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Strengthening Ties Strengthening Communities


									        Strengthening Ties -
Strengthening Communities

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        An Aboriginal Strategy on
        HIV/AIDS   in     Canada

      First                           People
 F or F irst Nations, Inuit and Métis People
                                   July 2003
Over view of the Canadian Aboriginal AIDS Network
•    Established in 1997
•    National and not-for-profit
•    Represents over 160 member organizations and individuals
•    Governed by a National twelve member Board of Directors
•    A four member Executive
•    Provides a National forum for members to express needs and concerns
•    Ensures access to HIV/AIDS-related services regardless of where one resides
•    Provides relevant, accurate and up-to-date information.

Mission Statement
The mission of the Canadian Aboriginal AIDS Network (CAAN) is to provide leader-
ship, support and advocacy for Aboriginal people living with and affected by HIV/
AIDS regardless of where they reside.

Funding to the Canadian Aboriginal AIDS Network has been provided by Health
Canada under the Canadian Strategy on HIV/AIDS. The views expressed herein are
solely those of the author and do not necessarily reflect the official position of Health

The Canadian Aboriginal AIDS Network would like to express deep appreciation to
all 173 Aboriginal and non-Aboriginal people who took the time to contribute to this
document. In addition, all members of the two Working Groups who first prepared a
framework and later this document, are hereby recognized. Without them, the
process would not have been a success.

Cover Art
Artist is Tom Cheyenne, Lakota. Chosen to reflect that this strategy is about people -
Aboriginal people, in particular. CAAN and this strategy recognize the importance
of Elders and culture in the struggle to overcome HIV/AIDS and all related issues.

Researched and developed by
J. Kevin Barlow Consulting

                                                  A Vision    i

                                              Our Mission     i

                                        Glossary of Terms    iii

                                       Guiding Principles     v

                                 1.0 Executive Summary       1

       2.0 Background: Why an Aboriginal Strategy now?       3

          3.0 HIV/AIDS Among the Aboriginal Populations      7

               4.0 Canada's Strategy on HIV/AIDS (CSHA)      9

                            5.0 Nine Key Strategic Areas     11

                                   Aboriginal leadership     11

                    Coordination and technical support       11

Community development, capacity building and training        13

                              Prevention and education       14

            Sustainability, partnerships and collaboration   15

                 Legal, ethical, and human rights issues     16

         Engaging aboriginal groups with specific needs      17

  Supporting broad-based harm reduction approaches           19

                    Holistic care, treatment and support     21

                               Research and evaluation       22

                       6.0 Diverse Groups, Many Needs        25

                                     7.0 Implementation      37

                       Working Group Guiding Principles      39

                 Appendix A: CSHA Funding allocations        41

 Appendix B: Current ASHAC Working Group membership          43

         Appendix C: List of Key Aboriginal Stakeholders     45

        Appendix D: Description of Consultation Process      47
                        A Vision
Aboriginal People in Canada will achieve and maintain
 strong, healthy, and fulfilling lives, free of HIV/AIDS and
                     related issues.

                     Our Mission
To support meaningful, lasting efforts for Aboriginal com-
   munities to address HIV/AIDS and related issues in a
                culturally relevant manner.

                                                                           Glossar y of Terms

                                A boriginal A IDS Ser v ice O rganization / A IDS Ser v ice
                                O rganization
                                I n d i g e n o u s p e o p l e s i n C a n a d a , i n c l u d i n g I n u i t,
A boriginal                     Métis, and First Nations who are Status or Non-Status,
                                O n or O ff-reser v e.
A IDS                           A cquired Immune Deficiency Syndrome
                                A tte n ti o n D e fi c i t D i so r de r /A tte n ti o n D e fi c i t
                                Hyperactiv ity Disorder
A SHA C                         A boriginal Strategy on HIV/A IDS in Canada
ANAC                            A boriginal Nurses A ssociation of Canada
A PHA                           A boriginal Person liv ing with HIV/A IDS
CA A N                          Canadian A boriginal A IDS Network
CA S                            Canadian A IDS Society
CATIE                           Canadian A IDS Treatment Information Ex change
                                A Peer Education and Counselling Training manual
                                recently dev eloped for A boriginal O ffenders around
Circles of K nowledge Keepers
                                H IV, T u be r c u l o si s an d H e pati ti s av ai l abl e th r o u g h
                                CA A N.
CSC                             Correctional Ser v ice Canada
CSHA                            Canadian Strategy on HIV/A IDS
CHA L N                         Canadian HIV/A IDS L egal Network
CIHA N                          Canadian Inuit HIV/A IDS Network
CTA C                           Canadian Treatment A ction Council
EG A L E                        Equality for G ays and L esbians Ev er ywhere
                                Emerging Issues Committee of the A SHA C Work ing
                                G roup
                                Fetal A lcohol Spectrum Disorder formally k nown as
                                FA S/FA E
                                 A so c i al po l i c y appr o ac h , i n i ti al l y appl i e d to
                                injection drug use, yet can be adapted to respond
Harm Reduction                  to o th e r d r u g u s e i n c l u d i n g a l c o h o l , w h o s e fi r s t
                                priority is to decrease negativ e consequences from
                                drug use.
HA V/HBV/HCV                    Hepatitis A , B or C Virus, respectiv ely
HIV                             Human Immunodeficiency Virus
                                A nother term for hermaphrodite, a person born with
Inter-sex ed
                                genitals that show characteristics of both sex es.
                                 A medication used to support addicts to stop using
Methadone Maintenance
                                injection drugs, more commonly heroin.

NA CHA              National A boriginal Council on HIV/A IDS
                    A group of national organizations that play k ey roles in the HIV/A IDS
National Partners   h e a l th fi e l d a n d c o l l e c ti v e l y p r o v i d e a d v i c e to th e fe d e r a l
                    Stre e t-o utre ac h se r v ic e age nc ie s that distribute c le an, unuse d
                    needles in exchange for the used ones as part of harm reduction.
Needle Exchanges
                    Education, counselling, condoms and other types of support are
                    also provided.
                    N a ti o n a l I n d i a n a n d I n u i t C o m m u n i ty H e a l th R e p r e s e n ta ti v e s
                    O rganization
NNA DA P            National Native A lcohol and Drug A buse Prevention
                    O wnership, Control, A ccess and Possession. Refers to the status
                    Information and programs intended to benefit A boriginal people
                    In Can ada an d th at th e se pro gram s sh o u l d be ru n u n de r th e
                    princ iple s o f O CA P me aning that the y are o wne d, c o ntro lle d,
                    ac c e sse d an d po sse sse d by A bo r i g i n al Pe o pl e fo r A bo r i g i n al
                    people. The A SHA C is committed to the principles of O CA P            .
                    A n o rgan i zati o n i de n ti fi e d i n o n e o r m o re o f th e gro u ps l i ste d
Stak eholder        A ppendix C. A ny group or individual who can affect or is affected
                    by this Strategy.
Social Mark eting   Use of resources with targeted methods to mark et social change.
                    People who feel they are members of the opposite sex with which
                    t h e y w e r e b o r n . T h i s e x i s t s w i t h o r w i t h o u t t h e n e e d /d e s i r e t o
                    change their bodies. Transgendered people may or may not tak e
                    hormones and may or may not have genital surger y.
                     A g e n e r i c te r m u s e d m o s tl y b y s o m e F i r s t N a ti o n s a n d M é ti s
                    people to describe from a cultural perspective, people who are
Two-Spirited        k n o wn i n m ai n stre am as e i th e r gay, l e sbi an , bi se x u al o r i n te r-
                    sexed/transgendered. It is used in place of words which may exist
                    in Indigenous languages, such as the Wink te in L ak ota culture.
WG                  Work ing G roup of the A SHA C.
WG 2                Phase 2 members of the Work ing G roup of the A SHA C.
                    A committee that work s within the Work ing G roup to support the
WG 2 Secretariat
                    Strategy Coordinator and help plan and guide all meetings.

                                                             Guiding Principles

•   First and foremost, show respect and honour for all Aboriginal beliefs, practices
      and customs, acting with pride and dignity that Aboriginal heritage demands.

•   Remember who we are, as Inuit, Métis and First Nations People while keeping a
     community-based approach.

•   Recognize the importance and contributions of those living with HIV in develop-
     ing the strategy and in all its phases and implementation.

•   Strive to ensure that Aboriginal people will be afforded the best possible ac-
     cess, to an improved and equitable quality of health, life and wellness.

•   Support and demonstrate unity amongst all Aboriginal people regardless of
     where they reside and without distinctions which may be drawn between
     Status and Non- Status First Nations, or amongst Métis and Inuit people.

•   Support and uphold the principles of OCAP (Ownership, Control, Access and
     Possession) of information and programs by Aboriginal People.

•   Honour and respect the commitments to all Aboriginal People living with and
     affected by HIV/AIDS in Canada.

•   Honour and respect the commitments to the stakeholders.

                     Strengthening Ties - Strengthening Communities

                                                              1.0       Executive Summar y

HIV/AIDS among Aboriginal people in                   tinue to be quite high. Although infection rates
Canada, is a serious health issue with an ever        vary among Inuit, Métis, and First Nations
increasing need for action and strategic plan-        people, there is an over-representation for
ning. As infection rates continue to rise, more       Aboriginal people in terms of HIV/AIDS,
and more Aboriginal people, their families and        who make up approximately 4.4% of the Ca-
communities are faced with the many and               nadian population, yet are seeing HIV/AIDS
complex challenges that go with this disease.         figures continue to rise. There are wide gaps
Although new medications are helping peo-             in the data, and more research with the full
ple live longer - there remains no cure. Abo-         involvement of Aboriginal people, is needed
riginal Leaders are called upon to speak pub-         to accurately reveal how this disease is im-
licly about this serious health issue. There is       pacting Inuit, Métis, and First Nations peo-
an urgency that requires political support, so        ple.
that HIV/AIDS among Aboriginal people is
properly addressed. Further examples of how           This strategy will offer a vision for Inuit, Métis
Aboriginal Leaders can support this cause, is         and First Nations1 (status or non-status, on or
found at the beginning of the nine strategic          off-reserve) people to respond to HIV/AIDS.
areas, which could include council resolutions        It will outline and describe key issues and nine
ensuring respect for individual human rights,         strategic areas which can be taken to ensure
lobbying for increased funding, etc.                  that a range of programs and services are in
                                                      place to meet the needs of Aboriginal People
Access to adequate care, treatment and sup-           Living with and affected by HIV/AIDS. The
port can be a huge task when many Aborigi-            following nine strategic areas were selected
nal people live below the poverty line: some          after researching all Provincial/Territorial
are incarcerated, while others yet are dealing        Aboriginal HIV/AIDS strategies, some main-
with issues that complicate prevention meth-          stream HIV/AIDS strategies in Canada, and
ods, such as injection drug use or the Resi-          the National Australian HIV/AIDS Strategy.
dential School Legacy. Northern communi-              Common ground made its way into this docu-
ties also face sub-standard health with little        ment, as each strategy reviewed essentially
access to healthcare because of their isola-          were stating the same issues, just in different
tion. As well, different health care coverage         language and formats.
exists within Aboriginal populations depend-
ing on the status of individuals in-
cluding residency and system in-
volvement.                                                       1 This document will use the term "Abo-
                                                                 riginal", which is meant to include Inuit,
                                                                 Métis and First Nations (On or Off-reserve,
From what is known through epi-
                                                                 Status or Non-Status) people.
demiological evidence, between
1996-1999 both cumulative (91%)
and new (19%) HIV infections con-

  An Aboriginal Strategy on HIV/AIDS in Canada for First Nations, Inuit and Métis People

