At AIDS2016, in Durban, South Africa, Canadian Federal Health Minister Jane Philpott made a commitment to strengthen the consultative process with Canada’s marginalized indigenous communities. As a result of that promise, on July 10-12 of this year the Canadian Aboriginal AIDS Network (CAAN) brought together indigenous leaders and stakeholders from 14 countries to to share promising practices that highlight progress towards achieving global HIV, TB, and hepatitis C targets in Indigenous communities.
The Honourable Jane Philpott, P.C., M.P., Minister of Health: “I applaud the leadership and dedication of the people and organizations working to drive down the prevalence of AIDS, tuberculosis and hepatitis C in Indigenous communities through culturally safe and innovative approaches to prevention, detection and treatments. They are making a difference, and I have seen firsthand some of the tremendous successes that have been achieved following the implementation of programs, such as ‘Know Your Status’. Our Government is committed to ending the public health threat of both AIDS and hepatitis C by 2030 and tuberculosis by 2050 and this can be achieved only with the continued support and perseverance of our partners and through knowledge-sharing opportunities, such as this assembly.”
To end the AIDS epidemic, UNAIDS and the World Health Organization have established the following 90-90-90 goals to achieve by the year 2020:
90% of people diagnosed with HIV to be in treatment
90% of people in treatment to have undetectable viral loads.
On World AIDS Day 2016, the Government of Canada announced Canada’s progress towards these goals. National estimates are 20% of people living with HIV in Canada are not aware of their infection; 24% of those aware they have HIV are not taking anti-HIV therapy. “Indigenous communities play a critical role in closing target gaps, as they continue to be over-represented 2.7 times higher than other Canadians,” said Ken Clement, CEO of Canadian Aboriginal AIDS Network.
“This project is an opportunity for Indigenous Peoples, researchers, and policy makers from all over the world to share wise and promising practices, learn from each other and build relationships across continents, cultures, and languages,” said Clement.
Opportunities like that don’t come along every day and as the meeting was coming to a close I thought it would be great to discuss with Ken Clement what he sees as the main issues facing indigenous people in their struggle against these diseases and what “wise and promising practices” were discussed.
I was in luck as Ken proved more than affable and happy to talk despite the fact that he was coming off a bout of the flu. He has quite a few observations to make about the current state of these epidemics within the indigenous communities,how things got that way and where he'd like to see them go..
Hi Ken, thanks for talking with PositiveLite.com So CAAN just held a summit of international and domestic stakeholders and inidigenous leaders to discuss what are the main issues in dealing with HIV, TB and Hep C and to share best practices and wisdom for dealing with those epidemics. So first of all, what do you see as the main issues in dealing with HIV, TB and Hep C that indigenous people here in Canada are facing?
I think obviously the primary issues facing indigenous people are connected in particular with the social determinants of health, which have been a challenge for many indigenous people in Canada. I think when you look at it from a historical perspective, the impact of colonization … residential schools, poverty, child welfare issues, lack of education. All the negative kind of outcomes that indigenous peoples face in Canada lead to poor health standards and inequalities for indigenous people, which makes for higher rates in HIV, Hep C and TB and it’s all of those sort of issues. So I think that’s what it is, in summary.
Across the world we see that HIV, Hep C and TB are all occurring at high rates among all marginalized people
I think that’s one of the messages of our meeting last week is that indigenous people, we share a lot of common challenges in a lot of areas when we look at indigenous populations around the world. Colonization and contact with European settlers is sort of the foundation, I guess, of why we are where we are around the world, as indigenous people.
What, for you, was the most exciting in terms of best practices and wisdom that were shared during the meeting?
Well, I don’t know so much about the excitement part. I think that for me what stands out is the lack of movement we’ve had and the lack of success we’ve had over ten years.
I think a lot of the people who were present spoke to these issues ten years ago and unfortunately the lack of movement is of concern to me because you would think that after ten years we’d at least have been able to mobilize in a positive way to ensure that the voices and concerns were at least being met.
