Land-Based Retreats as a Method for Building Enabling Environments for HIV Prevention with Northern and Indigenous Adolescents in the Northwest Territories, Canada: Mixed-Methods Findings.

The Northwest Territories (NWT), Canada has high rates of sexually transmitted infections (STI) that elevate HIV acquisition risks. We conducted a mixed-methods study to explore the potential of land-based peer leader retreats (PLR) in building HIV prevention enabling environments among Northern and Indigenous youth in the NWT. PLRs are grounded in Indigenous principles and ways of knowing, acknowledging the land as a physical, spiritual, emotional, and intellectual being with the potential to facilitate (re)connection to culture, community, and self. We conducted one-week PLRs between 2016 and 2021 with adolescents aged 13-17 in the NWT. PLRs addressed HIV/STIs, safer sex, and gender equity. We conducted post-retreat focus groups (FGs) and pre/post-retreat surveys with youth participants (n = 353), and post-retreat FGs with PLR facilitators (n = 252). We applied thematic analysis to FGs and assessed pre/post-retreat changes in HIV/STI knowledge and safer sex efficacy (SSE) using paired sample t-tests. We assessed factors associated with post-test SSE and HIV/STI knowledge using multivariable linear regression. Youth participants (n = 353; mean age: 14.5, standard deviation [SD]: 1.3) were mostly Indigenous (71%) and women (66%). Participant narratives revealed PLRs enhanced technical communication (e.g., correct condom use). There were significant post-retreat HIV/STI knowledge increases; change score increases were lower for Indigenous participants. Qualitative narratives described how PLRs fostered transformative communication (e.g., sexual consent). There were significant post-retreat increases in SSE, and these were lower among men and sexually diverse (vs. heterosexual) participants. Land-based PLRs offer the potential to build technical and transformative communication to facilitate HIV prevention with youth in Canada's North.

The Impact of Indigenous Youth Sharing Digital Stories About HIV Activism.

INTRODUCTION: This article reports on the micro-, meso-, and macro-level impacts of sharing digital stories created by Indigenous youth leaders about HIV prevention activism in Canada. METHOD: Eighteen participants created digital stories and hosted screenings in their own communities to foster dialogue. Data for this article are drawn from individual semistructured interviews with the youth leaders, audio-recordings of audience reflections, and research team member's field notes collected between 2012 and 2015 across Canada. Data were coded using NVivo. A content analysis approach guided analysis. RESULTS: The process of sharing their digital stories had a positive impact on the youth themselves and their communities. Stories also reached policymakers. They challenged conventional public health messaging by situating HIV in the context of Indigenous holistic conceptions of health. DISCUSSION: The impact(s) of sharing digital stories were felt most strongly by their creators but rippled out to create waves of change for many touched by them. More research is warranted to examine the ways that the products of participatory visual methodologies can be powerful tools in creating social change and reducing health disparities.

Research Done in "A Good Way": The Importance of Indigenous Elder Involvement in HIV Community-Based Research.

OBJECTIVES: We examined the role that Indigenous Elders can play in ensuring that community-based research (CBR) is conducted ethically. METHODS: We present data from a larger qualitative study exploring ethical issues that occur in HIV-related CBR through the experiences of researchers engaged in CBR. Between May 2010 and July 2011, we interviewed 51 academic and community research team leaders of federally funded HIV CBR studies. We used thematic analysis techniques to identify themes. RESULTS: Participating researchers engage Elders in research because Elders are keepers of Indigenous knowledge, dynamic ethical consultants, community protectors, and credible sources of information who are able to counsel and support, mediate conflict, provide local context and history, and conduct ceremonial roles. Potential challenges cited by participants to engaging Elders in research include finding the right "fit," approaching Elders in a culturally appropriate way, and bureaucratic environments that do not honor Indigenous processes. CONCLUSIONS: Culturally appropriate Elder engagement in HIV CBR with Indigenous communities is vital for promoting positive relationships and culturally safe research that respects ceremony and Indigenous ways of knowing.

"I'm still not over feeling so isolated": Métis women, Two-Spirit, and gender-diverse people's experiences of the COVID-19 pandemic.

