The Cedar Project: Intergenerational child apprehension and HIV health and wellness among young Indigenous peoples who have used drugs: A mixed methods study
Bibliographic record
Abstract
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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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.008 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.058 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".