Arts-based HIV and STI prevention intervention with Northern and Indigenous youth in the Northwest Territories: study protocol for a non-randomised cohort pilot study

Abstract

IntroductionIndigenous youth are disproportionately represented in new HIV infection rates in Canada. Current and historical contexts of colonisation and racism, disconnection from culture and land, as well as intergenerational trauma resulting from the legacy of residential schools are social drivers that elevate exposure to HIV among Indigenous peoples. Peer-education and arts-based interventions are increasingly used for HIV prevention with youth. Yet limited studies have evaluated longitudinal effects of arts-based approaches to HIV prevention with youth. The authors present a rationale and study protocol for an arts-based HIV prevention intervention with Northern and Indigenous youth in the Northwest Territories (NWT), Canada.Methods and analysisThis is a multicentre non-randomised cohort pilot study using a pretest/post-test design with a 12-month follow-up. The target population is Northern and Indigenous youth in 18 communities in the NWT. The aim is to recruit 150 youth using venue-based sampling at secondary schools. Participants will be involved in an arts-based intervention, Fostering Open eXpression among Youth (FOXY). Participants will complete a pretest, post-test survey directly following the intervention, and a 12-month follow-up. The primary outcome is new or enhanced HIV knowledge, and secondary outcomes to include: new or enhanced sexually transmitted infections knowledge, and increased self-esteem, resilience, empowerment, safer sex self-efficacy and cultural connectedness. Mixed effects regression analyses will be conducted to evaluate pretest and post-test differences in outcome measurement scores.Ethics and disseminationThis study has received approval from the HIV Research Ethics Board at the University of Toronto (REB: 31602). In addition, the project is currently registered in the NWT with the Aurora Research Institute (Licence: 15741). Trial results will be published according to the Transparent Reporting of Evaluations with Nonrandomised Designs statement.Trial registration numberNCT02743026; Pre-results.

Exploring coping strategies and mental health support systems among female youth in the Northwest Territories using body mapping

“…In response to the dearth of youth-driven public health interventions in the NWT, the researcher and other Northerners including youth developed an arts-based intervention called FOXY (Fostering Open eXpression among Youth) [12]. FOXY was developed for female-identifying (trans inclusive) youth and initially focused specifically on sexual health but evolved during its early implementation to include mental health as a core component.…”

Social Ecological Factors of Sexual Subjectivity and Contraceptive Use and Access Among Young Women in the Northwest Territories, Canada

“…An initial pilot study indicated that the FOXY sexual health education intervention holds promise as an effective method of delivering sexual health information through peer education and increasing STI knowledge, safer-sex self-efficacy, and resiliency among participants who identified as young women . Interactive, culturally relevant, arts-based approaches like FOXY (Lys et al, 2016), the Taking Action! HIV prevention project (Flicker et al, 2013), and the Sexy Health Carnival have recently grown in popularity, particularly among Indigenous youth populations.…”

“…This qualitative study was grounded in the social ecological framework and conducted using arts-based methods of data collection. Specifically, individual body maps were created as an activity during participation in the FOXY intervention (Lys et al, 2016) and provided the basis for in-depth interviews (Lys, Gesink, Strike, & Larkin, 2018) that were analyzed using framework analysis (Gale, Heath, Cameron, Rashid, & Redwood, 2013).…”

“…FOXY utilized a peereducation model and employed adolescent peer leaders to cofacilitate workshops with adult facilitators. Some of the sexual health topics covered through FOXY programming included contraception, HIV and other STIs, healthy relationships, negotiating safer sex, gender, communication, stigma, sexual orientation, and accessing local health services (Lys et al, 2016).…”

“…Indigenous youth are becoming empowered and using their personal resiliency and leadership to reclaim traditional sexual health teachings and rites-of-passage ceremonies (Wilson et al, 2016) through youth-driven, arts-based sexual health interventions that are trauma informed and rooted in cultural practices, such as the Taking Action! human immunodeficiency virus (HIV) prevention project (Flicker et al, 2013;, the Sexy Health Carnival (Monchalin, Lesperance, Flicker, & Logie, 2016), and Fostering Open eXpression among Youth (FOXY;Lys et al, 2016).…”