                     Strengthening Ties - Strengthening Communities

These nine key strategic areas are:                    needed, assist in the development of frame-
•    Coordination and Technical Support                works, action plans, protocols and other tools.
•    Community Development, Capacity                   Much of the early advocacy and prevention
       Building and Training                           efforts around HIV/AIDS started in urban
•    Prevention and Education                          areas. However, there have also been good
•    Sustainability, Partnerships and Col-             examples from on-reser ve and isolated
       laboration                                      populations. One example was the establish-
•    Legal, Ethical, and Human Rights Is-              ment of the Atlantic First Nations AIDS Task
       sues                                            Force (now Healing our Nations), which mo-
•    Engaging Aboriginal Groups with Spe-              bilized from a regional perspective. Another
       cific Needs                                     is the Canadian Inuit HIV/AIDS Network,
•    Supporting Broad-based Harm Reduc-                which has actively engaged its members to
       tion Approaches                                 raise the profile of HIV/AIDS among Inuit.
•    Holistic Care, Treatment and Support              Numerous other resources have been devel-
•    Research and Evaluation                           oped in other regions, for First Nations on and
                                                       off-reserve, as well as with Inuit and Métis
The title was chosen to reflect the need to            rural HIV/AIDS response teams exist in some
create stronger ties, at any level. By doing so,       regions.
HIV/AIDS work will not operate in isolation
of other health and social issues. Whether it          It is with these in mind that the ASHAC will
is creating a Community Wellness Team, a               seek to provide broad strokes that will bring
Regional Network, or bringing together groups          together current efforts and resources. This
on a national level - the potential exists to          Strategy is not about prescribing a vision. It
strengthen the response to HIV/AIDS among              is about building common ground that can
Aboriginal communities. The Aboriginal Strat-          enhance, guide, support and complement work
egy on HIV/AIDS in Canada (ASHAC) is not               in all regions so that Aboriginal people can
about competing with regional and local ef-            continue to find innovative ways of taking
forts - it is more about offering support and          control of a disease that has taken far too
national coordination that can strengthen ties         many lives. Aboriginal people are not a spe-
and strengthen Aboriginal communities. By              cial interest group, and have been impacted
doing so, it will identify and support meas-           differently by HIV/AIDS, resulting in varied
ures which can take Aboriginal people that             responses based on a number of reasons. The
much closer to meeting and overcoming the              last section will offer glimpses into issues and
many challenges related to HIV/AIDS.                   factors that may be affecting a diverse listing
                                                       of groups, such as injection drug users,
In some parts of Canada, Provincial/Territo-           women, men, etc. There is also an appendix
rial Aboriginal HIV/AIDS Strategies are in             D, which is the Consultation process used
existence. The ASHAC will build upon these             which reached 173 Aboriginal and non-Abo-
regional strengths to support and encourage            riginal people across the country.
other regions to develop strategies, create and
maintain effective networks, and where

  An Aboriginal Strategy on HIV/AIDS in Canada for First Nations, Inuit and Métis People

                       Strengthening Ties - Strengthening Communities

                      2.0        Background: Why an Aboriginal Strategy Now?

The ASHAC comes at a time when we are                   Two broad goals will be supported by the
several years past the first and second phases          ASHAC, which are:
of the National AIDS Strategy (NAS), now                •   ensure the best possible efforts, in
known as the Canadian Strategy on HIV/                        all areas, are placed to meet the
AIDS (CSHA). It has only been in recent years                 needs of Aboriginal People living
that the Canadian Aboriginal AIDS Network                     with HIV/AIDS; and
(CAAN) had secured resources to build and               •   prevent the further spread of HIV/
maintain a national coalition which is deter-                 AIDS       among      Aboriginal
mined to respond to this health issue. The                    populations, through education,
key advantage of having an organization like                  awareness, and whatever means
CAAN is that it has a single health issue as its              available and necessary.
sole mandate - which is HIV/AIDS.
                                                        Underlying these broad goals, is the recogni-
As stated earlier, HIV/AIDS among Aborigi-              tion that because Aboriginal people are fam-
nal communities has seen a steady increase in           ily-based, support is also needed for those af-
the numbers of infections. As Aboriginal peo-           fected by this disease, such as family mem-
ple are largely family-based cultures, this means       bers, partners, and HIV/AIDS workers to
that for every Aboriginal person that is living         name a few. These two goals will be realized
with HIV or AIDS, an entire immediate and               through the nine key strategic areas which
extended family system is being affected. In            have specific objectives and expected out-
a country such as Canada, with all its resources        comes attached to direct the work. These are
and expertise, it is simply unacceptable how            found later in this document under section 5.
Aboriginal communities continue to be in-               The Canadian Strategy on HIV/AIDS has six
fected and affected by a preventable disease.           goals (see page 9) that the ASHAC supports,
                                                        yet some of those goals are beyond the direct
                                                        scope of the Aboriginal community. For in-
A strategy can be defined as“a careful plan or          stance, it is unlikely Aboriginal HIV/AIDS
method.”2 The ASHAC will be plan out areas              dollars will be doing medical research to find
to reach certain goals. Some people may un-             a cure, yet ASHAC supports continued efforts
derstand strategy and strategic planning dif-           to find a cure, so that ALL people living with
ferently. This strategy is about setting future         HIV/AIDS can rid this disease from their
directions, and does not deal with                                  bodies and lives. This can also in-
day to day operations, which is oth-                                clude reducing the factors that place
erwise known as operational plans.                                  individuals at risk for HIV.

                                                                   A key advantage regarding the
 Webster’s Ninth New Collegiate                                    ASHAC, is the potential exists to
Dictionary, Merriam-Webster Inc.1989                               use resources more wisely, rather
                                                                   than rushing into areas which have

    An Aboriginal Strategy on HIV/AIDS in Canada for First Nations, Inuit and Métis People

                     Strengthening Ties - Strengthening Communities

not been properly planned out. What this               irregardless if they are heterosexual, homo-
means is that without a plan, whatever actions         sexual, bisexual, women, babies develop HIV
that are taken stand the risk of not being ef-         from HIV+ mothers, youth, or older individu-
fective. Some of the earlier efforts in the            als.
Aboriginal AIDS movement can now be re-
viewed with more objectivity. In essence, the          Yet some groundwork within the Aboriginal
lessons learned from a few fledgling Aborigi-          community was being laid to support the even-
nal AIDS Service organizations, can now be             tual realization of a national Aboriginal AIDS
said to be the normal growing pains of groups          network, as well as this strategy. As HIV/
who knew there was a serious issue facing Abo-         AIDS is growing significantly among Aborigi-
riginal people, but struggled with creating an         nal populations and within most groups in
effective organization to meet the challenges.         Aboriginal societies, this strategy is built upon
                                                       the lessons learned from years of advocacy
Thus, the absence of an Aboriginal HIV/                and hard work. It is also built on hope, that
AIDS Strategy has been felt for sometime. In           as Aboriginal People who have endured so
its place the federal strategy guided actions,         much, our spirit and determination remains
but several factors complicated efforts to ef-         strong. It is this fact that will allow Aborigi-
fectively reach Aboriginal populations. Some           nal Cultures and Traditions to meet the chal-
were systematic weaknesses found in the fed-           lenges head on.
eral funding, as many Aboriginal AIDS Serv-
ice organizations were quite late in getting           Achieving Holistic Health
started. In the first and second phases of the
federal strategy, the main source of funds that        Determinants of health which are factors
could be accessed by Aboriginal groups were            known to affect or influence a persons health,
known as "special projects", which meant they          can be either negative or positive. Negative
were time-limited.                                     determinants can be such things as living in
                                                       poverty, having inadequate or no housing, as
Medical Services Branch (now called First              well as childhood traumas that remain unre-
Nations & Inuit Health Branch) also offered            solved. Positive determinants can be getting
funding for On-reserve and Inuit communi-              higher education, having stable home environ-
ties, but again, these funds did not support           ments, or strong cultural connections. Gen-
organizational structures. Other factors ex-           erally, the main factor affecting the health of
perienced, included the fact that, as with main-       Aboriginal people is socio-economic status,
stream populations, HIV/AIDS first began af-           in addition to environmental factors. Many
fecting Two-Spirited (gay) males, and also             Aboriginal people experience higher rates of
occurred mostly in larger urban centers. Thus,         disease and extensive health issues, mainly
many Aboriginal political leaders, and even            because these social determinants of health
health portfolios did not heed the warnings            are much lower for far too many Aboriginal
being raised. Today, we know that HIV/AIDS             people.
is being spread through unprotected sex and
injection drug use among all people,

  An Aboriginal Strategy on HIV/AIDS in Canada for First Nations, Inuit and Métis People

                     Strengthening Ties - Strengthening Communities

When there are too many negative determi-
nants in a person's life, the risks for HIV/AIDS
and other diseases increase. Aboriginal com-
munities have experienced major negative
forces, like the Residential School Legacy.
While Aboriginal people's experiences are not
all the same, there are some common issues,
such as: a loss of language, culture, and tradi-
tional use of land. As well, systemic discrimi-
nation; gender inequality and displaced roles;
are just some of the other forces that have
shook the foundations that Aboriginal cultures
once thrived upon. It is easy to see how many
of these underlying issues can complicate in-
tervention strategies. For many Aboriginal
people, achieving holistic health after genera-
tions of trauma and losses, is necessary to re-
building our societies and in order for our
health conditions to improve, including re-
moving much of the risk for HIV and AIDS.
Holistic health is about finding balance emo-
tionally, physically, spiritually, and mentally.

Northern and isolated communities face chal-
lenges brought on simply by their geographic
location, such as access to adequate resources
and health systems. Language can also be a
factor when an indigenous language is mostly
spoken such as Inuktitut, Slavey, or Cree,
while many of the resources are printed in
English and/or French. Few hospitals or clin-
ics offer services in indigenous languages, or
provide interpreters who can. The ASHAC rec-
ognizes that HIV/AIDS is one of the many
health and social challenges facing Aborigi-
nal people today. The need for an Aboriginal
Strategy is largely based on the information
in the next section, as well as what has been
echoed by Aboriginal HIV/AIDS advocates
in the last ten years or so.

  An Aboriginal Strategy on HIV/AIDS in Canada for First Nations, Inuit and Métis People

                     Strengthening Ties - Strengthening Communities

                          3.0                                         Populations
                                        HIV/AIDS Among the Aboriginal Populations

Although there are numerous gaps in research          describe the potential behind how this disease
and surveillance data, there have been im-            may continue to unfold. In essence, these fig-
provements in trying to gauge more accurately         ures describe only part of the situation, and
how HIV/AIDS is truly impacting the Abo-              not the whole picture.
riginal populations. One reason for the inac-
curate picture is that some provinces, like           HIV Figures:
Ontario, do not collect ethnic identifiers mak-
ing it hard to determine how many new infec-          From 1996 to 1999, there was:
tions and cumulative cases exist. In other ar-        •    an estimated 91% (ninety-one) increase
eas, the physician or testing site may not ask              (from 1,430 to 2,740) in the number
or accurately determine if a patient is Abo-                of Aboriginal people living with HIV;
riginal, simply because they may be faired            •     an estimated 19% (nineteen) increase
skinned or could resemble another ethnic                    (from 310 to 370 infections) in the
group. Although the statistics presented here               number of Aboriginal people newly
are significant, HIV trends may differ from                 infected with HIV.
region to region and community to commu-
nity, as well as between Inuit, Métis and First       Of the estimated 2,740 Aboriginal people liv-
Nations. In fact, some groups have different          ing with HIV infection at the end of 1999,
risk factors as the main methods of HIV trans-        their risk factors for HIV infection were:
mission for them.                                     •        54% through injection drug use;
                                                      •        15% through heterosexual sex;
While some people feel statistics soon become         •        23% through male-to-male sexual ac-
outdated, or can present an inaccurate picture                 tivity;
of how HIV/AIDS is affecting specific                 •        6% through male-to-male sexual ac-
groups, there is value to seeing how figures                   tivity and injection drug use.
have been increasing. It is important to lo-
cate information that is more relevant to ones        Among this estimate of 370 Aboriginal peo-
own community or region. This disease con-            ple newly infected with HIV, their risk factors
tinues to infect and affect high numbers of
Aboriginal people.

The figures below come from a
number of studies, and may not
best describe regional variations, or
those between Inuit, Métis, and the
various First Nations. However, as
many Aboriginal people experience
similar socio-economic issues,
some of what is stated below may

  An Aboriginal Strategy on HIV/AIDS in Canada for First Nations, Inuit and Métis People

                        Strengthening Ties - Strengthening Communities

for HIV infection were:
•      64% through injection drug use;
•      17% through heterosexual sex;
•      11% through male-to-male sexual ac-
•      8% through male-to-male sexual ac-
       tivity and injection drug use.3

AIDS Figures:

       “As of December 31, 2001, there has
been 18,026 AIDS cases reported to the Cen-
tre for Infectious Disease Prevention and Con-
trol in Canada. Of that total, 437 were re-
ported as Aboriginal persons (17 Inuit, 34
Métis, 354 Native Indians (i.e. First Nations)
and 32 Aboriginal unspecified).”4

       As can be seen, unprotected sex and
injection drug use are playing key roles in the
transmission of HIV/AIDS among many Abo-
riginal people - regardless of residency, eth-
nicity, or sexual orientation. It is no longer
just a gay disease.
 Centre for Infectious Disease Prevention and Control,
Health Canada, HIV and Aboriginal People in Canada: A
Report on the Estimated Number of HIV Infections
Among Aboriginal People in Canada. Prepared by the
Focus Group on Aboriginal HIV Estimates and Bureau
of HIV/AIDS, STD and TB, May 2001.

