HIV/AIDS research in Canada extends to behavioural, biomedical, clinical, economic, epidemiological, legal and psychosocial fields of studies. Aboriginal HIV/AIDS research also includes community-driven research projects that examine issues that are identified by Aboriginal communities. Flicker et al note that “including communities most affected by HIV in the research process makes it more likely that results will be acted upon”  and the research will be responsive to the needs of these communities.
For example, the Canadian Institutes of Health Research (CIHR) HIV/AIDS Research Initiative includes a Community-Based Research Program, which works in partnership with CIHR’s Institute of Aboriginal Peoples’ Health. A key feature of the Community-Based Research Program is the involvement of Aboriginal communities and organizations in the design and implementation of research projects. This approach provides study populations with control of the research they are involved in and helps to disseminate the knowledge that has been created back to that community to assist them in addressing HIV/AIDS.
In addition, there are specific ethical guidelines available for research with Aboriginal populations. For instance, the principles of ownership, control, access and possession/protection are important in the field of Aboriginal HIV/AIDS research and indicate “that Aboriginal people have relinquished the notion of ‘being researched,’ and have taken up the call to become active participants in the research process” . Work continues in this area to reflect the needs of First Nations [3;4], Inuit [5;6] and Métis communities . In addition, CIHR has developed Guidelines for Health Research Involving Aboriginal People  which aim to facilitate the development of mutually beneficial research partnerships, resulting in ethical and culturally relevant research. Furthermore, the Interagency Advisory Panel on Research Ethics (comprising CIHR, the Social Sciences and Humanities Research Council or SSHRC, and the Natural Sciences and Engineering Research Council or NSERC) is revising the Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans which contains a chapter regarding research involving Aboriginal peoples .
A review of funded research specific to HIV/AIDS and Aboriginal peoples in Canada identified 49 separate research projects. Of these projects, the majority focus on APHAs, prevention, youth, injection drug use and other substance use, issues related to HIV/AIDS service provision, and enhanced Aboriginal community research capacity. See Appendix B for a complete list of research projects captured in this analysis.
In general, the research projects identified are conducting psychosocial and behavioural research, which will allow for the description of experiences and the identification of needs, issues, challenges and solutions by community members, and, in some situations, service providers. The general areas of investigation are as follows:
The information in this chapter was gathered from the following organizations: Canadian Institutes of Health Research (CIHR), the Canadian Association for HIV Research (CAHR), the Canadian Foundation for AIDS Research (CANFAR), and the Social Sciences and Humanities Research Council of Canada (SSHRC). It was assumed that research completed before 2006 would have been published and identified in the academic and grey literature review completed for the previous chapters of this status report. Therefore, projects were included that were either completed in 2006 or later, or are currently under development.
This section offers an overview of current research (2006 to 2008) being undertaken on issues related to HIV/AIDS among Aboriginal peoples. Using the information presented earlier in the status report, this chapter attempts to assess whether currently funded research on the HIV/AIDS epidemic among Aboriginal peoples responds to identified needs and gaps.
Information in Appendix B includes research project titles, the names of investigators, the project abstract, dates, and the source of funding. In the following analysis, research projects are identified with a number (e.g. R1) corresponding to the project description in Appendix B.
The majority of the research projects do not identify a primary location for the research. Of the 22 projects that identify a location for the research, 8 are focused on British Columbia [R7-R10, R20, R24, R26, R35]; 6 of these projects focus on Vancouver and/or the Downtown Eastside neighbourhood in Vancouver, two projects also examine the Aboriginal populations in Prince George and Kamloops, and one project examines Aboriginal communities in northern British Columbia.
The remaining 14 projects focus on Aboriginal populations in Alberta [R38], Saskatchewan [R23, R29], Ontario [R2, R6, R39, R47], Quebec [R4, R19], and the north [R1, R16, R44]. In addition, 2 projects focus on research capacity development in eastern Canada, including Labrador and Nunavut [R27], and western Canada, the Yukon and Northwest Territories [R28].
There are 25 research projects which address the themes of prevention, care and treatment, representing 51% of the projects.
Given the over-representation of Aboriginal people among new HIV infections, prevention is a key element of the response to HIV/AIDS in the Aboriginal population. There are 13 current research projects which focus on prevention. Of these projects, four are focused on prevention in First Nation communities [R4, R15, R16, R47], and one examines prevention among Inuit youth [R44]. Six of the projects address prevention issues among Aboriginal youth [R4, R11, R21, R31, R44, R46]. Two projects focus on barriers to prevention in high-risk populations: Aboriginal youth who inject drugs [R31], and Aboriginal women engaged in survival sex work [R26].
