HIV / AIDS

A Culturally-Relevant Perspective on This Issue

Introduction

Acquired immune deficiency syndrome (AIDS) is caused by the human immunodeficiency virus HIV, which progressively weakens the immune system, leaving the body susceptible to infections and diseases. HIV/AIDS can be transmitted through unprotected sex, hypodermic needles, blood transfusions, pregnancy, childbirth, and breastfeeding. Among the Aboriginal population in Canada, injection drug use (IDU) is the primary mode of HIV transmission, with just over half of AIDS cases attributable to IDU [1].

Aboriginal people are disproportionately affected by HIV, making up to 12% of all new HIV infections in Canada, despite comprising only 3% of the population [2,3]. HIV/AIDS is affecting Aboriginal people at a younger age than the general population and is a significant burden among Aboriginal women, who represent 45% of positive HIV reports among the Aboriginal population [1]. Further, a disproportionate number of Aboriginal women engage in survival sex [4] and exchange sex for money, drugs, shelter, or other commodities, which increases their risk for HIV infection [5].

The surveillance data on Aboriginal HIV/AIDS rates are incomplete due to a lack of ethnicity reporting [1]. There is a need for improved HIV/AIDS epidemiology and HIV testing data among Aboriginal peoples to better prevent and control the spread of HIV/AIDS.

First Nations

Census data from 2001 report that 73% of Aboriginal AIDS cases occur among First Nations people. Females represent approximately one quarter of First Nations AIDS cases [1]. Economic and social problems that exist among many First Nations communities, such as poverty, violence, and both alcohol and drug use are often associated with higher rates of HIV infection [6].

Métis

The Public Health Agency of Canada 2004 report on Aboriginal AIDS cases states that 7% of Aboriginal AIDS cases occur among Métis community. Females are less likely to be affected, with 8% of Métis AIDS patients being female. AIDS is extremely prevalent among youth and accounts for 36% of Métis AIDS cases.

IDU is a key mode of transmission, with 29% of reported Métis AIDS cases attributed to IDU [1]. The high mobility of Métis people between urban and rural areas may increase the risk of HIV among remote rural communities, making HIV/AIDS prevention and control measures a priority among all Métis communities [7].

Inuit

Inuit people with AIDS make up 4% of the AIDS cases among Aboriginal people and roughly 21% of these cases are female. According to the Aboriginal AIDS Network, heterosexual transmission is the predominant mode of HIV transmission among the Inuit population [8]. However, IDU is also a major transmission mode, accounting for 30% of infections [8]. 

Awareness about HIV/AIDS among Inuit communities is lower than in other Aboriginal and non-Aboriginal populations making prevention and control efforts challenging. Urban Inuit are at greater risk of HIV infection compared to rural Inuit, due to a high prevalence of poverty, violence, and addictions (including IDU) [8]. 

Tuberculosis

A Culturally-Relevant Perspective on This Issue

Introduction

Tuberculosis (TB) is an airborne infectious disease caused by Mycobacterium tuberculosis (TB bacilli) [1].  TB infects the lungs and the symptoms include coughing, sometimes with sputum or blood, chest pains, fever, night sweats, weight loss and weakness. Healthy people infected with TB bacilli generally do not present symptoms, since their immune system kills the TB bacilli, or the bacilli becomes dormant. When a person’s immune system weakens, dormant TB bacilli can turn into active TB disease [1]. Though TB is easily prevented by vaccine, it is very prevalent in Aboriginal populations in Canada, and is 17 times higher among some Aboriginal groups compared to the Canadian population [2].

There are several reasons used to explain the high TB rate among the Aboriginal population including a large number of TB infected people living in Aboriginal communities; poor socioeconomic conditions, such as overcrowded housing [3]; and limited access to health care services in remote areas [3]. Though TB is widespread among Aboriginal people, there remains a lack of information regarding the disease, particularly among the Métis population. Also, given that TB is a common co-infection of HIV, systematic reporting of HIV status among TB cases is needed to improve the prevention and control of TB in Canada, including among Aboriginal peoples [4].

First Nations

The rate of tuberculosis among First Nations people has been decreasing over the past decade, however is still extremely high in comparison to the Canadian population. In 2000, the TB rate in First Nations population was nearly six times that of the general population with 34 cases/100,000 population in First Nations people compared to 6 cases/100,000 in the general Canadian population[5].

