Summary findings from Tracks surveys implemented by First Nations in Saskatchewan and Alberta, Canada, 2018–2020

Abstract

Background: The Public Health Agency of Canada’s integrated bio-behavioural surveillance system—Tracks surveys—assesses the burden of HIV, hepatitis C and associated risks in key populations in Canada. From 2018–2020, Tracks surveys were successfully implemented by First Nations Health Services Organizations in Alberta and Saskatchewan. Methods: First Nations-led survey teams invited community members who identified as First Nations, Inuit or Métis to participate in Tracks surveys and testing for HIV, hepatitis C and syphilis. Information was collected on social determinants of health, use of prevention services, substance use, sexual behaviours and care for HIV and hepatitis C. Descriptive statistics are presented. Results: Of the 1,828 survey participants, 97.4% self-identified as First Nations and 91.4% lived in an on-reserve community. Over half (52.2%) were cisgender female, average age was 36.3 years, 82.5% lived in stable housing, 82% had access to primary healthcare and 73.8% reported having good to excellent mental health. Most participants (97%) had a family member who had experienced residential school. High proportions experienced stigma and discrimination (65.6%), financial strain (64.3%) and abuse in childhood (65.1%). Testing for HIV (62.8%) and hepatitis C (55.3%) was relatively high. Prevalence of HIV was 1.6% (of whom 64% knew their infection status). Hepatitis C ribonucleic acid prevalence was 5% (44.9% of whom knew their current infection status). Conclusion: Historical and ongoing experiences of trauma, and higher prevalence of hepatitis C were identified, reaffirming evidence of the ongoing legacies of colonialism, Indian Residential Schools and systemic racism. High participation in sexually transmitted blood-borne infection testing and prevention reflect the importance of First Nations-led culturally sensitive, safe and responsive healthcare services and programs to effect improved outcomes for First Nations peoples.

Infectious diseases in Indigenous populations in North America: learning from the past to create a more equitable future

“…128 Data concerning HCV are even more scarce, but the data that do exist suggest a similar pattern. 71 , 72 When such data are reported, indigeneity is erroneously portrayed as a risk factor, failing to underscore the historical and contemporary inequities that are actually responsible for such over-representation. Furthermore, Indigenous women are over-represented in the behaviours and circumstances considered high risk for HIV and HCV infections, including injection drug use, incarceration, and sex work, but attempts at linking these circumstances to coloniality are very rarely made.…”

“…Furthermore, Indigenous women are over-represented in the behaviours and circumstances considered high risk for HIV and HCV infections, including injection drug use, incarceration, and sex work, but attempts at linking these circumstances to coloniality are very rarely made. 71 The misclassification of Indigenous as a separate risk factor was discussed by Fayed and colleagues 73 as simultaneously at-risking and asterisking Indigenous women while ignoring the high-risk circumstances and activities of Indigenous over-representation, thereby minimising Indigenous leadership and voices in solutions. Many in the Indigenous HIV space see the need for structural changes to both programme and research funding so that distinctions-based, locally-led initiatives can be sustainably resourced.…”