Historic trauma in aboriginals boosts hepatitis C risk

The trauma of having a parent who was forced to attend a residential school is linked to higher rates of hepatitis C infection among aboriginal young people in B.C., new research suggests.

The research was part of the Cedar Project, a long-term collaborative research project focusing on HIV and hepatitis C infection in young aboriginal drug users in British Columbia.

The project aims to understand the relationship between historical trauma — such as having a parent or grandparent who attended a residential school — and vulnerability to blood-borne diseases.

Researchers had already linked a history of sexual abuse among the young group under study with having a parent who attended a residential school or was involved in the child welfare system.

The latest study focused on hepatitis C rates. The Public Health Agency of Canada estimates the prevalence of hepatitis C infection is 0.8 per cent in the general Canadian population, but says the disease is seven times more prevalent among aboriginal people than non-aboriginal people.

Vancouver, Prince George studied

The Cedar Project study looked at 512 aboriginal people with an average age of 23 living in Vancouver's Downtown Eastside and in Prince George, B.C., a forestry and mining town in the northern interior of the province.

Of those studied, 286 participants reported injecting drugs while enrolled in the study between September 2003 and April 2005. In this group, 59 per cent, or 170 participants, were infected with hepatitis C when the study began, Prof. Patricia Spittal of the University of British Columbia's school of population and public health and her colleagues reported in the journal Open Medicine.

Among the 199 participants who tested negative for hepatitis C initially, 21 new infections were recorded over an average followup of 11 months. Among participants who reported injection drug use, the researchers estimated 23 per cent would develop hepatitis C.

The findings emphasize the importance of acknowledging the role of historical trauma in the health of aboriginal people, said Chief Wayne Christian of the Splatsin Secwepemc Nation, one of the study's investigators. Young people who use injection drugs are often coping with unresolved trauma, including the impact of the residential school system that continues to play out, he said.

The hepatitis C virus is spread through contact with infected blood, such as sharing poorly sterilized needles or other contaminated equipment. While it can cause liver damage or cancer, the disease is often not detected in patients for years.

Factors strongly linked with hepatitis C infection among study participants who used injection drugs included:

• Being female (women were 1.9 times more likely to test positive).
• Having at least one parent who attended a residential school (1.9 times more likely).
• Reusing syringes (2.4 times more likely).

Aboriginal leaders and those who care for people with HIV/AIDS have been concerned about the impact of the HIV and hepatitis C epidemics in cities and rural areas.

Since the 1980s, Vancouver has been considered a provincial and national epicentre for HIV and hepatitis C. The Cedar Project findings indicate the face of these epidemics is changing to an increasingly aboriginal one, the researchers said.

Window of opportunity in North

The prevalence of hepatitis C was similar in Prince George (34.5 per cent) and Vancouver (35 per cent).

The similar rates of hepatitis C infections in Vancouver and Prince George are a concern and could foreshadow a larger epidemic in Canada's North, said study co-author Dr. Martin Schechter, director of UBC's school of population and public health.

HIV rates in the North are still lower than in the rest of Canada, the researchers said.

"We still have a window of opportunity in northern communities," Schechter said. "But what the hepatitis C shows is that that window of opportunity doesn't last forever."

'Intergenerational trauma passes down and ends up demonstrating itself as risk-taking in the next generation.' — Martin Schechter, director, UBC School of Population and Public Health

Chief Christian urged more support for young aboriginal people — in particular, young women whose safety is at risk because they're living on the street .

He also urged wider use of traditional healing practices such as the sweat lodge ceremony alongside mainstream therapies.

Half of the $60 million in federal funding earmarked for residential school survivors from the Truth and Reconciliation Commission should be re-directed to help the younger generation, Christian said.  

Clean needles

Schechter said the research suggests that breaking apart communities and separating children harms cultural identity and social cohesion, which, in turn, affects disease risk.

"Intergenerational trauma passes down and ends up demonstrating itself as risk-taking in the next generation," Schechter said. That risk-taking can manifest as injection drug use and sharing needles.

The study's authors called for culturally based prevention, treatment and harm-reduction programs that are designed and delivered by aboriginal people, including needle exchanges, wide distribution of clean needles and safe injection sites.

The researchers estimated more than 100,000 aboriginal children were removed from their families between 1874 and 1986, based on studies and the 1996 Royal Commission on Aboriginal Peoples.

The Cedar Project is funded by the Canadian Institutes of Health Research.