The Cedar Project: Intergenerational child apprehension and HIV health and wellness among young Indigenous peoples who have used drugs: A mixed methods study

Purpose

Wellbeing is eroded when Indigenous children are forcefully removed from families and communities. This study explored how intergenerational child apprehension shapes human immunodeficiency virus (HIV) health and wellness among young Indigenous peoples who have used drugs and are living with HIV.

Methods

This exploratory sequential mixed-methods study took place within the Cedar Project cohort and involved young Indigenous peoples who have used drugs in British Columbia, Canada. In-depth interviews addressing HIV cascade of care experiences involved 12 participants living with HIV in 2016. Interpretive description identified themes. Based on qualitative findings, longitudinal generalised linear mixed effects models involving 52 participants investigated relationships between intergenerational child apprehension and HIV viral suppression using data collected between 2011–14.

Main findings

Family connections, child apprehension and parenting concerns were identified as central to HIV health and wellness. Themes highlighting intersections included: (1) impact of removal from families on long-term health and wellbeing; (2) (re)connecting with family; (3) intersections of substance use, child apprehension and HIV; (4) fear, stress and demands of maintaining/regaining custody of children; and (5) traditional wellness practices being valued but complicated. Having been apprehended as a child (aOR 0.23; 95% CI 0.06–0.82) and having had a child apprehended (aOR 0.24; 95% CI 0.07–0.77) were associated with reduced odds of HIV viral suppression.

Principal conclusions

Young Indigenous peoples who have used drugs were >75% less likely to be virally suppressed if they had been apprehended from their parents as children, or their own children had been apprehended. It is believed that this is the first study to demonstrate statistical links between intergenerational child apprehensions and negative HIV outcomes among Indigenous people with HIV. Respecting Indigenous rights to self-determination over child welfare processes is urgent. HIV care for young Indigenous peoples who have used drugs must acknowledge and address ongoing impacts of intergenerational child apprehensions. Supporting parenting and family connections is essential to culturally-safe, healing-centred HIV care.