Table 2 The multiple intersecting social determinants of health for Indigenous people who were infected with HIV as youth in Manitoba, Canada
Social determinant | Experiences prior to infection (as youth) | Experiences after infection (from youth to later years) |
|---|---|---|
Child welfare system | • Growing up in care | • Having children taken into care |
(Trans-generational) trauma | • Parents not knowing how to parent (reflections on the Residential School System as eroding parenting) | • Reflections on trauma from different stages of development • Trauma from experiences later in life (e.g., late-term miscarriages) |
Sexual orientation | • LGBTQ2* youth not being able to be “out” (express sexuality freely) in the community (urban and on-reserve) | • HIV positive LGBTQ2* youth and adults not always (only sometimes) being able to find the appropriate spaces for care (e.g., group counseling) • Lack of resources for HIV positive transgendered Indigenous people, including youth |
Gender | • Gender violence • Sexual assault | • Gender violence • Access to gender specific HIV-support programming |
Disability | • Learning disabilities (e.g., ADHD) | • Learning disabilities (e.g., ADHD) • HIV-related disability |
Racism | • Experiences with racism when accessing health services (e.g., lack of understanding of Indigenous culture) | • Experiences with people (i.e., family, friends, and other people in the community) thinking HIV is an “Aboriginal disease” |
Sex work | • Selling sex as a survival mechanism • Being trafficked by pimps as a child | • Continued involvement in the sex trade • Discontinuation of involvement in the sex trade |
Stigma | • Not discussing HIV because it is taboo and considered to be something only “dirty” people have | • Not being able to access services in First Nations communities because of heavy stigma around HIV and fear that personal information will be spread around the community |
Employment / Income | • Full-time work • Part-time work • Unemployment • Low-to-medium income | • Unemployment • Part-time work • Volunteering • Low income |
Drug and alcohol use / Addictions | • Drug and alcohol use • Addiction • Sobriety | • Drug and alcohol use • Addiction • Sobriety |
Coping strategies | • Drug and alcohol use • Friends and family | • Drug and alcohol use • Friends and family • Music and art • Journaling • Cultural practice (e.g., ceremony) • Humour |
Violence / Abuse | • Physical and/or sexual abuse from parents and step-parents • Abusive partner • Gender violence and sexual assault | • Abusive partner • Violence from strangers (especially for those who are homeless) |
Justice system | • Arrest • Incarceration (juvenile detention) | • Arrest • Incarceration |
Education | • In high school • Finished high school • Dropped out of high school • Some health and sexual education through school | • Finishing high school • Training programs • Post-secondary education • HIV specific education |
Nutrition and food security | • Low food security because of instable home environment or homelessness • Medium to high food security through stable home environment | • Low food security due to poverty and homelessness • Medium to high food security due to own income • Improved food security due to access to food banks • Attention to special HIV supportive diet |
Housing / Homelessness | • Residing with parents • Independent living • Periodic and prolonged homelessness • Residing with foster parents | • Stable in depending housing • Shared housing (e.g., rooming houses) • Periodic and prolonged homelessness • Incarceration |
Social support network | • Family and friends • Teachers | • Family (including children) and friends • Partner • Health providers (Indigenous and non-Indigenous) • Church and religious community |
Community health services | • For participants living on reserve, limited access and travel required to access health services, especially for specialized services • Fear of accessing local services due to stigma in the community and fear that information will be shared • Fear of accessing services due to their location (not wanting to see certain people, have street drugs offered to them, encounter violence, etc.) • Lack of information/education on HIV prevention prior to diagnosis | • Both positive and negative experiences with nurses and doctors at hospitals and clinics • HIV management programs • HIV medications • Mental health counseling • Culturally appropriate services (e.g., through Tribal Nursing Officer) |