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BackgroundIndigenous leaders continue to be concerned about high rates of HIV and barriers to HIV treatment among young Indigenous people involved in substance use. Growing evidence suggests that using mobile phones for health (mHealth) may be a powerful way to support connection with health services, including HIV prevention and treatment. ObjectiveThis study examined the patterns of mobile phone ownership and use among young Indigenous people who have used drugs living with or vulnerable to HIV and explored the acceptability of mHealth to support access to health care in this population. MethodsThe Cedar Project is a cohort study involving young Indigenous people who have used drugs in Vancouver and Prince George, British Columbia. This mixed methods exploratory study involved 131 Cedar Project participants enrolled in our WelTel mHealth program. At enrollment, participants completed a questionnaire related to mobile phone use and interest in mHealth. Data were linked to Cedar Project questionnaires and serodata. We present comparative statistics (quantitative) and results of a rapid thematic analysis (qualitative) related to mobile phone patterns and interest in receiving mHealth. ResultsLess than half of the participants (59/130; 45.4%) reported owning a phone. Among those with a phone, the majority owned a smartphone (46/59; 78%). Most participants with a phone reported having an unlimited texting plan (39/55; 71%), using the internet on their phone (44/59; 75%), and texting daily (44/55; 80%). A majority reported that using a mobile phone for health would be invaluable (120/130; 92.3%). There were no differences in mHealth acceptance between participants who owned a phone and those who did not (P>.99). All but one participant living with HIV felt using a mobile phone would be helpful for their health, while a small proportion of HIV-negative participants remained unsure (1.9% vs 11.7%; P=.047). In response to open-ended questions asking why using a mobile phone may be helpful for health, participants identified a diverse set of anticipated benefits: (1) connection for emotional, mental, and spiritual support, (2) connection to family, (3) staying in touch and/or being reachable, (4) overcoming current barriers to phone use, (5) convenience, privacy, and safety, and (6) access to health care and emergency services. ConclusionsWe observed high acceptance and interest in using mobile phone technology for health despite low rates of personal mobile phone connectivity among young Indigenous people who have used drugs living with and vulnerable to HIV in British Columbia, Canada. Mobile phones were viewed as a way to support connections and relationships that are seen as critical to health and well-being among young Indigenous people in this study. Findings may be useful for health care providers preparing to scale up mHealth programs to support HIV prevention and treatment in this population.

In this paper, we critically evaluate the use of a weekly "rapid responses (RR) to learning" process in the context of teaching a graduate course on research methods over a three-year period. The RR process involved use of a short set of open-ended questions about key moments in learning that students complete, in writing, during the last five minutes of each class. The questions asked students to identify salient take-away messages, note when they felt the most and least engaged, name actions taken by anyone that were affirming or confusing, and consider specific "aha" moments. Our specific aim was to assess the following questions: What was the pedagogic value of the RR process? How did it inform our teaching and to what extent were there direct benefits of the process for students as well as for us as teachers? We found that the systematic feedback we obtained in this way supported weekly monitoring of student learning, facilitated response to trouble spots, and assisted in assessment of student engagement and classroom climate. It also provided insight into the efficacy of pedagogic strategies, such as student engagement in metacognitive learning, and models a process of instructors receiving feedback and being flexible to change. For instructors, the process enhanced motivation and professional development; plus, we found benefits in documenting instructor leadership and development. Finally, it facilitated deeper appreciation of the need to better integrate student self-assessment and the development of metacognitive skills as core components of the course.

