Context: What can community research fellowship become when articulated from within First Nations, Inuit, or Métis (FNIM) perspectives?
Background: The Feast Centre for Indigenous STBBI Research at McMaster University in collaboration with CAAN Communities, Alliances and Networks, is a Canada-wide project focused on the use of Indigenous Knowledges in STBBI research with aims to support the development of scholars and scholarship grounded in Indigenous knowledges. Our Community Fellowship (CF) Program supports research training for early-career scholars that comes from within FNIM ways of being and knowing.
Discussion: We explore Indigenous research fellowship through our relational network. In its structures and offerings, the CF Program contributes to developing a skilled multidisciplinary community of Indigenous and allied scholars, intended to increase uptake and implementation of Indigenous informed research practices.
Lessons Learned: The unique structure of the program supports 8 Community fellows in 2022/2023, mentored by Feast Team Members. Further relational programming includes conversations, check-ins, peer mentorship opportunities, and welcoming access to the larger Feast team, including a Council of Elders. Fellows can organically create connections, ask questions, and seek feedback. Our non-prescriptive format engages ongoing consultation on training needs, in a non-hierarchical organization recognizing we all learn from each other. Research skills development opportunities are responsive, including an initial iterative review process and an ongoing learning series. Fellows are encouraged and supported to write about their research for journals and conferences through relational training supports from Knowledge Holders. Community fellowship grounded in Indigenous perspectives advances community-based research supporting Indigenous people’s autonomy to respond to STBBI in ways consistent with diverse cultures. Our fellowship builds capacity for researchers regarding Indigenous Peoples and STBBI and channels thinking about policy and program impacts within larger communities. Relational community fellowships flourish when we stand together in joyful connections as an Indigenous research network.

Background: Innovative approaches for building enabling environments for HIV prevention are needed in the Northwest Territories (NWT), where youth are disproportionately affected by sexually transmitted infections (STIs) and teen pregnancy—both HIV acquisition risk factors. Our mixed-methods study examined Northern and Indigenous youth participation in arts- and land-based Peer Leader Retreats (PLR) in the NWT and associations with HIV prevention self-efficacy.

Methods: We conducted one-week PLR in the NWT with purposively sampled adolescents aged 13-17 years old annually between 2016-2021. Retreats addressed HIV and STIs, safer sex, healthy relationships, and gender equity using interactive learning approaches (e.g., role-plays, Elder teachings, arts-based methods). We conducted pre-post retreat surveys measuring socio-demographics and safer sex self-efficacy (SSSE), and post-retreat focus groups (FG). We conducted thematic analysis of FG data. We conducted paired sample t-tests, and multiple linear regression, to assess pre-post retreat changes in SSSE scores.

Results: There were 326 participants (mean age: 14.5, standard deviation: 1.3), most Indigenous (87%) and young women (64%). A subset (n=158) of these participants, apprentices, and facilitators participated in 24 post-retreat FG. Qualitative narratives revealed that retreats contributed to technical communication (HIV and STI knowledge, condom benefits, correct condom use) and transformative communication (confidence, healthy relationships, sex-positivity). We found statistically significant SSSE mean score increases (2.14, 95% confidence interval (CI)= 1.58-2.71). In multiple linear regression analyses, higher pre-test SSSE (β=0.59, 95% CI, 0.51-0.67) and gender (women) (β=1.84, 95% CI= 0.77-2.92) were associated with higher post-test SSSE scores. Sexually diverse (vs. heterosexual) (β= -1.14, 95%CI= -2.25, 0.03) and food insecure (vs. food secure) (β= -2.44, 95%CI = -5.05, 0.16) participants had smaller post-test SSSE increases.

Conclusion: Enabling environments such as those fostered in arts- and land-based retreats can build technical (e.g., knowledge) and transformative communication (e.g., confidence) to empower youth in the NWT to engage in HIV prevention practices.

Issue: There is an urgent need to improve access to culturally relevant gender-based violence (GBV) prevention and intervention resources for Indigenous people living HIV and/or HCV (IPLWH), which has increased over the COVID-19 pandemic. In response, CAAN and the Dr. Peter Centre established the Well-Being Project to identify how COVID-19 has impacted the experiences of GBV amongst this key population, and explore ways to support community-based health/social services in delivering culturally safe, stigma-free, and trauma-informed GBV response services amidst crisis situations.

Description: Phase 1: Following a literature review, we held dialogue sessions in the four directions. We invited Indigenous women (inclusive of transgender women, Two-Spirit, femme-identifying, genderqueer and non-binary people) living with HIV and/or HCV to share expert perspectives and recommendations. Following thematic analysis of the dialogues, participants reconvened to review and verify the findings. Phase 2: Interested dialogue participants supported the creation of a Gender Safety Medicine Basket of resources to increase health/social service providers’ capacity to provide stigma-free, trauma-informed, and culturally safe services for IPLWH experiencing GBV amid crises and beyond.

Lessons Learned: Participants’ perspectives support the evidence that GBV has increased over the COVID-19 pandemic. Increased isolation due to physical distancing ordinances and service limits is a key contributor to this trend. Participants reported deteriorations in mental health due to the normalization of abuse, increased experiences of racism, and reduced access to safer spaces. These barriers can be mitigated by incorporating wise practices for cultural and gender safety into community-based programming, including culturally-responsive safety planning, Elder engagement, ceremony, and arts- and land-based healing practices.

