4.7: Indigenous Populations

From the early days of the HIV epidemic, Indigenous peoples were identified as a population group that experiences social and economic determinants – including colonialism, marginalization and racism – that increase exposure to HIV.¹ There are now substantial disparities in HIV rates between Indigenous and non-Indigenous peoples in many high-income countries.¹ Determinants of HIV-related behaviours in these countries include domestic violence, stigma and discrimination, and injection drug use.¹ Many of the factors associated with HIV risk also contribute to mistrust of health services, which in turn contributes to poor HIV and health outcomes among Indigenous peoples.¹

Indigenous leaders remain concerned that systemic oppression and culturally unsafe care impede Indigenous peoples living with HIV from accessing health services that make up the HIV cascade of care.² The majority of research in high-income countries has addressed HIV testing/diagnosis. Relatively little research has addressed post-diagnosis experiences such as linkage, retention, treatment initiation, treatment adherence, and viral suppression.² With the HIV cascade of care increasingly the focus of global, national, and local HIV agendas, it is critical that culturally-safe care for Indigenous peoples is available at all stages of the cascade of care.²