 HIV/AIDS Epi Update, Centre for Infectious Disease
Prevention and Control, Health Canada. April 2002

    An Aboriginal Strategy on HIV/AIDS in Canada for First Nations, Inuit and Métis People

                     Strengthening Ties - Strengthening Communities

                                 4.0       Canada's Strategy on HIV/AIDS (CSHA)

The Canadian Strategy on HIV/AIDS (CSHA)             ever, much more needs to be done among the
has been designed to continue efforts on this        Aboriginal populations to prevent the need-
serious health issue. The CSHA has six goals         less loss of lives, to properly care and support
and the ASHAC will work within these through         those now living with the disease and to meet
the measurable objectives and expected out-          the prevention challenges related to HIV/
comes later presented under nine key areas.          AIDS and other illnesses like Hepatitis C.
Obviously, some of the following CSHA goals
will not be the primary responsibility of the        In order for this to happen, Aboriginal and
ASHAC, such as finding a cure or finding ef-         non-Aboriginal stakeholders and governments
fective vaccines, drugs and therapies. Cer-          must take collaborative efforts that will en-
tainly Aboriginal people can participate in          sure this health issue is met with all the re-
medical research, including clinical trials,         sources it requires so that Aboriginal people
however it is unlikely that Aboriginal HIV/          living with and affected by HIV/AIDS are not
AIDS resources would be devoted to these             alone.
areas. Traditional medicines also require rec-
ognition, since some people choose to pursue
this approach to treating their illness.

The six goals of the CSHA are:
•    to prevent the spread of HIV infection
       in Canada;
•    to find a cure;
•    to find effective vaccines, drugs and
•    to ensure effective care, treatment and
       support for Canadians living with
       HIV/AIDS, and for their families,
       friends and caregivers;
•    to minimize the impact of HIV/AIDS
       on individuals and communities; and
•    to counter the social and economic fac-
       tors that increase individual
       and collective risk of HIV

Within the CSHA, and in light of
more than two decades that this dis-
ease has been in North America, a
lot of work has been done. How-

  An Aboriginal Strategy on HIV/AIDS in Canada for First Nations, Inuit and Métis People

                     Strengthening Ties - Strengthening Communities

                                                       5.0           Key
                                                                Nine Key Strategic Areas

The ASHAC will support the following key               based staff get the direction and support they
strategic areas:                                       need to develop programs and services is criti-
1     Coordination and Technical Support;              cal to fighting this battle.
2     Community Development, Capacity
       Building and Training;                          There is a critical role that Aboriginal Lead-
3     Prevention and Education;                        ers can play in each of these strategic areas
4     Sustainability, Partnerships and Col-            and in the overall struggle to overcome all the
       laboration;                                     challenges that come with HIV/AIDS. Abo-
5     Legal, Ethical and Human Rights Issues;          riginal Leaders need to speak publicly about
6     Engaging Aboriginal Groups with Spe-             HIV/AIDS so that Aboriginal communities
       cific Needs;                                    hear their Leaders talking about these issues
7     Supporting Broad-based Harm Reduc-               and begin to take it more seriously. A few
       tion Approaches;                                examples for Aboriginal Leaders can be:
8     Holistic Care, Treatment and Support;            negotiating Health Transfer agreements which
       and                                             include adequate HIV/AIDS programming
9     Research and Evaluation.                         needs;
                                                       passing Band/Hamlet/Settlement Council
Each of these strategic areas will be intro-           Resolutions to ensure that Aboriginal People
duced, and described more fully with a ration-         living with HIV/AIDS in their communities
ale, objectives and expected outcomes. Be-             are not discriminated against;
fore doing so, a message to Aboriginal Lead-           supporting lobbying efforts to ensure that ad-
ers is provided.                                       equate funding is available to combat this
                                                       health concern; and
ABORIGINAL LEADERSHIP                                  simply learning enough about this disease so
                                                       that it gets the proper attention and any mis-
Elected Aboriginal Leaders as a group, are no          conceptions can be removed.
more at risk than whatever their sexual orien-
tation, gender, or risk behaviors may be. They         COORDINATION AND TECHNICAL
are listed here as a group that requires educa-        SUPPORT
tion about all the aspects involved in HIV and
AIDS. Whether at the community level,                  Coordination and technical support will be
through regional bodies or the na-                              carried out by the Strategy Coordi-
tional scene, greater work is re-                               nator and will focus on linking Pro-
quired to ensure that HIV/AIDS                                  vincial/Territorial/Local levels up
stays on the agenda of political or-                            to the national level. As the HIV/
ganizations. These types of part-                               AIDS epidemic changes, coordina-
nerships can lead to a stronger                                 tion and technical support will re-
voice. Likewise, engaging Aborigi-                              spond accordingly. Understanding
nal Leaders so that community-                                  the Canadian and Provincial/Ter-

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                     Strengthening Ties - Strengthening Communities

ritorial Aboriginal HIV/AIDS strategies is key          •     to utilize various communication meth-
to the success of the ASHAC and is the basis                    ods to ensure timely and accurate in-
for forming partnerships and supporting local                   formation flow to/from national level
initiatives.                                            •     to identify and provide advocacy, which
                                                                is to represent issues and influence
The ASHAC is viewed as a parallel approach                      outcomes, and support regional/local
within the CSHA. The process will be dynamic                    levels in order to share information
with information coordinated at the national                    and learn from varied experiences
level, and local experiences relayed up to the          •     to provide technical support to assist,
national level. This creates an "Information                    when requested, in the development
Clearinghouse" for which coordinated efforts                    of regional strategies, networks,
can support regional funding initiatives and                    protocols, frameworks, proposal writ-
program development needs.                                      ing, etc.
                                                        •     to engage mechanisms for effective col-
This process will also result in the develop-                   laboration and partnership develop-
ment of new materials, up to date data re-                      ment to support regional and local ef-
flecting the health needs of Aboriginal Peo-                    forts, including advocating for appro-
ple, and a leadership role for the strategy to                  priate Federal/Provincial/Territorial
be a supportive document that will tie in to                    responses in critical areas
the NACHA and other key stakeholders. There             •     to create and/or update a directory of
can also be a role for ASHAC and CAAN to                        Aboriginal-specific HIV/AIDS re-
lobby for increased attention to Aboriginal                     sources and services
HIV/AIDS issues, or to advocate on certain              •     to conduct ongoing evaluation of the
issues that APHAs may be experiencing, such                     ASHAC.
as those with Child Tax Credits, or treatment
issues.                                                 Expected Outcomes:
                                                        •    strengthened network
Rationale:                                              •    increased awareness among Aboriginal
Central coordination and ongoing technical                     Communities of existing resources
and human support are available to support              •    effective communication system
regional/local HIV/AIDS efforts, while influ-           •    increased recognition of barriers to
encing related agencies/governments/funding                    overcome regarding mainstream com-
sources to be responsive in various areas listed               munication systems, including internet
throughout this document.                               •    increased advocacy effectiveness
                                                        •    improved communication and dialogue
Objectives:                                             •    increased response time for appropriate
•    to ensure central coordination is avail-                  actions
       able to Aboriginal People so that re-            •    enhanced organization at various lev-
       gional/local trends and issues are                      els
       known at the national level                      •    shared expertise

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•      newly developed initiatives at the re-             Rationale:
         gional/local levels                              Resources, including human, financial, infor-
•      improved cross-jurisdictional communi-             mational and others, are available to Aborigi-
         cation/action                                    nal communities for capacity building and
•      improved knowledge of resources and                sustained effective responses to HIV/AIDS.
•      increased accountability                           Objectives:
•      efficient local and regional input into na-        •    to provide accurate and timely informa-
         tional efforts                                          tion which can increase capacity to
COMMUNITY DEVELOPMENT, CA-                                •    to collaborate where possible and nec-
PACITY BUILDING AND TRAINING                                     essary to ensure human and financial
                                                                 resources are obtained
Community development, capacity building                  •    to recruit, retain, support and enhance
and training are key to the success of the                       more human resources by working
ASHAC, as well as the Aboriginal HIV/AIDS                        through Universities and Colleges,
movement in Canada. Capacity building can                        high school graduates, etc
include informal learning, whereas training               •    to support the creation and adoption of
generally (not always) involves more formal                      preferred practices, including minimal
learning environments. In large part, Aborigi-                   two-year project initiatives as the op-
nal communities are doubly burdened, both                        timal length for resource development
with the challenge of playing catch up to the                    and focus testing
rest of Canada in regard to HIV/AIDS, but                 •    to secure resources and support the de-
also because significant social, economic and                    sign and delivery of training packages
other health issues continue to exhaust re-                      to gain more qualified human re-
sources.                                                         sources to work in this health field,
                                                                 including certification processes, in-
Greater efforts are required to plan, design,                    service training opportunities and
create and support implementation and/or                         other professional development
adoption of preferred practices to ensure the             •    to encourage the establishment of in-
best possible use of both human and finan-                       ter-agency, rural and system response
cial resources. It is also critical to understand                teams or community wellness teams
that Aboriginal communities have generations              •    to assist in development of policy,
of negative impacts from failed government                       through meaningful public participa-
policy such as Residential Schools and assimi-                   tion.
lation in general. These have contributed di-
rectly and indirectly, to the multitude of un-            Expected Outcomes:
derlying issues that Aboriginal people experi-            •    skilled, knowledgeable workers
ence.                                                     •    accurately informed workers
                                                          •    mobilized communities
                                                          •    cross-jurisdictional support

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                      Strengthening Ties - Strengthening Communities

•      matured and nurtured workforce with                Rationale:
         expanded expertise                               Increased focus is directed toward prevention
•      expanded workforce opportunities                   and education efforts, especially targeted pre-
         gained through individuals in ad-                vention messages to curb increases in HIV/
         vanced learning environments                     AIDS.
•      appropriate, culturally designed re-
         sources                                          Objectives:
•      increased effectiveness in design and im-          •    to examine and enhance current preven-
         plementation                                            tion efforts by convening a national
•      enhanced staff and agencies                               meeting of Aboriginal HIV/AIDS
•      expanded workforce                                        educators to review and revise current
•      appropriately delivered staff/board ori-                  tools and methods being utilized, and
         entation                                                recommend new approaches
•      effective mechanisms at the local level            •    to create implementation strategies for
•      cross-jurisdictional collaboration                        hard-to-reach target groups which re-
•      strengthened ties and communities                         quire a specialized focus
•      increased understanding and community              •    to proclaim and promote adoption by
         support                                                 Aboriginal communities for a national
•      effective public policy                                   Aboriginal HIV/AIDS Awareness
                                                                 Week with new promotional methods
PREVENTION AND EDUCATION                                         and resources to be developed
                                                          •    to assist in the development and utili-
Because HIV/AIDS is a preventable disease,                       zation of evaluation tools and meth-
significant energy and resources are required                    ods
to ensure that accurate and timely informa-               •    to collaborate with related agencies and
tion is being delivered. There is also a need                    services to ensure appropriate means
to ensure that targeted messages are designed,                   and efforts are secured
created and implemented which look at spe-                •    to design and deliver age appropriate
cific high-risk activities, such as injection drug               prevention messages starting at mini-
use or unprotected sex. All this must be done                    mum, grade 5.
within the context of the community and en-               •    to develop, where appropriate, addi-
vironment where prevention and education are                     tional prevention and education re-
being delivered and in proactive ways. The                       sources to respond to any existing gaps
use of Aboriginal languages and other cultur-                    or future needs.
ally appropriate means, are also needed and               •    to examine and develop appropriate ini-
necessary. Inmate populations, street-involved                   tiatives to address mother-to-child
people, youth, and others all require appro-                     HIV transmission.
priate interventions. More information is
available in the section on Diverse Groups -              Expected Outcomes:
Many Needs, on some of the key issues fac-                •    enhanced prevention and education mes-
ing specific groups.                                             sages/approaches

