"Another thing to live for": Supporting HCV treatment and cure among Indigenous people impacted by substance use in Canadian cities.

BACKGROUND: Colonization and colonial systems have led to the overrepresentation of Indigenous people impacted by substance use and HCV infection in Canada. It is critical to ensure Indigenous people's equitable access to new direct acting antiviral HCV treatments (DAAs). Identifying culturally-safe, healing-centered approaches that support the wellbeing of Indigenous people living with HCV is an essential step toward this goal. We listened to the stories and perspectives of HCV-affected Indigenous people and HCV treatment providers with the aim of providing pragmatic recommendations for decolonizing HCV care. METHODS: Forty-five semi-structured interviews were carried out with Indigenous participants affected by HCV from the Cedar Project (n = 20, British Columbia (BC)) and the Canadian Coinfection Cohort (n = 25, BC; Ontario (ON); Saskatchewan (SK)). In addition, 10 HCV treatment providers were interviewed (n = 4 BC, n = 4 ON, n = 2 SK). Interpretive description identified themes to inform clinical approaches and public health HCV care. Themes and related recommendations were validated by Indigenous health experts and Indigenous participants prior to coding and re-contextualization. RESULTS: Taken together, participants' stories and perceptions were interpreted to coalesce into three overarching and interdependent themes representing their recommendations. First: treatment providers must understand and accept colonization as a determinant of health and wellness among HCV-affected Indigenous people, including ongoing cycles of child apprehension and discrimination within the healthcare system. Second: consistently safe attitudes and actions create trust within HCV treatment provider-patient relationships and open opportunities for engagement into care. Third: treatment providers who identify, build, and strengthen circles of care will have greater success engaging HCV-affected Indigenous people who have used drugs into care. CONCLUSION: There are several pragmatic ways to integrate Truth and Reconciliation as well as Indigenous concepts of whole-person wellness into the HCV cascade of care. By doing so, HCV treatment providers have an opportunity to create greater equity and support long-term wellness of Indigenous patients.

Improving mental health services for urban First Nations: policy issues relevant to health care reform.

This paper discusses issues related to the development of plans to improve the effectiveness of mental health services for urban First Nations people. The discussion focuses on emerging issues related to health care reform and regionalization. While it is impossible to make specific recommendations without reference to local conditions, developing an awareness of the general issues involved will help in the process of identifying the principles and approaches needed to frame local solutions.

What makes us strong: urban aboriginal perspectives on wellness and strength.

The limitations of a needs orientation for aboriginal mental health planning are evaluated in terms of the discrepancy between First Nations and western medical paradigms of health. We propose an alternative approach that focuses on how aboriginal people conceptualize wellness and describe their strengths. This provides a focus for initiatives that promote well-being by enhancing strengths rather than concentrating solely on deficits. We illustrate this approach by highlighting the indigenous knowledge of urban First Nations people in Vancouver's Downtown Eastside neighbourhood. We conclude that supporting existing strengths promotes wellness in holistic, culturally appropriate, and empowering ways.