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
16th 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
New HIV
infections infections in
per day
2008
People living
with HIV in
2008
Children
1200
430,000
2,100,000
Young people (15-24)
2500
920,000
5,000,000
Adults (25+)
3700 1,340,000
26,300,000
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
www.unaids.org/en/PolicyAndPractice/KeyPopulations/IndigenPeople/default.asp
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
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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 - 2003
• 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
• 1998-2003 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