Why is HIV self-testing important?
HIV self-testing is an enormous leap forward in the HIV movement. It offers the potential for an individual to decide when and where they take an HIV test.
Testing, as a diagnostic tool, lets people know their HIV status. Testing represents an entry point to health care services. If a person tests negative, they have an opportunity to discuss ways to stay HIV negative. These discussions may also connect the person to other services such as housing support, access to nutritious foods, and harm reduction services for addictions and mental health.
If a person tests positive for HIV then, ideally, they will soon be connected to the kind of care that ensures healthy outcomes. This connection includes access to anti-retroviral treatment, which is one of the important medicines of an HIV-positive person’s wellness journey. For Indigenous People, connections to culture and land are equally important medicines.
What does HIV self-testing mean for Indigenous People?
In this land now called Canada, the health needs and outcomes of Indigenous People have often been framed through a negative lens. Colonial structures have created boundaries and barriers that reduce equitable health care across the land. These inequities have far-reaching impacts on all people, not just Indigenous People.
The technology of HIV self-testing offers a democratizing platform to increase health care access. It offers autonomy, where a person has more flexibility in when and where they take an HIV test. However, the test has the greatest impact when it is also accessible and affordable. These three aspects – availability, accessibility, and affordability – MUST exist together, not as silos that perpetuate historical and present-day barriers.
How do we move forward?
HIV self-testing is more than a diagnostic tool. It also presents research opportunities to build upon epidemiologic and implementation science evidence. Coordinated and systematic research, guided by Indigenous Ways of Knowing and Doing (IWKD), will demonstrate the efficacy, feasibility, and sustainability of this testing technology. Such research will illuminate some of the gaps and opportunities to increase well-being across the diversity of this land.
A principle of IWKD is that Indigenous people must be the stewards of Indigenous data. Jurisdictional constructs must be set aside to facilitate this, and any work with non-Indigenous partners must also be aligned with these ethics. When this research is done respectfully, collaboratively, and (w)holistically, it is a powerful force of change.
A legacy of colonialism is the focus on dis-eases, creating a pessimistic narrative about Indigenous communities. But, as Indigenous Peoples, we are guided by our ancestors and our medicines. There is a Nehiyaw (Cree) word that describes the love needed for life to grow, Sakihitowin. This concept is shared by Indigenous People, though we use different words to describe it. The intentions and efforts of stakeholders across the land – people living with HIV, community organizations, researchers, and government leadership – will manifest sakihitowin in how we ensure the availability, accessibility, and affordability of HIV self-testing technology.
To honour these relationships, CAAN will lead a summer pipe ceremony. More information about this will be available soon.