Clive Aspin

MORE than 30 years after the world became aware of the emergence of HIV and AIDS, it has become apparent that Indigenous peoples are among the populations most adversely affected by HIV.

In their haste to understand this new disease, researchers were quick to identify subpopulations considered to be most vulnerable.

The word “risk” rapidly became associated with vulnerability and as a consequence the term “The 5 H’s” — homosexuals, heroin users, haemophiliacs, Haitians, and whores or hookers — became part of the vernacular. These groups were considered to be at the highest risk of being infected with HIV and the ones most likely to pass the infection on to others.

Not only has this simplistic approach served to marginalise certain population groups, exposing people living with HIV and AIDS to stigma and discrimination, it has also meant that other key population groups have been excluded from the main focus of HIV prevention programs, with the most notable of these being Indigenous peoples.

Today, there is mounting evidence that Indigenous populations around the world suffer from significant HIV disparities. In countries such as Australia, Canada and New Zealand, where national HIV data collection systems report Indigenous status, we now know that there are significant HIV disparities between Indigenous and non-Indigenous peoples.

In Australia, the notification rate of newly diagnosed HIV infection in the Aboriginal and Torres Strait Islander population (5.5 per 100 000) was similar to that in the non-Indigenous population. However, HIV diagnosis rates are higher among Aboriginal and Torres Strait Islander females than among non-Indigenous females.

In New Zealand, Maori men are more likely to test late for HIV than non-Maori men, leading to poorer health outcomes.

In Canada, where HIV among Indigenous peoples has become a generalised epidemic, diagnosis rates are considerably higher among Indigenous peoples compared to non-Indigenous Canadians. In 2011, Indigenous peoples made up 4.3% of the Canadian population, yet accounted for 12.2% of new HIV infections and 18.8% of reported AIDS cases.

In countries where Indigenous HIV data are not collected, we know that Indigenous people are vulnerable to HIV because of factors such as high rates of sexually transmitted infections, lack of information about HIV, and poor access to HIV resources such as condoms and clean injecting equipment.

While Indigenous populations might be vulnerable to HIV, they also have tremendous reserves of resilience, something that has scarcely been considered in efforts to prevent HIV transmission within Indigenous communities.

Indigenous peoples around the world have confronted multiple and diverse challenges to their health and wellbeing since the onset of colonisation, some of which continue to have negative impacts today. Histories of sexual abuse, dislocation and mistrust of health services increase the likelihood of HIV transmission and poor health outcomes.

And just as Indigenous peoples strive to overcome these challenges, we need to be confident that they will also overcome HIV-related challenges.

Our review of published literature on HIV and Indigenous peoples from the last 30 years has shown that much of the research into Indigenous peoples and HIV has been driven by a deficit model approach, with research questions that focus on vulnerability and risk factors. This approach fails to examine and understand the strengths and resiliences of Indigenous peoples that provide protection or promote physical, emotional or spiritual wellness while living with HIV.

More attention to, as well as research into, Indigenous resilience is warranted, to move beyond this narrow perspective of the past.

The 20th International AIDS Conference in Melbourne next month provides an opportunity to reflect on the impact of HIV on Indigenous communities around the world. For the first time in the history of these international meetings, Indigenous peoples have been listed as a key population group affected by HIV.

In recognition, the Global Village, a conference venue that is open to the public, will showcase activities that demonstrate the strengths and resilience of Indigenous peoples as they confront HIV-related challenges to their health and wellbeing.

This is also the first time that the official conference program features an Indigenous keynote plenary speaker. Associate Professor James Ward, a descendent of the Pitjantajarra and Nurrunga clans of Central and South Australia with many years’ experience of working on HIV and sexually transmissible infections within Aboriginal and Torres Strait Islander communities, will discuss strategic approaches to building and enabling self-determination in Indigenous communities affected by HIV.

After more than three decades of HIV, it is timely that international attention is being brought to the high rates of HIV among Indigenous populations. By failing to recognise Indigenous peoples as a key population group affected by HIV, public health agencies and researchers have failed to address current HIV disparities.

The combined recognition of the world’s Indigenous peoples as a key affected group and of their innate resilience will go a long way towards achieving equitable outcomes for Indigenous peoples affected by HIV.

Dr Clive Aspin is from the International Indigenous Working Group on HIV and AIDS, and with ATRIO Consulting, a management and research consultancy group focusing on primary health, governance, strategic planning and Indigenous health. Dr Joel Negin is a senior lecturer in international public health and director of research at the School of Public Health, University of Sydney.

The authors acknowledge the contribution of Professor Charlotte Reading of Victoria University, British Columbia, Canada, and Thomas Gadsden of the University of Sydney.