through collaboration and shared responsibility.• For Aborig<strong>in</strong>al clients, a culturally safe health care environment considers <strong>the</strong>irhistorical context and honors who <strong>the</strong>y are now; it respects <strong>in</strong>teractions based onhumility and reciprocity and allows for a mutual exchange of <strong>in</strong>formation.• Relational care is an important Aborig<strong>in</strong>al approach to health care provision becauseit captures <strong>the</strong> physical, social, emotional, and spiritual dimensions of humanconnection.• Healthy care relationships foster positive outcomes for Aborig<strong>in</strong>al patients whoare access<strong>in</strong>g treatment and support, specifically when <strong>the</strong>y are HIV positive.Without healthy care relationships many patients discont<strong>in</strong>ue care because <strong>the</strong>y feelstigmatized or judged.• Respectful care relationships reflect <strong>the</strong> seven sacred teach<strong>in</strong>gs: love, respect,courage, honesty, wisdom, humility, and truth.• Relational care operates <strong>in</strong> an environment of open communication, acceptance,and accommodation of desired level of care of Aborig<strong>in</strong>al people liv<strong>in</strong>g with HIV. It ism<strong>in</strong>dful of both short and long term stages of care.Community HIV Competence:• The most effective responses to HIV are generated and guided by communitymembers.• HIV competent communities have knowledge and skills to prevent HIV <strong>in</strong>fections andto provide care and support to community members liv<strong>in</strong>g with and affected by HIV;safe social spaces to discuss <strong>in</strong>formation about HIV and what this looks like <strong>in</strong> <strong>the</strong>community; a sense of ownership over <strong>the</strong> problem of HIV <strong>in</strong> <strong>the</strong> community and asense of responsibility for f<strong>in</strong>d<strong>in</strong>g solutions; confidence <strong>in</strong> <strong>the</strong> community’s abilityto respond to HIV; a sense of solidarity; and access to relationships and resources tosupport <strong>the</strong> community to respond effectively.• Respond<strong>in</strong>g to HIV/AIDS is one of many priorities that test Aborig<strong>in</strong>al communitycapacity. Issues such as safe dr<strong>in</strong>k<strong>in</strong>g water, <strong>in</strong>sufficient fund<strong>in</strong>g allocations, grow<strong>in</strong>gpopulations, substandard hous<strong>in</strong>g, high unemployment, and resource extractivedevelopments are significant obstacles to health and well-be<strong>in</strong>g. These issuesrequire immediate attention.86Self-Determ<strong>in</strong>ation:• The important role of people liv<strong>in</strong>g with HIV – particularly young people – andaffected communities <strong>in</strong> HIV responses is enshr<strong>in</strong>ed <strong>in</strong> <strong>the</strong> Pr<strong>in</strong>ciple of GreaterInvolvement of People Liv<strong>in</strong>g with HIV (GIPA) from <strong>the</strong> Paris Declaration and <strong>the</strong>Declaration of Commitments from <strong>the</strong> United Nations Special Session on HIV/AIDS.• The active and mean<strong>in</strong>gful participation of people liv<strong>in</strong>g with HIV and affectedcommunities <strong>in</strong> HIV helps to ensure that programs, services, and policies areculturally competent, relevant and, <strong>in</strong> turn, effective; that <strong>the</strong>y streng<strong>the</strong>ncommunity HIV competence; and that <strong>the</strong>y nurture <strong>the</strong> resiliency of <strong>in</strong>volved<strong>in</strong>dividuals.• Aborig<strong>in</strong>al self-determ<strong>in</strong>ation occurs when <strong>the</strong> <strong>in</strong>dividual and community are <strong>in</strong>control of <strong>the</strong>ir situations. Self-determ<strong>in</strong>ation is a right that was all too often takenaway from <strong>the</strong> First Nations, Métis, and Inuit <strong>in</strong> Canada. <strong>Communities</strong> all overCanada have been and are assert<strong>in</strong>g <strong>the</strong>ir right to self-determ<strong>in</strong>ation <strong>in</strong> many ways<strong>in</strong>clud<strong>in</strong>g rega<strong>in</strong><strong>in</strong>g control of community <strong>in</strong>frastructures, land claims, treaties, and<strong>the</strong> delivery of health services through health transfers.
Sexual and Reproductive Rights• Sexual and reproductive rights are human rights.• Sexual rights are about sexuality, sexual orientation, gender identity, and sexualhealth. They <strong>in</strong>clude <strong>the</strong> right to express and enjoy one’s sexuality, experiencesexual pleasure, learn about sexual health, access sexual health services, andpractice safer sex.• Reproductive rights are about fertility, reproduction, and reproductive health. This<strong>in</strong>cludes <strong>the</strong> right to choose if, when, how many, and with whom one wants to havechildren.• When o<strong>the</strong>r <strong>in</strong>dividuals, communities, and governments respect, protect and fulfill<strong>the</strong>se rights, people are better able to take care of <strong>the</strong>ir sexual health and preventHIV <strong>in</strong>fections.Wise PracticesThe primary focus of <strong>Beh<strong>in</strong>d</strong> <strong>the</strong> <strong>Pandemic</strong> is to <strong>in</strong>crease understand<strong>in</strong>g of <strong>the</strong> broad social,cultural, historical, political, and economic factors that contribute to HIV vulnerabilityand resiliency. The follow<strong>in</strong>g resources are suggested for those who are <strong>in</strong>terested<strong>in</strong> learn<strong>in</strong>g more about wise practices for HIV responses with<strong>in</strong> Aborig<strong>in</strong>al communities.They can be found on <strong>the</strong> CAAN website: http://www.caan.ca.• Aborig<strong>in</strong>al Strategy on HIV/AIDS <strong>in</strong> Canada (ASHAC)• CAAN Wise Practices87
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