More support needed for HIV prevention, testing, treatment in northern Ontario First Nations, researcher says

A researcher who specializes in how federal policy impacts access to health care in First Nations says more needs to be done so people in Ontario's northern Indigenous communities can receive prevention education, testing and treatment for HIV closer to home.

Sean Hillier, who is an assistant professor in the school of health policy and management at York University's faculty of health, said the federal government spent just under $1 million on HIV prevention, education, testing and treatment in Ontario's First Nations during the 2016-2017 fiscal year. He said his research also found that those resources were not spread out evenly.

The result, he said, is that many people, especially in the north, have to leave their communities for larger centres, even to get tested for the disease.

"Certainly we see massive service gaps in communities, a lack of prevention, a lack of education across the board, especially in the north," he said. "That's forcing people out of their communities and into urban centres in order to access care, treatment and services."

As part of his research, Hillier, who is a member of the Qalipu Mi'kmaq First Nation in Newfoundland, said he spoke with 30 Indigenous people in Ontario with HIV to hear their stories about living with the disease; a common theme, he said, was that they had to leave their communities to access basic health services for HIV.

In some cases, he said, on-reserve resources for basic testing was so lacking that patients only found out they had HIV after seeking healthcare in cities like Thunder Bay for other medical issues.

Federal officials say more money is now being spent on HIV prevention, testing and treatment in Ontario First Nations. In an email to CBC News, Indigenous Services Canada spokesperson William Olscamp said the 2019-2020 budget allocates $1.6 million to 39 funding recipients, including individual communities, organizations and other partners.

Funding for programs in First Nations around HIV and other sexually transmitted and blood-borne infections is proposal-based, Olscamp said, adding that the money improves access "to culturally safe prevention, testing, treatment, care and support." It's essentially administered by Indigenous Services Canada along with a body coordinated by the Chiefs of Ontario and including, among others, the Anishinabek Nation, Grand Council Treaty 3 and Nishnawbe Aski Nation.

"These community-based and community-driven models also raise awareness in order to reduce stigma and discrimination to improve health outcomes and reduce transmission."

But adding to the problem, Hillier said, is that his research also found that a number of Indigenous people from northern communities experienced racism or at least culturally-insensitive care when seeking treatment in urban centres.

Systemic issues

Addressing the higher rates of HIV and other blood-borne infections among the Indigenous population needs a holistic approach, Hillier said, adding that one of the primary causes of the disease is needle drug use, which often points to other systemic issues, like historical trauma.

"These all [are] factors, and significant factors, into people's risk exposure because people have not been given the adequate healthcare, counselling, psychological counselling they require to get over many of the traumas they face," he said.

"So they turn to negative coping mechanisms, and so alcohol, drug use, and specifically injection drug use, and the vast majority of these participants show these very high risk factors for that."

The federal government said it has pledged $37.5 million over five years dedicated to prevention, testing, treatment and care for diseases such as HIV and hepatitis C, for First Nations and Inuit communities.

Grassroots initiatives

Public health units and other grassroots organizations do try, Hillier said, but many operate with "very little funding."

"We look at the AIDS Bureau in the province of Ontario, [it's] working with a number of Indigenous organizations [and] are doing amazing work," he said. "But they do this on skeleton staff and they do this on skeleton funding."

"Their ability to create and adapt very specific cultural programming is fairly limited."

The temporary nature of people coming and going from urban centres like Thunder Bay for treatment doesn't make it any easier, Hillier added.

"We recognize that each community has unique health needs," Olscamp's statement said. "As such, we will continue working with First Nations and Inuit leaders, communities and partners as well as provincial and territorial governments, to prioritize community and distinctions-based approaches to addressing [sexually-transmitted and blood-borne infections]."