BackgroundDespite successes in preventing and treating HIV, Indigenous people in Canada continue to face disproportionately high rates of HIV infection. Programs that support healing from lifetime trauma, support connection to culture, and reduce drug-related harms are critical to preventing HIV among young Indigenous people who use drugs. The Cedar Project WelTel mHealth intervention proposed here is a structured mobile-phone initiative to connect young Indigenous people who use drugs with Cedar Case Managers in a community-based setting. The intervention consists of a package of supports, including a mobile phone and cellular plan, weekly two-way text messaging, and support from Cedar Case Managers.MethodsThe Cedar Project WelTel mHealth study is a multi-site Zelen pre-randomized trial to measure the effect of a two-way supportive text-message intervention to reduce HIV vulnerability among young Indigenous people who use illicit drugs in two Canadian cities. The trial is nested within the Cedar Project, an ongoing cohort study addressing HIV and hepatitis C vulnerability among young Indigenous people who use drugs in Vancouver and Prince George, British Columbia. The Cedar Project Partnership, an independent body of Indigenous Elders, leaders, and health/social service experts, governs all aspects of the study. Two hundred participants will be followed over a 16-month period, with HIV propensity score at 6 months as the primary outcome. Secondary outcomes include HIV propensity at 1 year, HIV risk, resilience, psychological distress, access to drug-related services, and connection to culture measured at 6 months and 1 year. Primary analysis is by intention to treat.DiscussionCulturally safe interventions that address barriers to HIV prevention while supporting the strength of young Indigenous people who use drugs are urgently needed. Despite presenting a tremendous opportunity to connect young, highly transient Indigenous people who use drugs to prevention services, supportive two-way mHealth programs have yet to be tested for HIV prevention in a community-based setting with this population.Trial registrationClinicalTrials.gov NCT02437123 https://clinicaltrials.gov/show/NCT02437123 (registered 4 May 2015). Protocol version: 24 July 2015.

BackgroundIndigenous scholars have long argued that it is critical for researchers to identify factors related to cultural connectedness that may protect against HIV and hepatitis C infection and buffer the effects of historical and lifetime trauma among young Indigenous peoples. To our knowledge, no previous epidemiological studies have explored the effect of historical and lifetime traumas, cultural connectedness, and risk factors on resilience among young, urban Indigenous people who use drugs.MethodsThis study explored risk and protective factors associated with resilience among participants of the Cedar Project, a cohort study involving young Indigenous peoples who use illicit drugs in three cities in British Columbia, Canada. We utilized the Connor-Davidson Resilience Scale to measure resilience, the Childhood Trauma Questionnaire to measure childhood maltreatment, and the Symptom-Checklist 90-Revised to measure psychological distress among study participants. Multivariate linear mixed effects models (LME) estimated the effect of study variables on mean change in resilience scores between 2011-2012.ResultsAmong 191 participants, 92 % had experienced any form of childhood maltreatment, 48 % had a parent who attended residential school, and 71 % had been in foster care. The overall mean resilience score was 62.04, with no differences between the young men and women (p = 0.871). Adjusted factors associated with higher mean resilience scores included having grown up in a family that often/always lived by traditional culture (B = 7.70, p = 0.004) and had often/always spoken their traditional language at home (B = 10.52, p < 0.001). Currently knowing how to speak a traditional language (B = 13.06, p = 0.001), currently often or always living by traditional culture (B = 6.50, p = 0.025), and having recently sought drug/alcohol treatment (B = 4.84, p = 0.036) were also significantly associated with higher mean resilience scores. Adjusted factors associated with diminished mean resilience scores included severe childhood emotional neglect (B = -13.34, p = 0.001), smoking crack daily (B = -5.42, p = 0.044), having been sexual assaulted (B =  14.42, p = 0.041), and blackout drinking (B = -6.19, p = 0.027).ConclusionsYoung people in this study have faced multiple complex challenges to their strength. However, cultural foundations continue to function as buffers that protect young Indigenous people from severe health outcomes, including vulnerability to HIV and HCV infection.

