The Cedar Project: Intergenerational child apprehension and HIV health and wellness among young Indigenous peoples who have used drugs: A mixed methods study
Notice bibliographique
Résumé
Wellbeing is eroded when Indigenous children are forcefully removed from families and communities. This study explored how intergenerational child apprehension shapes human immunodeficiency virus (HIV) health and wellness among young Indigenous peoples who have used drugs and are living with HIV. This exploratory sequential mixed-methods study took place within the Cedar Project cohort and involved young Indigenous peoples who have used drugs in British Columbia, Canada. In-depth interviews addressing HIV cascade of care experiences involved 12 participants living with HIV in 2016. Interpretive description identified themes. Based on qualitative findings, longitudinal generalised linear mixed effects models involving 52 participants investigated relationships between intergenerational child apprehension and HIV viral suppression using data collected between 2011–14. Family connections, child apprehension and parenting concerns were identified as central to HIV health and wellness. Themes highlighting intersections included: (1) impact of removal from families on long-term health and wellbeing; (2) (re)connecting with family; (3) intersections of substance use, child apprehension and HIV; (4) fear, stress and demands of maintaining/regaining custody of children; and (5) traditional wellness practices being valued but complicated. Having been apprehended as a child (aOR 0.23; 95% CI 0.06–0.82) and having had a child apprehended (aOR 0.24; 95% CI 0.07–0.77) were associated with reduced odds of HIV viral suppression. Young Indigenous peoples who have used drugs were >75% less likely to be virally suppressed if they had been apprehended from their parents as children, or their own children had been apprehended. It is believed that this is the first study to demonstrate statistical links between intergenerational child apprehensions and negative HIV outcomes among Indigenous people with HIV. Respecting Indigenous rights to self-determination over child welfare processes is urgent. HIV care for young Indigenous peoples who have used drugs must acknowledge and address ongoing impacts of intergenerational child apprehensions. Supporting parenting and family connections is essential to culturally-safe, healing-centred HIV care. • Child apprehension is a concern among young HIV+ Indigenous peoples who use(d) drugs. • Nearly 80% had been apprehended as children, reflecting the Sixties Scoop. • Over 60% of parents had their child apprehended, reflecting the Millennial Scoop. • Apprehension experiences were associated with >75% lower odds of viral suppression. • (Re)connecting with family and identity was vital to overall health and wellness.
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Prédiction machine sur la base complète
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Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,009 | 0,006 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,002 | 0,002 |
| Études des sciences et des technologies | 0,005 | 0,001 |
| Communication savante | 0,002 | 0,001 |
| Science ouverte | 0,001 | 0,003 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».