The OHTN, along with its collaborators, are proud to announce the release of “The Current State of the HIV Epidemic among Indigenous People in Ontario.”
All of us who work with Indigenous people in Ontario to prevent and manage HIV, hepatitis C and other sexually transmitted and bloodborne infections (STBBIs) have long been frustrated by the lack of data on HIV or other STBBIs among Indigenous people in this province.
Thanks to the leadership of people like LaVerne Monette, Executive Director of the Ontario Aboriginal HIV and AIDS Strategy (Oahas) until her death in 2010, the OHTN began structuring its studies, particularly the OHTN Cohort Study, to gather information on how HIV was affecting Indigenous people in Ontario.
Using these data as well as information from studies conducted with populations most at risk of HIV — such as the I-Track studies, which include people who use drugs, and the Lambda study, which includes (but is not limited to) men who have sex with men — we have taken the first steps in trying to understand how the HIV epidemic is affecting Indigenous people in Ontario. In OCASE, the electronic case management system that the OHTN manages for Ontario’s dedicated community-based AIDS service organizations, agencies can now include information on client ethnicity and the services that people receive can be analyzed by ethnicity. We received permission from the agencies to include aggregate (non-identifiable) information on the number of Indigenous peoples being served and the services they are using.
Below, you’ll find the Executive Summary, which outlines our key findings. We also invite you to read the full report, and to share this page with your networks via the social media buttons at the top of the page.
- The gaps in socioeconomic status between Indigenous and non-Indigenous people in Ontario are narrowing. The number of Indigenous people with higher levels of education, higher incomes, and stable employment and housing has increased. However, the Indigenous population in Ontario still experiences significant health and social disparities that may increase their HIV risk and reduce their access to health services.
- Indigenous people in Ontario are more at risk of HIV than non-Indigenous people. The prevalence of HIV among Indigenous people (0.42%) is 1.7 times higher than among non-Indigenous people. Rates of HIV infection appear to be higher in Indigenous people in certain parts of the province, including Northern Ontario, Toronto and southwestern Ontario.
- Indigenous people in Ontario are less at risk of HIV than Indigenous people in other parts of Canada. The prevalence of HIV among Indigenous people in other parts of Canada was 3.6 times higher than among non-Indigenous people in Canada — compared to 1.7 times higher in Ontario.
- HIV risk in Indigenous people in Ontario is driven by the legacy of racism and colonialism as well as social, structural and systemic factors, and risk behaviours.
- Among Indigenous people in Ontario diagnosed with HIV from 2009 to 2011, the most commonly reported risk factors were sexual exposure (64%) and injection drug use (45%). Fifty-nine percent of Indigenous women and 48% of Indigenous men reported “sex with men” as a risk factor. Twenty percent of Indigenous men who reported having sex with men also reported using injection drugs, suggesting overlap in the drivers of the epidemic. About one-third of Indigenous people in Ontario with HIV are diagnosed later in the course of HIV disease.
- About one in three Indigenous people in Ontario who are living with HIV are also co-infected with hepatitis C (HCV) and, therefore, at higher risk of developing liver disease, liver cancer and other complications.
- Injection drug use is one of the key drivers of both HIV risk and HCV risk among Indigenous people in Ontario. Although we did not identify any substantial differences in drug-using behaviours between Indigenous and non-Indigenous people, Indigenous people were more likely to inject non-prescribed morphine, Ritalin, benzodiazepines, barbiturates, oxycodone/OxyContin, and the combination of Talwin & Ritalin. These drug preferences may be driven by prescribing patterns and/or by the cost or availability of these drugs.
- Indigenous women are more likely than Indigenous men to share drug equipment, which increases their risk of infection.
- Indigenous people with HIV report higher levels of psychological distress than non- Indigenous people with HIV or Indigenous people who are HIV-negative. They are less likely than non-Indigenous people with HIV to have used mental health services and more likely to report an unmet need for these services.
- In general, Indigenous people with HIV were more likely to report that their needs for a variety of health and social services — including having a family doctor — are not being met. The most commonly reported barriers that Indigenous people face accessing health and social services are lack of local availability and financial costs (e.g. transportation).
- Despite the barriers that Indigenous people with HIV face, they engage in care as frequently as non-Indigenous people. They are also highly successful in accessing antiretroviral therapy (ART) and adhering to treatment regimens.
- Despite the fact that Indigenous people experience serious health and social disparities overall, there is no substantial difference in health status, quality of life or HIV-related deaths between Indigenous and non-Indigenous people living with HIV — which is not the case in other parts of Canada. In fact, three of every four Indigenous people who are receiving HIV care in Ontario rated their health as “good” or better. We are aware that this may not be the experience of Indigenous people who are not in care.