There is a lack of Métis-specific resources available for addressing prevention and care for HIV, HCV, STBBI and/or related health issues. Métis communities are often expected to use resources that are adapted from resources developed for, or by, First Nation communities who have different cultural beliefs and norms from Métis communities. To address this gap, as part of the DRUM & SASH implementation science team grant, we are working in partnership with a provincial Métis health service organization based in Alberta to develop a Métis cultural response to HIV, HCV, STBBI and related mental health issues.

The development of a community-led Métis cultural response to HIV, HCV, STBBI and related health issues is grounded in community-based and Indigenous research methodologies that privilege Métis ways of knowing and doing. This cultural response is developing iteratively through reciprocal learning processes, and is guided by Elders/knowledge keepers, with the participation of Métis service providers, community members, and researchers.

Through these processes, 1) community priorities and leaders have been identified; 2) Elders and other community members have developed a holistic conceptual model of Métis health that is grounded in Métis culture, identity, and imagery; 3) language keepers and community members have developed language in Cree-Michif to address wellbeing and STBBIs; 4) the Métis community has successfully piloted Dried Blood Spot testing in Alberta, which included wrap around services for Métis individuals; 5) an advisory committee has been formed to guide future initiatives, and 6) Métis-specific resources have been developed for community including an assessment tool for Métis wellbeing.

Creating a Métis-specific cultural response to HIV, HCV, other STBBI, and related health issues will improve cultural safety and improve access to services, including access to testing and treatment, for Métis communities.

Background: In the Northwest Territories (NWT), food insecurity (15.9%) is nearly double the national prevalence (8.8%). Food insecurity is an established structural determinant of HIV. Food insecurity harms mental health and contributes to maladaptive coping, in turn reducing HIV prevention uptake. Condom use efficacy, a proxy for sexual agency, encompasses knowledge, intentions, and relationship dynamics for negotiating safer sex. We explored the direct effect of food insecurity on condom use efficacy, and indirect effect via resilience, among NWT adolescents.

Methods: We conducted cross-sectional surveys with adolescents aged 13-18 in 17 NWT communities in 2018-2019. We assessed socio-demographics, food insecurity (frequency of going to bed hungry due to insufficient food, dichotomized: ever/never), and resilience (Child and Youth Resilience Measure). We conducted descriptive statistics, bivariate analyses (chi-squared, Mann-Whitney U tests), and tested hypothesized pathways from food insecurity to condom use efficacy using mediation analyses with full-information maximum-likelihood methods to account for missing data.

Results: Most participants (n=410; mean age: 14.3, SD: 1.26) identified as Indigenous (79%), heterosexual (85%), and lived in rural regions outside of Yellowknife (n= 82%); 45% reported any food insecurity. Food insecurity was higher among Indigenous youth (48% vs. 34%, p=0.02). Food insecurity was associated with lower resilience (β= -0.14, p=0.006, 95% CI= -0.23, -0.04), and resilience was associated with increased condom use efficacy (β=0.55, p<0.001, 95% CI=0.45, 0.65). While the direct path from food insecurity to condom use efficacy was not significant (β= 0.03, p=0.53, 95% CI= -0.06, 0.11), the indirect effect via resilience was significant (β= -0.08, p=0.008, 95% CI= -0.13, -0.02). These results signal that food insecurity is associated with lower resilience, that in turn, is associated with lower condom use efficacy.

Conclusion: HIV prevention strategies focused on building individual resiliencies are insufficient to address larger social contexts of food insecurity for Northern and Indigenous youth.

In this talk, I present the findings from an analysis of Canadian legal decisions where Indigenous people have been accused of HIV non-disclosure. The purpose of this research is not to name or identify those who have been accused, rather, the focus is on how Indigeneity, HIV, and law are talked about by those working in the criminal justice system (such as judges and lawyers). This research examines how the narratives in these cases about Indigeneity, HIV, and “the law”, are shaped by, and deeply entangled in, settler colonial and heteropatriarchal histories and ongoing practices. However, the legal discussions and decisions are treated as objective, fairly reasoned, and as serving justice and broader social interests. I challenge these representations through an analysis that is informed by Indigenous feminisms and which recognizes Indigenous laws and the plural nature of law on these lands. Discourse analysis is used to draw out dominant representations, as well as to examine silences and that which is marginalized. The key findings will be discussed, including an assessment of how Gladue principles are engaged in the cases, and problems regarding the absence of Indigenous laws in these legal discussions. There is an ongoing need in HIV literature to examine not only how Indigenous people’s experiences with HIV are shaped by settler colonialism, but to also closely examine the connections between HIV criminalization and settler colonialism.

It is difficult to address HIV, HCV, and STBBI if these concepts do not exist within a language or culture, which is the case for many First Nation communities. Using a culturally-grounded approach, members of the DRUM & SASH implementation science team grant are working in partnership with several First Nation communities in Alberta to support the community-led creation of a place in the culture for addressing HIV, HCV, STBBI and related health issues that are specific to each community.

Grounded in community-based and Indigenous research methodologies that prioritize First Nation ways of knowing and doing and reciprocal learning, the DRUM & SASH team, which includes First Nation community research partners, has engaged with Elders/Knowledge Keepers and community members to develop community-led initiatives, including the development of traditional language for the discussion of HIV, HCV, STBBI and related topics such as sexual health and sexuality.

The development of traditional language has supported the creation of health promotion materials in local languages and improved communication about sensitive and often taboo topics. Additionally, our team has found that working with Elders and other community members to develop traditional language is an optimal opportunity for reciprocal learning, whereby Elders, community members including health service providers, and DRUM & SASH team members are able to learn from each other – sharing knowledge about language, culture, STBBIs, and concepts of health – all of which contribute to building trust and respectful relationships to further STBBI prevention and treatment.

Without having concepts and language for HIV, HCV, and STBBI grounded within the culture, it is hard to have a cultural response that is effective and culturally safe. Developing a place for HIV, HCV and other STBBI within the culture is essential to curbing the rates of transmission and improving access to culturally safe services and treatment.