ObjectivesIndigenous leaders and child and family advocates are deeply concerned about the health impacts of the child welfare system, including HIV vulnerability. The objectives of this study were to describe the prevalence of having been apprehended into the child welfare system and associated HIV vulnerabilities among young Indigenous people who use drugs.MethodsThe Cedar Project is a cohort of young Indigenous people ages 14-30 years who use illicit drugs in Vancouver and Prince George, British Columbia. Multivariable logistic regression modeling determined associations between a history of involvement in the child welfare system and vulnerability to HIV infection.ResultsOf 605 participants, 65% had been taken from their biological parents. Median age of first apprehension was 4 years old. Having been sexually abused, having a parent who attended residential school and being HIV-positive were all independently associated with having been involved in the child welfare system. Participants who had been involved in the child welfare system were also more likely to have been homeless, paid for sex, diagnosed and hospitalized with mental illness, self-harmed, thought about suicide, and attempted suicide. Among participants who used injection drugs, those who had been involved in child welfare were more likely to have shared needles and overdosed.ConclusionThis study has found compelling evidence that young Indigenous people who use drugs in two cities in BC are experiencing several distressing health outcomes associated with child welfare involvement, including HIV infection. Jurisdictional reforms and trauma-informed programs that use culture as intervention are urgently needed.

Objectives: Adolescent girls and young women younger than 25 years (AGYW) account for disproportionate HIV infections in sub-Saharan Africa. Impacts of war in Northern Uganda continue to affect HIV-related health and wellbeing of young people postcon- flict. Prevalence and incidence of HIV infection were estimated, and factors associated with HIV prevalence among sexually active AGYW in Northern Uganda were investigated. Methods: Cango Lyec is a cohort involving conflict-affected populations in Northern Uganda. Nine randomly selected communities in Gulu, Nwoya, and Amuru districts were mapped. House-to-house census was conducted. Consenting participants aged 13-49 years were enrolled over 3 study rounds (2011-2015), of whom 533 were AGYW and had ever had sex. Data were collected on trauma, depression, and sociodemographic--behavioral characteristics. Venous blood was taken for HIV and syphilis serology. Multivariable logistic regression determined baseline factors associated with HIV prevalence. Results: HIV prevalence among AGYW was 9.7% (95% CI: 7.3 to 12.6). AGYW living in Gulu (adjusted risk ratio, aRR: 2.48; 95% CI: 1.12 to 5.51) or Nwoya (aRR: 2.65; 95% CI: 1.03 to 6.83) were more likely than in Amuru to be living with HIV. Having self-reported genital ulcers (aRR: 1.93; 95% CI: 0.97 to 3.85) or active syphilis (aRR: 3.79; 95% CI: 2.35 to 6.12) was associated with increased risk of HIV infection. The likelihood of HIV was higher for those who experienced sexual violence in the context of war (aRR: 2.37; 95% CI: 1.21 to 4.62) and/or probable depression (aRR: 1.95; 95% CI: 1.08 to 3.54). HIV incidence was 8.9 per 1000 person-years. Conclusion: Ongoing legacies of war, especially gender violence and trauma, contribute to HIV vulnerability among sexually active AGYW. Wholistic approaches integrating HIV prevention with culturally safe initiatives promoting sexual and mental health in Northern Uganda are essential. