In recent months, high level discussions have been taking place at the federal level; the Public Health Agency of Canada (PHAC) has proposed to move towards a more integrated or holistic approach in the delivery of information and services for HIV, HCV, other ‘sexually transmitted blood borne infections’ (STBBIs) and Tuberculosis. Essentially what this translates to is that HIV and AIDS information and service delivery will now have to make room for STBBIs and Tuberculosis. This begs the question — what are the implications for the long-time established APHA caucus?
As one of two APHA Liaisons with the Canadian Aboriginal AIDS Network, both Trevor Stratton and I have always noted how honoured we are to be coordinating the work of the CAAN APHA Advisory Committee and the APHA Caucus. As the only recognized national Aboriginal organization with an HIV mandate grounded in the GIPA principle, the role that APHAs play within CAAN is significant. Generally in preparation for our annual and sometimes bi-annual APHA caucuses, the APHA Advisory Committee plays an important role in setting the agenda by prioritizing the issues that will need to be discussed. In the 5 years that I have been working as an APHA Liaison, I have witnessed tremendous growth within this formalized body. If truth be told, it is a formalized body where APHA leadership skills and knowledge levels are nurtured and honed, and also where APHA leadership begins to emerge. It is also a place where APHAs feel a sense of belonging and more importantly where APHA privacy and confidentiality is respected.
In our last two meetings with the APHA Advisory Committee, we began discussions about what is being proposed, and have begun planning for what we anticipate will be a very lively discussion at our upcoming APHA Caucus at the CAAN AGM. Although we have had preliminary discussions on how this ‘new’ approach could potentially impact the current established sitting APHA Caucus, it was decided that a formalized discussion would be necessary within the group. There was some discussion on the need to recognize that we are still fighting an uphill battle in addressing stigma and discrimination in our communities with regards to HIV and AIDS. It’s a multi-layered and complex area of discussion when you also include criminalization of HIV; an added layer that contributes to the continued stigmatization.
This may be a red flag for some, but truly, this integrated or holistic approach is not a new concept if you think about it. As Aboriginal people we have always worked within a holistic framework and have consistently advocated for these frameworks to be recognized at the national and international levels. For example, I would like to share two excerpts from past documents that recognize the Indigenous/Aboriginal holistic model.
Royal Commission on Aboriginal Peoples:
As Indigenous peoples we have always understood and practiced an integrated approach to health. The centrality of health to the total well-being of Indigenous peoples in Canada is summarized by the Royal Commission on Aboriginal Peoples (RCAP):
In the imagery common to many Aboriginal cultures, good health is a state of balance and harmony involving body, mind, emotions and spirit. It links each person to family, community and the earth in a circle of dependence and interdependence, described by some in the language of the Medicine Wheel. In non-Aboriginal terms, health has been seen primarily as an outcome of medical care. But we are quickly learning that any care system that reduces its definition of health to the absence of disease and disability is deeply flawed. (RCAP 1996)
Declaration on the Health and Survival of Indigenous Peoples
The Declaration on the Health and Survival of Indigenous Peoples had its origins in 1999 when the World Health Organization arranged an International Consultation on the Health of Indigenous Peoples in Geneva. This was subsequently prepared and presented to the UN Permanent Forum on Indigenous Issues in 2002. Written in five parts the Declaration affirms the basic tenets of the parent Declaration of the Rights of Indigenous Peoples but applies them to health. The links between culture, the wider natural environment, human rights, and health were discussed and a definition of health was proposed.
The 1999 Declaration on the Health and Survival of Indigenous Peoples by the World Health Organization proposed a definition of indigenous health: “Indigenous peoples’ concept of health and survival is both a collective and an individual inter-generational continuum encompassing a holistic perspective incorporating four distinct shared dimensions of life. These dimensions are the spiritual, the intellectual, physical, and emotional. Linking these four fundamental dimensions, health and survival manifests itself on multiple levels where the past, present, and future co-exist simultaneously. (A Briefing Paper for the Permanent Forum on Indigenous Issues, May 2002)
Our challenge has always been, and will continue to be, about addressing stigma and discrimination, whether we are working to address HIV/HCV care, treatment and support, or prevention. Within the hierarchy of disease, HIV and AIDS, is at the bottom of the heap, so to speak. In my community, HIV has been referred to as, ‘wiinaapinewin’, which translates to ‘dirty disease’. A peer, whom I greatly admire, and who has tirelessly worked with people in remote fly-in First Nations communities in Northern Ontario hits the nail on the head when he says, “There is a prevailing code of silence and reluctance to talk about HIV and sex in our communities.”
And herein lies our dilemma: against this backdrop of historical trauma and its ripple effects; the accompanying shame as a direct result of these experiences keep our people at a place where there is reluctance in talking about sex. How do we convey the importance of deconstructing our thinking, and finding ways to talk about sex in healthy ways as part of prevention?
It is important to note that a holistic model is an all encompassing approach, and works for all these diseases, including HCV and STBBIs, and will help us as we move towards the promotion of healthy sexuality.
The World Health Organization defines sexual health as follows:
‘Sexual health is a state of physical, mental and social well-being in relation to sexuality. It requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence.
One aspect of work that I, and several women across the country, have been involved with in the last two years has been on a research project entitled Visioning Health: An Arts-Informed Approach to Understanding Culture and Gender as Determinants of Health for HIV-Positive Aboriginal Women.This research project utilizes a strengths-based approach grounded in decolonizing methodologies, utilizing arts-based approaches that embrace culture and ceremony. It signaled a break away from how research has traditionally been done. It was time to tell a different story that honoured the ‘lived experience’ of Aboriginal women by showing their resiliency and strength in the face of an epidemic that is causing a huge impact in Canada.
In conclusion, I truly believe that by embracing, entrenching and embedding cultural practices and ceremony into all that we do as we move forward can only strengthen us as communities and nations. Our indigenous research is already moving in this direction within a decolonizing construct. We need to move away from the telling of a ‘dangerous story’ that focuses on our deficits. Our communities need to hear a different narrative, one that tells of our resiliency and strength; a story that speaks to how we thrive as opposed to just surviving.