Access to care
The issue of access to health care is an important and complex determinant of health that can impact on the well-being of Aboriginal people living with, and at risk of, HIV/AIDS. There are 14 projects which examine the issue of access to care for Aboriginal people in the context of HIV/AIDS [R2, R3, R5, R6, R10, R13, R15, R19, R22, R26, R32, R34, R43, R44]. Two of these projects focus on access to care issues among First Nations people and communities [R6, R15]; none of the projects focus on the unique needs of Inuit or Métis people.
Ten of the research projects focus on issues related to service provision; seven of these projects focus on service provision for APHAs [R5, R6, R10, R22, R32, R43, R48]. Two of these projects focus on cultural competency among HIV/AIDS service providers in First Nation communities. Two research projects examine the impact of gender, culture and HIV status for Aboriginal women when accessing HIV/AIDS services [R43, R48]; one of these projects focuses on two-spirit women, a significant research gap in the current literature. Another project examines factors that promote well-being among APHAs who use substances, the impact of gender, culture and HIV status for Aboriginal women when accessing services, and the service needs of Aboriginal families impacted by HIV/AIDS.
Although stigma and discrimination have a significant impact on Aboriginal people living with, and at risk for, HIV/AIDS, only two projects specifically identify stigma and discrimination in the context of HIV/AIDS service provision as a focus of the research [R12, R48]. The significant impact of stigma and discrimination on APHAs suggests that more research is needed to determine best practices for addressing this issue.
Five projects focus on barriers to accessing services and issues related to HIV treatment [R2, R10, R19, R26, R38]. Themes addressed in the research include beliefs, attitudes, risk behaviours and barriers to prevention and treatment for Aboriginal women, experiences of APHAs including access to services, treatment outcomes, mental health and well-being, and maternity experiences of mothers living with HIV/AIDS. Three of these projects examine issues of access to care for Aboriginal women: barriers to prevention and treatment for Aboriginal women who are engaged in survival sex work [R26]; access to care and treatment for Aboriginal mothers who are HIV positive [R19]; and, knowledge, attitudes and experiences of Aboriginal women in Ontario regarding HIV and HIV risks [R2]. One project examined improving access to HIV services, education, screening and treatment for Aboriginal people in northern British Columbia [R10]. One project examines the relationship between alcohol use among APHAs and access to care [R3].
Two projects examine mental health among APHAs [R34, R49], a subject area with little research currently available. Both projects examine depression among APHAs, and consider depression in the context of the social determinants of health, “as it relates to the ongoing stigmatization of HIV/AIDS, social isolation, lack of knowledge of HIV and its treatment, alcohol and drug use, personal biographies involving abuse and family disruption, medication side effects and poverty” [R34].
Thirty-six of the current research projects address issues pertaining to specific populations, including First Nations and Inuit (none of the research projects focused on Métis); Aboriginal people living with HIV/AIDS; people who inject drugs; youth; women; and, two-spirit, gay, lesbian, bisexual and transgender people. Projects that focus on specific populations represent 73% of all current research projects.
HIV/AIDS and First Nations, Inuit and Métis people
Five of the research projects focus on First Nations communities [R4, R6, R15, R16, R47]. Two of the projects focus on First Nations communities in Ontario, one on the James Bay Cree of Quebec and another on the Tlicho First Nation communities in the Northwest Territories. Three of the research projects focus on prevention programs, while the other two projects focus on the interplay between culture and successful HIV/AIDS service provision in First Nation communities.
There are two research projects that focus on Inuit and the territory of Nunavut [R1, R44]. These projects work on building HIV/AIDS research capacity in Nunavut, and examine approaches to HIV/AIDS education, screening and treatment for Inuit youth.
None of the current research projects identified focus on Métis people.
Aboriginal people living with HIV/AIDS
There are 16 projects that focus on APHAs [R5, R6, R10, R12, R14, R19, R22, R32-R34, R37-R39, R43, R48, R49]. As discussed in the previous section on Access to Care, 7 of these projects focus on the needs of APHAs in the context of service provision.
The absence of adequate housing and homelessness can greatly impact the physical and mental well-being of people at risk of, and living with, HIV/AIDS. As discussed in the previous chapter, research suggests that Aboriginal people are over-represented among homeless populations across the country. Two current research projects are examining this impact and strategies to address issues related to housing and homelessness for APHAs [R37, R39]. Similarly, access to healthy and nutritious food is an important determinant of health for PHAs, but there is currently little data available that examines this link among APHAs. There is currently one study underway that examines food choice and perceptions of nutritional needs among Aboriginal people in the context of HIV/AIDS [R14].
