What is this Educational Resource for?Aborig<strong>in</strong>al peoples (First Nations, Inuit and Métis) make up just over 3% of <strong>the</strong> total populationbut 7.5% of all persons liv<strong>in</strong>g with HIV and 9% of new HIV <strong>in</strong>fections <strong>in</strong> Canada(PHAC, 2007) 1 . The overrepresentation of Aborig<strong>in</strong>al peoples <strong>in</strong> Canada’s HIV epidemicis an important illustration of <strong>the</strong> health <strong>in</strong>equalities that Aborig<strong>in</strong>al peoples face and<strong>the</strong> factors that create <strong>the</strong>se <strong>in</strong>equalities.<strong>Beh<strong>in</strong>d</strong> <strong>the</strong> <strong>Pandemic</strong> provides a participatory learn<strong>in</strong>g tool that skilled facilitators canuse to foster greater understand<strong>in</strong>g and <strong>the</strong> ability to address factors that contribute to<strong>the</strong> health <strong>in</strong>equalities fac<strong>in</strong>g Aborig<strong>in</strong>al peoples. It can be can tailored to different audiencesand sett<strong>in</strong>gs, such as Aborig<strong>in</strong>al youth <strong>in</strong> schools, Aborig<strong>in</strong>al leaders <strong>in</strong> communitysett<strong>in</strong>gs, and people who currently or are be<strong>in</strong>g tra<strong>in</strong>ed to <strong>in</strong>form, design, and implemen<strong>the</strong>alth and social services, specifically around HIV and AIDS.This resource is <strong>in</strong>tended to:• Introduce <strong>in</strong> a simple way <strong>the</strong> complex issues that contribute to <strong>the</strong> health <strong>in</strong>equitiesthat Aborig<strong>in</strong>al peoples face.• Encourage responses to HIV that look at social change as well as personal change.• Be easy for facilitators to use.Overview of <strong>the</strong> Population Health Approach: Influences of HIVVulnerability among Aborig<strong>in</strong>al PeoplesIt is common <strong>in</strong> North America to look at health through a portrait frame, focus<strong>in</strong>g on<strong>the</strong> decisions and actions of <strong>in</strong>dividuals. A portrait frame focuses on attention on <strong>the</strong>risk – or likelihood – that a person will contract <strong>the</strong> HIV virus.There is a grow<strong>in</strong>g understand<strong>in</strong>g <strong>in</strong> Canada and around <strong>the</strong> world that <strong>the</strong> health andwell-be<strong>in</strong>g of <strong>in</strong>dividuals and populations is affected not only by <strong>the</strong>ir behaviours andgenetics, but also by <strong>the</strong> environment <strong>in</strong> which <strong>the</strong>y live <strong>the</strong>ir everyday life. This meanswe need to broaden our view so that we can see <strong>the</strong> social, cultural, economic, politicaland historical factors that affect people’s ability to control <strong>the</strong> risk of becom<strong>in</strong>g <strong>in</strong>fectedwith HIV (i.e. vulnerability) and to live positively when one is liv<strong>in</strong>g with HIV.Diagram 1 shows <strong>the</strong> many factors that affect <strong>the</strong> likelihood that an Aborig<strong>in</strong>al personwill be exposed to <strong>the</strong> HIV virus and that affect <strong>the</strong>ir ability to live well once <strong>in</strong>fected:The personal circumstances – or <strong>the</strong> social, physical and economic environments - <strong>in</strong>which a person grew up and lives <strong>the</strong>ir daily life affect <strong>the</strong> likelihood that <strong>the</strong>y willengage <strong>in</strong> behaviours that may expose <strong>the</strong>m to HIV as well as <strong>the</strong>ir ability to stay healthyonce <strong>in</strong>fected. These <strong>in</strong>clude whe<strong>the</strong>r a person has or can get <strong>the</strong> th<strong>in</strong>gs <strong>the</strong>y need tolive comfortably such as education, employment, health care, decent hous<strong>in</strong>g, food,and clean water; whe<strong>the</strong>r <strong>the</strong>y feel that <strong>the</strong>y belong to and are valued and respected by<strong>the</strong>ir community; whe<strong>the</strong>r <strong>the</strong>y are able to take part <strong>in</strong> society; and whe<strong>the</strong>r <strong>the</strong>y have81 Population data is from 2006. Epidemiological data is from 2005.
Diagram 1: Factors that affect HIVvulnerabilitiesVULNERABILITY– result<strong>in</strong>g from one’s personal circumstancesRESILIENCY– a protective buffer from vulnerabilitySYSTEMIC & STRUCTURAL INEQUALITIES AFFECTING ABORIGINAL PEOPLESFood <strong>in</strong>security,Homelessness,Unhealthylifestyle, Unsafewater supply,Insufficient& <strong>in</strong>adequatehous<strong>in</strong>g, Pollution,Unhealthy territories,Self-concept,Self-esteem,Criticalawareness,Social <strong>in</strong>clusion,Community HIVcompetence,Community-basedresearch, Culturalcont<strong>in</strong>uity, Positive youthrole models, Culturallysafe health services,GENERAL SOCIO-ECONOMIC, CULTURAL AND ENVIRONMENTAL CONDITIONSHistorical TraumaPhysical or sexual assault,Liv<strong>in</strong>g <strong>in</strong> foster homesor group homes, Low <strong>in</strong>come,HIV RiskBehaviours related tosex, drug use,pregnancyand breastfeed<strong>in</strong>gSexual & reproductive rightsUnderemployed or unemployed,Poor work<strong>in</strong>g conditionsSupportiveFamilies,Greater<strong>in</strong>volvementof people liv<strong>in</strong>gwith HIV/AIDS,Access toformal education,Community heal<strong>in</strong>g,Self-determ<strong>in</strong>ation,Relational care,Community capacity,Traumatic life events,Discrim<strong>in</strong>ation,Childhood abuse or neglect,Social exclusion,Lack ofsocial supportnetworks,Limited or lackof education,Unhealthy childdevelopment,Mobility,RacismColonizationPoverty9
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10/21/2010Activity Purpose• Incre
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approach must be undertaken with in
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through collaboration and shared re
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Diagram 1: Factors that affect HIVv
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Card Key Issues Affecting Vulnerabi
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Card Key Issues Affecting Vulnerabi
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Card Key Issues Affecting Vulnerabi
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Individual LevelIssue Exploration T
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Card Key Protective Factors Suggest
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Glossary
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Gender norms refer to the expectati
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About the AuthorsLia De Pauw, MHSc,
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Bouey, Paul D., and Betty E. S. Dur
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Public Health Agency Health of Cana
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Mill, Judy E., Randy C. Jackson, Ca
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Scanlon, K., Travers, R., Humberto,