Renata Sanders

Prioritizing the health of indigenous people in the collective response to HIV was highlighted in this session. Key topics included barriers to achieving the global 95-95-95 targets as evidenced by perpetuated stigma, political leadership, and under-resourcing, as well as a review of disparate drivers of the opioid epidemic.

Doris Peltier of Feast Centre for Indigenous STBBI Research reflected on the unlikely feasibility of meeting the global 95-95-95 target among indigenous people. These unlikely targets are due to impacts of stigma grounded in imposed ideologies of the church, government, and colonization, and a lack of commitment towards global resourcing. Shifts in the goalpost from the 90-90-90 to 95-95-95 targets do not automatically yield successes in the landscape of HIV responses, especially when barriers specific to a systematic dearth of resources and stigma exacerbate two converging epidemics—HIV and opioid. Thus, the path forward necessitates a commitment to stand with indigenous people not only in voice but in action—promptly recognizing indigenous people as a priority population at the global level. Why now? Julie Bruneau of Centre Hospitalier de l'Université de Montréal raised the question: “Is there any other prevalent disease with such a high deadly burden that we would accept such [prolonged] stagnation in the development of models of care?” While evidence-based strategies (e.g., Naloxone) in response to the syndemic of drug-related harms exist, scale-up of developed principles and funding are necessitated to support changes in legislation to address stigma, discrimination, and violence.

The thread of recognizing indigenous people as a priority population was highlighted throughout, particularly in the overview of the link between the HIV and opioid epidemics. While evidence-based strategies and responses were presented specifically to Canada, it was unclear whether this intersection of indigenous people and people who use drugs existed in the current response to the syndemic of drug-related harms. Nonetheless, this session incited critical reflections on urgency, leadership, and investment to not only visualize, but to actualize human rights-centered and equitable approaches for HIV responses among indigenous people—leveraging science over prejudice and conventional ideologies. Prepared by Kalai Willis

Stefan Baral

This session included two presentations, with the first focusing on social and structural challenges to combatting HIV among Indigenous communities and the second discussing the opioid epidemic primarily in North America, contextualized by a lack of access to pain relief and palliative care globally. Session Summary by Lillian Shipp.

Doris Peltier spoke about the pervasive stigma barriers for Indigenous communities reaching the 95-95-95 goals. Peltier emphasized that this stigma is grounded in colonization and the influence of the church and government, which diminished and shamed ancient Indigenous belief systems. She called for commitment from the Canadian government and global community to fund HIV services for Indigenous communities, and to meaningfully include all First Nations peoples as a priority population. The converging pandemics of COVID-19 and HIV, with the opioid epidemic was powerfully described as “exacerbating everything that has been barriers for us, revealing cracks in the system in a greater way.” Julie Bruneau highlighted the increase in opioid overdoses and deaths during the COVID-19 pandemic in both the United States and Canada, particularly among Black and Indigenous people. The Canadian response to the opioid crisis included adopting legislation to remove barriers for accessing harm reduction services, scaling up of evidence-based interventions and delivering telehealth services. Globally, the inaccessibility of pain medications was emphasized, with 75% of the world’s population lacking access to pain relief and palliative care. Urgency, leadership, and investment are needed globally to prevent opioid deaths while also ensuring pain management accessibility is a human rights priority.

Indigenous responses to HIV and the broader opioid epidemic are intersecting. Efforts to address stigma and violence facing Indigenous communities and PWID are needed to combat HIV and the opioid epidemic, including addressing the immense violence against two spirit people and trans women. Active decolonisation strategies, strengthening meaningful involvement of all Indigenous communities and minoritised populations at risk of opioid related harms should be paired with legislative reform including the decriminalization of drug use. Increasing access to pain management in the global south is a critical priority that cannot be undermined by the opioid crisis of the global north.

Ferdinand Mkumbang

Indigenous people and people injecting drugs remain sidelined in the fight against HIV. HIV should be made a priority again among indigenous people and should not be integrated into programs that turn to submerge the HIV agenda. Resources should, therefore, be made available for indigenous people to respond to HIV.

Stigma remains one of the most significant barriers to achieving the UNAIDS’ 95-95-95 goal especially among indigenous people and people injecting drugs. Indigenous people have shifting priorities and basic needs that sometimes overshadow the pursuit of their HIV agendas. While developed countries that have enough funding have been trying to sustain the HIV-related priorities of their indigenous population, developing countries offer resources for indigenous people. Therefore, developing countries with indigenous people should maintain their commitments through regular discussions with political leaders to ensure that resources are sustained for the continued fight against HIV among indigenous populations. Such discussions should result in obligations to make indigenous populations a priority. There is an opioid epidemic in North America. People who inject drugs have 5 times the chance of having HIV. Injecting drugs should be decriminalized to reduce HIV incidence. It does not help that some programs that were in place to prevent the transmission of HIV among opioid users are being shut down. For instance, needle programs in Canada were shut down in 2022. More needs to be done to respond to the opioid epidemic as mediations for managing opioid overdose were developed in the 1940s and 1960s.

Agencies are developing global consensus statements to ask for such commitment to prioritizing indigenous people. More resources should be made available for indigenous to respond to HIV. This should also include more support and investments for the two-spirit communities. When a slew of opioid overdoses occurs, there is usually an upsurge of response but hardly any sustained strategies such as addressing stigma and discrimination and addressing violence against people who inject drugs.