But on a positive spin, I think the fact that the Minister herself initiated this meeting from Durban is a testament, I suppose, to her commitment to fixing the health inequities for indigenous people in Canada. I think that’s a good step and certainly we hope that will continue and it appears, not to over emphasize, it, there is an appearance at least that this issue is on her radar.
Yes, she’s giving it some weight and some attention so there are some grounds for optimism.
Yes and overall I’m hoping, like all of us, that this government will respond to the Truth and Reconciliation and merge those recommendations to positive, healthy, equal outcomes in health generally.
I don’t think that we can speak to HIV, Hep C etc. without speaking in terms of the overall health of indigenous people in Canada. I think there is a recognition that there are inequities, but again, there are certainly concerns from our perspective that they’re not going deep enough, if you look at the growing epidemic of youth suicides in remote communities, the continued poverty rates, poor education etc. So there’s a balancing act that needs to happen, but at the same time, the whole issue around HIV and Hep C, we really need to put action to the words that are being put out there. I think the time is right for now to ensure that proper action is taken.
And what proper action would you like to see taken about HIV specifically?
Well, not to belabour the issue, but I think funding is certainly a major struggle for indigenous populations. I think just coming out of the community action fund, I think there were inequities in that whole process, not looking at indigenous specific, culturally sensitive projects and programs that would ensure that we as a people are part of an integrated approach to providing services to our people.
So I think funding obviously has a major impact. Also, there needs to be recognition that we’re coming to a point where many of those who have been at the forefront of HIV work are going into their senior years. I think we need to make sure that there’s mentoring and knowledge sharing with our own people. I think that’s another factor that needs to happen to ensure the elimination of HIV.
We know now that when a person who is HIV-positive is on ART and achieves an undetectable viral load, usually after six months of treatment, they can no longer communicate the virus sexually, which is huge for people living with HIV. Do you see that information getting out into the indigenous communities much so far and do you see it as an important step in dismantling the stigma indigenous people living with HIV face?
It could be useful, but HIV is still stigmatized by many of our people. I don’t think that there has been enough evidence shared with our people for the communities to really break down that stigma and discrimination.
It’s still a huge issue in the rural communities that HIV is contagious and people are still ostracized from their communities, so it’s a slow process, I think. Given the history and given the dynamics within indigenous communities, you can appreciate the challenges around something like HIV when all of the other determinants are affecting their lives on a daily basis. So when someone is positive and there’s no resources in the community, they’re remotely situated… all these sort of dynamics really don’t help to decrease stigma and discrimination amongst our people.
But it’s slowly coming. It’s a slow process. One of the ways of ensuring that stigma decreases is for our own leadership to be supportive of the work that we do across Canada. We have many AIDS service organizations across Canada that have done this work and our own leadership needs to come on board and support the work that we’re doing, so that we can break that silence, break that stigma and discrimination.
What role are indigenous peoples playing in meeting global 90-90-90 targets?
Well, I think certainly we’re making efforts at he UN with regard to indigenous health and we have had a number of meetings and discussions with the United Nations people. I think bringing global leaders from indigenous populations to present to the world the inequities around health. I think generally and certainly at a domestic level we have for the last number of years had an international indigenous working group on HIV, which presents the challenges around HIV, Hep C and many other health inequities. And we’re also working with local indigenous people across Canada to ensure that the issues we are facing and/or working with are front and centre in any discussions in terms of inequities and the 90-90-90.
Is there anything you wanted me to ask you that I didn’t?
I think we pretty much hit the nail on the head. I guess one other thing that needs to be mentioned is that aboriginal people living with HIV are certainly the warriors of our movement and they continue to be warriors who live strong lives and live with their families and within their communities in a strong way and have met the challenge for over thirty years with respect to HIV and they’ve been at the forefront of making sure that we’re on track in terms of AIDS service networks and AIDS service organizations.
So recognize that cultural safety and cultural awareness are key to ensuring a partnership not only with the ASOs but with the governments and other organizations across Canada.
Ken, thank you. I know you haven’t been feeling well and I really appreciate your taking the time to talk .
I guess I must have drained myself on my trip to Ottawa! (laughs).