Métis

TB data for the Métis population has only been recently collected, limiting the data available. The TB rate among the Métis population is relatively low, and has remained constant over the past couple of years [4]. Data from 2004 shows the total number of TB cases among the Métis to be 6. The incidence rate (the number of newly diagnosed cases) for TB among the Métis population was 2, compared to 5 in the general population. This rate was much lower compared to the incidence rate in Canadian born Aboriginals which was 24 [4].

Inuit

Inuit communities in Canada have the highest incidence rate of TB of any group in the country [6]. In 2006, five percent of Inuit adults had been diagnosed with tuberculosis [7]. The Inuit region of Nunavut has the highest prevalence of tuberculosis (6%), and Nunavik has the lowest (3%) prevalence of all Inuit regions. The TB rate in Nunavut is currently 17 times the Canadian rate [5]. There is speculation around the reasons behind the high TB rates among the Inuit people. Some possible reasons include crowded housing, malnutrition, lack of immunity to the mycobacterium bacillus and restricted access and delivery of health care services in rural and remote areas [8, 4]. 

Alcohol Use

A Culturally-Relevant Perspective on This Issue

Introduction

Alcohol use has been identified as a problem among Aboriginal communities and can lead to violence, sexual and physical abuse, accidents, self-inflicted injury, and death [1]. However, data on the extent and impact of alcohol use on Aboriginal communities are lacking. A number of risk factors have been linked to alcohol use in Aboriginal populations such as poverty, depression, and history of attendance at residential/boarding schools, childhood abuse, and being a victim of physical or sexual violence and/or a history of family violence [2,3].

First Nations

The rate of alcohol use is lower among First Nations communities (66%) compared to the general population (79%). However, alcohol misuse is a growing concern among First Nations communities who do use alcohol.  Alcohol-related deaths among First Nations people are six times higher compared to the general population [4]. First Nations men are more likely (69%) to drink alcohol than women (62%).  However, the proportion of heavy drinkers among First Nations people is more than double compared to the general population (16% versus 6%), with First Nations men being more than twice as likely to be heavy drinkers compared to women (21% versus 10%) [5].

Métis

Alcohol abuse is also considered a problem among Métis communities [6], however there is a lack of data available regarding alcohol use among the Métis. Improved data collection on alcohol use among Métis people is needed.

Inuit

The Pauktuutit Inuit Women’s Association identified alcohol misuse to be among the Inuit communities’ prominent health problems [7]. For example, there has been a 14% increase in alcohol use in Nunavik since 1992. Although the drinking prevalence in Inuit communities is low compared to the rest of Canada, binge drinking is the most prevalent pattern among those who drink, leading to increases social and health problems such as violence, abuse, accidents, and death in Inuit communities [1,8]. In Nunavik (the northern third of Quebec), 90% of drinkers reported having drunk heavily within the previous year, a rate which is double that of the general population [8]. More data is needed to understand alcohol use/abuse in Inuit communities. Also, culturally appropriate measures need to be developed to address the growing problem of alcohol abuse among Inuit communities. 

Body Mass Index

A Culturally-Relevant Perspective on This Issue

Introduction

Body Mass Index (BMI) is the most common measurement of body weight and is calculated by dividing a person’s height, squared (kg/m2). In Canada, body weight classes are categorized by BMI values (obese: BMI = 30, overweight: BMI = 25.0-29.9, underweight: BMI < 18.5, normal weight: BMI = 19.0-24.9). The Aboriginal population is 2.5 times more likely to be obese or overweight compared to their non-Aboriginal counterparts, making obesity a major health concern among Aboriginal communities [1]. Health risks are associated with weight classes higher and lower than the normal weight class [2]. This poses serious health issues such as increased risk of chronic health problems as diabetes, hypertension, gall bladder disease, arthritis, risk of cardiovascular disease, and other health problems. High rates of both overweight and obesity among Aboriginal peoples may reflect socioeconomic differences, eating habits, physical activity levels, as well as rapid changes in lifestyle and diet [2-4].

