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Increasing access to primary health care for people living with HIV/AIDS: lessons from a Canadian urban aboriginal healthcare context
D. Littlejohn1, A.J. Browne2, V.L. Smye2, C. Varcoe2, S. Wong2
Background: Effective and responsive health care continues to be inaccessible for many Indigenous communities worldwide. In Canada, contemporary manifestations of colonialism in public policies result in profound social, economic and health inequities between Aboriginal people and other Canadians. Alongside substance use and mental health problems, which disproportionally affect Aboriginal people, health inequities are most exemplified by steadily increasing rates of HIV among Aboriginal people and decreasing rates of HIV among others. The ineffectiveness of ‘mainstream’ health care in meeting the needs of people marginalized by social and systemic inequities call for alternative approaches to care. In this paper, we report on findings from a partnership-based study that explores how primary health care services are provided in an urban Indigenous healthcare context to meet the needs of people marginalized by systemic inequities and living with HIV/AIDS. The study is being conducted at two long-standing Urban Aboriginal Health Centres in Western Canada.
Method: Drawing on Indigenous epistemologies, postcolonial and critical theory, ethnographic methods were used to conduct
(a) individual and group patient interviews [n = 68],
(b) staff/provider interviews [n = 38],
(c) observations at both Centres, and
(d) analyses of organizational policy documents.
Results: The Centres’ models of care builds bridges among patients, communities, and providers to address barriers to effective, safe and responsive care including: systemic racism/discrimination; distrust; consequences of residential schooling; poverty; lack of education, adequate housing and culturally responsive services. Strategies to increase access include: a shared philosophical approach to care; increased awareness of provider/patient power differentials; addressing the socio-economic and historical contexts of people’s lives; critical self-reflection on clinical practice; and interdisciplinary team and community-driven approaches.
Conclusion: Effective health care services for people marginalized by social and systemic inequities and living with HIV must be responsive to the historical, political and socio-economic contexts of people’s lives.
Abstract no. WEPE0771
“D.Littlejohn, et al. Increasing access to primary health care for people living with HIV/AIDS: lessons from a Canadian urban aboriginal healthcare context. : : Abstract no. WEPE0771 “