Wednesday, October 28, 2015

The Cedar Project: Resilience in the Face of HIV Vulnerability within a Cohort Study Involving Young Indigenous People Who Use Drugs in Three Canadian Cities

This study explored risk and protective factors associated with resilience among participants of the Cedar Project, a cohort study involving young Indigenous peoples who use illicit drugs in three cities in British Columbia, Canada. We utilized the Connor-Davidson Resilience Scale to measure resilience, the Childhood Trauma Questionnaire to measure childhood maltreatment, and the Symptom-Checklist 90-Revised to measure psychological distress among study participants. Multivariate linear mixed effects models (LME) estimated the effect of study variables on mean change in resilience scores between 2011-2012.

Among 191 participants, 92 % had experienced any form of childhood maltreatment, 48 % had a parent who attended residential school, and 71 % had been in foster care. The overall mean resilience score was 62.04, with no differences between the young men and women (p = 0.871). Adjusted factors associated with higher mean resilience scores included having grown up in a family that often/always lived by traditional culture (B = 7.70, p = 0.004) and had often/always spoken their traditional language at home (B = 10.52, p < 0.001). Currently knowing how to speak a traditional language (B = 13.06, p = 0.001), currently often or always living by traditional culture (B = 6.50, p = 0.025), and having recently sought drug/alcohol treatment (B = 4.84, p = 0.036) were also significantly associated with higher mean resilience scores. Adjusted factors associated with diminished mean resilience scores included severe childhood emotional neglect (B = −13.34, p = 0.001), smoking crack daily (B = −5.42, p = 0.044), having been sexual assaulted (B = −14.42, p = 0.041), and blackout drinking (B = −6.19, p = 0.027).

Young people in this study have faced multiple complex challenges to their strength. However, cultural foundations continue to function as buffers that protect young Indigenous people from severe health outcomes, including vulnerability to HIV and HCV infection...

Research suggests that young Indigenous people living with unaddressed historical and lifetime traumas are more likely to use illicit drugs as a coping mechanism [9]. Further, young urban Indigenous people who use drugs in Canada experience high levels of injection drug use [10], residential transience [11], high risk sex [12], sex work [13], and sexual violence [14]. These cumulative traumas have also manifest as increased HIV and hepatitis C (HCV) vulnerability[15]–[19]. For example, extant literature has demonstrated that young Indigenous people who use drugs and have experienced childhood sexual abuse are twice as likely to be living with HIV infection [9], and those who had at least one parent who attended residential school are twice as likely to be living with HCV infection [20]. Taken together, these vulnerabilities have contributed substantially to the overrepresentation of Indigenous people among those living with HIV and HCV infection in Canada. Recent 2011 data indicates that Indigenous people constituted an estimated 12.2 % of all people in Canada newly diagnosed with HIV, which corresponded to an HIV incidence rate that was 3.5 times higher than among non-Indigenous people [21]. Likewise, between 2002 and 2008, the estimated incidence of HCV infection was 4.7 fold higher among Indigenous people than non-Indigenous people [19]...

Full article at: http://goo.gl/BpE7lY

By: Margo E. Pearce12, Kate A. Jongbloed12, Chris G. Richardson12, Earl W. Henderson3,Sherri D. Pooyak4, Eugenia Oviedo-Joekes12, Wunuxtsin M. Christian5, Martin T. Schechter12, Patricia M. Spittal12* and For the Cedar Project Partnership
1School of Population and Public Health, University of British Columbia, Columbia, Canada
2Centre for Health Evaluation and Outcome Sciences, 588-1081 Burrard St., Vancouver, V6Z1Y6, BC, Canada
3Cree, Métis; University of Northern British Columbia, Columbia, Canada
4Cree; University of Victoria; Canadian Aboriginal AIDS Network, Victoria, Canada
5Splatsin te Secwepemc First Nation, Columbia, Canada
   


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