HIV/AIDSANDINDIGENOUSPOPULATIONSINCANADAANDSUBSAHARANAFRICA

Introduction

Inbothhighincomeandlowormiddleincome
countries,indigenouspeoplesfacesomeofthe
heaviestburdensofillhealth.Inparticular,indigenous
populationsfaceahighervulnerabilitytoHIVduetoa
rangeoffactorsincludingstigmatization,structural
racismanddiscriminationandindividual/community
disempowerment.

DespitethefactthatHIVishighlyprevalentinthese
populations,thereisagapinresearchandpolicyto
addressthisepidemic,particularlyforsubSaharan
Africa.Fewcountrieshaveimplementedpoliciesor
programswhichspecificallytargetthespreadand
impactofHIVinindigenouscommunities;those
countriesthatdohavesuchprogramstendtobein
highincomecountriesratherthaninlowandmiddle
incomecountries.Integrationoftheseissuesintothe
globalHIVagendaisneededtoclosethegapin
reachingindigenouspopulations.

Usingasocialdeterminantsofhealthlens,this
factsheethighlightssomeoftheparticularissuesfacing
indigenouspopulationsregardingHIV,andprovides
somelessonslearnedfromboththeCanadianand
Africancontextsthatmaybeusefulindetermining
nextstepsforward.

Who are indigenous peoples in Canada

and sub-Saharan Africa?

Definingindigenouspopulationsisnotstraightforward;
therearemultipleindigenouscommunitiesinthe
worldthatarenoteasilycategorizedunderonelabel,
andtherightofpopulationstochoosetheirnamingis
paramount.Itisestimatedthatthereare
approximately370millionindigenouspeople

worldwide,livingin70countries.1

InCanada,approximately1.2millionpeopleself
identifiedasAboriginalin2008,includingFirstNations,
MtisandInuitpeoples.2Eachofthesedistinctsub
groupsisrecognizedashavinguniquecultural,
economicandsocialcharacteristics.Geographically,
thesecommunitiesarelocatedallacrossCanada,
includingremote,ruralandurbanareas;some
populationsliveonlandsdesignatedforspecificFirst
Nationscommunities,knownasreserves.

InsubSaharanAfrica,definingindigenouspopulations
isamorecomplextask.Accordingtoonesource,over
14.2millionpeoplelivingonthecontinenthaveself
identifiedasindigenous.3Thesepopulationscanbe
categorizedintothreegroups:huntergatherers,
migratorynomadicpastoralistsandgroupspracticing
drylandshorticulture.4Theycanbefurtherdefinedby
thefollowingcharacteristics:politicalandeconomic
marginalizationrootedinthelegacyofcolonialism;de
factodiscriminationbasedonthedominanceof
agriculturalpeoplesintheStatesystem;the
particularitiesofculture,identity,economyand
territorialitythatlinkhuntingandherdingpeoplesto
theirhomeenvironmentsindesertsandforests;and,
insomecases,physicallydistinctcharacteristics.5It
shouldbenotedthatthereissignificantdebatearound
thesedefinitions,discussedatsomelengthinthe
reportoftheAfricanCommissiononHumanand
PeoplesRights(ACHPR)WorkingGrouponIndigenous
Populations/Communities.Accordingtosomeviews,
allAfricanscanbeconsideredindigenoustothe
continent,particularlyiftheframeofcomparative
referenceistoEuropeanandothercolonizers.
However,itisalsoarguedthatindigenouspeoples
haveparticularfeaturesandcharacteristicsincluding
attachmenttoland,culturalpracticesandproduction
modesthatdefinethemseparatelyfromother

1 Nicholas Street, Suite 726, Ottawa ON K1N 7B7

Telephone: 613-233 7440 Fax: 613-233 8361
E-mail: info@icad-cisd.com www.icad-cisd.com