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•     expanded, working knowledge of broad            nal People at alarming rates. People who work
        and targeted deliveries                       in the HIV/AIDS field are required to be
•     increased and updated resources                 knowledgeable of numerous areas and issues.
•     formalized, appropriate and current edu-        Sexual health, sex education, addictions, op-
        cation messages                               portunistic infections, medications including
•     increased awareness of issues facing            drug resistance and negative interactions, psy-
        hard-to-reach groups                          cho-social issues including home or palliative
•     increased collaboration with shared ex-         care and holistic support, are all issues that
        pertise                                       come to play. There is greater need to broaden
•     shared knowledge of current trends and          our reach, so that related issues and initiatives
        emerging issues                               can partner and collaborate so that this work
•     enhanced awareness campaigns                    is sustainable or lasting. Sustainability rests on
•     mobilized regions and communities               how well efforts can influence and create posi-
•     broadened support through more                  tive outcomes. It is important to avoid a com-
        knowledgeable communities                     petition mind set between groups doing HIV/
•     effective delivery and refined ap-              AIDS work. This is especially true since there
        proaches                                      are few human and financial resources avail-
•     appropriately developed and maintained          able. Also, some people do not see govern-
        programs                                      ment staff as partners, yet there is value for
•     broadened awareness and support                 both stakeholders to find mutual ways of fur-
•     cross-jurisdictional approaches                 thering the HIV/AIDS agenda.
•     better informed children and youth
•     healthier life approaches to sex and            Rationale:
        sexuality, alcohol and drug use, and          Broader partnerships and collaborative efforts
        other related issues                          are created and maintained to widen the reach
•     enhanced and relevant educational de-           of interventions around HIV/AIDS and re-
        livery                                        lated issues.
•     up-to-date information delivery
•     enhanced and relevant educational de-           Objectives:
        livery                                        •    to identify, consult and develop effec-
informed and appropriate treatment choices                   tive partnerships and collaboration
                                                             (Alternative Justice, NNADAPP, Edu-
SUSTAINABILITY, PARTNERSHIPS                                 cation, Health, Homecare, CATIE,
AND COLLABORATION                                            CAS, CSC, ANAC, etc.)
                                                      •    to engage in an annual Stakeholders*
      Sustainability is about designing com-                 Consultation process to present and
prehensive efforts that can ensure HIV/AIDS                  review progress and set upcoming and
work gets incorporated into all relevant serv-               ongoing targets
ices and agencies. In this way, the necessary         •    to identify and survey key stakeholders
response can be formed and maintained be-                    on needs, issues and barriers encoun-
cause clearly, HIV/AIDS is affecting Aborigi-                tered in the design and implementa-
                                                      * see definition and list of stakeholders in Appendix C

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                      Strengthening Ties - Strengthening Communities

         tion of HIV/AIDS programs and                   •     improved and maintained communica-
         services within their structures                        tion
•      to support and utilize where appropri-            •     increased understanding of Aboriginal
         ate, cross-cultural sensitivity training                cultural norms
         for non-Aboriginal workers/agencies             •     enhanced service delivery
         who work with Aboriginal people                 •     increased effectiveness behind partner-
•      to identify and support means to col-                     ships
         laborate with Hepatitis C groups who            •     shared partnership roles
         address similar issues, which can in-           •     improved governmental/community re-
         clude dual-infection with HIV                           lationship
•      to advocate for greater transparency              •     accountability
         with governmental stakeholders, (e.g.
         Correctional Service Canada, etc.)              LEGAL, ETHICAL, AND HUMAN
•      to insist government departments en-              RIGHTS ISSUES
         gage Aboriginal input regarding deci-
         sions affecting policy and programs             HIV/AIDS is still largely misunderstood
         related to HIV/AIDS and determi-                which often results in fear and other reactions
         nants of health.                                which contribute to the alienation felt by those
                                                         living with and affected by this disease. In
Expected Outcomes:                                       some cases, people living with this illness are
•    strengthened ties                                   wrongly discriminated against, such as not
•    increased effective programs and serv-              having their confidentiality respected or not
       ices                                              being offered employment, just because they
•    shared expertise accessed in an ongo-               have HIV. Fear is a powerful obstacle, yet
       ing manner                                        the key behind ensuring individual human
•    collaboratively designed initiatives and            rights are respected, is to remove fear by edu-
       integrated services                               cation and awareness. It is also important to
•    increased accountability and effective              recognize that Aboriginal People living with
       mechanisms to evaluate the ASHAC                  HIV/AIDS are our relatives. They can be our
•    collective response processes                       brother, sister, uncle, aunt, mother, father,
•    effective mechanisms to collect and                 child, or cousin.
       analyze regional/local trends, issues
       and priorities                                    Reports exist from HIV/AIDS advocates that
•    increased and coordinated support and               tell of HIV positive individuals not being
       technical services                                welcomed in their community. Likewise, non-
•    increased awareness, shared informa-                Aboriginal service providers may also over-
       tion and broadened reach                          look basic client rights, either through igno-
•    increased access to current and relevant            rance or indifference. Specific work must be
       resources                                         done to ensure less of these types of viola-
•    shared best practices and lessons learned           tions occur. Tools need to be developed and
                                                         supported, so that Aboriginal communities can

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                     Strengthening Ties - Strengthening Communities

better understand and be trained in what is                   or minimizing impacts felt from policy
involved when respecting and protecting in-                   and program guidelines which differ-
dividual rights, including such things as Labor               entiate groups based on ethnicity or
Codes, and various resolution processes.                      risk behaviors

Rationale:                                             Expected Outcomes:
Address discrimination and ensure human                •    increased knowledge and respect for in-
rights and other legal, ethical issues are re-                dividual rights and responsibilities
spected and adopted within Aboriginal com-             •    informed APHAs of their rights, includ-
munities and by non-Aboriginal service pro-                   ing avenues and tools to handle griev-
viders.                                                       ances
                                                       •    better informed communities, agencies/
Objectives:                                                   services for APHAs
•    to inform, educate, promote and sup-              •    adopted and implemented protocols
       port the rights of Aboriginal People            •    increased awareness, sensitivity and re-
       living with HIV/AIDS within existing                   sponse to APHA needs, issues and
       local/regional structures, both Abo-                   concerns
       riginal and non-Aboriginal                      •    more informed and culturally sensitive
•    to discuss stigma and other types of dis-                non-Aboriginal operated services/
       crimination at all levels                              agencies
•    to collaborate with related agencies/             •    increased action to protect and respect
       services (EGALE, CHALN, Cana-                          the rights of APHAs, including fam-
       dian/regional Human Rights Commis-                     ily members and partners needs
       sions, etc.) to create more supportive,         •    increased knowledge and capacity to in-
       knowledgeable and caring environ-                      tervene in human rights violations,
       ments for Aboriginal People living                     and other legal, ethical issues
       with HIV/AIDS based upon Tradi-                 •    increased support and protection of
       tional & Cultural practices/teachings                  human rights and other legal, ethical
•    to plan, design, create and strengthen                   issues
       advocacy efforts by collaborating with          •    increased understanding of concepts
       currently funded initiatives, agencies                 and impacts of stigma and various
       and services, which can support and                    forms of discrimination
       educate communities to resolve and              •    removed and/or minimized impacts felt
       avoid human rights violations and en-                  from such occurrences
       sure confidentiality
•    to support, via policy templates Band/            ENGAGING ABORIGINAL GROUPS
       Hamlet/Settlement Council resolu-               WITH SPECIFIC NEEDS
       tions of respect
•    to define areas of concern and systemic           HIV/AIDS affects just about every group in
       discrimination, and to meaningfully             Canada and it matters little what your ethnic
       engage Aboriginal people in removing            roots are, how much money you have, or where

  An Aboriginal Strategy on HIV/AIDS in Canada for First Nations, Inuit and Métis People

                     Strengthening Ties - Strengthening Communities

you live. Although Inuit, Métis and First Na-           Rationale:
tions people have things in common, such as             Aboriginal people who come from groups with
assimilation, there are significant differences         specific needs are engaged and supported to
as well. A wide range of languages, values,             help design appropriate and relevant initiatives
customs and beliefs exist, not to mention hun-          that will target these needs (i.e. injection drug
dreds of years of disruptive influences. Nu-            users, inmate populations, two-spirited peo-
merous illnesses are among these influences,            ple, women, HIV+ children, families, etc.)
starting with measles and tuberculosis to now
HIV/AIDS.                                               Objectives:
                                                        •    to examine and enhance current preven-
Even within Aboriginal populations there are                   tion efforts by convening a meeting of
certain risk activities and issues that can con-               Correctional Elders, Halfway Houses,
tribute to how wide HIV/AIDS can impact a                      Alternative Justice, Healing Lodges,
group. Injection drug use is one, unprotected                  etc. to discuss and develop an action
sex is another, and for some people who find                   plan and increase advocacy role
themselves marginalized, or feel apart or iso-          •    to support implementation and timely
lated from their community - their circum-                     follow-up on the Circles of Knowl-
stances can mean the difference between                        edge Keepers manual, and expand
knowing and understanding the risks they may                   training and delivery to include Half-
face. The purpose here is when working with                    way Houses, Healing Lodges, etc. in
specific groups, it is best to meaningfully en-                an effort to create a solid base of pre-
gage members from these groups in all aspects                  vention and support workers
of how a program or service can best meet               •    to recruit Knowledge Keepers where
their needs. Cross-cultural training, increas-                 possible and when willing, to deliver
ing awareness among service providers, and                     prevention efforts for hard-to-reach
respecting individual choices are some exam-                   populations at the local level
ples where work is needed. As well, increas-            •    to create a National Aboriginal Task
ing Aboriginal participation in HIV/AIDS                       Force on Substance Use (Treatment
program planning, implementation and evalu-                    Centers, Prevention Workers, Harm
ation is another area.                                         Reduction programs, Street-Outreach
                                                               services, HIV/AIDS Organizations,
The issues around mental health and disabili-                  APHAs, etc.)
ties can also be an important issue to address.         •    to encourage and support development
Various players, such as Fetal Alcohol pro-                    of appropriate programs and services
grams, Public Health and other agencies can                    (direct and non-direct) for specific
be brought in to build effective approaches.                   groups (e.g. two-spirited people,
Community Health Workers are also a target                     women, men, children, youth, family
group to assist in this approach. Please re-                   members, partners, etc.) on specific
view the section, "Diverse Groups - Many                       risk activities
Needs" for more specific information re-                •    to ensure Aboriginal women are pro-
garding various issues.                                        vided access to current and accurate

  An Aboriginal Strategy on HIV/AIDS in Canada for First Nations, Inuit and Métis People

                      Strengthening Ties - Strengthening Communities

         information and support regarding                      hol Spectrum Disorder, Attention
         testing, prevention, sexual assault is-                Deficit Disorder, among others.
         sues, choices and treatment options
         around pregnancy and HIV/AIDS to                Expected Outcomes:
         address peri-natal HIV and HCV                  •    collaboratively developed action plan
         transmission, as well as female-specific        •    increased knowledge and awareness
         research on care and treatment issues,          •    enhanced prevention and support efforts
         which is both culture and gender spe-           •    increased number of human resources
         cific                                           •    enhanced programs and services
•      to continue to examine and respond to             •    mobilized efforts
         specific issues related to the role of          •    collaboratively developed initiatives
         unprotected sex in the spread of HIV/           •    focused efforts and interventions
         AIDS within all groups                          •    updated responses to new trends and
•      to ensure an increase in youth-specific                  issues facing Aboriginal women
         efforts are designed to provide access          •    effectively planned initiatives
         to current and accurate information             •    updated responses to new trends and
         and support regarding testing and pre-                 issues
         vention, as well as care and treatment          •    updated responses to new trends and
         needs                                                  issues facing Aboriginal youth
•      to increase knowledge and education on            •    increased understanding
         Inter-sexed and transgendered issues/           •    improved support
         needs regarding HIV/AIDS and re-                •    increased effectiveness behind targeted
         lated issues                                           messages
•      to expand efforts that respond to issues          •    improved interventions
         facing Aboriginal men in regards to             •    increased understanding and respect for
         HIV/AIDS and related issues                            family-based concept
•      to continue and expand efforts that re-           •    effective targeted prevention
         spond to issues facing Two-Spirited             •    improved interventions
         people in regards to HIV/AIDS and
         related issues                                  SUPPORTING BROAD-BASED HARM
•      to recognize, design and implement ef-            REDUCTION APPROACHES
         forts that address needs and issues,
         within a "family-based" cultural con-           Harm reduction can also be known as risk
         text, and in consideration of impacts           management, risk reduction, and harm mini-
         on Support and Prevention Workers               mization. Harm reduction is based largely in
         in the HIV/AIDS field                           recognizing that some individuals, for what-
•      to recognize unique and special needs             ever reason, may not be ready, willing or able
         and challenges in terms of mental               to completely change behaviors which may
         health issues, and developmental                pose risks to their health. The clearest exam-
         learning issues, including Fetal Alco-          ple in regards to HIV comes from the risks
                                                         associated with sharing injection needles.