First Nations

The First Nations population in general has a higher BMI compared to the general population; the obesity rate for the First Nations population is twice the Canadian obesity rate [5]. For example, among the age group 18-34 years, 35% of First Nations were overweight compared to 25% in the general population. Similarly, in the age group 34-54 years, 44% of First Nations people were found to be obese compared to 19% of 34-54 years olds in the general population [6]. Among First Nations people, the majority of overweight individuals are men (42% versus 32% in women). However, First Nations females are more likely than their male counterparts to be obese (40% versus 32%). [7]. Childhood obesity is also a growing problem among First Nations communities [8].

Métis

Data on body weight of Métis is limited, however numerous studies have identified obesity among the Métis population as a major risk factor for chronic disease, such as diabetes and cardiovascular diseases [9-11].

Inuit

The Inuit population has undergone rapid lifestyle changes, including changes to their diet and physical activity levels. This has lead to a steady increase in BMI, which is comparable or greater than that of the general population [12]. A 2007 study found that rates of overweight were 33% for women and 37% for men, while rates of obesity were 26% for women and 16% for men. Obesity in children has also recently been identified as a major health problem among Inuit communities [8].

Obesity and a tendency to store weight around the abdomen are especially high among Inuit women [13]. However, in the Inuit population, high BMIs are less likely to be associated with metabolic consequences (such as high blood lipids and blood pressure) and disease risk compared to the general Canadian population [14]. Several possible reasons for this could be genetic differences and dietary differences [13].

Due to differences in body shape and composition of Inuit peoples compared to the general population, there is debate surrounding the applicability of the BMI measurement as an indicator for obesity. Ethno-specific obesity criteria may be necessary to assess body weight among the Inuit population [14]. Nationally collected data on body weight among the Inuit is currently unavailable and is needed to understand and address the body weight and associated health issues among the Inuit population. 

Education

A Culturally-Relevant Perspective on This Issue

Introduction

Education is the gradual acquisition of knowledge, skills, and values through formal instruction or other informal teachings, such as hands-on experience [1]. Educational attainment refers to the highest level of schooling a person has attained in elementary and secondary school, or post-secondary education completed (e.g., trades, college, university), as well as certificates or diplomas obtained [2]. Education is an important determinant of health because it fosters an understanding of health, access, and use of health services. Education also influences health as it may affect employment opportunities and income. 

The educational attainment of Aboriginal women is improving, but still lags significantly behind that for women in the general population. Among Aboriginal women, pregnancy is a significant barrier to completing high school: 25% of Aboriginal women cited pregnancy and childcare as a reason for quitting school [3]. However, among Aboriginal peoples, women are more likely than men to attain higher levels of education.

Aboriginal people’s education is influenced by the legacy of colonization and residential schooling and a long history of conflict between Aboriginal and non-Aboriginal cultures, which has led to distrust and resentment of a system primarily run by non-Aboriginal, middle-class people [3]. Data specific to Aboriginal women’s education and its relationship to health are lacking.

First Nations

Educational attainment among First Nations people in Canada is low. Data from the 2006 census show that 42% of First Nations People (aged 25-64 years) had completed postsecondary education.  For on-reserve First Nations residents, 60% of those aged 20-24 had not completed high school or an alternative diploma or certificate program [4]. 

An estimated 12% of off-reserve First Nations had a trades certificate, 17% a college degree, and 7% of First Nations people had a university degree. Off-reserve First Nations people were more likely to have university and college degrees. First Nations women both on- and off-reserve (aged 25-64) were more likely than men to have completed a postsecondary education (44% compared to 39%) [4].

Métis

Among the population identifying as Métis between the ages of 25 and 64 years, half had obtained postsecondary qualifications, 24% had completed high school or a high school equivalent, and 26% had not completed high school or the equivalent. The most common postsecondary qualification was a college diploma (21%), followed by trades certificates (16%) [5].

Inuit

According to the 2006 census, 49% of the adult Inuit population had completed high school and 36% held a postsecondary certificate, diploma or degree. A greater proportion of Inuit high school graduates are female [6]. The most popular field of post secondary study among Inuit people was construction trades, with 22% attaining qualifications in that area. The number of Inuit with a university degree increased from 2% in 2001 to 4% in 2006 [5].