There are a number of gaps in the focus of current research. For example, although First Nations, Inuit and Métis PHAs have unique needs and challenges, there was only one project which focused on First Nations PHAs and none of the projects focused on Inuit or Métis PHAs. Although Aboriginal women make up nearly half of all new HIV-positive test reports, only 4 of the projects focused on women living with HIV/AIDS [R19, R29, R43, R48]. Two projects addressed Aboriginal mothers living with HIV/AIDS [R19, R29]. Similarly, although nearly one-third of Aboriginal persons who are diagnosed with HIV infection are under the age of 30, none of the research projects focused on the needs of young APHAs.
As discussed in Chapter 4, research suggests that APHAs experience increased mortality with an HIV diagnosis than non-Aboriginal PHAs , and experience reduced access to medical treatment [11-13]. One research study in northern Alberta is exploring outcomes of HAART among PHAs and APHAs [R38].
People who inject drugs
Injection drug use is the main exposure category for HIV infection for Aboriginal men and women. There are 7 research projects that focus on injection drug use and HIV/AIDS among Aboriginal people [R7-R9, R20, R24, R31, R35], 5 of which focus on Aboriginal youth who inject drugs. As research suggests that Aboriginal people are over-represented among persons who are co-infected with HIV and hepatitis C, it is encouraging that 4 of the 5 current research projects on injection drug use among Aboriginal people are examining prevention and vulnerability for both HIV and HCV infection [R9, R20, R24, R31].
Almost one-third of Aboriginal people who receive an HIV diagnosis are under the age of 30. There are 11 research projects focused on Aboriginal youth, comprising 22% of the research projects [R4, R7-R9, R11, R13, R20, R21, R31, R44, R46]. Seven of the projects focus on HIV prevention and examine themes such as barriers to HIV prevention among high-risk youth that inject drugs and other substances, factors influencing condom use among Aboriginal youth, and arts-based approaches to HIV prevention. One project focuses on First Nations youth [R4] and another on Inuit youth [R44]; none of the projects focus on Métis youth.
There are 6 research projects focused on Aboriginal women and HIV/AIDS [R2, R19, R26, R29, R43, R48]. Although Aboriginal women make up nearly half of all new HIV-positive test reports among Aboriginal people, only 12% of the current HIV/AIDS research projects focus on Aboriginal women. Two of the projects examine the impact of gender in the context of HIV/AIDS service provision for Aboriginal women [R43, R48]. Two projects address issues related to motherhood in the context of HIV/AIDS [R19, R29], and 1 explores the knowledge, attitudes and experiences of Aboriginal women regarding HIV and HIV risks [R2]. The remaining project examines barriers to HIV prevention and treatment among Aboriginal women engaged in survival sex work [R26].
Two-spirit, gay, lesbian, bisexual and transgender people
Only 1 research project focuses on this population [R48]. This project focuses on experiences of homophobia for two-spirit women accessing HIV/AIDS services. This project will begin to fill a significant research gap, as currently there is little available research that specifically examines two-spirit women’s experiences regarding HIV/AIDS. However, the lack of current research projects on two-spirit, gay, lesbian, bisexual and transgender Aboriginal people is problematic given the multi-faceted impacts of homophobia and discrimination which can contribute to increased vulnerability in this population.
The majority of available research on HIV/AIDS among Aboriginal people focuses on issues that increase the population’s vulnerability to HIV and AIDS. As a counter-balance to this focus on vulnerability, there are several research projects that focus on and/or utilize Aboriginal community resilience, health and well-being to address issues related to HIV/AIDS [R16, R33, R42]. These projects focus on dimensions of health and wellness of people living with HIV/AIDS, and resilience in Aboriginal communities in responding to HIV/AIDS.
There are 15 projects which focus on and/or contribute to increasing research capacity and knowledge translation for Aboriginal communities [R1, R7, R12, R13, R16-18, R22, R23, R27, R28, R36, R37, R40, R41]. These projects involve community partners in research projects and capacity building workshops, and focus on areas including design and implementation of research dissemination strategies; development of best practice guidelines; promotion of cultural competence among academic researchers; systematic data synthesis; research networking; and ethical considerations for HIV/AIDS research in Aboriginal communities. Increasing community research capacity ensures that research is relevant to the needs of Aboriginal communities, thereby increasing knowledge translation for improved policy and programs.
Though the following list should not be considered exhaustive, a selection of areas for further study identified in this chapter and by the Status Report Working Group includes:
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