Recommendations: This presentation will share findings from the Well-Being Project – including the ways that COVID-19 has impacted experiences of GBV amongst IPLWH – and recommendations on culturally-responsive practice for health/social service providers from the perspectives of IPLWH with living/lived experience of GBV.

Background: Indigenous peoples living with HIV (IPLWH) experience discrimination that has been shown to have negative impact health. The objective of this study is to describe experiences of discrimination among IPLWH in Ontario and its relation to their health.

Methods: 100 IPLWH participants in OHTN Cohort Study (OCS) completed interviews in 2020-2021. The Major Experiences of Discrimination (MED) assessed lifetime experience of discrimination (Williams et al, 1997), which includes refused healthcare, fired, not hired, denied promotion, discouraged from education, evicted/denied housing, denied banking, told “to go back”, stopped by immigration official, denied services in a store/pharmacy, or carded/stopped/searched/questioned by police. For each item, they were asked whether the experience was due to their identity (race, HIV status, gender, age, religion, education level, sexual orientation, or disability).

Results: 70 (70%) experienced at least one and 57 (57%) experienced multiple forms of unfairness. More female IPLWH (86%) reported experiencing unfairness than heterosexual male IPLWH (63%) or gay/bisexual male IPLWH (61%). The most common forms of unfairness were being carded, told to “go back”, and denial of service in store/pharmacy. The most common reasons of discrimination were Indigenous identity, HIV status, and sexual orientation.

IPLWH who experienced unfairness reported (p<0.05) worse health outcomes including, poor/fair self-reported general health (34.3% vs. 13.3%), diagnosis of mental health condition (57.1% vs. 26.7%), loneliness (52.9% vs. 20.0%), and depression (54.3% vs. 20.0%), but reported higher utilization of Indigenous cultural and health services (44.3% vs. 16.7%) than IPLWH with no experience of unfairness. IPLWH who experienced discrimination also reported significantly lower physical and mental health-related quality of life (HRQOL) and lower social support (adjusting for age and gender).

Discussion: The high level of experience of discrimination and its association with poor health outcomes is concerning. Interventions that can reduce the negative impacts of discrimination on health are required.

Background: Access to ceremony and cultural programming are key to wholistic health for Indigenous people living with HIV/AIDS (IPHA). This community-based participatory research study explored the impact of the COVID-19 pandemic on access to Indigenous ceremonies, medicines, and land-based cultural activities among IPHA in Saskatchewan and Manitoba.

Methods: The project was grounded in an Indigenized ethical space and utilized etuaptmumk/Two-Eyed Seeing. Participants in Manitoba (n=24) and Saskatchewan (n=21) were recruited using printed flyers, community-based agencies, peers, and social media. Interviews focused on pandemic’s impacts on ceremony among IPHA. Data were analyzed using thematic analyses.

Results: Restricted access to ceremonies, cultural activities, and community supports during the COVID-19 pandemic detrimentally affected the overall wellbeing of IPHA. Greater isolation from community, Elders, families, and culture, as well as interruption of ceremonial and cultural gatherings, sweat lodges, and pipe ceremonies resulted in the decline of mental, emotional, and spiritual health for IPHA. Poor access to ceremonies was particularly concerning for IPHA with intersecting vulnerabilities. The COVID-19 pandemic also triggered innovative strengths-based adaptations among IPHA and organizations that serve these communities. Community organizations dropped off supplies of sacred medicines to IPHA, while other innovations focused on online cultural activities embedded in ceremony, including virtual storytelling, sharing circles, smudging, and drumming. Participants also spoke of the ways culture, ceremony, land-based activities, medicines, and Indigenous Knowledges were applied in managing and responding to the impacts of COVID-19.

Conclusion: Indigenous responses to COVID-19 among IPHA in Manitoba and Saskatchewan exemplified the strengths-based culturally appropriate approaches that helped to address pandemic impacts and demonstrated how ceremony and Indigenous ways of knowing can foster innovative program adaptations based on culture and community. Supporting and enabling Indigenous ceremonial practices within HIV continuum of care can contribute to healing, wellbeing and reduce barriers Indigenous people experience within the Western healthcare system.

Background: Harm Reduction After Hours (HRAH) is a community-led harm reduction service in Prince Albert, Saskatchewan. Prince Albert's population is 35,926 (2016) Twenty-nine percent of the city's population is First Nations and with a HIV diagnosis rate of 60.3 per 100,000 vs 4.5 per 100,000 nationally (2021). Before HRAH there was only one fixed site needle syringe program (NSP) with limited hours.
Methods: HRA was developed in response to the increased HIV/Hepatitis C rates. Although funding was provided by Public Health Canada, the success of the program can be attributed to it's community-led design. Peers and First Nations peoples were involved throughout the entire process; from initial consultation to daily operating and hiring practices.
Results: A secondary, community-led mobile NSP was developed. This new service added 36 additional hours of operation per week, including evening, weekends and stat holidays. It included paid employment for six people with a history of injecting drug use.
Peers established their own working guidelines in partnership with a sexual health clinic that serves Northern central Saskatchewan. Funding was used to train and employ peers to deliver the harm reduction supplies , make referrals and administer Naloxone. Peers went out in teams of two for safety reasons and distributed harm reduction supplies by foot and carrying supplies. Backpacks and summer/winter clothing was provided. In a 32 month period (2019-2022) 15,948 client contacts made, 294,281 syringes dispensed and 12, 422 inhalation supplies given out. In addition early 80,000 used syringes were collected from clients and the streets. The success of the project can be attributed to the inclusion of peers throughout the entire consultation process and into the development, implementation and hiring of the peers.