July2011


HIV/AIDSANDINDIGENOUSPOPULATIONSINCANADAANDSUBSAHARANAFRICA

Using a Social Determinants of Health

Lens to Examine HIV and AIDS Risk

AusefullenstoexamineHIVriskinindigenous
populationsisusingtheconceptofsocialdeterminants
ofhealth.Socialdeterminantsofhealthcanbedefined
astheeconomicandsocialconditionsthatshapethe
healthofindividuals,communitiesandjurisdictionsas
awhole.12Thislensisparticularlyrelevantwhen
examiningHIVandAIDS,wherethesocialand
biomedicalcontextsaredeeplylinked.Inthewordsof
oneresearcher,thediseaseiscomplicatedbythe
culturalrealityofhumanbehaviorthediseasealso
needstobeunderstoodinregional,historical,and
socioeconomiccontexts.13

AccordingtotheWorldHealthOrganization,the
generalsocialdeterminantsofhealthinclude:(1)
incomeandsocialstatus;(2)education;(3)
employment/workingconditions;(4)socialsupport
networks;(5)healthychildhooddevelopment;(6)
socialenvironment;(7)physicalenvironment;(8)
personalhealthpracticesandcopingskills;(9)health
services;(10)gender;and(11)culture.

Althoughausefulstartingpoint,theaforementioned
determinantsdonotencompasstraditionalindigenous
conceptsofhealth,whichareholisticandincorporate
mental,physical,spiritual,emotionalandsocial
aspectsaswellasbiomedicalaspects.Furthermore,
thehealthandwellbeingofcommunitiesare
intertwinedwith,andequallyimportantas,thehealth
ofindividuals.Withthisunderstanding,theCanadian
basedNationalAboriginalHealthOrganization
developedasetofeightadditionalsocialdeterminants
ofhealthspecifictoindigenouspopulations.14While
thesebroadersocialdeterminantsofhealthwere
developedfortheCanadiancontext,theycanalsobe
usedtoexamineissuesfacingindigenouspopulations
worldwide.Eachofthesefactorsisdiscussedinmore
detailbelow,withexamplesandissueshighlightedfor
bothCanadaandsubSaharanAfricaasappropriate.

populationsandfromdominanteconomicandsocial
structures.6Selfdetermination,discussedlaterinthis
paper,isanimportantcomponentofthisdebate.

HIVandIndigenousPopulations

Currently,thereisnoglobalhealthprofileon
indigenouspopulations.InCanada,HIVinfectionrates
inAboriginalpopulationsarehigherthanamongstthe
generalpopulation;althoughtheyrepresentedonly
3.8%oftheCanadianpopulationin2006,Aboriginal
personscomprised8.0%ofpersonslivingwithHIV
(includingAIDS)inCanadaand12.5%ofnewHIV
infectionsinCanadain2008.7InsubSaharanAfrica,
estimatesofHIVinfectionin2009were1.8million
people;specificratesforindigenouspopulationsare
notknown.8

Generally,obtainingcomprehensiveandaccuratedata
onHIVinfectionratesisdifficult,particularlyinlowor
middleincomecountries.Thedatawhichdoesexistis
notalwaysdisaggregatedbyethnicityandveryfew
countrieshaveindigenousspecificdataatthenational
level.9Additionally,thegeographicdistributionof
indigenouspeoplesmaynotnecessarilycorrelatewith
thephysicalboundariesofnationstates,althoughin
somecasesdatacanbeinferredfromregional
differencesincountrieswhereindigenouspopulations
areknowntobeconcentratedinspecificareas.10The
epidemiologyofHIVandAIDScanalsobevery
differentindifferentpopulationsbothwithinand
acrosscountries.

