Alternate description of Earl Nowgesic’s Causal Loop Diagram

OHTNText Alternatives

Diagram PDF

The diagram depicts complex, mono-directional relationships between 27 factors related to antiretroviral (ARV) use among Indigenous peoples living in Saskatchewan. The 27 factors connect to each other as well as to three central nodes: Access to ARV therapy, acceptance of ARV therapy, and adherence to ARV therapy.

There are multiple entry points into the diagram, but this text describes the chain of relationships that feeds into each of the three central nodes.

High-level Overview

On net, the factors that have an overall positive effect on access to ARV therapy, acceptance of ARV therapy, and adherence to ARV therapy are:

  • Respectful relations between Indigenous people living with HIV and healthcare agencies
  • Sense of community and family between Indigenous people living with HIV and healthcare agencies
  • Location of healthcare agencies
  • Knowledge of viral load and CD4 counts
  • Setting goals, having a social routine, social supports (e.g., community, partner, and children), and spirituality
  • Valuing indigenous cultures (e.g., traditional healing strategies)
  • Self-management support
  • Methadone maintenance therapy
  • Positive outlook
  • Indigenous people living with HIV co-planning health care with physicians

On net, the factors that have an overall negative effect on access to ARV therapy, acceptance of ARV therapy, and adherence to ARV therapy are:

  • Physicians refusing ARV therapy to people living with active drug use disorders
  • The historical relationship between the Canadian state and Indigenous peoples
  • Racial discrimination
  • The congregation of people living with active drug use disorders selling, buying, and using drugs
  • Negative thinking
  • The Aboriginal residential school legacy
  • Mistrust of institutions with authoritative powers (e.g., healthcare establishments)
  • Long wait times for HIV biomarker testing
  • Restrictive health policies guiding treatment for drug use disorder (e.g., methadone maintenance therapy as the standard of care for opioid use disorder)
  • Negative outcome expectations of ARV therapy
  • Feeling embarrasses of having directly observed ARV therapy
  • Incarceration

Access to ARV therapy

  • Physicians refusing ARV therapy to people living with active drug use disorders decreases access to ARV therapy.
  • Respectful relations between Indigenous people living with HIV and healthcare agencies increases access to ARV therapy.
  • The congregation of people living with active drug use disorders selling, buying, and using drugs negatively effects the location of healthcare agencies. The location of healthcare agencies increases access to ARV therapy.
  • Long wait times for HIV biomarker testing decrease access to ARV therapy.

Acceptance of ARV therapy

  • Indigenous people living with HIV co-planning health care with physicians increases acceptance of ARV therapy.
  • Long wait times for HIV biomarker testing decrease knowledge of viral load and CD4 counts. Knowledge of viral load and CD4 counts increases acceptance of ARV therapy.
  • Self-management support increases acceptance of ARV therapy.
  • The legacy of Aboriginal residential schools increases mistrust of institutions with authoritative powers (e.g., healthcare establishments). Mistrust of institutions decreases acceptance of ARV therapy.
  • The historical relationship between the Canadian State and Indigenous peoples increases racial discrimination. Racial discrimination increases negative thinking. Negative thinking increases negative outcome expectations of ARV therapy. Negative outcome expectations of ARV therapy decrease acceptance of ARV therapy.
  • The congregation of people living with active drug use disorders selling, buying, and using drugs increases negative thinking. Negative thinking increases negative outcome expectations of ARV therapy. Negative outcome expectations of ARV therapy decrease acceptance of ARV therapy.
  • Respectful relations between Indigenous people living with HIV and healthcare agencies increases a sense of community and family between Indigenous people living with HIV and healthcare agencies. A sense of community and family decreases negative thinking. Negative thinking has increases negative outcome expectations of ARV therapy. Negative outcome expectations of ARV therapy decrease acceptance of ARV therapy.
  • Feeling embarrassed of having directly observed ARV therapy decreases acceptance of ARV therapy.
  • Setting goals, having a social routine, having social supports, valuing Indigenous cultures (e.g., traditional healing strategies), and spirituality increase positive outlook. Positive outlook increases acceptance of ARV therapy.

Adherence to ARV therapy

  • Self-management support increases adherence to ARV therapy.
  • Incarceration decreases adherence to ARV therapy.
  • Setting goals, having a social routine, having social supports, valuing Indigenous cultures (e.g., traditional healing strategies), and spirituality increase positive outlook. Positive outlook increases adherence to ARV therapy.
  • Setting goals, having a social routine, having social supports, valuing Indigenous cultures (e.g., traditional healing strategies), and spirituality increase positive outlook. Positive outlook decreases stress. Stress increases relapse into drug use among people recovering from drug use disorders. Relapse into drug use decreases adherence to ARV therapy.
  • Restrictive health policies guiding treatment for drug use disorder (e.g., methadone maintenance therapy as the standard of care for opioid use disorder) increase relapse into drug use among people recovering from drug use disorders. Relapse into drug use decreases adherence to ARV therapy.
  • Methadone maintenance therapy decreases relapse into relapse into drug use among people recovering from drug use disorders. Relapse into drug use decreases adherence to ARV therapy.
  • The historical relationship between the Canadian State and Indigenous peoples increases racial discrimination. Racial discrimination increases negative thinking. Negative thinking increases negative outcome expectations of ARV therapy. Negative outcome expectations of ARV therapy decrease adherence to ARV therapy. Negative thinking also increases relapse into drug use among people recovering from drug use disorders. Relapse into drug use also decreases adherence to ARV therapy.
  • The congregation of people living with active drug use disorders selling, buying, and using drugs increases negative thinking. Negative thinking increases negative outcome expectations of ARV therapy. Negative outcome expectations of ARV therapy decrease adherence to ARV therapy. Negative thinking also increases relapse into drug use among people recovering from drug use disorders. Relapse into drug use also decreases adherence to ARV therapy.
  • Respectful relations between Indigenous people living with HIV and healthcare agencies increases a sense of community and family between Indigenous people living with HIV and healthcare agencies. A sense of community and family decreases negative thinking. Negative thinking has increases negative outcome expectations of ARV therapy. Negative outcome expectations of ARV therapy decrease adherence to ARV therapy. Negative thinking also increases relapse into drug use among people recovering from drug use disorders. Relapse into drug use also decreases adherence to ARV therapy.