Alarming rates of HIV/AIDS for Canada’s Aboriginal women
Aboriginal women are greatly over-represented in HIV/AIDS statistics, yet there is a startling lack of gender-specific, Aboriginal-specific, HIV/AIDS resources, programs and services to support them.
Aboriginal women are the caregivers of their communities, and while they have repeatedly shown themselves to be strong, resilient and undaunted by hardship, they can not be expected to bear the burden of HIV/AIDS in Aboriginal communities alone. Governments, communities and AIDS services organizations must recognize their responsibility to Aboriginal women and begin to provide the Aboriginal, women-specific research, programs, services and supports they need.
The rate of new HIV infections among Aboriginal women in Canada has been steadily increasing over the past two decades. Aboriginal women now account for approximately 50% of all HIV-positive test reports among Aboriginal people, compared with only 16% of their non-Aboriginal counterparts (2003). Aboriginal women comprise nearly 25% of reported AIDS cases among Aboriginal people, while non-Aboriginal women account for only 8.2% among non-Aboriginal cases (2003).
Alarmingly, a large and increasing portion of HIV infections are occurring in young Aboriginal women between 15-29 years old. Between 1985 and 1995, roughly 13% of HIV-positive test reports among Aboriginal women were in young women in this age group. However, this percentage has increased steadily to approximately 37% in 1998, and 45% in 2001.
Injection drug use (IDU) is the main mode of HIV transmission for Aboriginal women, followed by heterosexual contact, sometimes with partners who use injection drugs. In 2002, 64.9% of reported AIDS cases among Aboriginal women reported their exposure category as injection drug use, and 30.9% reported the mode of transmission as heterosexual contact (2003). Research studies with injection drug users in Vancouver indicate that Aboriginal women are over-represented in the IDU population, and consequently, are overrepresented in HIV positive test reports with IDU as the known mode of transmission.
Of the many factors that increase Aboriginal women’s vulnerability to HIV infection, a common undercurrent is colonization. Intensive and sustained efforts on the part of the government to colonize Canada’s Aboriginal peoples have had affects on the socio-economic status of Aboriginal women. Aboriginal women are twice as likely to be poor than their non-Aboriginal counterparts, and they are more likely to live in an environment where substance abuse and spousal violence are widespread.
These socio-economic conditions are strongly associated with a positive HIV test result for Aboriginal women, and they contribute to the creation of harsh living environments in which techniques used to simply survive often include high-risk behaviours, such as rural to urban migration, homelessness, sex trade and/or sex work, injection drug use and alcohol abuse.
There are also many factors associated with gender, and a power imbalance between genders, that increase Aboriginal women’s vulnerability to HIV infection. For instance, studies show that repeated physical and sexual abuse is strongly associated with a positive HIV test report, and that Aboriginal women are significantly more likely than non-Aboriginal women to have experienced all kinds of violence, including physical and sexual abuse.
When women are forced or coerced into having sex against their will, the likelihood of contracting HIV is increased; their abusers are unlikely to wear condoms and women are unable to insist that they do so. As a result, the likelihood of tears or abrasions to the women's genitals is increased, which in turn, increases the likelihood of HIV transmission.
Repeated sexual or physical abuse affects women's vulnerability in other ways as well. Women who experience abuse are highly likely to be poor, have limited access to education and employment, have low levels of self-esteem and often turn to alcohol and drugs as a way of coping and reducing the pain or post-traumatic effects of sexual abuse and other traumas. The experience of abuse often results in powerlessness in intimate relationships and an inability to negotiate safer sex, even during consensual sex.
It is clear that we need to develop a national response to HIV/AIDS that is designed, developed and implemented by Aboriginal women. Aboriginal women and Aboriginal women with HIV/AIDS must be integral in the design and delivery of these initiatives. In particular, we need to have targeted prevention and educational initiatives for Aboriginal women in relation to IDU, and we need to target prevention and educational initiatives for Aboriginal women between 15-29 years old.
We also need to make sure these programs address:
Substance abuse:
*Provide short and long-term supports for Aboriginal women struggling with addictions.
Poverty:
*Since poverty is directly related to HIV vulnerability, increasing meaningful job opportunities and job training for Aboriginal women will, over time, decrease their vulnerability to HIV infection.
Power:
*HIV prevention efforts for Aboriginal women must also begin to address the imbalance of power that is often a feature of intimate relationships. Prevention and education must target Aboriginal heterosexual men as well as women, and prevention efforts must address domestic and sexual violence against women.
*We must develop cultural sensitivity training for health professionals to equip doctors, nurses, and other health practitioners with appropriate skills to communicate about HIV with Aboriginal women.
Many Aboriginal women do not have the information or the skills they need to protect themselves from HIV, and many HIV positive women live in isolation and fear of having their status revealed. On the whole, however, the voices of Aboriginal women have not been silenced, nor have their spirits been dampened. On the contrary, Aboriginal women, and Aboriginal HIV positive women are speaking out in record numbers, offering their experiences to others as learning tools, telling their stories, breaking down stereotypes, acting as role-models, and changing the way we think about Aboriginal women living with HIV/AIDS. For this they may be applauded. For this, they must be respected. In this, they must be supported.