Thesegapsinsurveillancedatapresentaformidable
challengetodevelopingappropriatehealth
interventions,monitoringprogramsandotherpolicies
tailoredtoindigenouspopulations.Insomecases,
theymayevenhaveanegativeeffectasdifferent
methodsofdatacollectioncanbeusedtomaskor
illuminatehealthandsocialinequalityforindigenous
peoples.11


HIV/AIDSANDINDIGENOUSPOPULATIONSINCANADAANDSUBSAHARANAFRICA

1. Colonization

Thecolonizationofpeopleandlandsisanissuewhich
affectsthehealthofindigenouspopulationsacrossthe
globe.(Notethatinthiscontext,theterm
colonizationdoesnotreferexclusivelytothe
EuropeancolonizationoftheAfricancontinentbut
rathertothegeneraloppressionofindigenouspeoples
bycolonizingpeoples.)Onereasonthatmanyillnesses,
includingHIV,disproportionatelyimpactindigenous
peoplesisduetosystemiccolonistandracist
structures.Theeffectsofcolonizationarenumerous:
breakageofaconnectiontoland,familyand
community;environmentaldegradationoftraditional
lands;suppressionofculturalandlinguisticrights;
institutionalracism;developmentaggression;forced
displacement;andeconomicexploitation.15

InCanada,thelegacyoftheresidentialschoolsystem
inparticularhashadaprofoundimpact.Inthe
nineteenthcentury,theCanadiangovernment
establishedaresidentialschoolsystemforAboriginal
peoples,intendedtoteachEnglish,Christianityand
Canadiancustoms.Apolicyknownasaggressive
assimilationwasusedtoeducateyouth,with
mandatoryattendance.Itisnowrecognizedthatthis
systemhashadfarreachingnegativeimpactson
Aboriginalpeopleswhichhasbeenhandeddown
throughgenerations.Manyhealthissuesincluding
addictions,povertyandmentalhealthissuescanbe
tracedbacktotheresidentialschoollegacy.This
exampleisparticulartoCanada,withsimilarprograms
implementedinNewZealandandAustralia,butthere
maybelessonslearnedherethatlinktothecolonial
legacyinAfricaandthefarreachingimpactsof
colonizationeventoday.

2. Globalization

Inanincreasinglyinterconnectedworld,itisimpossible
foranypopulationtoescapetheeffectsof

globalization.Butdespitetheincreasedintegrationof
peoples,marketsandresources,UNdeskreportshave
identifiedmarginalization,discriminationandexclusion
ofindigenouspeoplesasapersistentsocialissue.16

Anumberoffactorslinkedtoglobalizationaffectthe
healthofindigenouspopulations.Environmental
degradation,changingmigrationpatternsandnewly
developedtradeandtransportationroutesallhavean
indirectimpactonhealthoutcomes.Integratedglobal
healthepidemicsandinternationalhealthreformhave
alsodirectlyaffectedindigenouspopulations.In
particular,asthegapbetweentheglobalNorthand
globalSouthwidens,attentiontotheglobalHIV
epidemichasshifted.Resourcesbothfinancialand
otherwiseandinternationalattentionarelimited;
fundingforHIVandAIDSasawholehasplateauedin
recentyears,makingtargetedfundingforspecificsub
populationsevenmorechallengingtoaccess.
InternationalbodiesanddocumentssuchastheUN
DeclarationontheRightsofIndigenousPeopleshelp
toaddresssomeoftheseissuesandensurethatthey
aretackledonthegloballevel.

3. Migration

Manyindigenouscommunitiesareconcentratedin
remoteorruralareas.InsomeinstancesinCanada,
thishasledtohigherHIVprevalenceratesinthese
areas.Inotherinstances,geographicorsocialisolation
ofthesecommunitieshasofferedamoderatelevelof
protectionfromriskfactorsandexposuretoHIV.For
example,informal2002dataontheHIVinfectionrate
fortheSanpeopleintheGhanziareaofBotswanawas
lowerat21.4%thanthenationalrateof35.4%,
implyingthatthegeographicalisolationofthis
communitymayhaveprovidedprotectionfromhigher
ratesofinfection.17AndinNamibia,HIVratesare
extremelyhighoverallbutparticularlylowamongthe
Ju/hoansipeople,withsomeconjecturethatthis
mightbedueinparttohighlevelsofgenderequality,


HIV/AIDSANDINDIGENOUSPOPULATIONSINCANADAANDSUBSAHARANAFRICA
18

aswellasfactorsofisolation.