OBJECTIVES: The aim of this study was to explore and learn from the experiences of Métis women, Two-Spirit, and gender-diverse people accessing health and social services in Victoria, British Columbia, during the COVID-19 pandemic. METHODS: This paper comes from a larger study exploring Métis women, Two-Spirit, and gender-diverse people's experiences accessing health and social services in Victoria. Using a by-and-for Métis approach that employed a conversational interview method, we conducted interviews with Métis women, Two-Spirit, and gender-diverse people who lived in and/or accessed services in Victoria in December 2020 and January 2021. This paper focuses specifically on data addressing how COVID-19 impacted these participants. RESULTS: A total of 24 Métis women, Two-Spirit, and gender-diverse people participated in the study. Overall, three themes specific to COVID-19 were identified. First, participants described the detrimental impacts of COVID-19 on their ability to connect with their Métis community and practice their culture, as well as their overall feelings of isolation. Second, participants highlighted some of the ways that COVID-19 has exacerbated existing barriers to culturally safe healthcare. Last, participants spoke about the mixed economic impacts that COVID-19 has had for them, sharing insight into the ways in which gender, in particular, has shaped their financial instability. CONCLUSION: Improving access to culturally safe health and social services by incorporating the experiences and expertise of Métis women, Two-Spirit, and gender-diverse people is crucial to mitigating the disproportional negative impacts of the pandemic and improving overall health outcomes within Métis communities across Canada.

RéSUMé: OBJECTIFS: Explorer les expériences de femmes métisses et de personnes métisses bispirituelles et de diverses identités de genre ayant accédé aux services sociaux et de santé à Victoria (Colombie-Britannique) pendant la pandémie de COVID-19, et en tirer des leçons. MéTHODE: Cet article vient d'une vaste étude sur les expériences de femmes métisses et de personnes métisses bispirituelles et de diverses identités de genre ayant accédé aux services sociaux et de santé à Victoria. À l'aide d'une démarche par et pour les personnes métisses qui a fait appel à une méthode d'entrevue directe, nous avons mené des entrevues avec des femmes métisses et des personnes bispirituelles et de diverses identités de genre ayant vécu à Victoria en décembre 2020 et janvier 2021 et/ou accédé à des services dans cette ville durant cette période. Le présent article porte spécifiquement sur les données liées aux incidences de la COVID-19 chez ces personnes. RéSULTATS: En tout, 24 femmes et personnes métisses bispirituelles et de diverses identités de genre ont participé à l'étude. Dans l'ensemble, trois aspects relatifs à la COVID-19 sont ressortis des données. Premièrement, les personnes participantes ont décrit les effets préjudiciables de la COVID-19 sur leur capacité de rester en lien avec leur communauté métisse et de pratiquer leur culture, ainsi que leurs sentiments d'isolement en général. Deuxièmement, elles ont souligné certaines des façons dont la COVID-19 a exacerbé les barrières existantes à l'accès aux soins de santé culturellement sûrs. Enfin, les personnes participantes ont parlé des retombées économiques mitigées de la COVID-19 dans leur cas, et elles ont partagé leurs idées sur le rôle du genre, en particulier, dans leur instabilité financière. CONCLUSION: Pour atténuer les effets préjudiciables disproportionnés de la pandémie et améliorer les résultats cliniques globaux au sein des communautés métisses du Canada, il est essentiel d'améliorer l'accès aux services sociaux et de santé culturellement sûrs en y intégrant les expériences et le savoir-faire de femmes métisses et de personnes métisses bispirituelles et de diverses identités de genre.

'By identifying myself as Métis, I didn't feel safe ': Experiences of navigating racism and discrimination among Métis women, Two-Spirit and gender diverse community members in Victoria, Canada.

OBJECTIVE: Racism acts as a major barrier to accessing health services for Indigenous communities in Canada, often leading to delayed, avoided or lack of treatment altogether. The Métis population is uniquely positioned in urban settings, as they experience discrimination from both Indigenous and mainstream health and social services due to Canada's long colonial history that is ongoing. Yet, Métis are often left out of discussions regarding racism and health service access. This study explores the experiences of racism and health service access among Métis peoples in Victoria, British Columbia. METHODS: We allied a conversational interview method to explore and understand experiences of self-identifying Métis women, Two-Spirit and gender diverse people (n = 24) who access health and social services in Victoria. Data analysis followed Flicker and Nixon's six-stage DEPICT model. RESULTS: In this paper, we share the experiences of racism and discrimination of those who accessed health and social services in Victoria, British Columbia Such experiences include passing as White, experiencing racism following Métis identity disclosure and witnessing racism. Passing as White was viewed as a protective factor against discrimination as well as harming participants' sense of identity. Experiences of racism took the form of discriminatory comments, harassment and mistreatment, which influenced the willingness of disclosing Métis identity. Witnessing racism occurred in participants, personal and professional lives, negatively impacting them in indirect ways. Each experience of racism had a negative influence on participants' wellbeing and shaped their experience of accessing health and social services. CONCLUSIONS: Métis people confront racism and discrimination when attempting to access health and social services through first-hand experiences, witnessing and/or avoidance. While this study contributes to the all too often unacknowledged voices of Métis in Canada, there is a continued need for Métis-specific research to accurately inform policy and practice.