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Indigenous leaders and child and family advocates are deeply concerned about the health impacts of the child welfare system, including HIV vulnerability. The objectives of this study were to describe the prevalence of having been apprehended into the child welfare system and associated HIV vulnerabilities among young Indigenous people who use drugs. METHODS: The Cedar Project is a cohort of young Indigenous people ages 14-30 years who use illicit drugs in Vancouver and Prince George, British Columbia. Multivariable logistic regression modeling determined associations between a history of involvement in the child welfare system and vulnerability to HIV infection. RESULTS: Of 605 participants, 65% had been taken from their biological parents. Median age of first apprehension was 4 years old. Having been sexually abused, having a parent who attended residential school and being HIV-positive were all independently associated with having been involved in the child welfare system. Participants who had been involved in the child welfare system were also more likely to have been homeless, paid for sex, diagnosed and hospitalized with mental illness, self-harmed, thought about suicide, and attempted suicide. Among participants who used injection drugs, those who had been involved in child welfare were more likely to have shared needles and overdosed. CONCLUSION: This study has found compelling evidence that young Indigenous people who use drugs in two cities in BC are experiencing several distressing health outcomes associated with child welfare involvement, including HIV infection. Jurisdictional reforms and trauma-informed programs that use culture as intervention are urgently needed. KEYWORDS: Child welfare; HIV; substance-related disorders; Indians; North American La traduction du resume se trouve a la fin de l'article. OBJECTIFS: Les dirigeants autochtones et les defenseurs des enfants et des familles sont profondement preoccupes par les effets du systeme de protection de la jeunesse sur la sante, notamment sur la vulnerabilite au VIH. Notre etude vise a decrire la prevalence de la prise en charge par un organisme de protection de la jeunesse et des vulnerabilites au VIH connexes chez les jeunes autochtones qui consomment de la drogue. METHODE: Le Cedar Project est une cohorte de jeunes autochtones de 14 a 30 ans consommant de la drogue a Vancouver et a Prince George (Colombie-Britannique). Un modele de regression logistique multivariee a determine les associations entre les antecedents de prise en charge par un organisme de protection de la jeunesse et la vulnerabilite a l'infection a VIH. RESULTATS: Sur 605 participants, 65 % avaient ete retires a leurs parents biologiques. L'age median a la premiere prise en charge etait de 4 ans. Le fait d'avoir ete victime d'agression sexuelle, d'avoir un parent ayant frequente un pensionnat et d'etre seropositif pour le VIH etaient trois variables independamment associees a la prise en charge par un organisme de protection de la jeunesse. Les participants ayant ete pris en charge par un organisme de protection de la jeunesse etaient aussi plus susceptibles d'avoir ete sans abri, d'avoir ete payes pour un rapport sexuel, d'avoir ete diagnostiques et hospitalises pour une maladie mentale, de s'etre automutiles, d'avoir songe au suicide et d'avoir fait une tentative de suicide. Parmi les participants utilisant des drogues par injection, ceux ayant ete pris en charge par un organisme de protection de l'enfance etaient plus susceptibles d'avoir partage des aiguilles et fait une surdose. CONCLUSION: Nous avons des preuves convaincantes que dans deux villes de la C.-B., les jeunes autochtones qui consomment de la drogue presentent plusieurs resultats de sante troublants, notamment l'infection a VIH, associes a la prise en charge par des organismes de protection de la jeunesse. Il existe un besoin urgent d'amorcer des reformes du systeme judiciaire et d'etablir des programmes eclaires par les traumatismes en utilisant la culture comme outil d'intervention. MOTS CLES: protection de l'enfance; VIH; troubles lies a une substance; Indiens d'Amerique Nord doi: 10.17269/CJPH.106.5026, Prior to the arrival of European missionaries and settlers, Indigenous families and communities supported healthy, independent children through spiritual connection to lands, traditions, language and culture. (1) However, traditional styles [...]

