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Inequalities in Determinants of Health Among Aboriginal and Caucasian Persons Living With HIV/AIDS in Ontario: Results From the Positive Spaces, Healthy Places Study

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Aboriginal Canadians (i.e., First Nations, Inuit and Métis) are disproportionately affected by HIV/AIDS, and experience greater social and economic marginalization and poorer housing conditions. This study sought to understand the differences in the determinants of health and housing-related characteristics between samples of Aboriginal and Caucasian adults living with HIV/AIDS in Ontario. We analyzed baseline demographic, socio-economic, health, and housing-related data from 521 individuals (79 Aboriginal and 442 Caucasian) living with HIV/AIDS and enrolled in the Positive Spaces, Healthy Places study. We compared the characteristics of Aboriginal and Caucasian participants to identify determinants of health and housing-related characteristics independently associated with Aboriginal ethnicity. Compared to Caucausian participants living with HIV, Aboriginal participants were more likely to be younger, female or transgender women, less educated, unemployed, and homeless or unstably housed. They were also more likely to have low incomes and to have experienced housing-related discrimination. In a multivariate model, gender, income, and experiences of homelessness were independently associated with Aboriginal ethnicity. Aboriginal individuals living with HIV/AIDS in our sample are coping with significantly worse social and economic conditions and are more likely to experience challenging housing situations than a comparison group of Caucasian individuals living with HIV/AIDS. To develop effective care, treatment and support strategies for Aboriginal peoples with HIV, it is critical to address and improve their socio-economic and housing conditions.
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... This is particularly true when evaluation teams focus on overcoming challenges to data collection collectively, while retaining the communities' voice and equity [39][40][41][42][43][44]46]. Finally, intersectional approaches to research facilitate an unpacking of stigmatic, health-based and cultural cross-overs between Indigeneity and other experiences of health-or socially-based marginalisation [211,387,428,453,473]. ...
... Transgender women are at a high risk of HIV acquisition compared to other Aboriginal subpopulations [428]. ...
... Despite some Aboriginal women undergoing HIV testing more on average compared to Aboriginal men [195], Aboriginal WLWH also make a significant proportion of P/WLWH [352,428,534,535], and experience some of the highest rates of mortality and ill health [186,536]. They are at significant risk of treatment attrition or aversion [418], particularly when they are also PWUD [452]. ...
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... Following the work of Delavega and Lennon-Dearing (2015), Ion et al. (2018), and Monette et al. (2011), our findings confirm the need for culturally appropriate health and social supports that incorporate Housing First options for Indigenous women living with HIV. These supports should be Indigenous-led and prioritize Indigenous sovereignty over health and well-being. ...
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... Indigenous people have been noted to suffer higher mortality even after receiving antiretroviral treatment, suggesting that social determinants may need to be addressed in order to realise the expected effectiveness of medical treatment. 40 Interventions must consider the intergenerational context of Indigenous homelessness, and promote the health of children through investments in families and communities. This analysis has strengths and limitations. ...
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... The history of residential schools continues to echo in poverty, limited access to education and fair employment, alcoholrelated stigma (Egan, 2014), lack of access to health care and education, unsafe sexual behaviour, and use of contaminated injecting equipment (McCall & Lauridsen-Hoegh, 2014). Thus, social and economic conditions, which are significantly worse for Aboriginal individuals (Monette et al., 2011), shape the risk of acquiring HIV (Cain et al., 2013). ...
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