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                     Strengthening Ties - Strengthening Communities

Responses to reduce the risk have included              many cases, basic life skills and issues around
needle exchanges, condoms, education, and               healthy sexuality need to be taught and im-
methadone to name a few. In this way, a per-            portant to consider for all strategic areas.
son is not required to abstain from drug use,           Aboriginal people who have been caught up
and the focus becomes one of educating and              in the world of injection drug use need sup-
supporting this person to make changes to               port, not only in terms of treatment options,
reduce risks for HIV or Hepatitis C for exam-           but also training to pursue other life opportu-
ple.                                                    nities such as employment, and to have ac-
                                                        cess to Traditional Elders and spiritual sup-
The term "broad-based" is meant to respect              port, when requested.
communities where they are at, for example,
needle exchanges or methadone maintenance               In addition to injectable drugs, are other sub-
programs may not be what the community                  stances and alcohol. The role of addictions
wants to implement. Broad-based implies that            in many Aboriginal communities is a serious
as a principle, most communities likely sup-            one. The byproduct is social isolation, which
port reducing harm, yet require the autonomy            can lead to increase risk taking. Issues of self-
to develop approaches that fit their needs and          esteem and self-image can also contribute to
circumstances.                                          why some individuals engage in risk behaviors,
                                                        even when they may know the risks for such
The challenge is that for many Aboriginal               things as HIV and Hepatitis.
Customs and Traditions generally require ab-
stinence or freedom from mind and mood al-              Rationale:
tering drugs. Likewise, almost all Aboriginal           Health promotion and harm reduction mod-
addictions programs and treatment centers               els can assist in the prevention of HIV/AIDS
operate under abstinence philosophies. There            and Hepatitis C and must be better defined
is room for educating relevant agencies, and            and encouraged as one means to reach spe-
better defining harm reduction so that greater          cific groups/risk activities.
efforts are placed to overcome how addictions
or substance use relate to HIV/AIDS, includ-            Objectives:
ing offering sensitized treatment services for          •    to define, educate and support imple-
HIV positive clients, including those who may                  mentation of harm reduction mes-
be on methadone maintenance.                                   sages which acknowledge and respect
                                                               regional/local beliefs and choices, as
Harm reduction and abstinence based philoso-                   well as varieties of methods that can
phies are not in conflict with each other - they               be used and is based on what will work
both support similar goals for the individual                  in any given locale
while using different ways to reach that goal -         •    to collaborate with existing harm reduc-
which is no harm, and when that is not possi-                  tion agencies and services
ble, reducing the harm. Harm reduction ef-              •    to examine, define, design and support
forts ought to also include efforts to support                 greater use of social marketing ap-
individuals to realize a different lifestyle. In

  An Aboriginal Strategy on HIV/AIDS in Canada for First Nations, Inuit and Métis People

                      Strengthening Ties - Strengthening Communities

         proaches which acknowledges diver-               involve a persons choice to not take anti-
         sity and need to be culturally appro-            retroviral medications to combining Tradi-
         priate                                           tional medicine with Western. Support can
•      to recognize the link between achiev-              start with a parent showing love to their Two-
         ing holistic health, as it relates to in-        Spirited child or from a friend talking with
         tervening in the spread of HIV/AIDS              someone about when and why they may want
•      to support and recognize the importance            to be tested for HIV. As this illness continues
         of community-based efforts and staff             to show itself, Aboriginal communities are
         who are aware of local issues and ap-            also becoming more and more affected.
         proaches, including community norms
         and methods for information sharing              For each Aboriginal person living with HIV/
                                                          AIDS, there is a whole family and community
Expected Outcomes:                                        that is affected. Partners, children, parents,
•    enhanced prevention efforts                          and even those who work in this health field
•    increased awareness, knowledge and use               have grief and loss issues that require sup-
       of harm reduction messages that fit                port. From HIV positive mothers who need
       the community                                      to plan for who will take care of their chil-
•    increased understanding (not just receiv-            dren when they go to the next world, or for
       ing) of messages being delivered                   same-sex partners who have to fight for sur-
•    shared expertise                                     viving spousal benefits, there is a wide range
•    improved cross-cultural relations and                of needs that require continued efforts that
       culturally sensitive programs and serv-            are culturally appropriate. Funding sources
       ices                                               are an issue in terms of ensuring appropriate
•    increased, targeted messages                         programs, services and training is available.
•    increased planning and design of pre-                Remote or isolated communities also are faced
       vention and education                              with access, medical staffing issues, and the
•    increased understanding for the role of              added burden of medical transportation costs
       personal histories and unresolved                  to urban facilities.
       trauma in interventions
•    increased understanding of multi-risk                There are also issues around mental health,
       groups                                             disabilities such as deafness, or a wide range
•    increased understanding for the role of              of developmental learning issues, such as with
       local dynamics, belief systems, and                Fetal Alcohol Spectrum Disorder (FASD),
       practices                                          Attention Deficit Disorder (ADD) or Atten-
                                                          tion Deficit Hyperactivity Disorder (ADHD).
HOLISTIC CARE, TREATMENT AND                              New policies need to be developed, and in
SUPPORT                                                   some cases, support to implement them prop-
                                                          erly is also important. Efforts to support com-
Each of these three areas require more ex-                passionate leave so a caregiver can support
amination. Care issues can range from                     an ailing partner or family member is also
homecare to palliative care. Treatment may                needed. Creating more supportive environ-

    An Aboriginal Strategy on HIV/AIDS in Canada for First Nations, Inuit and Métis People

                     Strengthening Ties - Strengthening Communities

ments is key. Co-infections with either hepa-                  treatment and support, including pal-
titis or tuberculosis are also areas that need                 liative care needs
attention. For some, reductions in Non-In-             •     to design or create, encourage and sup-
sured Health Benefits are creating hardships                   port adoption of appropriate preferred
and require advocacy work.                                     practices within a cultural and local
Rationale:                                             •     to examine and design responses to pri-
Holistic Care, Treatment and Support options                   vacy issues, confidentiality, access,
are available to address issues facing Aborigi-                transportation costs, community plan-
nal People living with HIV/AIDS and their                      ning needs, etc. in order to define pre-
support systems, through culturally appropri-                  ferred practices
ate means. Access and availability are linked
to related efforts, such as the Homecare ini-          Expected Outcomes:
tiative and others.                                    •    expanded knowledge and capacity to
                                                              provide culturally appropriate services
Objectives:                                            •    increased number of trained, skilled
•    to expand knowledge and capacity to                      workers
       related services to increase trained            •    shared expertise
       workers who can provide culturally              •    enhanced initiatives
       appropriate services and utilize holis-         •    improved and/or introduced appropri-
       tic approaches                                         ate care and support
•    to collaborate with existing agencies             •    improved knowledge and skills among
       (CTAC, etc.) using existing or newly                   APHAs and Treatment Workers
       designed care models to develop cul-            •    increased access to clinical trials
       turally sensitive approaches                    •    increased education and policy devel-
•    to support initiatives for Aboriginal                    opment on treatment issues
       women or families who have HIV                  •    enhanced knowledge and capacity to
       positive children                                      provide culturally appropriate support
•    to examine issues related to treatment                   services
       in terms adherence to drug protocols,           •    increased understanding of the role of
       and faster access to improved and new                  personal histories and unresolved
       medications                                            trauma in support services
•    to support creation of more supportive            •    increased understanding of the various
       and responsive environments to en-                     stages of HIV infection
       sure Aboriginal People living with              •    decreased isolation for caregivers and
       HIV/AIDS are welcomed into their                       APHAs
       home communities without fear of                •    improved care, treatment and support
       discrimination or isolation                     •    developed and adopted/recognized pre-
•    to support and train caregivers and                      ferred practices
       where appropriate, family members in            •    skilled, trained caregivers
       understanding all aspects of care,

 An Aboriginal Strategy on HIV/AIDS in Canada for First Nations, Inuit and Métis People

                     Strengthening Ties - Strengthening Communities

•      enhanced knowledge and capacity to             tion and medical advancements as they relate
        provide culturally appropriate support        to Aboriginal populations.
RESEARCH AND EVALUATION                               •    to promote and expand the Aboriginal
It has been often said that Aboriginal people                Capacity Building project on Commu-
have been researched to death and the time is                nity Based Research to train more
here to research us back to life. The time is                Aboriginal students
long overdue for Aboriginal people them-              •    to collaborate with existing Aboriginal
selves to use research as a tool for designing               researchers to collect accurate data on
efforts that can support greater opportunities               HIV/AIDS and related issues respect-
to collect and analyze data, so as to respond                ing an OCAP philosophy in all areas
appropriately and effectively. There remains          •    to support the creation of Aboriginal
a need to train and increase the number of                   Ethics Review Boards
Aboriginal researchers.                               •    to recruit Aboriginal researchers and
                                                             expand existing Ethics Review Boards
For those who now are working in this field,                 to include Aboriginal people in the
there is room for expanding their knowledge                  peer review process, respecting an
of HIV/AIDS. A number of efforts are now                     OCAP philosophy
being placed, and the ASHAC can be a tool             •    to set targets of specific research initia-
to engage these efforts so that more research                tives that can increase the availability
is undertaken within the OCAP (ownership,                    of accurate data which can reveal cur-
control, access and possession) philosophy.                  rent trends, in relation to prevention
There are issues around intellectual property                efforts
rights, as pharmaceutical companies are claim-        •    to support national research initiatives,
ing ownership of many Traditional Aborigi-                   which can reflect and respond to re-
nal medicines. There is opportunity to part-                 gional disparities
ner with newly formed Aboriginal research             •    to support research and evaluation
entities, such as the Institute of Aboriginal                which can be better used to address
Peoples Health, National Aboriginal Health                   issues raised at the community level
Organization, and the ACADRE (Aboriginal              •    to implement and support use of vari-
Capacity and Developmental Research Envi-                    ous evaluation techniques to ensure
ronments) Centers being funded across the                    efficient use of resources
country. The Regional First Nations and Inuit
Health Surveys is another resource.                   Expected Outcomes:
                                                      •    more trained, experienced Aboriginal re-
Rationale:                                                   search students
Expand capacity and build coalitions to cre-          •    increased knowledge and understanding
ate a solid base of Aboriginal researchers who               of HIV/AIDS and related issues
can examine critical areas in terms of preven-        •    enhanced interventions

    An Aboriginal Strategy on HIV/AIDS in Canada for First Nations, Inuit and Métis People

•   enhanced, appropriate peer review sys-
•   expanded efforts to conduct OCAP Abo-
      riginal research initiatives
•   collected and analyzed current data to
      better identify issues and trends
•   improved program design and account-
      ability outcomes

                     Strengthening Ties - Strengthening Communities

                                                   6.0             Groups,
                                                           Diverse Groups, Many Needs

While all Aboriginal populations may be                  In terms of HIV/AIDS, two key barriers con-
deemed "vulnerable", there are diverse groups            tinue in varying degrees, to hinder prevention
within our populations with different needs.             efforts. These barriers are that HIV/AIDS is
This section is not about isolating any one              seen by some as: 1) a gay disease; and, 2)
group and leaving out others. It is more about           HIV/AIDS is only in the cities. However, the
educating what some of these needs or issues             evidence provided in section three disputes
may be. Whether based on ethnicity (Inuit,               these myths. There is also a "perceived" re-
Métis or First Nations), geographic location,            sponsibility or blame assignment suggesting
social isolation, language, risk behavior(s) or          fault for people who become HIV positive,
a combination of these, the purpose here is              whereas there may be sympathy for those who
to provide a general understanding of some               did nothing to become HIV positive, such as
of the issues. We know that certain behaviors            children.
have higher risks than others - injection drug
use, specifically sharing used needles is one            This section is about introducing the diver-
in particular.                                           sity that exists among Aboriginal populations.
                                                         It will describe some key risk behaviors within
First Nations, Inuit and Métis People have               certain key groups or provide specific needs
long histories on this continent, as well as vi-         where risk behaviors are not the issue (as with
brant cultures. Many of the traditional teach-           children). As stated earlier, the determinants
ings, however unique to each group, can be               of health for Aboriginal people are much lower
the basis to recover the strengths once com-             than the rest of Canada. One needs only to
mon in Aboriginal communities. These                     visit Statistics Canada's website to determine
strengths and values, included a respect for             socio-economic status facing Aboriginal peo-
the land and for all life. Aboriginal people             ple. Issues like poverty, lower education lev-
can be called family-based cultures, because             els for some, and personal histories all con-
of the role and importance of extended fam-              tribute to how we address HIV and AIDS.
ily systems. Diversity among many groups,                Again, some Aboriginal people may need ba-
was also seen as having purpose and place,               sic life skills, because they have missed out
generally speaking. If a child was born differ-          on many essential learning experiences vital
ent, many Aboriginal cultures saw that as hap-           to achieving and maintaining strong, healthy
pening for a reason. Spirituality, was a cen-            and fulfilling lives.
tral approach largely based on re-
specting life and demonstrating                                    The reality is that HIV/AIDS can
thankfulness for what blessings the                                and does infect and affect Aborigi-
Creator provided. These same cul-                                  nal people\from all walks of life,
tural values can be the basis for re-                              all ages, regardless of whether they
sponding to HIV and AIDS, in ways                                  are Inuit, Métis or First Nations or
that utilize traditional teachings.                                where they reside.

