Using a Social Determinants of Health Lens to Examine HIV and AIDS Risk

1 Nicholas Street, Suite 726, Ottawa ON K1N 7B7 Telephone: 613-233 7440 ● Fax: 613-233 8361 E-mail: [email protected] ● www.icad-cisd.com July 2011 In both high‐income and low‐ or middle‐income countries, indigenous peoples face some of the heaviest burdens of ill health. In particular, indigenous populations face a higher vulnerability to HIV due to a range of factors including stigmatization, structural racism and discrimination and individual/community disempowerment. Despite the fact that HIV is highly prevalent in these populations, there is a gap in research and policy to address this epidemic, particularly for sub‐Saharan Africa. Few countries have implemented policies or programs which specifically target the spread and impact of HIV in indigenous communities; those countries that do have such programs tend to be in high‐income countries rather than in low‐ and middle‐ income countries. Integration of these issues into the global HIV agenda is needed to close the gap in reaching indigenous populations. Using a social determinants of health lens, this factsheet highlights some of the particular issues facing indigenous populations regarding HIV, and provides some lessons learned from both the Canadian and African contexts that may be useful in determining next steps forward. Defining indigenous populations is not straightforward; there are multiple indigenous communities in the world that are not easily categorized under one label, and the right of populations to choose their naming is paramount. It is estimated that there are approximately 370 million indigenous people worldwide, living in 70 countries. In Canada, approximately 1.2 million people self‐ identified as Aboriginal in 2008, including First Nations, Métis and Inuit peoples. Each of these distinct sub‐ groups is recognized as having unique cultural, economic and social characteristics. Geographically, these communities are located all across Canada, including remote, rural and urban areas; some populations live on lands designated for specific First Nations communities, known as reserves. In sub‐Saharan Africa, defining indigenous populations is a more complex task. According to one source, over 14.2 million people living on the continent have self‐ identified as indigenous. These populations can be categorized into three groups: hunter‐gatherers, migratory nomadic pastoralists and groups practicing drylands horticulture. They can be further defined by the following characteristics: political and economic marginalization rooted in the legacy of colonialism; de facto discrimination based on the dominance of agricultural peoples in the State system; the particularities of culture, identity, economy and territoriality that link hunting and herding peoples to their home environments in deserts and forests; and, in some cases, physically distinct characteristics. It should be noted that there is significant debate around these definitions, discussed at some length in the report of the African Commission on Human and Peoples’ Rights (ACHPR) Working Group on Indigenous Populations/Communities. According to some views, all Africans can be considered indigenous to the continent, particularly if the frame of comparative reference is to European and other colonizers. However, it is also argued that indigenous peoples have particular features and characteristics – including attachment to land, cultural practices and production modes – that define them separately from other Introduction