The Cedar Project: Understanding the association between childhood maltreatment and psychological distress, resilience, and HIV and HCV vulnerability among young Indigenous people who use drugs in three Canadian cities (2015)
Background: Indigenous leaders are deeply concerned about the adverse impacts of intergenerational and lifetime trauma on their young people, particularly those who use drugs and are vulnerable to HIV and HCV infection. However, few researchers have investigated the complex intersections of trauma, mental health, resilience, and HIV and HCV vulnerability among young Indigenous men and women in Canada. Methods: This multidisciplinary research was based on information gathered by the Cedar Project, a cohort of young Indigenous people (aged 14-30) who use drugs in Vancouver, Prince George, and Chase, British Columbia. The qualitative analyses used an interpretive thematic approach to analyze in-depth interviews. The quantitative analyses first evaluated the construct validity of psychometric questionnaires that measured childhood maltreatment, psychological distress, and resilience. Next, those questionnaires were integrated with longitudinal Cedar Project data to assess associations between childhood maltreatment with HIV and HCV vulnerability, psychological distress, and resilience. Results: The qualitative research highlighted participants’ ongoing struggles with unaddressed childhood maltreatment and the association between emotional pain and HIV and HCV vulnerability. However, participants were actively resisting the negative effects of trauma maintaining hope for a better life. In quantitative analyses, each of the psychometric questionnaires had acceptable fit for the data. In total, 91.7% of the participants had experienced at least one form of childhood abuse/neglect. Longitudinal vulnerabilities associated with specific types of childhood trauma and cumulative trauma experiences included significant drug and sex-related HIV and HCV risks, in addition to HCV infection. Childhood maltreatment, sex work involvement, sexual assault, heavy alcohol use, and injection drug use increased psychological distress, while living by traditional culture decreased psychological distress. Resilience was increased by having grown up in a traditional family environment, and by having access to and being able to speak traditional languages.Conclusion: This research supports the development of comprehensive, Indigenous-directed healing strategies for HIV/HCV prevention that are tailored for young Indigenous people who use drugs. These strategies must address concurrent trauma and mental health, support connections to Indigenous cultural identity, and facilitate understanding of the impacts of the residential school system and intergenerational trauma on family relationships.