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Aboriginal Women                                        Aboriginal women have yet to be more widely
The role of Aboriginal women as caregivers              encouraged for voluntary HIV testing during
and lifegivers is common among all Aborigi-             prenatal visits. In Alberta for instance, since
nal cultures. As was noted in section 3, there          May 1998, all pregnant women are tested for
is also a significant number of HIV infections          HIV during prenatal screening unless they opt
occurring for women. There are more Abo-                out. In these cases, improved pre and post
riginal women becoming infected, especially             test counseling must occur as some women
when compared to infection rates for non-               do not understand they are being tested or
Aboriginal women, which is a cause for great            that they can opt out. There are HIV positive
concern. Family violence may be one factor,             women who want to have children, yet it is
but unprotected sex and having a partner who            still largely unknown what effect medications
is an injection drug user plays a greater role.         have when taken during pregnancy. While it
More Aboriginal women also engage in injec-             is believed to greatly reduce risks for the in-
tion drug use as well.                                  fant to become HIV positive, issues of ac-
                                                        cess to medications, prenatal care, and com-
The result is both partners may become HIV              pliance become factors. Many people think
positive and if a pregnancy occurs, then there          the fetus is more important than the woman,
have also been cases where the child too be-            while others see both fetus and woman as
came HIV positive. Aboriginal women who                 being equally important. It is important to
are HIV positive and choose to give birth to            see both the woman's choice over what they
children can experience reactions that are of-          ingest, and their choice over what happens to
ten discriminatory and offensive. Family plan-          their body. The need is one of building up
ning, may become more of a focus on con-                respect and honor for women, and supporting
dom use or birth control, instead of the present        them in whatever decision they make, includ-
child care needs or those that arise when one           ing pregnancy terminations if that is their in-
or both partners loses their battle with AIDS.          formed choice. Empowerment to help make
Poverty and discrimination can also factor in,          difficult life decisions is a key requirement.
making the delivery of sexual health messages
much harder to have impact that translates              Ongoing attention needs to be given to pre-
into behavior change. Many Aboriginal                   vent mother-to-child transmission of HIV.
women place other peoples needs first, as part          Working with health professionals and Abo-
of their caregiver role, but also for unhealthy         riginal Women's groups, efforts need to take
reasons, such as low self-esteem. The Resi-             place to examine this area more closely and
dential School Legacy (outlined later on), is           identify multi-pronged approaches to educate
being seen more as a significant negative force         around mother-to-child HIV transmission, and
that has battered a persons psyche, spirit, and         prevent future infections. There are also is-
making them exposed to sexual assault and               sues for breast-feeding when a woman is HIV
other acts of violence, because of feelings of          positive, which needs to have proper atten-
low self-worth.                                         tion.

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                      Strengthening Ties - Strengthening Communities

Aboriginal Children                                      ties and developmental disorders pose chal-
Some children born to HIV positive Moms also             lenges for life success.
become HIV positive. For those who live in
poor and unstable homes, finding the proper              Students with learning disabilities and devel-
support is a difficult task whether the child is         opmental disorders need a wide range of teach-
HIV positive or not. Other parents may react             ing methods in order to learn the need to use
with fear and not want children to be in the             safer sex or to practice other personal safety
same daycare or school with an HIV positive              behaviors. Headstart, Brighter Futures and
child.                                                   Building Healthy Communities are some of
                                                         the partnerships that can be developed to en-
Healthy sexuality education and the preven-              sure our children have the best chances pos-
tion of sexual abuse, nutrition and stable en-           sible. There can also be Provincial resources
vironments are key areas to help raise healthy           such as NB's Chit Chat Program and Ontario's
children and to increase their chances of liv-           Preschool Initiative that can be accessed to
ing a full and happy life. It is also useful to          support children and families with develop-
look at games that some children play, such              mental issues. Some parent support programs
as "bloody knuckles" or similar games where              also provide developmental support in a cul-
blood and broken skin are key parts of the               turally meaningful context, for example, the
game. There is a need to begin HIV/AIDS                  Hanen Center in Toronto also offers parenting
education as early as grade 5. Hopefully, this           training from a First Nations perspective.
long-term preventative approach can assist               Early intervention and a family centered ap-
Aboriginal children to understand the disease            proach leads to healthy development of all
and make healthier choices about when and                children.
how to become sexually active, and to under-
stand the risks behind alcohol and substance             There is also the issue of orphaned children,
abuse.                                                   who lose their parent(s) to AIDS. The added
                                                         burden and concern of preparing for your chil-
Where dysfunctional issues, such as family               dren, after a parent(s) loses the battle with
violence, addictions, mental health issues, etc.         AIDS is a difficult one. The emotional, spir-
are present with the parent(s), then children            itual and psychological issues can be especially
too may experience difficulty in understand-             hard, when the family may also be experienc-
ing boundaries and/or need behavior manage-              ing poverty or feel socially isolated because
ment. Lack of environmental stimulation at               of the illness. Add to this the possibility of
home may also be a concern and impact fu-                more than one family member being HIV posi-
ture learning for these children. Early inter-           tive and the challenges become that much
ventions and understanding developmental                 greater.
milestones is critical to alleviating the affects
of developmental delays, Attention Deficit               Special attention must be given to children
Hyperactivity Disorder (ADHD), Fetal Alco-               who are system involved (e.g. child welfare,
hol Spectrum Disorder (FASD formally                     group homes, etc.) or who have been taken
known as FAS/E) and other learning disabili-             into care by Provincial/Territorial authorities.

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                     Strengthening Ties - Strengthening Communities

In some cases, when a parent is HIV positive,           Peer pressure also is a deciding factor, and
children are apprehended and subjected to               some end up homeless because they do not
screening processes which may not be neces-             have the necessary skills to secure a job and
sary. The issue of child welfare and adoption           home or prefer to be outside the home and
is a factor facing all too many Aboriginal peo-         their immediate family due to abuse issues.
ple. For some time, Aboriginal communities              The lack of family support in some cases, can
did not have meaningful say in this area, and           also send the message to a youth that nobody
there was even mass adoptions of Aboriginal             wants or understands where they are coming
children into non-Aboriginal homes including            from. Some end up sexually exploited or be-
the United States. These are further exam-              come involved in the sex-trade to survive fi-
ples of historical wrongs by a dominant soci-           nancially or feel welcomed in a community.
ety which can affect how Aboriginal people              Others may be sexually assaulted, especially
trust and relate to systems in place today.             female youth who engage in alcohol and drug
                                                        use and experience blackouts because of ex-
Aboriginal Youth                                        cess consumption. There may even be value
With over half the Aboriginal population be-            to establishing youth detoxification units and
ing youth, the need to design and deliver               treatment programs, as youth may have dif-
youth-specific interventions is of utmost ne-           ferent issues than older individuals. Regional
cessity. Aboriginal Youth need to be full par-          directories listing Aboriginal Social Service
ticipants in determining priority actions which         Agencies and increased efforts within the edu-
address their needs. Some who may drop out              cational system can prepare Aboriginal youth
of school, lose opportunity to advance them-            with the adequate knowledge and support if
selves in life. They may also miss the oppor-           and when they move to a new community.
tunity to learn about HIV/AIDS when it edu-
cation is being delivered in high school. There         Aboriginal youth face a number of challenges
are also those who may have learning disabili-          that were not present even a decade ago. Some
ties and developmental disorders, which make            become parents to their parents and this may
it harder to instill messages that can help pro-        be a reason that they are not in school. It is a
tect them. Some move to urban centers, un-              role reversal, oftentimes because of the pres-
prepared for the harsh realities that can come          ence of alcohol, other substance use, or dys-
with unfamiliar territory. Without adequate             function in the home. Other homes may dis-
knowledge of the need for safer sex, or the             own or reject a child because they are Two-
introduction to alcohol and drugs, many youth           Spirited or Inter-sexed.
become at risk for HIV. In fact, Aboriginal
people who are becoming infected are younger            Two-Spirited People 5 (Gay, Les-
than their non-Aboriginal counterparts. The             bian, Bisexual, Inter-sexed)
issue of teen pregnancies indicates to some             While many Two-Spirited males have been
extent the frequency of unprotected sex.                significantly affected by HIV/AIDS, there are
There is also the prevalence of sexually trans-         several issues that continue to play out. Un-
mitted diseases, which supports the concern             protected sex, more recently called bare back-
around HIV.                                             ing and injection drug use are key ways that

  An Aboriginal Strategy on HIV/AIDS in Canada for First Nations, Inuit and Métis People

                        Strengthening Ties - Strengthening Communities

HIV is being spread within this group. Homo-                  these dynamics need to be examined and bet-
phobia and discrimination contribute to so-                   ter understood. As well, some people con-
cial alienation or isolation that many Two-                   fuse love and sex, which is especially true when
Spirited people experience.                                   sexual abuse histories are present.

Another new phenomenon is the active pur-                     Injection Drug Use and other Sub-
suit by some people to become infected with                   stance Abuse
HIV. Bareback parties sometimes actively                      Increasingly, injection drug use and sharing
promote the "gift" givers and seekers, refer-                 unclean needles are creating very significant
ring to HIV as the gift. To what extent this is               rates of infection for both HIV and Hepatitis
occurring among the Aboriginal Two-Spirit                     C. Depending on the type of drug being in-
population is unclear and requires further                    jected, an injection drug user may inject sev-
study. Another issue is regarding young Two-                  eral times a day, and often much more. Nee-
Spirited males who move to urban areas, with-                 dle Exchange Programs and Harm Reduction
out adequate knowledge of HIV/AIDS and                        approaches have been used to reduce the ad-
risk behaviors.                                               verse affects or harm, associated with this very
                                                              high-risk behavior. Methadone maintenance
Two-Spirited females can also be faced with                   is another method used to get addicts off of
risks for HIV, even though there may be fewer                 injection drugs, but access can be an issue.
women becoming HIV positive than males.
There are also grief and loss issues, such as                 The challenge remains that many of the Abo-
when friends who are HIV positive become                      riginal Addiction Treatment centers are using
more ill or experience many ups and downs.                    abstinence-based models and are not prepared
An important issue appears to be presence or                  to deal with injection drug use. Elder sup-
absence of spirituality in relation to suscepti-              port and training is also key to broadening our
bility to HIV infection. Love or perception                   reach. As with all areas, there are underlying
of love, may also be a factor if a partner says               issues that can increase chances that an Abo-
"don't use a condom." When HIV is present                     riginal person would turn to alcohol and/or
in a relationship and there are subsequent is-                drugs to negatively cope with life circum-
sues for that relationship because of HIV,                    stances. These issues can include growing up
                                                              in a violent home, sexual abuse, poverty, and
                                                              loss of loved ones to suicide or other violent
  Note: Inuit do not use the term “Two-Spirited”.
                                                              deaths, and more. All of these personal his-
Likewise, some Aboriginal people and communities
do not use this term at all, as traditionally they did        tories need to be dealt with, if a person is to
not assign labels or speak publicly in terms of               overcome negative experiences, which are
sexual orientation. The term itself is a generic              often multiple losses.
term to fill the place of words in various Indigenous
languages which include Traditional roles not based
                                                              The creation of a National Aboriginal Task
solely on sexual orientation, such as the Winkte in
Lakota culture. It is important to point out that this        Force on Substance Use may begin to exam-
section is about risks and issues facing men who              ine more closely, ways of intervening. Bring-
have sex with other men. This can and does include            ing together Elders, including those working
married men.

