The OHTN’s Mark Gilbert presented an overview of “syndemics.” The term syndemic recognizes that social and medical conditions interact, and that multiple conditions can be epidemics, particularly in marginalized communities. Together, these overlapping epidemics create a “perfect storm” that increases the likelihood of someone contracting HIV, hepatitis C, or other STBBIs.
The shift to a syndemics approach within HIV research is important. Gilbert explained that it reminds us to consider broad health and social challenges that shape people’s lives, and that affect many people simultaneously, rather than just individual risk behaviours. Even though infections happen at the individual level (and pharmaceutical treatments focus on individuals), a syndemics framework forces us to address “upstream” factors driving individual infections.
Tracey Prentice of the University of Ottawa, and Doris Peltier of the Canadian Aboriginal AIDS Network, explained that one way to think about syndemics is to use what’s known as a “deficit” model. Within this model, social or health problems are foregrounded. In the case of Indigenous women, for example, factors such as substance use, homelessness, violence, and discrimination might be cited as “causing” higher rates of HIV infection. They explained that while this way of talking about HIV is accurate, the analysis focuses on the problems rather than the individual.
Prentice and Peltier proposed an alternate, or Indigenous, way of approaching syndemics, which is to place the person at the centre. If a woman has become HIV-positive, what has led to this outcome? Higher rates of homelessness or substance use might contribute, but so do the effects of colonization and ongoing colonial systems.
“There is more to us than all of a sudden being a statistic and being HIV-positive. You know, there are circumstances, there is a pathway, there is a history”.
Working outwards from the individual leads to different perspectives on how to address HIV. If the well-being of the individual comes first, it should lead to solutions grounded in “good medicine.” Good medicine means that HIV-related research, policy, and practice should be:
- grounded in local Indigenous knowledge and culture
- holistic
- strengths-based
- rooted in self-determination for Indigenous People
In a good medicine approach, the voices of Indigenous people should always be privileged, and the medicines that emerge should include community, empowerment, inclusion, and spirituality.
“Every one of us that sits in a circle here are advocates, and activists, and educators, and strong leaders in our community.”
Harlan Pruden of TwoSpiritJournal.com stressed that grounding HIV within a syndemics perspective can lead to hopeful discussions. Syndemic analysis pivots away from biomedical lingo and attempts to engage the whole person, contextualized within a community. This means that responding to or preventing HIV can take the form of building up a community. Within Indigenous contexts, it has been shown that instilling cultural pride increases self-esteem and that increased self-esteem leads to better decision-making processes.
“If you love, respect, and honour who you are, you’re going to make better decisions.”
Prudent explained that, in terms of HIV prevention, placing the person and community first means that interventions do not need to start with HIV messaging or “safer sex” tips. Instead, interventions can start by creating spaces where people celebrate their Indigenous identity and two-spiritness. Once people start feeling good about themselves, then issues such as condom use can be introduced. Interventions can start by bringing people together to stand in community, rather than asking them to stand alone.
Resources
- The current state of the HIV epidemic among Indigenous people in Ontario (2014)
- Indigenous people and HIV in Ontario – An overview (2015)
- Summary of the syndemics framework (The Lancet, 2017)
- Restoring the traditional importance of two-spirit people (CBC radio interview)