However,thisischangingasruralurbanmigrationand
othershiftingmobilitypatternsbecomeincreasingly
common.Asindigenouscommunitiesbecomemore
integratedwithmainstreamsociety,individualsareat
greaterriskbecausetheymaylackbasicknowledge
aboutHIVorotherhealthissues,mayfacelanguage
barriersandmayhavepreconceivednotionsabout
illnesswhichmaketreatmentviaARVsorother
medicationschallenging.Migrationmayalsomeanthat
manyindividualsorfamiliesbecomedisconnected
fromfamilyorsocialsupportnetworks,leadingto
increasedriskfactorsforHIV,includingdruguseor
unprotectedsex.Furthermore,movementawayfrom
traditionallandsmakesindigenouspopulationsmore
vulnerabletoracism,discriminationandabuse;
womeninparticularmayfacesexualviolenceormay
beengagedinsexwork,allofwhicharesocialrisk
factorsforHIV.Thereissomeevidenceofincreased
HIVexposureforindigenouspopulationsdueto
resettlementcampsandworkcampsforresources
extractionactivitieswomeninparticularcanbe
vulnerableinremoteandsometimesinsecure
environments,andinlocationsalonghighwaysand
othertransportationroutes.19

4. CulturalContinuity

Culturalcontinuityreferstotheintergenerational
connectednessofindividuals,familiesand
communities.20Thisconnectednessensuresthat
culturalknowledge,valuesandpracticesareshared
overtimeandamongstpeople.However,inmany
casesinCanadaandinsubSaharanAfrica,cultural
continuityhasbeenbrokenascommunitieshavebeen
forcedtoassimilateintomainstreamcultures.Andin
manycountries,suchasUganda,RwandaandBurundi,
indigenousstatusisnotrecognizedbythegovernment,
therebyunderminingthesenseofculturalbelonging.21
Embeddedintheconceptofculturalcontinuityisthe

importanceofrecognizingculturalbeliefs,andhow
thesebeliefsmayaffectdecisionmakingprocesses,
particularlyaroundsexualpractices.Forexample,
beliefsystemsaroundfertility,deathorcausesofHIV
mayaffectchoicesoncondomuseordecisionstoseek
medicalcareviatraditionalorWesternmedicine.This
challengehighlightstheimportanceoffindingan
appropriatebalancebetweentraditionaland
biomedicalapproachestopreventionandtreatment.

5. AccesstoHealthCare

Accesstohealthcarebyindigenouspopulationscanbe
compromisedbyanumberoffactors.Many
indigenouspopulationsliveinruralorremoteareas
andthisgeographicaldistance,sometimes
compoundedwithseasonalisolation,canlimittheir
abilitytoreachhealthcareservices.InCanada,within
flyinorisolatedcommunities,womenmust
sometimesflyoverathousandkilometerstoreacha
hospitalinordertogivebirth,haveatoothextracted
ortreatanillness.Manyhaveneverlefttheir
communitiesbeforeandthereisareluctancetodoso
inmanycases.Evenwhenaffordableservicesdoexist
inindigenouscommunities,somestudieshaveshown
thattheyareoflowerqualitythanservicesavailable
fornonindigenouspopulations.22InCanada,health
careprioritiessetbythegovernmentmaynotmatch
theprioritiesthatwouldotherwisebesetby
indigenouscommunities;however,someprogresshas
beenmadeonthisfrontasmanycommunitieshave
movedtomanagingandadministeringtheirown
healthcaresystems.23

