HIGH RISK GROUPS

The first fact that any HIV/AIDS prevention worker has
to confront is the variety of ways HIV/AIDS is now
entering their communities. Today, high-risk populations
include injection drug users, men having sex with men, and
people having unprotected heterosexual activity. With the
high percentage of women becoming infected, perinatal
transmission, where infants are infected at birth or through
breastfeeding from HIV-positive mothers, is also becoming
a growing concern.

By far the largest group of new Aboriginal infections
are from injection drug users. HIV/AIDS workers
are looking at the expansion of harm reduction programs
such as needle exchanges. Part of the problem with
delivering these programs to Aboriginal people is their
high mobility, with many moving back and forth between
their communities and urban centres. The idea of expanding
needle exchange programs into the communities has been
suggested, but HIV/AIDS activists said that this meets strong
resistance from community leaders who fear they will be seen
to be sanctioning drug use.

Many HIV/AIDS workers feel that the only long-term solution
is to treat the root causes of injection drug use. They refer to
the "post-colonial stress syndrome," which continues to drive
many young First Nations people to self-abusive behaviours,
including alcohol and drug use and suicide. In the prevention
of the disease among the young, HIV/AIDS workers say that it
is imperative to address the underlying emotional and
self-esteem issues.

A Community Approach
The call at "Breaking Down the Barriers - Addressing the
Emerging Epidemic" was to begin HIV/AIDS education and
awareness programs with the young and involve all elements
of the community. Carl Orr of the Union of Ontario Indians
said that for the very young, you could begin to teach about
HIV/AIDS without mentioning the disease, or even sex.
He suggested Elders could explain to children that if they
cut themselves when they were skinning a fox, they could
get any illness that the fox had. "And from there they can
talk about the exchange of fluids in a more general way."
But the direct approach was preferred for older children
with the HIV/AIDS workers calling for a broad-based
community education campaign. "We have to get to the
children in the second or third grade," Orr said. "Age
7 to 12 are the most formative years and this is
the critical group to equip with information. We know that
children as young as 14 are already having babies in some
communities."

Teaching tools like Let's Rap About AIDS were recommended
as starting points. Among other things, this game teaches
kids about needles and condoms, and how they should go
to find an adult if they see one. It was also suggested that
children be brought into community HIV/AIDS awareness
campaigns, like the Annual AIDS Walk.

As part of the community mobilization, and to encourage open,
honest dialogue, band councils and daycares were encouraged
to develop HIV/AIDS policies and protocols. In programs for
young people in the 12 and up age group, it was thought essential
that the young people themselves be brought in to help design
the programs and to take a leadership role in running them.
Two other crucial elements in HIV/AIDS awareness and
prevention programs were parental and school involvement.
Jake Linklater, the executive director of the Canadian Aboriginal
AIDS Network (CAAN), pointed out that the schools were often the
weak link because of jurisdictional problems with provincial
governments. But cooperation from the schools was viewed as
essential, and healthcare workers called on the political leadership
to help them break the political logjam.

Carl Orr said that child abuse was also an issue, and that one
way to prevent HIV/AIDS was to ensure you have a safe community.
Kids who grow up in an abusive home, or a home with violent or
addicted parents, are at high risk for developing the behaviors
- injection drug use, unprotected sexual activity, and behaviors
leading to incarceration - that greatly increase the risk of
contracting HIV/AIDS.

Working with the Incarcerated
A special focus at the conference was also placed on the role
of Aboriginal prisoners. People in prisons are 10 times more
likely to have HIV/AIDS than the general population and
Aboriginal people are incarcerated at a much higher rate than
other people in Canada. As one participant pointed out, unless
the incarcerated people are given prevention and awareness
programs, they will bring the virus home.

Health workers described the current HIV/AIDS awareness
programs in prisons as inadequate. Most of them are peer
education programs, which didn't seem to be working on HIV/AIDS
issues. They suggested enlisting Elders into making prison visits
to promote healthy lifestyles and to give spiritual support.
Teaching prisoners, and all young people, their national language
would also help to root them more firmly into their culture and its
traditional values.

Communities were encouraged to look into early release
programs that would allow them to bring some band members
home from prison so they could intervene in positive ways.
The returning prisoners, if they responded well, could become
important role models for the young, particularly for young men
who tend to look up to those who have been incarcerated and
are far more likely to heed a warning from a man who has
experienced street life, than from a social worker or health
professional.

Two-spirit People
Art Zoccole of the Red Road AIDS Network reminded the
conference about the need to work to address discrimination
against two-spirit men. His own connection to HIV/AIDS, he said,
came in 1982 when a friend died from the disease. In 1989,
he started an association of two-spirit Aboriginal men in Toronto.
"Two-spirit people generally migrate to urban areas," he said,
"with only a few very courageous individuals staying home. When
most two-spirit were infected, they were living away from the
community. They had no one to tell. They couldn't tell their
families they were gay, let alone that they had HIV and AIDS."
He added that now even straight men who contract AIDS as
injection drug users are afraid to admit it because people will
think they are gay.

"We need to talk about these things all of the time," he said.
"We have to go to every venue we can to talk about
HIV/AIDS - to get it into the open. People are waiting
for communities to take on the AIDS issue. And the
moment they do, people are going to start to return home.
They are waiting."

Aboriginal Women
One of the most startling elements of the new statistics on HIV
infections is the number of Aboriginal women who are becoming
infected. In the general Canadian population, only 20 per cent of the
new infections are among women. In the Aboriginal population,
more than 45 per cent of the new infections are among women, and
most of these are young injection drug users, who are often
forced to work as prostitutes to support their drug habit.
Arlo Yuzicappi-Fayant described the risk factors for
infection among women as low education, unemployment,
substance abuse, injection drug use, and unprotected sex.
But she also said that when working with women at risk,
it was important not to be judgemental about their lives.
"The most essential first step is that women get help with
their self-esteem," she said.

A large number of women also get HIV from sex with their
husbands, lovers or boyfriends, or from sharing needles with
their partner as injection drug users - unaware that their partner
has been sharing needles or having unprotected sex with others.
In heterosexual activity they sometimes assume they don't need
condoms because they trust their partners. "This often leaves
them not knowing they are infected because they haven't been
engaging in risky behavior. So they are diagnosed only when
they have full-blown AIDS, and therefore they have a very short
survival rate," Yuzicappi-Fayant said.

Part of the problem for young women, Yuzicappi-Fayant added,
was that they did not understand their own historical roles as
highly respected members of their Nations. It was suggested
that community women's groups and health agencies target
information workshops at women, particularly at young women,
to give them a better sense of pride in their heritage.

Children with AIDS
The youngest victims of HIV/AIDS are those who receive the
virus at birth, or shortly after, through breastfeeding. Testing
for young women becomes particularly important because a
caesarean section birth, with no breastfeeding, can
dramatically cut down the rate of transmission of
the disease to the children of HIV-positive mothers.
When the virus is transmitted perinatally, the symptoms of
AIDS for young children are similar to those of adults, although many
of these children die before reaching adolescence. During
their life, children with HIV/AIDS often face discrimination
within the community with parents pulling kids out of schools
and daycares because they don't want them near children
with HIV. The conference delegates urged communities to
pass resolutions guaranteeing the rights of all children, as well
as adults with HIV/AIDS, to all community services.
Ultimately, the message HIV/AIDS workers had about the
disease was a stark one: from birth until death, everyone
is vulnerable. Getting that message out, and changing
the behaviours that result in transmission of the virus,
has become a matter of life and death for growing numbers
of Aboriginal people, families and communities.