November 17, 2015

People of the land and HIV in Africa
By Trevor Stratton, IIWGHA Coordinator

What is it like to be an Indigenous person living with HIV in Africa?

Good question, right? As we begin to prepare for AIDS 2016 and the International Indigenous Pre-conference on HIV & AIDS in Durban, South Africa, we need to try to understand the answers to this question and many others.

And just what does the word “Indigenous” mean in Africa? Aren’t all black Africans Indigenous to Africa? Well…. yes and no.

The difference with Africa and other global regions’ experience with colonization is that in Africa since the 50’s and 60’s they have undertaken a decolonization process during which many Europeans packed up and left. The general view is that all Africans are Indigenous.

This is obviously true that they are indigenous to the continent but the San and the Khoi are the original First Peoples of the Durban area in South Africa.

However, over time there has been a shift in people’s understanding about what Indigenous means in Africa.

The best resource to understand and explain this concept would be from the African Commission called Indigenous Peoples in Africa: The Forgotten Peoples? The African Commission’s work on indigenous peoples in Africa, which put together a team to study this question. They developed a broad sense of criteria to distinguish between Indigenous and other African people in the context of ILO Convention 169 and other internationally defining documents. Across Africa there are communities that practice ways of life such as nomadic pastoralism, etc. There is now a legal framework where we can talk about Indigenous people without denying the Africanness of the rest of Africans.

Through engagement at the United Nations Permanent Forum on Indigenous Issues (UNPFII), Burundi and other countries are starting to recognize that their forest dwelling people are largely Indigenous. Indigenous Peoples experience similar marginalization, modes of consumption and develop their own self-identification criteria.

In South Africa there seems to be less resistance from government to Indigenous identity. President Nelson Mandela established the National Khoi/San Council, which is the body that negotiates with government on behalf of the Khoi and San. At the rhetorical level at least, the South African government accepts that they are the original people of the land.

Often it’s a question of how you talk about it. It’s always a good practice to contextualize what we’re talking about so that one does not alienate some of the other African groups in the country. It is probably easier to define what we don’t mean when using the word “Indigenous” so we can speak about it in a way that is respectful of all Africans. San and Khoi face marginalization from their ways of life, attachment to their territories and the environment, which is a value system similar to other Indigenous Peoples around the world.

Durban is in KwaZulu-Natal province and is the place of the Zulus. So Zulus would consider themselves Indigenous people. But for the work we do, we would still say that the San are the Indigenous People within the definition of the Africa Commission and UNPFII.

For the purposes of IIWGHA, we define “Indigenous” loosely as the people of the land who have no power over that land. It is IIWGHA’s objective to work with countries whether or not they recognize their Indigenous Peoples.

6th International Indigenous Pre-conference on HIV & AIDS

It is beginning to look like our Durban Indigenous Pre-conference needs to begin by helping the delegates to understand the definition of the term “Indigenous” in the Southern African context and how this contentious issue has been a barrier for an Indigenous-led HIV response.

We need to help Indigenous Peoples in Africa lead the discussion about the importance of the Indigenous connection to a traditional land base and their displacement from that land. And how the laws displacing Indigenous people result in them becoming marginalized and neglected. We must demonstrate land as a way of defining who we are and how this connection is central to the definition of Indigenous.

We would like to see the Pre-conference as a place where Indigenous Peoples standing together with their allies can begin the growth of an Indigenous-led HIV response in Africa. It is important for them to take control of any narratives on HIV and Indigenous Peoples that exist and we must assist as allies in the development of the evidence to support this. It would be most useful to bring potential activists to the Pre-conference to meet other Indigenous people like the Leaders of IIWGHA and others to use it as a learning opportunity. They will be able to meet other people who may be in similar positions in other parts of the world and to connect with the Indigenous Peoples movement and their Indigeneity around the world.

We hope this will create a base to begin this work.

Nothing about us without us!

> Read the document called “Indigenous Peoples in Africa: The Forgotten Peoples? The African Commission’s work on indigenous peoples in Africa” here.

