HIV and Indigenous Peoples in Aotearoa, Australia and Canada Clive Aspin

Ko Matai Whetu te marae

Ko Moehau te maunga

Ko Waihou te awa

The needs of indigenous peoples in the face of rising rates of HIV We need a new approach to HIV We need to take control of our own lives HIV programs need to be designed, implemented and delivered by indigenous people We need strong indigenous leadership

Launch of the Toronto Charter at the 16 th International AIDS Conference, 2006

It is essential that HIV and AIDS data on indigenous peoples be collected, analysed and reported in a manner that is respectful of the needs of indigenous peoples as identified by indigenous peoples themselves

Some key statistics for 2008 New HIV infections per day New HIV infections in 2008 People living with HIV in 2008 Children ,0002,100,000 Young people (15-24) ,0005,000,000 Adults (25+) 37001,340,00026,300,000 Source: UNAIDS, Annual Report 2009

Three Decades of HIV and AIDS Rising rates of HIV No sign of a cure Increasing rates of unprotected sex among MSM in developed countries Treatments available for positive people, but limited mainly to developed countries Almost two thirds of PLWH are in sub-Saharan Africa Disease of the poor, marginalised and dispossessed MSM, sex workers, IDU, prisoners, indigenous peoples

Indigenous Peoples Indigenous people are living on every continent. In many countries they were displaced by peoples who colonized their land centuries ago, and they continue to suffer prejudice and discrimination at the hands of mainstream society. Many indigenous people live today as marginalized minorities in conditions of poverty and powerlessness—conditions favourable to the spread of HIV. However, specific efforts to monitor the epidemic among indigenous people are rare. Most of the scarce information available comes from the developed world. Source: UNAIDS

Indigenous peoples, HIV and AIDS What we know Data collection is poor, data are limited, ethnicity not accurately recorded Marginalised communities less likely to be counted, geographical isolation, stigma and discrimination act as disincentives to disclose status Social taboos and cultural norms prevent indigenous people from disclosing behaviour Accurate data may increase stigmatisation But absence of data can lead to neglect and invisibility The absence of reliable data about HIV infection means concerns about the impact of the HIV epidemic on indigenous populations may not be given priority on national and international policy agendas

HIV prevalence is a poor measure of the HIV risk faced by a community Factors that render individuals and communities vulnerable to HIV poverty marginalization lack of political or social power fragmentation of family and community relationships geographical isolation low literacy poor general health limited access to health care and health resources drug use/injection low individual and community self-esteem

AIDS, Maori and vulnerability to HIV MOH Action Plan on HIV/AIDS, 2003 Lack of access to culturally appropriate services Maori are disproportionately on low and very low incomes Trans-Tasman migration Lack of information Poor access to health resources such as condoms High rates of sexually transmitted infections High level of discrimination and stigmatisation Changing pattern of the AIDS epidemic

Australia - Aboriginal and Torres Strait Islanders 2002 to 2006 Non-Indigenous Most HIV transmission due to male homosexual contact Indigenous Higher rates of HIV infection due to heterosexual contact Higher proportion of infections attributed to IDU Higher proportion of infections were among women (33% vs. 11%)

Canada First Nations, Metis and Inuit Aboriginal peoples make up 3.3% of the Canadian population yet accounted for 13.4% of AIDS and 25.3% of HIV IDU principal mode of transmission - approx 60% of all cases females represented 45% of AIDS cases and HIV notifications Youth made up 31.4% of HIV diagnoses Ethnicity information is not reported on HIV surveillance data in the two largest provinces, Ontario and Quebec

Data forthcoming

Main points Rates of HIV diagnosis in Canada much higher than in Aotearoa and Australia in both males and females Rising rates of infection in Canada are due to injecting drug use In Aotearoa and Australia, rates of infection are highest among MSM Higher rates of infection due to IDU in Australia than in Aotearoa All countries operate NSP but Canada started later and did not use pharmacies for distribution

What does the public health system need to do to protect all members of society from HIV infection?

Kia ora Merci Gracias Thank you