Permanent Supportive Housing (PSH) increases housing stability and improves health outcomes among people living with HIV (PLHIV) at risk of homelessness. We conducted 24 semi-structured qualitative interviews with PLHIV at risk of homelessness living in a PSH building in Vancouver, Canada, with the aim of understanding how PSH building policies impact residents' health. Interviews were analyzed using self-determination theory and Housing First principles. The housing provider prioritized residents' physical safety, while participants often prioritized other needs, such as autonomy and relatedness. While building policies improved some participants' perceived safety or autonomy, these policies simultaneously interfered with other participants' efforts to meet alternative needs. In contrast, supportive strategies, such as the autonomy-supportive models of Housing First initiatives, appear more effective at meeting needs, with fewer unintended consequences. A shift towards autonomy-supportive housing environments for persons with complex psychosocial needs at risk of homelessness is needed, as is the deliberate alignment of resident population, tenant intake, building structure, and program model. [ABSTRACT FROM AUTHOR]

Indigenous leaders are gravely concerned over disproportionate representation of Indigenous children in Canada's child welfare systems. Forced separation from children is deeply traumatizing for mothers and detrimental to the wellbeing of Indigenous families, communities and Nations. This study examined relationships between child apprehension and suicide attempt within a cohort of young Indigenous women impacted by substance use. We utilized data collected every 6 months (2008–2016) by the Cedar Project, an Indigenous-governed cohort study involving young Indigenous people who use drugs in British Columbia, Canada. Recent child apprehension was defined as having a child apprehended by the Ministry of Child and Family Development since last visit. Recurrent event Cox proportional hazards models estimated the independent effect of child apprehension on maternal suicide attempt. Among 293 participants, 78 (27%) reported 136 child apprehensions; incidence of first apprehension was 6.64 (95%CI: 5.25–8.29) per 100 person-years. Forty-seven (16%) participants reported 75 suicide attempts with an incidence of 4.00 (95%CI: 2.94–5.33) per 100 person-years. Participants who reported recent child apprehension (HR: 1.88, 95%CI: 1.00–3.55), had a parent attend residential school (HR: 4.12, 95%CI: 1.63–10.46), experienced recent sexual assault (HR: 4.04, 95%CI: 2.04–7.99), violence (HR: 2.54, 95%CI: 1.52–4.27) or overdose (HR: 4.97, 95%CI: 2.96–8.35) were more likely to attempt suicide. Participants who had a traditional language spoken in the home growing up were half as likely to attempt suicide (HR: 0.49, 95%CI: 0.23–1.01). Results suggest that child welfare systems in Canada perpetuate historical and intergenerational trauma among young Indigenous mothers. Indigenous self-determination over child welfare and culturally safe services are urgently needed to end cycles of child apprehension and support the wellbeing of families, communities and Nations. [ABSTRACT FROM AUTHOR]

Training and recruitment of First Nations and Indigenous health professionals is part of reconciliation, addressing health disparities and embedding cultural safety and humility into the health ecosystem of the province of British Columbia (BC), Canada. Calls to develop the First Nations and Indigenous health workforce are articulated within the Truth and Reconciliation Commission of Canada's Call to Action 23, BC's Transformative Change Accord: First Nations Health Plan, and the seven directives that guide the work of the First Nations Health Authority in BC and its health governance partners. This article brings forward the voices of current Indigenous students training in allied health professions at the University of British Columbia and their Indigenous mentors who participated in the 2018 International Indigenous HealthFusion Team Challenge in Sydney, Australia. The Challenge represents a promising practice in training Indigenous health professionals here in BC as it: (1) Affirmed their Indigenous identity, knowledge, and aspirations, supporting them to become more "visible" as Indigenous students; (2) Created a space where both Indigenous and mainstream health discipline knowledges were encouraged, valued, and respected; (3) Provided opportunity to connect with Indigenous peers and health leaders; and (4) Built students' confidence to take on leadership roles. First Nations and Indigenous students studying in health fields represent the future of BC's health and wellness ecosystem that brings together the best of Indigenous and mainstream healing approaches. Creating opportunities for students to grow as Indigenous health leaders is part of reconciliation and the new relationship represented by the BC First Nations Health Governance Structure. [ABSTRACT FROM AUTHOR]

Background To be consistent with the United Nations' sustainable development goals on gender equality, mobile health (mHealth) programmes should aim to use communications technology to promote the empowerment of women. We conducted a pre-trial analysis of data from the WelTel Retain study on retention in HIV care to assess gender-based differences in phone access, phone sharing and concerns about receiving text messages from a healthcare provider. Methods Between April 2013-June 2015, HIV-positive adults were screened for trial participation at two clinics in urban slums in Nairobi, Kenya. Proportions of men and women excluded from the trial due to phone-related criteria were compared using a chi-square test. Gender-based differences in phone sharing patterns and concerns among trial participants were similarly compared. Results Of 1068 individuals screened, there was no difference in the proportion of men ( n = 39/378, 10.3%) and women ( n = 71/690, 10.3%) excluded because of phone-related criteria ( p-value = 0.989). Among those who shared their phone, women ( n = 52/108, 48.1%) were more likely than men ( n = 6/60, 10.0%) to share with other non-household and household members ( p < 0.001). Few participants had concerns about receiving text messages from their healthcare provider; those with concerns were all women ( n = 6/700). Discussion In this study, men and women were equally able to participate in a trial of an mHealth intervention. Equitable access in these urban slums may indicate the 'gender digital divide' is narrowing in some settings; however, gender-specific phone sharing patterns and concerns regarding privacy must be fully considered in the development and scale-up of mHealth programmes. [ABSTRACT FROM AUTHOR]

