segment one express high levels of support and sympathy around people with HIV/AIDS. They tend to rely on television, school, and the Internet for information and would consult the Internet to obtain further information. They express high confidence in people living with HIV/AIDS, AIDS service organizations, and health care professionals in their community as reliable information sources. This group is over-represented by women, youth, and individuals with post-secondary education and higher income earners.
• Uninformed Deniers: This group comprises one in four to one in five Aboriginal people. Members of this group have low knowledge about HIV/AIDS, and demonstrate average levels of comfort with people living with HIV/AIDS. They also show average levels of stigma and discrimination. They tend to minimize the seriousness of the issue and are somewhat more likely to distance themselves from the issue of HIV/AIDS, and see it as a disease affecting the third world, gay community or drug users. This group does not stand out in terms of its differences from the overall population as much as the other four segments do. This group is over-represented by men, and individuals who are younger than 25 years of age and have high school education.
• Semi-Informed Distancing: This segment comprises one in seven to one in four Aboriginal people. It is characterized by low to medium knowledge levels, strong discomfort around people with HIV/AIDS, and high levels of stigmatizing views. They tend to minimize and distance themselves from the issue, and are most likely to support the discrimination of people living with HIV/AIDS. This group is, in many ways, similar to the fifth group (Uninformed Uncomfortable), however, their knowledge level is higher and their tendency to distance themselves from HIV/AIDS is more acute. In terms of information sources, this group is less likely to have heard about HIV/AIDS from newspapers and the Internet. They would be most uncomfortable seeking information from people with HIV/AIDS. They are typically less likely to know someone with HIV/AIDS and are less likely to be sexually active. This group includes a higher number of men and individuals with low levels of income and education.
• Uninformed Uncomfortable: This segment comprises only a small segment of First Nations and Métis people but reaches one in eight in the Inuit sample. Individuals in this group are characterized by the lowest knowledge about HIV/AIDS by far, the highest discomfort around people living with HIV/AIDS, and high levels of stigmatizing views. This group is likely to distance themselves from the issue of HIV/AIDS, viewing it as a disease found mostly in third world countries, among gay people and drug users, and are inclined to support the discrimination and isolation of people with HIV/AIDS.

¹ Based on HIV/AIDS Attitudinal Tracking Survey - 2006, EKOS Research Associates.

² The margin of error is a measure of the accuracy of the results, indicating how far the survey’s results typically stray from the true value in the entire population (i.e., the finding will be accurate to within a certain number of percentage points 19 times out of 20).

³ HIV/AIDS Attitudinal Tracking Survey - 2006, EKOS Research Associates.

⁴ HIV/AIDS Attitudinal Tracking Survey, EKOS Research Associates, 2006.

⁵ As measured by the HIV/AIDS Attitudinal Tracking Survey, 2006.