Theroleoftraditionalorindigenousmedicinein
addressingboththepreventionandtreatmentofHIVis
ofspecialconsideration.Manyhealthcareclinicsor
healthcarepractitionersmaynothaveathorough
understandingofindigenoushealthpractices;
moreover,therelianceonWesternmedicineand
interventionsmayleadtohealthcareserviceswhich


HIV/AIDSANDINDIGENOUSPOPULATIONSINCANADAANDSUBSAHARANAFRICA

areunsuitableorevenoffensivetoindigenous
patients.Servicesandresourcesmaynotbeavailable
intheappropriatelanguages,andinsomecases,
discriminationorstigmatizationmayalsoactasa
deterrenttoindividualsseekinghealthservices.

However,usefulalternativemodelsdoexist.For
example,theKeurMassarLeprosyTreatmentCenterin
Senegalhassuccessfullyusedtraditionaltherapiesto
treatdifferentillnesses,includingHIVandAIDS.The
treatmentsusedarenontoxic,addresssecondary
infectionssuchastuberculosisandarebasedon
naturalcomponentswhichdonotrequirefinancialor
scientificsupportfromhighincomecountriesinorder
towork.Treatmentssuchasthesecanactnotonlyas
aneffectivecomplementtobiomedicaltreatmentbut
mayalsobemoreculturallyappropriatethansome
Westernapproaches.24Otheroptionsaresystems
whichbalanceindigenousandmainstreamhealthcare
systems.Whiletherearesomechallengeswithsuch
interculturalsystems,thereisevidencethatintegrating
traditionalhealersintoHIVpreventionprogramscan
significantlyimprovethe[ir]effectiveness.25

6. Territory

Formanyindigenouscommunities,relationshipswith
thelandandtheenvironmentareacriticalcomponent
ofselfidentification.Impactsonphysicalterritoryby
factorssuchasmigration,globalizationandclimate
changethereforehaveaprofoundeffectonlifestyles
andhealthoutcomes.

LandrightsinparticulararedescribedbytheACHPRas
fundamentalforthesurvivalofindigenous
communities.InCanada,landrightsareanissueof
ongoingdebate,withsomelandsspecifically
designatedforFirstNationpopulations.InAfrica,land
rightsareanissuefacingmanyindigenouspopulations
includingpopulationsintheNigerDeltaofNigeria;the
BatwapopulationsinRwandawhohavebeen

dispossessedofancestrallandsandtheBatwapeople
whohavebeendisplacedinUgandaduetothe
creationofnationalparksandconservationzones;and
variouspeoplesinTanzaniawhohavebeendisplaced
duetotheexpansionofagriculturallandsaswellas
thecreationofnationalparks.26Inaddition,onereport
findsthatthemajorityofarmedconflictsacrossthe
globearebeingfoughtonterritoriesofindigenous
peoples,suchasintheDemocraticRepublicof
Congo.27

Thisdisplacementdoesnotsimplymeanthelossof
land;thereisastronglinkbetweenthistypeof
territorialdisplacementandpoorhealth.28For
example,asthepygmypopulationsofcentralAfrica
havebeenforcedtomoveawayfromtheirtraditional
wayoflifeandjointheformaleconomyduetothe
encroachmentontheirlandbyloggingandfarming,
theyhavealsofacedincreasedriskofsexual
exploitationandHIVandAIDS.Climatechangeand
environmentaldegradationcanalsoaffectthe
lifestylesofmanyindigenouspeoples,particularly
thosewhohavehunter/gathererlifestyles.Asthese
populationsmigrateandmixwithnonindigenous
populations,additionalculturallyappropriateHIV
sensitizationwillbeneeded.29

7. Poverty

Forindigenouspopulationsworldwide,povertyis
widespread.Therelationshipbetweenpovertyandrisk
ofHIVinfectioniswellrecognizedanddocumented;
thoselivinginpovertyarefarlesslikelytohaveaccess
toeducationandhealthcare,befoodinsecureand
havelimitedmeansforincomegeneration.Studies
havealsoshownthatHIVpositivestatuscanfurther
exacerbatepoverty,thuscreatingaviciouscyclewhich
hasfurthernegativeimpactsonhealth.30

