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Indigenous scholars have called for responses to substance use and HIV among young Indigenous people that acknowledge ongoing colonization, structural violence, and the impacts of intergenerational traumas, while building on cultural strengths and resilience. This mixed method dissertation took place within The Cedar Project cohort involving young Indigenous people who have used drugs in Vancouver and Prince George, British Columbia (BC). The purpose was to examine experiences of engagement with the HIV cascade of care, and evaluate The Cedar Project WelTel mHealth program for HIV-related health and wellness, among young Indigenous people who have used drugs living in British Columbia, using both qualitative and quantitative approaches. Findings support understanding of how a wholistic perspective of health and wellbeing, as well as experiences of ongoing colonial violence including child apprehension, inform engagement with the HIV cascade of care among Indigenous peoples. Results add to mounting evidence that state-based apprehensions of Indigenous children are a negative determinant of health for Indigenous families. Findings further illustrated how mobile phones can be a tool to support family (re)connections, relationships with health and social services, and self-determination within young Indigenous people who have used drugs’ health and wellness journeys. Moreover, this dissertation demonstrates that a supportive two-way texting mHealth initiative integrated into existing wraparound care from trusted case managers is acceptable and valued by young Indigenous people who have used drugs. Study findings provide evidence that the Cedar Project WelTel mHealth program may be an effective approach to support engagement in HIV care for young Indigenous people who have used drugs, and should be considered for application in other program settings as well. Four overarching recommendations for policy makers and health providers were developed in collaboration with Cedar mentors, committee members, and investigators: (1) uphold a wholistic perspective to walk with young Indigenous people who have used drugs on their health and wellness journeys; (2) urgently address ongoing apprehensions of Indigenous children; (3) offer the Cedar Project WelTel mHealth model for HIV health and wellness; and (4) explore integrating mHealth with healing modalities for substance use and other aspects of wholistic health and wellness.
Background: Epidemiologists have long noted a paucity of research addressing the role of substance use in conflict and post-conflict settings especially as it interacts with mental health and HIV vulnerability in affected populations. Such is the case in northern Uganda where after two decades of conflict the region is rapidly changing, and where community leaders are expressing concerns as to perceived rapid increases in substance use and its impact on the population and growing HIV epidemic.Methods: This multidisciplinary research explored the intersection of mental health, substance use, and HIV in the context of conflict. This project was conducted in partnership with the “Cango Lyec Project” a five-year cohort project exploring HIV risk among Acholi people aged 14-49 in the Gulu, Nwoya, and Amuru districts of northern Uganda. The quantitative analyses began with a confirmatory factor analysis of the structure and underlying validity of the AUDIT alcohol scale. Next, multivariable regressions explored factors associated with hazardous drinking in the population. Qualitative analyses used an interpretive and interpretive description (ID) thematic approach to analyze 30 in-depth interviews and explored within the context of the quantitative analyses.Results: Quantitative findings indicated strong validity for the AUDIT scale. Overall, rates of drinking were much lower than the rest of Uganda, and women were significantly less likely than men to consume alcohol or have hazardous use behaviors. After adjustment neither post traumatic stress disorder (PTSD), depression, nor HIV were significantly associated with problematic drinking though there were significant associations with many sexual behaviors, and abduction was protective against problematic drinking among men. Qualitative findings highlighted participants’ views that substance use remained a large and growing problem in the region that was closely tied to HIV. Use was highly stigmatized especially as it pertained to perceptions that it constituted a rejection of Acholi traditions.Conclusion: This research highlights the need to integrate rigorous and population-level epidemiological evidence within community perspectives and understandings of risk. While at times the results appeared to contrast, underlying both were clear areas for intervention that acknowledge the profound trauma inflicted by the conflict and areas to support community- driven change.
No abstract available.