    An Aboriginal Strategy on HIV/AIDS in Canada for First Nations, Inuit and Métis People

                     Strengthening Ties - Strengthening Communities

in Correctional facilities, injection drug users        be implemented and supported. Although few
themselves, and other interested and related            efforts have seen this manual implemented or
stakeholders may help to take control of this           tested, the issue is that increased attention
key area. Sexual partners (including female             must be placed to address this area of con-
spouses) have been known to become HIV                  cern. Training must be expanded to include
positive by having sex with their husbands or           Correctional Elders and other people who
by sharing needles with them. As can be seen,           work in this area, to receive the training and
men and women face equal risks when injec-              properly support inmates. There are also is-
tion drug use, more so sharing uncleaned nee-           sues for young offenders and some variations
dles, as well as other substances that are at           of issues within provincial/territorial institu-
play.                                                   tions from federal institutions which can af-
                                                        fect what approaches are needed.
Recent notice in Eastern Canada along the US
border, are certain prescription drugs being            The creation of a National Aboriginal Task
used more frequently referred to as "cheap              Force on Substance Use must include Correc-
man's cocaine and hillbilly heroin". They are           tional Elders and former inmates. Needle
percoset which is snorted up the nose, and              exchange programs are being considered
dilaudid, which is melted down and injected,            within Institutions but it is unclear whether
like cocaine. Both prescription drugs and sol-          these would be established. Methadone main-
vent abuse needs to be acknowledged. Even               tenance is also another area that creates diffi-
for methadone maintenance treatment pro-                culty when trying to provide it to inmates.
grams, these are very limited, and there is a           Inmates generally need to be on the program
need for more programs across the country               before incarceration in order to qualify for it
                                                        on the inside.
Aboriginal Inmate Populations
Aboriginal inmates are over-represented in              Harm reduction, and effective safer sex mes-
many Provincial/Territorial/Federal correc-             sages for sexual practices both inside Correc-
tional institutions. Injection drug use within          tional Centers and during private family visits
Correctional Institutions is one environment            are key to the prevention of HIV and Hepati-
where the opportunity is great for the spread           tis C. Alternative Justice Initiatives and Cor-
of HIV and Hepatitis C. Regulations that                rectional Healing Lodges need to be partnered
prohibit the use or possession of drugs or para-        with, to reach those on conditional releases
phernalia (needles) make the sharing of nee-            or to divert people away before entry into the
dles much more likely and greatly increases             penal system. As both Aboriginal men and
risk for both HIV and Hep C. Upon eventual              women are incarcerated, there are equal risks
re-integration into the community, there re-            and challenges for responding to HIV and
mains a need to provide adequate education              Hepatitis C within institutions. Training
and counseling which can start at intake,               around harm reduction for Correctional staff,
throughout their sentence and upon release.             parole and probation officers is also necessary
The Circles of Knowledge Keepers Peer Edu-              in order to recognize drug abuse issues and
cation manual developed by CAAN needs to

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                     Strengthening Ties - Strengthening Communities

support diversion programs away from incar-             and in some ways, money represents your self
ceration.                                               worth.

Correctional Institutions may provide bleach            There are also a lot of emotional issues as
to clean needles, however there is recent evi-          well. When mental illness is present, these can
dence that suggests bleach may not be an ef-            be factors that contribute to social isolation.
fective measure against HIV, as well as Hep             The isolation that sex-trade workers feel, needs
C. Most inmates may not use it properly or              to be addressed when providing services and
have old, overused, and even homemade sy-               support. Some Aboriginal people in the sex-
ringes/rigs, and there is no evidence that              trade do so to feed their habit to alcohol and/
bleach kills Hep C. Advocates and health                or drugs. Addiction treatment services and
workers need to revisit whether they should             programs aimed at supporting individuals to
still be advocating bleach kits as a harm re-           find other means of income, can assist in re-
duction practice, given the barriers and un-            ducing risks found in the sex-trade, including
clear effectiveness. Although bleach is likely          violence. Development of support programs
better than nothing, the message may need               to assist individuals to leave the sex-trade are
changing, since it may be setting people up             linked to housing availability, labor market,
for false hope. Caution ought to be used, since         and skills development including life skills
some may interpret the message to mean                  training, etc.
bleach does not work in all cases, and thus
not use anything. For some inmates, such as             Street-Involved
with Inuit Offenders, it may not be so much             Aboriginal people can also become street-in-
the injection drug use but the tattooing which          volved perhaps running from a bad home situ-
can also pose risks for HIV transmission, when          ation. Injection drug use, isolation from com-
the tools are not properly cleaned. Tattooing           munity, mental illnesses can all pose risks to a
and use of unsterilized equipment is an issue           persons health and safety, if they engage in
for all offenders.                                      risk behaviors. Some leave their home com-
                                                        munities for the city, to find jobs or pursue
Sex-trade Workers                                       their education, but are ill-prepared for city
The term "sex-trade workers" replaced pros-             life. In some cases, they end up homeless,
titutes, largely because some of those involved         experience poverty, addictions, unemploy-
in this area see it as a profession, complete           ment, all which can create a vicious cycle and
with occupational hazards such as assault, and          dependency that is difficult to break. Another
health risks. Sadly, some Aboriginal people             consideration is a need for belonging. Many
including children as young as twelve, become           Aboriginal people become street-involved and
involved with the sex-trade, more so to sur-            find a community there, including support ,
vive rather than it being a profession. In other        information and other needs.
words, there are likely more Aboriginal peo-
ple involved in sex-trade as a means of sur-              Abuse, sexual exploitation, especially for
vival or when a person is in need of a place to         youth, discrimination, and racism - are all as-
stay. Sadly, another reason is to feel needed           pects of street life that eat away at a persons

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                     Strengthening Ties - Strengthening Communities

social standing. Aboriginal people are more             gion in some cases is a factor in many com-
mobile or migratory and may do so for vari-             munities on how best to deliver safer sex mes-
ous reasons. As stated, some are escaping bad           sages, deal with Two-Spirited issues, and even
situations at home or feel unsafe in their home         how to approach addictions. The difference
communities, possibly because they are Two-             between rigid interpretation of church teach-
Spirited. Others simply travel from coast to            ings and having an openness toward working
coast and couch to couch. Even in On-re-                within today's environment can mean the dif-
serve environments, there can be street-kids            ference between reaching people before they
when their home situation is not a safe place           engage in risks.
or a parent(s) are not able to provide the
proper guidance. Access to affordable hous-             The health transfer system, access to adequate
ing or shortages of adequate housing in some            health care or even medical staff in remote
communities are also factors for why some               communities, are some issues that need to be
people end up on the streets. Mental health             considered when designing community ap-
issues can also factor in to the marginalization        proaches. Isolated communities have addi-
that some people experience when street-in-             tional costs for transporting people to medi-
volved. The level of support, complexity be-            cal facilities. Resource development guides,
hind interventions, and the diversity and tran-         action plans, and implementation frameworks
siency behind this aspect of society all are is-        are available to help support community ac-
sues that affect how HIV/AIDS is a reality              tion. Securing political support and using an
for many street-involved people.                        integrated approach to programs and services
                                                        can help create environments that will meet
The Community level                                     the challenges of HIV/AIDS work. Transfer
At the community level, a lot can be done to            negotiations can also affect the availability and
begin or further efforts on HIV/AIDS and                access to harm reduction supplies, such as
related issues. The establishment of Commu-             condoms.
nity Wellness or Inter-agency Teams can be a
solid first step because it allows broader in-          Northern Issues
put from all agencies and services who can              It is important to understand that isolated re-
play a role. Community-based health work-               gions of Canada, face unique challenges. The
ers need ongoing support and training to as-            first, is access to health care, which is gener-
sist them in delivering HIV/AIDS related                ally not available. Likewise, there are also dif-
work. It is difficult to do community devel-            ferent cultures, from the Inuit to a number of
opment from a national level, but support can           First Nations and Métis. Language is often a
be given to build the capacity of communi-              barrier, for example it has only been more re-
ties.                                                   cently that some resources have been avail-
                                                        able in Inuktituut. Costs are also higher up
An example can be studies that look at knowl-           north, even to mail or courier a package. To
edge, attitudes and beliefs. These can be use-          do HIV/AIDS education essentially means
ful in offering insight into how communities            airfare, even within a territory. Conferences
view this health issue. The influence of reli-          and training in southern Canada for northern

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residents is also a barrier, because of costs.          play an important role in that they are keep-
Some northern communities experience diffi-             ers of the culture and teachers for youth. They
culty in delivering HIV/AIDS education. For             need education around HIV/AIDS to assist
example, how does HIV/AIDS rate when                    them in being more knowledgeable in their role
there may be high suicides, or violence and             to help address this disease and related issues.
addictions in a community? Although these               The influence of older adults and Elders on
social issue are not unique to just northern            younger generations requires recognition. Peo-
communities, they can be issues to contend              ple in management and leadership positions,
with. The geographic isolation can also lead            or heads of large families, can impact preven-
to more youth engaging in gas sniffing or sol-          tion and education messages and influence
vent abuse. It is important for initiatives de-         environments.
veloped in southern Canada to recognize the
additional costs and burdens that northern, iso-        Residential School Survivors
lated communities face.                                 Aboriginal communities have experienced
                                                        generations of what is becoming more widely
Adults and Older Aboriginal                             known as a significantly disruptive force, (less
People                                                  so for Inuit communities) and that is the Resi-
Although there are fewer Aboriginal Seniors             dential School system, including Boarding and
or elderly people becoming diagnosed with               Mission Schools. Not all experiences were
HIV, there can still be risk behaviors for these        negative, and not all groups had Residential
groups. It is a false perception that elderly           Schools. Depending on the generation that
people don't have sex or all of them are in             went and what was occurring at home, many
stable relationships/marriages. Some elderly            people who did attend found themselves be-
people find themselves single for several rea-          ing abused and traumatized in several ways.
sons. Perhaps a partner has died, or in some            Even those who were not sexually abused,
cases, a couple may have married straight out           may have witnessed it. Sexual and physical
of high school, only to find the marriage failed        abuse, forbidden to speak their languages, dis-
after a lengthy period. These are some of the           connected from Elders and their traditional
ways heterosexual people may face risks for             societies because when they returned they
HIV infection.                                          could not communicate in their mother
                                                        tongue. All of these are factors in how many
Conceivably, someone in their mid-forties or            Aboriginal communities, families, and indi-
older could find themselves dating again only           viduals who attended, have been struggling
to find out that there are much more serious            to overcome major traumas and life changing
health risks today, than when they were a               experiences.
youth. These are some of the ways that het-
erosexual individuals may face risks for HIV.           Parents who went, those in foster care, and
Without proper guidance and education, a                others involved in the child welfare system,
person may find themselves out of touch and             especially in the fifties and early sixties have
feeling awkward about how to use protection             been deeply wounded. The result, now called
or knowing what is risky or not. Elders can             the Residential School Legacy because many

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social issues are linked to it, is that many Sur-        as well as Hepatitis C. Unprotected sex can
vivors have turned to alcohol and drugs to               lead to partners becoming infected as well.
numb the pain. Others have used physical                 Thus, injection drug use and/or unprotected
violence as ways of lashing out, seemingly               sex means heterosexual transmission rates are
without the ability to stop the cycle of abuse.          also increasing. Aboriginal men who become
Emotionally and spiritually shut down, many              incarcerated also face greater risks because the
have difficulties in intimate relationships or           environment is a closed one where HIV and
showing affection to their own children. With            Hepatitis C exist. All it takes is one try of
such deep wounds, some ending up incarcer-               sharing a needle with HIV or Hepatitis C, and
ated, several factors exist that can lead or con-        the result is very likely to be infection. Until
tribute to whether a person can practice per-            Aboriginal communities find balance in ad-
sonal safety or even if they care enough about           dressing the healing needs of men and women,
themselves to want to. Self-destructive pat-             there likely will be continued disharmony
terns are common until the pain and hurt is              which can lead to more HIV infections.
dealt with. Some Residential School Survi-
vors did not learn proper parenting skills.              The traditional roles of men as protectors
Others may have difficulty talking about sex             needs to be regained, and Aboriginal men need
and sexuality to their children, because they            to use this role effectively. Young men need
had such negative experiences themselves.                to see and hear adult men show them how to
                                                         be respectful of their partners, how to respect
Aboriginal Men                                           the gift of their sexuality, and to be responsi-
In Traditional societies, men were often seen            ble in how this gift is used. Issues of father-
as protectors and providers. For some of the             hood can support prevention and education
reasons mentioned under Residential Schools,             goals around HIV/AIDS and related issues,
roles have changed, and not always for the               when adult and young men set aside being ma-
better. Even for Aboriginal men who did not              cho and false pride, to learn exactly what their
go to a Residential School, they can experi-             role involves.
ence what is called inter-generational impacts.
In some cases, Aboriginal men have become                Transgendered, Inter-sexed and
the abusers, acting out unresolved trauma or             Transsexual People
repeating learned behaviors such as growing              Transgendered, inter-sexed, and transsexual
up in a violent home. Aboriginal men are not             people have been largely misunderstood by
always as willing to participate in healing type         society and often even within their families.
activities, until the consequences become too            Living conflict between mind and body cre-
great or they are unable to ignore the realities         ates a lifelong journey - and lengthy process -
facing them.                                             for some who are undergoing a transitioning
                                                         (the process of changing from one state to
Again, patterns of self-destructive behavior             another, formerly called a sex change opera-
can become major challenges. In terms of                 tion by some). Others undergo just the hor-
HIV/AIDS, substance use and injection drug               monal procedures. Yet still, some may dress
use can create major risks for HIV infection,            in what may be termed "opposite-sex" cloth-

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ing. There is evidence that many people who
call themselves transgendered, inter-sexed, or          Medical procedures for post-operative trans-
transsexual are living with HIV. Some turn to           sexuals, can also factor into risks with recon-
the sex-trade to survive, many out of nega-             structed vaginas that cannot lubricate. There-
tive experiences with societal barriers and dis-        fore, abrasions or tearing can provide oppor-
crimination. For those incarcerated, signifi-           tunity for infection. Not only is there a need
cant risks exist, as with all inmates for HIV           for comprehensive HIV education and preven-
and Hepatitis, as well as for physical safety.          tion strategies for members in these groups,
Transphobia, like homophobia is when peo-               but much work is needed to educate about
ple have unfounded fear oftentimes resulting            specific medical and social needs as well.
in physical assault or threats toward safety.

