Native Health

A ‘SECOND PLAGUE’

Why AIDS is on the rise among Aboriginal people

DARREN GREER August 2 2004
Native Health

A ‘SECOND PLAGUE’

Why AIDS is on the rise among Aboriginal people

DARREN GREER August 2 2004

A ‘SECOND PLAGUE’

Native Health

DARREN GREER

Why AIDS is on the rise among Aboriginal people

WHEN ROD MICHANO moved from the Ojibway reserve of Pic River near Thunder Bay, Ont., to Toronto in 1987, he knew nothing about HIV. Six months later the man he had been dating fell ill, was hospitalized and tested positive for the deadly virus. Michano was diagnosed one month later. “I was told that I’d have two years to live,” he says. “So I sat around and waited for my two years to be up.”

Now, 16 years on, Michano lives alone in a small apartment in central Toronto with his six-year-old pit bull, Coco, wondering just what mix of medicines, prayer and luck allowed him to dodge the bullet. The air in his flat is heavily scented with burnt sweetgrass and sage, the ritual smudge used by many First Nations to spiritually cleanse themselves and the spaces in which they live. A handmade rawhide vest he inherited from his late father hangs prominently in one corner of his living room. “My father was chief of my reserve for 24 years,” he says proudly. Michano wears the vest to conduct ceremonies for other Aboriginal people coping with HIV. “I pray for peace,” he explains, “and I pray against illness.” He has his work cut out for him.

Michano is just one of as many as 4,500 Aboriginal people living with HIV in Canada, a surprisingly high number given their population. Native peoples account for 3.3 per cent of the Canadian demographic but as much as eight per cent of HIV infections—more than twice the rate of the general population. As well, more Aboriginal people are infected with HIV than any other ethnic group and, according to some studies, Natives account for about a quarter of the roughly 4,000

Prayer and medicine have helped make Michano one of the few lucky ones

new HIV cases every year. “We know that certain behaviours result in the acquisition of HIV,” says Dr. Frank Plummer, director general of Health Canada’s Centre for Infectious Disease Prevention and Control. “We also know that these behaviours are driven by factors such as poverty, inequity and alienation.”

When Michano was diagnosed, there was little attention paid to HIV among Canada’s Natives. There were no services designed specifically for them, and non-Aboriginal services weren’t set up to deal with a people ravaged by Canada’s colonial history. “We’d walk into a drop-in centre and the non-Natives in the room thought we were all alcoholics or whatever,” says Michano. “There was a cultural barrier that kept many of us from getting tested.”

There was also little happening on the reserves. As Michano says: “We were never taught anything about HIV.” For some Natives, it was seen as a white man’s diseasenothing to do with them. And yet epidemiologists have long known that sexually transmitted diseases were a major concern among Aboriginal people—and that conditions were ripe for them to spread.

Those conditions included young Natives constantly travelling from inner cities to rural communities and carrying infections back and forth; a legacy of residential school abuse that left many distrustful of nonAboriginal authority, including doctors and nurses; plus a grinding poverty on many reserves and the fact that Natives have also been disproportionately represented in prisons, another breeding ground for disease. “Wherever

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in the world you have those ingredients,” says Plummer, “you have the recipe for an epidemic.”

FOR GENERATIONS, Cree elders have been prophesying a “second plague,” another great disease that would shred the ranks of First Nations the way smallpox and cholera had centuries ago. Kevin Barlow, executive director of the Canadian Aboriginal AIDS Network in Ottawa and a Micmac from Indian Island, N.B., first heard about AIDS being this “second plague” in 1993. Within a few years, he says, that talk was widespread. “But there was no money for us then,” says Barlow. “And not only were there no resources, there was no response from the Aboriginal leadership and little even from community health workers. It seemed like every door we knocked on was closed.”

This early resistance, argues Barlow, is one reason so many Aboriginal people are now infected with HIV. In the early ’90s, as Native politicians were negotiating land claims and self-government from Ottawa, Barlow and other AIDS activists were lobbying governments and their own leaders for more funding and attention to AIDS. But too many Native leaders still saw it as a white man’s disease.

Another problem, during that period, was that AIDS funding was based at least partly on statistics. The more the system showed a particular community was affected, the more money that group received. But health statistics for Aboriginal people have been patchwork at best. And the system just wasn’t set up to monitor HIV/AIDS among highly mobile Aboriginal youth. Even today, the numbers, as high as they are, are likely underrepresented, as reporting is not standardized. Several provinces, populated Ontario among them, don’t even keep track of ethnic status for those who are HIV positive. And in some cases there is no breakdown between the three main groups—Inuit, Metis and First Nations. Without such information, Aboriginal AIDS organizations often don’t know where to begin prevention measures.

Some of this began to change after 1998. In its third national AIDS strategy for Canada, Ottawa specifically set aside $5.9 million for Aboriginal initiatives, from the $42.2 million that was being spent each year to fight the disease. A National Aboriginal Council on HIV/AIDS was created to

advise the federal government where to put its money, and a half-dozen or so organizations sprang up across the country to deliver services to Aboriginal people. As this was going on, large Native organizations like the Assembly of First Nations, the Métis National Council and the Inuit Tapirsat began to see political ramifications in the fight against HIV-it became a new front in their broader battle for self-determination.

Then, in 1999, Health Canada released its first HIV estimates. Up until that time, the disease was monitored through AIDS cases and some reported HIV testing data. But since the advent of new medications, fewer people were developing end-stage AIDS and it was difficult to judge the reach of the disease from reported tests alone. The HIV estimates, calculated using a combination of methods and data from a wide

variety of sources, including HIV test reports, would give a more accurate snapshot of how many people in Canada were living with the virus.

What they showed was an estimated 56,000 people living with HIV in Canada, almost two per cent of the population. That was broadly anticipated. The shocker was that fully nine per cent of new HIV infections that year were Aboriginal, a 91-percent increase from estimated 1996 levels. Natives, who made up only 3.3 per cent of the population in the 2001 census, now accounted for between five and eight per cent of total HIV cases in the country. And where infection rates among the general * population were levelling off, the

rate among Aboriginal people was still rising. Indeed, it was approaching Third World levels in some communities, some researchers said.

For those in the front ranks, none of this was surprising. “We are the walking wounded,” Barlow says. “We have people who have been through residential-school abuse, who were told that their identity is dirty, or wrong. We were told not to speak our languages. Some of us turned to the sex trade to survive, and others, sadly, to drugs and alcohol.” And, Barlow argues, instead of dealing with this and acknowledging that even more support is needed to stem the rising tide of Aboriginal HIV infections, the federal government looks to be stepping backwards. In April 2004, Health Canada trimmed the Aboriginal network’s administrative budget by almost 10 per cent, or about $40,000, to spread the money around other AIDS groups, not necessarily Native. Urged on in large measure by Irish rock star Bono, Prime Minister Paul Martin announced more money for international AIDS efforts in Africa and a doubling of the national AIDS strategy, over the next five years, from $42.2 million to $84.4 million annually. But as yet there has been no Health Canada commitment to increase AIDS funding for Canadian Natives. Given the need and the numbers, one has to wonder why. Iffl

Darren Greer, a former AIDS activist himself, is a Toronto-based writer and the author of two recent novels, Tyler’s Cape and Still Life with June.