InCanada,theaverageannualincomeofAboriginal
peoplesismuchlowerthanthenonAboriginal


HIV/AIDSANDINDIGENOUSPOPULATIONSINCANADAANDSUBSAHARANAFRICA

population;accordingtothe2006census,theaverage
maleincomewas62%oftheincomeofanon
Aboriginalmale,whiletheaveragefemaleincomewas
75%ofanonAboriginalfemale.31InAfrica,extreme
povertyhasbeenoneof,ifnotthe,largest
contributingfactortotheHIVepidemic.Forexample,
inUganda,thepooresthouseholdsaremorelikelyto
beHIVpositivethanwealthierhouseholds.32In
Uganda,TanzaniaandRwanda,theindigenous
populationsareamongthepoorestandmost
marginalized.33Justasimportantly,theabsenceof
hopeanddepletedemotionalresourceswhichare
oftenassociatedwithpovertymayleavepeople
withouttheresourcesneededtoprotectthemselves
andothersfromHIVinfection.HIVinterventionswill,
ofnecessity,havetoaddresspovertyaswell.

8. SelfDetermination

Selfdeterminationcanbedefinedasaconsciousand
deliberateobjectivebyindigenouspeoplestoassert
theirrighttobethedrivingforceinpolicyprocesses
andinthedesignanddeliveryofHIV/AIDSservices.34
Thisneedformeaningfulengagementbyindigenous
populationsisnotlimitedtothedesign,deliveryand
evaluationofhealthcaresystemsbutitalsoextendsto
policyformulation,thedevelopmentofinternational
agendas,engagementinpoliticalprocessesand
beyond.Atthe2007InternationalSymposiumonthe
SocialDeterminantsofIndigenousHealth,itwas
recognizedthatIndigenouspopulationsrighttoself
determination,includingthestandardsoutlinedinthe
UNDeclarationoftheRightsofIndigenousPeoples,
wasakeyfactorforreversingcolonization.35

However,inmanycases,selfdeterminationfor
indigenouspeoplesdoesnotoccur,andthis
marginalizationthroughthedenialofrightscanbe
extremelyharmful.Thelackofpoliticalandsocial
powerheldbyindigenouspopulationshasbeen
identifiedbyUNAIDSasakeyriskfactorwhichleaves

indigenouscommunitiesacutelyvulnerabletoHIV
withthisvulnerabilitybeinginsufficientlyrecognized
ininternationalresponses.36Furthermore,self
determinationcanhelptodevelopanumberof
protectivefactorsattheindividual,family,community
andsystemlevelthatprovidestrengthandresiliency.
Whenthesefactorssuchaspositiveselfconcepts,
socialinclusionandculturalcontinuityarenot
compromised,theyhelptoinformhealthyselfimages
anddecisionmaking.37

Alongsideselfdetermination,recognitionof
indigenouspeoplesbygovernmentandnon
indigenouspopulationsremainsimportant.InCanada,
variousformalprocessesexisttorecognizethelegal
statusofindigenouspeoples.InAfricancountries,legal
recognitionandprotectionforindigenouspeopleis
highlyuncommon,contributingtoalackoflegaland
socialpower.TheRepublicofCongowasactuallythe
firstAfricancountrytorecognizeindigenouspeoplesin
January2011,developingalawaimedtocounterthe
chronicmarginalizationofindigenouspopulations.38In
otherinstances,thechallengesrangefromindifference
tooutrightdiscrimination;forexample,inKenya,it
wasonceillegalforindigenouspopulationstohold
meetingsortodiscussissuesfacedbyindigenous
communities39andinRwanda,thegovernmenthas
bannedtheuseofthetermindigenousandany
promotionofethnicidentity.40Comprehensiveself
determinationremainsoneofthemostimportant
factorstoimprovinghealthoutcomesofindigenous
populations.

