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The Cedar Project : understanding the sexual vulnerabilities of Indigenous young people who use drugs in British Columbia, Canada Chavoshi, Negar

Abstract

Background: For Indigenous communities in Canada, the legacies of colonization have severely compromised sexual wellbeing. Indigenous leaders are growing increasingly concerned for the sexual health of their young people, particularly those who use drugs to cope with adversity. However, there is a critical gap in evidence pertaining to the complex and multifaceted relationships between intergenerational trauma, self-medication, and sexual wellbeing. Methods: Data was gathered from the Cedar Project: an ongoing prospective cohort study of Indigenous young people who use drugs and live in British Columbia. A multidisciplinary approach was used to investigate historical and lifetime factors that impact sexual health. Epidemiological analyses were used to determine the prevalence and correlates of Herpes Simplex Virus-2 (HSV-2) and syphilis positivity among 250 participants. An interpretive thematic approach was used to qualitatively analyze in-depth interviews with 28 participants. Results: The seroprevalence of HSV-2 among women and men was 79% and 36%, respectively. For women, HSV-2 positivity was associated with being taken away from biological parents, involvement in survival sex work, and injecting drugs. For men, having ever been in prison was significantly associated with HSV-2 positivity. Young men who stated that culture played an important role during their developmental years were less likely to test positive for HSV-2. A history of syphilis infection was observed among 21 participants, 95% of which occurred among women living in Vancouver. Results from the qualitative study highlighted how sexual health continues to be negatively impacted by intergenerational trauma stemming from the residential school and child welfare systems. Participants’ narratives demonstrated the protective effect of family and cultural connectedness on sexual wellbeing. Participants offered detailed recommendations on how to improve sexual health outcomes through culturally-safe and trauma-informed sexual health resources that are integrated with mental health and drug recovery programs aimed at supporting struggling families. Conclusion: To support the sexual wellbeing of Indigenous young people who use drugs, the underlying causes of ongoing trauma and social marginalization must be urgently addressed. These findings call for the backing of Indigenous-led healing strategies that focus on young people’s inherent strengths, and use Indigenous wellness frameworks to promote collective healing.

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Attribution-NonCommercial-NoDerivatives 4.0 International

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