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                                                                     7.0      Implementation

As stated earlier, the advantage of having              For communities or regions without Aborigi-
CAAN is that it is a national organization              nal HIV/AIDS strategies, this document can
dedicated to Aboriginal HIV/AIDS issues.                begin the developmental process that is
The ASHAC recognizes that implementation                needed to design an approach that works
of the strategic areas in this document can             within your community or region. Some prov-
occur at various levels. For example, any group         inces or territories may not fund a regional
or region can design efforts under prevention           strategy or the process may be long to lobby
and education, or any of the other strategic            for such a resource. When funding is not avail-
areas. In support of this, the Strategy Coor-           able for a provincial/territorial strategy, the
dinator, the Working Group, its committees              coordination role is notably absent. It be-
and the Canadian Aboriginal AIDS Network                comes much more difficult to have an effec-
will support and guide implementation issues            tive network and flow of information. It is
related to the ASHAC.                                   not enough for a community to be given a re-
                                                        source manual, and reasonably expect that
It is important to also recognize, that in get-         community to implement all the necessary
ting organized, each region or group needs to           aspects to an effective HIV/AIDS program.
manage and design their own developmental               Support is needed, which is a key role that a
process. As stated earlier, the ASHAC is not            Strategy can provide. The ASHAC supports
about prescribing what or how a community               the development of provincial/territorial
or region should implement HIV/AIDS ini-                Aboriginal HIV/AIDS strategies in those re-
tiatives. This strategy is a key resource and           gions where none currently exist. Communi-
describes nine strategic areas with numerous            ties can begin by starting a Community Health
objectives that can be used in the fight against        and Wellness Team, made up of various com-
HIV/AIDS. It is a very useful exercise for a            munity-based health workers, such as Alco-
community or region to set its own priorities           hol and Drug Workers, Community Health
based on information relevant to their own              Representatives, Nurses, Public Health, vol-
needs. The Strategy Coordinator can be a sup-           unteers, etc. Going through this document as
port in related efforts under the ASHAC, by             a team, can assist in identifying areas where
fulfilling the role outlined under Coordination         your community wants to focus its energy.
and Technical Support, as well as other CAAN            The Assembly of First Nations has also de-
staff. Ongoing communication and tools will             veloped an Implementation Framework, and
be developed and shared.                                some regions with Aboriginal HIV/AIDS

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Strategies have similar resources. All of these
can assist your own developmental needs.

In addition, the working group (see appendix
B) is comprised of a variety of individuals and
organizations committed to this health issue
who will continue in their role. Two phases
of the working group were held, the first kick
started the process by developing guidelines
that would outline how the ASHAC would be
developed. These guidelines included terms
of reference, composition, and guiding prin-
ciples. The following guiding principles ap-
ply to the Working group and its committees.
Also, there are two committees: Emerging Is-
sues Committee and Working Group Secre-
tariat. 1) The Emerging Issues examines new
trends that are being noticed and raises these
with the larger working group. 2) The Secre-
tariat supports the Strategy Coordinator in
planning out processes, especially agendas for
all meetings.

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                                                  Working Group Guiding P rinciples

•       We will endeavour to work in a cooperative manner with other groups and organizations, be
        they Aboriginal or non-Aboriginal, in order to develop a society of equal opportunity for all
        people and respect for all living things.

•       We will support and work towards achieving the stated aims and objectives of the Strategy.

•       We honour diversity, will be forthright in expressing our views on particular issues and re-
        spectful of the opinions of other Working group members, stakeholders and all Aboriginal

•       We encourage people to bring grievances, comments, or complaints relating to the Working
        Group to the attention of the Working Group Secretariat.

•       We endeavour to work in a cooperative manner with working group colleagues, strategy
        partners, stakeholders and individuals to solve issues of mutual concern.

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                                         A:                  OCATIONS
                                APPENDIX A : CSHA FUNDING ALLOCATIONS

CSHA COMPONENT                                          FUNDING AMOUNT

Prevention                                              $3.9 Million

Community Development/NGO Support                       $10.0 Million

Care, Treatment and Support                             $4.75 Million

Research                                                $13.15 Million **

Surveillance                                            $4.3 Million

International Collaboration                             $0.3 Million

Legal, Ethical and Human Rights                         $0.7 Million

Aboriginal Communities                                  $2.6 Million *

Consultation, Evaluation, Monitoring and Reporting      $1.9 Million

Correctional Service Canada                             $0.6 Million

T O T AL                                                $42.2 Million

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Aboriginal HIV/AIDS Funding Allocations

HPPB Aboriginal Allocation                                               Reser
                                                    FNIHB Allocation (On R eser ve/Inuit)

$100 K Prevention and Education                     $300 K Prevention and Education

$1.2 Million Community Development                  $300 K Community Development

$100 K Care, Treatment and Support                  $300 K Care, Treatment and Support

$100 K Coordination                                 $200 K Coordination

Sub-total = $1.5 Million                            Sub-total = $1.1 Million

$800 K Research                                     $2.5 Million A-Based Funding ***

TOTAL = $2.3 Million                                TOTAL = $3.6 Million

*      The $1.1 Million requires regional workplans to guide how dollars will be spent.
** $800,000 is the Aboriginal allocation under research for both On & Off-reserve.
*** First Nations & Inuit Health Branch (FNIHB) has an additional $2.5 million in A-Based
funding dedicated to the First Nations & Inuit HIV/AIDS Program. What is meant by A-Based
funding is this amount comes out of the overall budget for this Branch, and not from the CSHA.
FNIHB uses a funding formula with a base amount, then factors in geographic location, remote-
ness, population size, etc. to determine what a region or a First Nation would get as their share
of this funding allotment. Some dollars also stay at national level for coordination.

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Following is a list of organizations and individuals who reside in various regions of Canada. Mem-
bers were selected based on various criteria, including: Aboriginal People living with HIV/AIDS,
relationship to the Aboriginal HIV/AIDS movement in Canada, organizational political mandates,
and representation of current regional Aboriginal HIV/AIDS Strategies. Regions were not a decid-
ing factor, although current membership represents almost all regions in Canada, with CIHAN and
other national organizations providing access to wider networks. All three Aboriginal groups are
represented, namely Inuit, Métis and First Nations.

•       Métis Nation of Canada, Mr. Duane G. Morrisseau-Beck
•       Assembly of First Nations, Ms. Anita Stevens
•       Canadian Inuit HIV/AIDS Network, (CIHAN), Mr. Todd Armstrong
•       Ontario Aboriginal HIV/AIDS Strategy, Ms. LaVerne Monette
•       Healing Our Spirit, BC First Nations AIDS Prevention Society, Mr. Ken Clement
•       Kimamow Atoskanow Foundation, Alberta Aboriginal HIV Strategy, 2001-2004,
        Ms. Denise Lambert
•       The Circle of Hope: The First Nations and Inuit of Quebec HIV and AIDS Strategy,
        Ms. Guylaine Chastroux
•       Ms. Jonelle Garriock, YK
•       Ms. Lillian George, BC (Co-Chair)
•       Ms. Margaret Akan, SK
•       Ms. Donna Everette, MB
•       Mr. Trevor Stratton, ON
•       Mr. Ashley Dedam, NB/Atlantic (Co-Chair)
•       Mr. Fred Anderson, NF/Labrador
•       Mr. Quinn Wade, NS/Atlantic
•       Two Health Canada seats: Ms. Anita Tuharsky-Ross and Mr. Alain Houde
•       CAAN Staff: Mr. Art Zoccole, Ms. Kim Thomas and Ms. Eve Louttit
•       Strategy Consultant: Mr. Kevin Barlow

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                             C:                         STAKEHOLDERS

Note: The process of involving stakeholders in the process is on-going and part of the mandate of
the working group. Below are listed the categories for inclusion as a stakeholder.

Groups that advocate for Aboriginal people on a national level (E.g. Assembly Of First Nations,
The Métis National Council, Inuit Tapirisat of Kanata, Tribal Councils, Friendship Center Collec-
tives, etc..)

Service-delivery type organizations, with health portfolios and are committed to advocating on
various health issues for Aboriginal people, including general health mandates and specific HIV/
AIDS related issues. (E.g. Friendship Centers, Métis coalitions, Inuit Health Boards, etc.)

Organizations and individuals that advocate and set policies for Aboriginal people on a community
level, such as specific urban friendship centers and Inuit and Métis community centers.

Aboriginal Heath Advocacy organizations that have a national mandate, such as Aboriginal Nurses
Association of Canada, Native Physicians in Canada, the Canadian Aboriginal AIDS Network,
National Indian/Inuit Community Health Representatives Organization, etc.

Aboriginal HIV/AIDS Networks and Strategies, such as: The Red Road in BC, The Circle Of
Hope HIV/AIDS Strategy in Quebec, Alberta Aboriginal HIV/AIDS Strategy, and the Ontario
Aboriginal HIV/AIDS Strategy.

Aboriginal community-specific health and/or HIV/AIDS organizations, such as Healing Our Na-
tions in Atlantic, 2-Spirited People of the 1st Nations in Toronto, Healing Our Spirit in BC, etc..

National partners or those groups such as the Canadian AIDS Society, Canadian AIDS Treatment
Information Exchange, etc. who are mainly non-Aboriginal but have mandates to work within the
HIV/AIDS health field.

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                         D:                 CONSULT

The consultation version of the ASHAC was released June 2002, which led into summer, normally
a slow time of year and very little activity took place until September. Time and budget did not
allow for a different approach because of when funding was released. The second expanded work-
ing group brought additional knowledge, support and well needed expertise to the process which
helped prepare the consultation version. The process was left open - depending on needs and
requests of any region or group - a Focus Group or Presentation could be held or individual input
could occur.

The budget for this project simply did not allow for travel to bring participants in to consult, which
also limited the Strategy Coordinator's travel. Some Working Group members delivered Focus
Groups or Presentations, and some were done by teleconference. A mass mail out also occurred,
inviting individual feedback. In the end, 173 Aboriginal and non-Aboriginal people took time to
read and comment on this document. Much of the feedback made its way into the document.
Some did not, because issues were already included in the first draft or were more of an implemen-
tation issue. Many questions were around the consultation process and implementation. CAAN
hopes to eventually release two additional resources: 1) Summary Consultation Report; and 2)
Condensed version of the ASHAC. The Canadian Aboriginal AIDS Network wishes to thank each
person who contributed.

Location                                                Attendance
Yukon Community Groups                                       11
APHA Consult                                                 15
Quebec                                                         8
Assembly of First Nations                                      6
AIDS Calgary                                                   2
Saskatchewan Conference                                      12
NWT Healing Connections                                        2
Ontario First Nations HIV/AIDS Education Circle                8
Alberta Consult                                              38
Métis Addictions Council SK Inc.                               1
Canadian Inuit HIV/AIDS Network (4 + 11)                     15
Labrador Aboriginal HIV/AIDS Circle                            5
Atlantic Aboriginal HIV/AIDS Circle                          10
Ontario Federation of Friendship Centers                       5
Manitoba (3 + 8)                                             11
BC (Healing Our Spirit/Red Road)                              7
2-Spirited People of the 1st Nations                          7
Ontario Aboriginal HIV/AIDS Strategy                         10
TOTAL                                                        173

 An Aboriginal Strategy on HIV/AIDS in Canada for First Nations, Inuit and Métis People

Note: Some meetings had multiple interests involved, including Métis, Inuit and First
Nations, as well as APHAs. Efforts were made to reach each Province/Territory, all
three major Aboriginal groups, and National Aboriginal Organizations, but not al-
ways possible. For example, Métis National Council affiliates were approached, but
unable to participate in a teleconference, however fully support the ASHAC. Like-
wise, no Newfoundland or PEI representatives were available, yet all were provided


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