Conclusion

InbothCanadaandsubSaharanAfrica,social
determinantsofhealthcanbeusedasanappropriate
lenstoexaminesomeoftheunderlyingreasonsfor
healthdisparitiesandtheparticularvulnerabilitiesof
indigenouscommunitiestoHIV.Addressingthe
epidemicinthesecommunitieswillrequiretargeted


HIV/AIDSANDINDIGENOUSPOPULATIONSINCANADAANDSUBSAHARANAFRICA

andeffectiveprogrammingaswellasaconsideration
oftheunderlyinghealthdeterminantstoensurelong
lastingandmeaningfulinterventions.

Atthe20095thInternationalPolicyDialogueinCanada
(jointlyhostedbyUNAIDS,PHACandHealthCanada),
indigenouspeoplesandHIVwasaprioritytopicfor
discussion.Thefinalreportfromthedialogueargued
thattherelationshipbetweenHIVandindigenous
peopleshasnotreceivedsufficientinternational
attention,andcallsfortheidentificationofindigenous
peoplesasaprioritygroupwhenaddressingthe
epidemic.41Strategiesfordoingsoincludethe
developmentofnationalstrategiesandincreased
collaborationwithrepresentativesfromindigenous
communities.Thesestrategiesandanawarenessof
someoftheissueshighlightedinthisfactsheetwill
helptoensuremeaningfulinterventionstoaddressthe
HIVepidemic.

WorksCited

1.
Smylie,Janet.TheHealthofAboriginalPeoples.
SocialDeterminantsofHealth:CanadianPerspectives,
2ndEdition.Ed.DennisRaphael.Toronto:Canadian
ScholarsPressInc,2009.Hortonquotedonp.280

ofCanada,2010.p.vii
8.

UNAIDS.GlobalReportFactSheetSubSaharan
Africa.UNAIDSwebsite.UNAIDS:November23,2010.
9.

UnitedNations.PermanentForumonIndigenous
Issues,ReportontheFifthSession1526May2006.
UnitedNations,2006.p.4
10.

UnitedNations.StateoftheWorldsIndigenous
Peoples.NewYork:UnitedNations,2009.p.166
11.

Prentice,TraceyandRandyJackson.Indigenous
PeoplesandHIV/AIDS:Policyandpracticeimplications
ofworktodateFinalReport.Ottawa:Health
Canada,March26,2010.Mowbrayquotedonp.13.
12.

Raphael,Dennis.SocialDeterminantsofHealth:An
OverviewofKeyIssuesandThemes.Social
DeterminantsofHealth:CanadianPerspectives,2nd
Edition.Ed.DennisRaphael.Toronto:Canadian
ScholarsPressInc(2009).p.2
13.

Feldman,Douglas(ed).AIDS,CultureandAfrica.
Gainesville:UniversityPressofFlorida,2008.p.172
14.

NationalAboriginalHealthOrganization.Broader
DeterminantsofHealthinanAboriginalContext.
Presentation.May2,2007.
15.

UnitedNations2009,PrenticeandJackson2010

16.

AboriginalPeoplesinCanadain2006:Inuit,Mtis
andFirstNations,2006Census.StatisticsCanada,
website,2006.

Donato,Jennifer.HumanDevelopmentReportsand
IndigenousPeoplesADeskReview.Secretariatofthe
UnitedNationsPermanentForumonIndigenous
Issues,2009.

3.

17.

2.

Ohenjo,Nyangorietal.HealthofIndigenous
peopleinAfrica.TheLancet367(2006):19371945.

18.

Susser,Ida.Ju/hoansisurvivalinthefaceofHIV:
questionsofpovertyandgender.Anthropologica45
(1):121128.2003.

4.

