“Getting to zero” Means Addressing Equity and Supporting Indigenous Community-based Responses and Leadership

By Trevor Stratton, North American NGO Delegate

In the dead of winter in mid-February of 2018, Michel Sidibé, the Executive Director of UNAIDS, 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 Saskatoon Tribal Council’s (STC) Health and Family Services, owned by the seven First Nations of STC. 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. 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 a great deal of trust for their 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 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 creates 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 per cent self-identified as indigenous.

Despite the lack of trust towards the system, there are positive examples of collaboration and solutions. Indigenous communities, with their partners in Saskatchewan, are showing the world that a community-led response with strong and equitable partnerships with government and civil society organizations really 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 just 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 adequately address HIV in this mostly overlooked priority population. Action using epidemiologic data should be collaborative with indigenous populations 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 own 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. It is important to know who they are, and where they are, so we can help the most vulnerable. UNAIDS global targets will not be achieved if indigenous communities continue to be ignored.

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