The article offers information on the WelTel mobile health program which involves sending weekly interactive text messages to check on patients introduced by the British Columbia (BC) Centre for Disease Control (BCCDC) and the Oak Tree Clinic for women in BC. Topics discussed include implementation of WelTel among populations with HIV infections, views of health care providers and patients on WelTel, and use of WelTel in latent tuberculosis infection (LTBI) treatment and care.

The article discusses various reports published within the issue, including one by Rachel Buchanan and Carmen Budiwski on urban redevelopment in Spence Neighbourhood in Winnipeg, Manitoba, one by Julia Huys on her analysis of Mexico's civil society and democracy and one by Jane Powell Leadbeater on a policy of structural adjustment in Haiti.

The article discusses various reports published within the issue, including one by Sam Grey on polygyny in Sub-Saharan Africa and another on Jonathan Patch on the role of the non-violent activism of women in the Niger Delta resource conflict.

Background: As previously encamped resettle, potential for rapid HIV transmission in post-conflict Northern Uganda is concerning. Women in particular may be experiencing heightened vulnerability resulting from war-related sexual violence., Setting: Cango Lyec (Healing the Elephant) Project is a cohort involving conflict-affected people in 3 districts in Northern Uganda., Methods: Eight randomly selected communities were mapped, and a census was conducted. Participants aged 13-49 years completed questionnaires in Luo on war-related experiences, mental health, sexual vulnerabilities, and sociodemographics. Blood samples were tested for HIV and syphilis. Baseline data from all sexually active participants was used to determine gender differences in HIV prevalence. Multivariate modeling determined correlates of HIV by gender., Results: Among 2008 participants, HIV prevalence was higher among women [17.2; 95% confidence interval (CI): 14.7 to 19.7] compared to men (10.6; 95% CI: 8.0 to 13.2, <0.001). Among women, correlates of HIV included: war-related sexual assault [adjusted odds ratio (AOR): 1.95; 95% CI: 1.16 to 3.26]; probable depression (AOR: 2.22; 95% CI: 1.46 to 3.37); probable post-traumatic stress disorder (AOR: 2.03; 95% CI: 1.45 to 2.84); experiencing ≥12 traumatic events (AOR: 2.04; 95% CI: 1.31 to 3.18); suicide ideation (AOR: 1.67; 95% CI: 1.22 to 2.28); living in a female-headed household (AOR: 2.76; 95% CI: 1.70 to 4.49); first sexual partner ≥10 years older (AOR: 1.69; 95% CI: 1.07 to 2.67); sex for exchange (AOR: 5.51; 95% CI: 1.76 to 17.31); having 2 (AOR: 2.54; 95% CI: 1.23 to 5.23) or 3+ (AOR: 4.65; 95% CI: 2.65 to 8.18) sexual partners; inconsistent condom use (AOR: 0.40; 95% CI: 0.29 to 0.57); genital ulcers (AOR: 3.08; 95% CI: 2.16 to 4.38); active syphilis (AOR: 4.33; 95% CI: 1.22 to 15.40); and ill health without medical care (AOR: 2.02; 95% CI: 1.22 to 3.34). Among men, correlates of HIV included no condom at sexual debut (AOR: 1.92; 95% CI: 1.30 to 2.83) and genital ulcers (AOR: 4.40; 95% CI: 1.35 to 14.40)., Conclusion: Women are disproportionately impacted by HIV, trauma, and depression in this conflict-affected population. Trauma-informed HIV prevention and culturally safe mental health initiatives are urgently required.