WhoisindigenousinAfrica?IndigenousPeoplesof
AfricaCoordinatingCommittee.Online.
http://www.ipacc.org.za/eng/who.asp.2010.
5.
6.

Ohenjo2006,p.1943

19.

ibid

20.

Ohenjo2006,p.1943

DePauw,LiaMarleneLarocque,andNancyCooper.
BehindthePandemicinAboriginalCommunities:An
EducationalResourceKitonHIVandAIDS.ICADand
CAAN,2010.p.85

Ohenjo2006,p.1938

7.

PublicHealthAgencyofCanada.PopulationSpecific
HIV/AIDSStatusReport.Ottawa:PublicHealthAgency


HIV/AIDSANDINDIGENOUSPOPULATIONSINCANADAANDSUBSAHARANAFRICA
21.

Donato2009

22.

UnitedNations2009,p.173

23.

Raphael2009,p.2

40.

UnitedNations2009,p.174

41.

24.
25.

Feldman2008,pp.6

26.

Donato2009

27.

UnitedNations2009,p.167

28.

Ibid,p.159,168

29.

IRINAfrica.CONGO:Newlawtoprotectrightsof
indigenouspeoples
http://www.irinnews.org/Report.aspx?ReportID=9156
4.January7,2011.
30.

Feldman2008,p.40

31.

StatisticsCanada.2006CensusDataProduct.
IncomeStatistics(4)inConstant(2005)Dollars,Age
Groups(5A),AboriginalIdentity,RegisteredIndian
StatusandAboriginalAncestry(21),HighestCertificate,
DiplomaorDegree(5)andSex(3)forthePopulation
15YearsandOverWithIncomeofCanada,Provinces,
Territories,2000and200520%SampleData.Online,
2006.
32.

Feldman2008,p.7

33.

Donato2009,p.24

34.

PrenticeandJackson2010,p.6

35.

Smylie2009,p.282

36.

UNAIDS.Vulnerabilityofindigenouspeoplesto
AIDSinsufficientlyrecognizedininternational
response.UNAIDS,June10,2006.
37.
38.

DePauwetal2010,p.85

IRINHumanitarianNewsandAnalysis.CONGO
Newlawtoprotecttherightsofindigenouspeoples.
UNOfficefortheCoordinationofHumanitarianAffairs,
January7,2011.

39.

Sakuda,FrancisNkitoriaOleSakuda.Thehardships
andsuccessesofbeingindigenousinAfrica.Cultural
Survivalwebsite:2004.
Ohenjo2006,p.1938

InternationalAffairsDirectorate,HealthCanada.
HIV/AIDSandIndigenousPeoples:FinalReportofthe
5thInternationalPolicyDialogueOctober2123,2009.
Ottawa:HealthCanada,2009.

AdditionalResources

AboriginalAffairsandNorthernDevelopmentCanada:
http://www.aincinac.gc.ca/indexeng.asp

CanadianAboriginalAIDSNetwork:
http://www.caan.ca

CenterforWorldIndigenousStudies:
http://cwis.org/

CulturalSurvival:
http://www.culturalsurvival.org/

IndigenousPeoplesofAfricaCoordinatingCommittee:
http://www.ipaac.org.za

NationalAboriginalHealthOrganization:
http://www.naho.ca

PublicHealthAgencyofCanada:
http://www.phacacsp.ca

UNPermanentForumonIndigenousIssues:
http://www.un.org/esa/socdev/unpfii

UNAIDS:
http://www.unaids.org/en/

8
ICADsmissionistolessenthespreadandimpactofHIVandAIDSinresourcepoorcommunitiesandcountriesbyprovidingleadershipandactivelycontributingtothe
Canadianandinternationalresponse.FundingforthispublicationwasprovidedbythePublicHealthAgencyofCanada.Theopinionsexpressedinthispublicationare
thoseoftheauthors/researchersanddonotnecessarilyreflecttheofficialviewsofthePublicHealthAgencyofCanada.