In the dead of winter in mid-February of 2018, UNAIDS Executive Director Michel Sidibé attended a local HIV conference organized by indigenous communities in central Canada.
The local HIV Indigenous Conference, Know Your Status HIV Forum – From Knowledge To Action, was held on February 14 and 15, 2018, in Saskatoon, Saskatchewan. It was organized by the Saskatoon Tribal Council’s (STC) Health and Family Services, owned by the seven First Nations of the STC. The STC has a strategy to work with its communities and levels of government to improve the quality of life of its members. Opportunities for improved living are accessed through programs and services in health, safety, economic development, education, and financial investments in the broader community. The STC strives to provide HIV prevention, treatment, and care services that are culturally safe and culturally appropriate. Indigenous peoples living with and at risk for HIV have expressed great trust in the services provided through a harm reduction framework.
The Canadian government recognizes that indigenous people are a key affected population and works toward their accurate representation in HIV and AIDS epidemiological data. However, with a history of colonization, assimilation, and the legacy of the indigenous residential school system, indigenous communities have a high level of mistrust for the government, institutions, and the dominant culture across Canada. Similarly, not everyone working in the response to HIV understands and respects the rights of indigenous peoples, which can lead to discrimination and create additional structural barriers for local people to access treatment.
In an interview with the Canadian Broadcasting Corporation (CBC), Mr. Sidibé expressed his surprise at the perceived lack of trust. He learned that Saskatchewan has the highest rates of HIV in Canada, with 2,090 cases reported between 1985 and 2016, and that of the 170 new cases of HIV in the province in 2016, 79 percent self-identified as indigenous.
Despite the lack of trust in the system, there are positive examples of collaboration and solutions. With their partners in Saskatchewan, Indigenous communities show the world that a community-led response with solid and equitable partnerships with government and civil society organizations can work.
Both Ahtakakoop and Big River First Nations have received recognition for their targets on the UNAIDS 90-90-90 treatment targets through implementing the critical social support systems that must work collaboratively to activate change. A community-led response is what is needed for indigenous peoples the world over. Unfortunately, we don’t have the epidemiological data to accurately represent the lived reality of indigenous peoples in most other countries.
Collection and analysis of indigenous-specific epidemiology is vital to address HIV in this mostly overlooked priority population adequately. Action using epidemiologic data should be collaborative with indigenous people and driven by the community themselves.
Ending AIDS by 2030 will be impossible if indigenous peoples are left behind. It is the indigenous communities themselves who must be at the forefront of their response to HIV. In that light, UNAIDS is working behind the scenes with the UN Permanent Forum on Indigenous Issues (UNPFII) and the United Nations Population Fund (UNFPA) to plan for an Expert Group Meeting on HIV in the coming year.
Getting to zero means addressing equity. Outcomes in prevention and treatment in Indigenous communities should reach national and world targets, not lowered targets. To get to zero, we must address the 10-10-10 in the 90-90-90. We must know who they are and where they are to help the most vulnerable. UNAIDS global targets will not be achieved if indigenous communities remain ignored.