386P
THE CULTURAL DIVIDE: A COMPARISON OF USE/NEED AND BARRIERS (TRADITIONAL WELLNESS APPROACHES vs PRIMARY HEALTH CARE) FOR ABORIGINAL PEOPLE LIVING WITH HIV/AIDS
R Jackson1, L Monette2
¹Canadian Aboriginal AIDS Network; 2Ontario Aboriginal HIV/AIDS Strategy, Toronto, Ontario
Background: Traditional Aboriginal cultural needs are important factors to consider when addressing continuing rates of HIV infection in Aboriginal communities. When Aboriginal people are afforded opportunities to learn and re-connect with culture, generally the stronger their resolve will be to cope with negative life experiences (Jackson, 2003; Walters and Simoni, 2002; Assembly of First Nations, 2001). In the context of HIV/AIDS, coupled with "limited access to or use of health care services" (CIDPC, May 2003), these factors define the backdrop against which this study was first developed. This presentation examines traditional Aboriginal health service needs and barriers compared to primary health care. Based in part on preliminary data presented to the Ontario HIV Treatment Network (November 2004), such information may provide services with more detailed information on both the best means of providing care and the special care need of APHAs.
Methods: Using a participatory action research design, with assistance from 31 recruitment agencies, we provided a purposive sample of 305 APHAs from across Canada a self-administered mail survey, resulting in 195 responses (a response rate of 63.9%). All responses were coded and entered into SPSS(r) with the main type of analysis focused on frequency and cross-tabulation. Where appropriate, given the non-random nature of the sample, tests of statistical significance were preformed (where expected counts exceed n=5) using Pearson chi square (c2). Additionally, open-ended responses were analysed for content, assigned values, and entered into SPSS(r). Regional representation was achieved and participants include Inuit, Métis and First Nation APHAs who represent the full cross-section of Canada's Aboriginal population in terms of gender, sexual orientation, age, and urban/rural residence. The study design was approved by Carleton University Ethics Committee.
Results: Approximately two thirds (60.5%) of participants indicated they need or use one or more traditional services. Traditional health and wellness services are defined to include care offered by elders, traditional medicines, and participation in ceremonies and/or healing circles. Analyses of open-ended responses indicate the importance of traditional health and wellness services for participants. As one participant described his experience, "[it] helps calm my body." Another stated, "[my elder] spoke to me in a way that I understood." Clearly, given use and the importance attributed to participation in cultural health and wellness, it is unfortunate that many APHAs (25.0%) indicated their needs are only sometimes or never met by primary health care providers. Common reasons supplied by participants for this included logistical access barriers (52.4%), the sense that medical services generally are not providing adequate care (46.0%), and expressions that point to HIV/AIDS stigma, racial prejudice and homophobia (30.2%) in primary health care settings.
Discussions: Analysis reveals the following; when afforded opportunities to participate in culturally sensitive health and wellness care, many APHAs will. A variety of positive outcomes result in this type of participation, including understanding of information, peer social support, and general improvements in quality of life. However, several barriers require attention to improve the experience for APHAs when obtaining care in primary health care settings, particularly addressing such issues as adequate care and resolving perceived issues of racial discrimination. It may be that offering some level of traditional health and wellness programming within conventional health care will help ensure APHAs become more likely to access primary health care support.
Acknowledgements: The authors are grateful for the participation of Aboriginal people living with HIV/AIDS; to other members of the research team (Gabe Saulnier, Kim Thomas, Henry Kudluk and Todd Armstrong); to members of the Community Advisory Committee (Trevor Stratton, Michael Parsons, Duane Morriseau-Beck, Claudette Cardinal, Roger Carson-Fox, Eric Aubrichon and Peetanacoot Nenakawekapo); to Karen Richter for assistance with the literature review; to F van Veldoven for statistical analysis assistance and to Sarah Kemp and Michel Danis for implementing the APHA client database.
This project was supported with a grant by the Canadian Institutes of Health Research