A qualitative study exploring access barriers to abortion services among Indigenous Peoples in Canada.

OBJECTIVE: This paper reports on findings from our exploratory qualitative study that aims to advance knowledge around access to and experiences with abortion services among Indigenous Peoples in Canada. STUDY DESIGN: We applied an Indigenous methodology to engage with 15 Indigenous Peoples across Canada utilizing a conversational interview method. Our study was informed by an Indigenous Advisory Committee consisting of front-line service providers working in the area of abortion service access and/ or support across Canada. RESULTS: We conducted conversations from September and November 2021. Participants identified with Métis, Cree, Dene, Inuit, Haudenosaunee, Anishinaabe, and Mi'kmaq nations, across nine provinces and territories. Participants spoke to six themes encompassing challenges and potential solutions around abortion access experiences among Indigenous Peoples in Canada. These included (1) logistical barriers, (2) poor treatment, (3) stigma, (4) impacts of colonialism on attitudes towards abortion, (5) traditional knowledge, and (6) follow-up care and support. CONCLUSIONS: Our study demonstrates that Indigenous Peoples experience abortion access barriers that are different than non-Indigenous Canadians, and that these barriers are closely linked to colonialism. IMPLICATIONS: Indigenous knowledges and practices that honor reproductive choice that pre-dates settler colonialism, must be brought forward into today to enhance the quality of abortion care.

"I would love for there not to be so many hoops ": recommendations to improve abortion service access and experiences made by Indigenous women and 2SLGTBQIA+ people in Canada.

Acknowledging the barriers in accessing sexual and reproductive health services that disproportionately impact Indigenous women and 2SLGTBQIA+ people, coupled with the lack of knowledge surrounding Indigenous peoples' experiences with abortion, we present qualitative findings from a pilot study investigating Indigenous experiences of accessing abortion services in Canada. We focus on findings related to participant recommendations for improving safety and accessibility of abortion services made by and for Indigenous people in Canada. Informed by an Indigenous Advisory Committee consisting of front-line service providers working in the area of abortion service access and/ or support across Canada, the research team applied an Indigenous methodology to engage with 15 Indigenous people across Canada utilising a conversational interview method, between September and November 2021. With representation from nine provinces and territories across Canada, participants identified with Anishinaabe, Cree, Dene, Haudenosaunee, Inuit, Métis and/ or Mi'kmaq Nations. Five cross-cutting recommendations emerged, including: (1) location, comfort, and having autonomy to choose where the abortion takes place; (2) holistic post-abortion supports; (3) accessibility, availability, and awareness of non-biased and non-judgemental information; (4) companionship, advocacy, and logistical help before and during the abortion from a support person; and (5) cultural safety and the incorporation of local practices and knowledges. Recommendations demonstrate that Indigenous people who have experienced an abortion carry practical solutions for removing barriers and improving access to abortion services in the Canadian context.

"I Guess I Shouldn't Come Back Here": Racism and Discrimination as a Barrier to Accessing Health and Social Services for Urban Métis Women in Toronto, Canada.

Racism serves as a major barrier in access to health and social services, leading to absent, delayed, and/or avoidance of treatment. Métis Peoples experience barriers to accessing both Indigenous-specific and mainstream services yet are often left out of discourses surrounding racism and service access. Racism and discrimination experienced by Métis people is rooted within a deep history of assimilative and racist colonial policies. The objective of this research was to create space for the all too often unacknowledged voices of Métis Peoples by engaging with the traditional community health experts, Métis women. This research aimed to learn from Métis women's experiences to build an understanding on steps toward filling the health service gap. Nested within a longitudinal cohort study, this research employed a conversational method with urban Métis women in Toronto, Canada. In this paper, we share the experiences of racism and discrimination faced by urban Métis women when accessing and working within health and social services. Métis women (n = 11) experience racial discrimination such as witnessing, absorbing, and facing racism in mainstream service settings, while experiencing lateral violence and discrimination in Indigenous-specific services. This research highlights the need for reframing conversations around race, identity, health services, and the urban Métis community.