Abstract
Objective
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
Résumé
Objectifs
Les dirigeants autochtones et les défenseurs des enfants et des familles sont profondément préoccupés par les effets du système de protection de la jeunesse sur la santé, notamment sur la vulnérabilité au VIH. Notre étude vise à décrire la prévalence de la prise en charge par un organisme de protection de la jeunesse et des vulnérabilités au VIH connexes chez les jeunes autochtones qui consomment de la drogue.
Méthode
Le Cedar Project est une cohorte de jeunes autochtones de 14 à 30 ans consommant de la drogue à Vancouver et à Prince George (Colombie-Britannique). Un modèle de régression logistique multivariée a déterminé les associations entre les antécédents de prise en charge par un organisme de protection de la jeunesse et la vulnérabilité à l’infection à VIH.
Résultats
Sur 605 participants, 65 % avaient été retirés à leurs parents biologiques. L’âge médian à la première prise en charge était de 4 ans. Le fait d’avoir été victime d’agression sexuelle, d’avoir un parent ayant fréquenté un pensionnat et d’être séropositif pour le VIH étaient trois variables indépendamment associées à la prise en charge par un organisme de protection de la jeunesse. Les participants ayant été pris en charge par un organisme de protection de la jeunesse étaient aussi plus susceptibles d’avoir été sans abri, d’avoir été payés pour un rapport sexuel, d’avoir été diagnostiqués et hospitalisés pour une maladie mentale, de s’être automutilés, d’avoir songé au suicide et d’avoir fait une tentative de suicide. Parmi les participants utilisant des drogues par injection, ceux ayant été pris en charge par un organisme de protection de l’enfance étaient plus susceptibles d’avoir partagé 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 présentent plusieurs résultats de santé troublants, notamment l’infection à VIH, associés à la prise en charge par des organismes de protection de la jeunesse. Il existe un besoin urgent d’amorcer des réformes du système judiciaire et d’établir des programmes éclairés par les traumatismes en utilisant la culture comme outil d’intervention.
Mots Clés: protection de l’enfance, VIH, troubles liés à une substance, Indiens d’Amérique Nord
Footnotes
Acknowledgements: We are grateful to the Cedar Project participants who continue to share their stories with us. Special thanks are due to the Cedar Project Partnership for their conviction and for holding us accountable to the voices of young Indigenous people. To the Elders who support our study, we are indebted to you for your continued wisdom and guidance. To our study staff in Prince George and Vancouver, thank you for your conviction and contributions. This study was funded by the Canadian Institutes of Health Research.
Conflict of Interest: None to declare.
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