Introduction. During the past decade, the number of Aboriginal people diagnosed with HIV in Canada has grown more than any other ethnicity. Whereas the majority of infections are related to injection drug use, factors that explain elevated risk and transmission of HIV among Aboriginal young people who use illicit drugs are not well understood. Study design. Observational study. Methods. The Cedar Project is an observational study of Aboriginal youth living in Vancouver and Prince George, BC. Eligibility criteria include age (14-30 years) and self-reported use of noninjection or injection drugs at least once in the month before enrolment. Between October 2003 and April 2005, 512 participants were recruited and completed a questionnaire administered by an Aboriginal interviewer. Multivariable logistic regression analysis was used to model the independent association of demographic and behavioural variables of individuals with HIV infection. Results. Of the participants, 235 resided in Prince George and 277 in Vancouver. Among the 276 participants that used injection drugs, HIV prevalence was significantly higher in Vancouver (17% vs. 7%) but HCV prevalence was higher in Prince George (62% vs. 57%). In Vancouver, 40% of injectors reported daily heroine use compared with 12% in Prince George. In contrast, Prince George participants were more likely to report daily injection of cocaine compared with those in Vancouver (37% vs. 21%). A higher percentage of Prince George participants reported having difficulty accessing clean syringes (22% vs. 8%). History of non-consensual sex, residing in Vancouver and duration of injection drug use were independent factors associated with increased risk of HIV infection.

BackgroundFactors associated with HCV incidence among young Aboriginal people in Canada are still not well understood. We sought to estimate time to HCV infection and the relative hazard of risk factors associated HCV infection among young Aboriginal people who use injection drugs in two Canadian cities.MethodsThe Cedar Project is a prospective cohort study involving young Aboriginal people in Vancouver and Prince George, British Columbia, who use illicit drugs. Participants’ venous blood samples were drawn and tested for HCV antibodies. Analysis was restricted to participants who use used injection drugs at enrolment or any of follow up visit. Cox proportional hazards regression was used to identify independent predictors of time to HCV seroconversion.ResultsIn total, 45 out of 148 participants seroconverted over the study period. Incidence of HCV infection was 26.3 per 100 person-years (95% Confidence Interval [CI]: 16.3, 46.1) among participants who reported using injection drugs for two years or less, 14.4 per 100 person-years (95% CI: 7.7, 28.9) among participants who had been using injection drugs for between two and five years, and 5.1 per 100 person-years (95% CI: 2.6,10.9) among participants who had been using injection drugs for over five years. Independent associations with HCV seroconversion were involvement in sex work in the last six months (Adjusted Hazard Ratio (AHR): 1.59; 95% CI: 1.05, 2.42) compared to no involvement, having been using injection drugs for less than two years (AHR: 4.14; 95% CI: 1.91, 8.94) and for between two and five years (AHR: 2.12; 95%CI: 0.94, 4.77) compared to over five years, daily cocaine injection in the last six months (AHR: 2.47; 95% CI: 1.51, 4.05) compared to less than daily, and sharing intravenous needles in the last six months (AHR: 2.56; 95% CI: 1.47, 4.49) compared to not sharing.ConclusionsThis study contributes to the limited body of research addressing HCV infection among Aboriginal people in Canada. The HCV incidence rate among Cedar Project participants who were new initiates of injection drug use underscores an urgent need for HCV and injection prevention and safety strategies aimed at supporting young people surviving injection drug use and sex work in both cities. Young people must be afforded the opportunity to provide leadership and input in the development of prevention programming.

Recent Indigenist scholarship has situated high rates of traumatic life experiences, including sexual abuse, among Indigenous peoples of North America within the larger context of their status as colonized peoples. Sexual abuse has been linked to many negative health outcomes including mental, sexual and drug-related vulnerabilities. There is a paucity of research in Canada addressing the relationship between antecedent sexual abuse and negative health outcomes among Aboriginal people including elevated risk of HIV infection. The primary objectives of this study were to determine factors associated with sexual abuse among participants of the Cedar Project, a cohort of young Aboriginal people between the ages of 14 and 30 years who use injection and non-injection drugs in two urban centres in British Columbia, Canada; and to locate findings through a lens of historical and intergenerational trauma. We utilized post-colonial perspectives in research design, problem formulation and the interpretation of results. Multivariate modeling was used to determine the extent to which a history of sexual abuse was predictive of negative health

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.KEY WORDS: Child welfare; HIV; substance-related disorders; Indians; North American La traduction du résumé se trouve à la fin de l'article.

BACKGROUND: Young Indigenous people, particularly those involved in the child welfare system, those entrenched in sub stance use and those living with HIV or hepatitis C, are dying prematurely. We report mortality rates among young Indigenous people who use drugs in Brit ish Columbia and explore predictors of mortality over time. METHODS:We analyzed data collected every 6 months between 2003 and 2014 by the Cedar Project, a prospective cohort study involving young Indigenous people who use illicit drugs in Vancouver and Prince George, BC. We calculated agestandardized mortality ratios using Indigenous and Canadian reference popu lations. We identified predictors of mortality using timedependent Cox pro portional hazard regression. RESULTS:Among 610 participants, 40 died between 2003 and 2014, yielding a mortality rate of 670 per 100 000 personyears. Young Indigenous people who used drugs were 12.9 (95% confi dence interval [CI] 9.2-17.5) times more likely to die than all Canadians the same age and were 7.8 (95% CI 5.6-10.6) times more likely to die than Indigenous people with Status in BC. Young women and those using drugs by injection were most affected. The lead ing causes of death were overdose (n = 15 [38%]), illness (n = 11 [28%]) and sui cide (n = 5 [12%]). Predictors of mortal ity included having hepatitis C at base line (adjusted hazard ratio [HR] 2.76, 95% CI 1.47-5.16), previous attempted suicide (adjusted HR 1.88, 95% CI 1.01-3.50) and recent overdose (adjusted HR 2.85, 95% CI 1.00-8.09). INTERPRETATION:Young Indigenous people using drugs in BC are dying at an alarming rate, particularly young women and those using injection drugs. These deaths likely reflect complex intersec tions of historical and presentday injus tices, substance use and barriers to care.