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Experiences of the HIV Cascade of Care Among Indigenous Peoples: A Systematic Review

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Abstract

Indigenous leaders remain concerned that systemic oppression and culturally unsafe care impede Indigenous peoples living with HIV from accessing health services that make up the HIV cascade of care. We conducted a systematic review to assess the evidence related to experiences of the HIV care cascade among Indigenous peoples in Australia, Canada, New Zealand, and United States. We identified 93 qualitative and quantitative articles published between 1996 and 2017 reporting primary data on cascade outcomes disaggregated by Indigenous identity. Twelve involved data from Australia, 52 from Canada, 3 from New Zealand and 26 from United States. The majority dealt with HIV testing/diagnosis (50). Relatively few addressed post-diagnosis experiences: linkage (14); retention (20); treatment initiation (21); adherence (23); and viral suppression (24). With the HIV cascade of care increasingly the focus of global, national, and local HIV agendas, it is critical that culturally-safe care for Indigenous peoples is available at all stages.

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Notes

  1. A note about terminology: we have chosen to use the word Indigenous to refer broadly to the First Peoples of the lands and territories that are the focus of this paper. We acknowledge that Indigenous peoples globally are diverse, made up of many nations and communities. Where possible, we have tried to honour the identities of the Indigenous participants involved in the research summarized here by using specific names; however, this is not always possible, especially where data are aggregated. In these cases, we use the term “Indigenous”. We use “Indigenous peoples” when referring to a group of populations and “Indigenous people” when referring to an individual’s engagement with care. When referring to individual Indigenous people living with HIV we use the acronym IPHA.

  2. We have attempted to avoid counting participants twice by adjusting for multiple articles published by the same study. However, it may be that some participants are represented in more than one study.

  3. This spelling is explicit as it implies “whole” instead of “hole” (deficit focused), as recommended by Mi’kmaq Elder Murdena Marshall.

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Acknowledgements

We are grateful for the guidance of the Cedar Project Partnership: Elders Violet Bozoki (Lheidli T’enneh) and Earl Henderson (Métis/Cree); Vancouver Native Health Society; Red Road HIV/AIDS Network; Canadian Aboriginal AIDS Network; Carrier Sekani Family Services; Positive Living North; Prince George Friendship Centre; All Nations Hope; Splatsin, Neskonlith and Adams Lake Indian Bands. Thank you also to Ursula Ellis, reference librarian at UBC's Woodward Library, for help developing the search strategy.

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Authors and Affiliations

  1. School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, BC V6T 1Z3, Canada

    Kate Jongbloed, Richa Sharma, Margo E. Pearce, Nancy Laliberte, Martin T. Schechter & Patricia M. Spittal

  2. Cree, Victoria, Canada

    Sherri Pooyak

  3. Aboriginal HIV and AIDS Community-Based Research Collaborative Centre, Victoria, Canada

    Sherri Pooyak

  4. Nak’azdli Whut’en, Vancouver, Canada

    Jennifer Mackie

  5. Peter A. Allard School of Law, University of British Columbia, Vancouver, Canada

    Jennifer Mackie

  6. Cree and Métis, Vancouver, Canada

    Nancy Laliberte & Lou Demerais

  7. Vancouver Native Health Society, Vancouver, Canada

    Lou Demerais

  8. Division of Infectious Diseases, University of British Columbia, Vancouver, Canada

    Richard T. Lester

  9. Mi’kmaq, Victoria, Canada

    Charlotte Loppie

  10. School of Public Health and Social Policy, Faculty of Human and Social Development, University of Victoria, Victoria, Canada

    Charlotte Loppie

  11. BC Children’s Hospital Research Institute, Vancouver, Canada

    Patricia M. Spittal

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  1. Kate Jongbloed
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  • Violet Bozoki
  •  & Earl Henderson

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Correspondence to Kate Jongbloed.

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This article involves a review of published studies and therefore does not contain any studies with human participants performed by any of the authors for this publication. Author CL was an author involved in two of the 93 articles selected for inclusion, both of which were conducted in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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The members of the Cedar Project Partnership are listed in the acknowledgements.

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Jongbloed, K., Pooyak, S., Sharma, R. et al. Experiences of the HIV Cascade of Care Among Indigenous Peoples: A Systematic Review. AIDS Behav 23, 984–1003 (2019). https://doi.org/10.1007/s10461-018-2372-2

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