November 24, 2013

Getting HIV to zero: Canada leads the way

By Clive Aspin 

When it comes to HIV and indigenous peoples, Canada is way ahead of everyone else, in more ways than one.

Canada’s lead position was on full display recently when the Canadian Aboriginal AIDS Network (CAAN) convened their tri-annual Wise Practices Conference.

The meeting took place on the land of the Treaty 6 Cree and Dakota Nations (Saskatoon, Saskatchewan) and brought together Inuit, Metis and First Nations peoples from throughout North America as well as a number of Indigenous delegates from Australia, Bolivia, New Zealand and Mexico.

This was the fourth Wise Practices meeting and with over 200 national and international delegates, it counts as one of the largest international gatherings of indigenous peoples affected by HIV in the world.

That’s certainly worth celebrating and something of which CAAN can be justifiably proud. The level of community support for the work of this community-based AIDS organisation was clearly on display. Their ability to bring together so many indigenous peoples from all walks of life is to be commended.

And on top of that, people of all ages were well-represented. From elders to youth, there were representatives of the whole indigenous lifespan and experience, providing testimony to the fact that we are all affected by HIV, no matter what our age.

But more importantly, each and everyone of us has a role to play in finding a solution to the HIV crisis and bringing HIV infections to zero, the over-riding theme of the conference. From the elders with their wisdom to the youth with their innovative ideas, everyone has a role to play in preventing the transmission of HIV and providing care and support to those members of our communities who are living with HIV.

In keeping with the UNAIDS themes of zero infections, zero discrimination, zero AIDS related deaths, the theme of this meeting focused on the role of research in getting to zero.

But it was made clear that this theme may not be realistic or even acceptable to indigenous peoples, especially since it includes a commitment to universal testing and treatment.  As one delegate said, “We are indigenous peoples. We don’t want to be indigenous peoples on medication.”

And therein lie serious problems for indigenous peoples. Unless health services change, indigenous peoples will continue to test late or not at all. Already, we know that indigenous peoples at risk of HIV in some countries are more likely to test late for HIV than their peers.

Barriers to testing such as distrust of health services, discrimination and stigma will have to be broken down if this is to change.

And while medication might be part of the solution for some people, anti-retroviral treatment (ART) still has serious limitations. Apart from being expensive and having potential side effects, ART also requires people to be rigidly adherent in order to be effective.

And most importantly, the social determinants of indigenous health that drive indigenous health disparities must be addressed as a matter of urgency if we are to get HIV infections to zero. Unless these are addressed, HIV will continue to affect indigenous communities at greater rates than everyone else.

So long as indigenous peoples continue to be marginalized from decision-making and deprived of resources and information, we will continue to see disproportionately high rates of HIV among Indigenous populations.

Respectful research partnerships vital

The community-based approach to research provided answers to overcome some of these problems.

Overwhelmingly, delegates at Wise Practices IV emphasised the need for researchers to engage in meaningful and respectful partnerships with communities.

And there was much agreement that Indigenous researchers are best placed to do this.

Throughout most of the HIV epidemic, non-indigenous researchers have conducted research that has contributed to the perception that indigenous peoples are diseased, at risk and in need of rescue.

And still significant HIV disparities persist.

As we consider a future where HIV affects all segments of indigenous life and experience, it is imperative that this change. Delegates at Wise Practices agreed that indigenous peoples and communities need to frame and drive the HIV research agenda.

Visioning Health is one example of Aboriginal women taking control of research activities and finding solutions that meet the needs of indigenous women living with HIV. The project focuses on aspects of women’s lives that provide them with protection against HIV rather than what places them at ‘so-called’ risk. And by engaging with HIV positive Aboriginal women the project has made a significant contribution to the building of Indigenous HIV research capacity.

An energized and vibrant Indigenous HIV research workforce is going to be fundamental to overcoming HIV in the future. Many of the people at Wise Practices IV are part of that workforce and they will need to have access to ongoing support and mentoring to meet and overcome challenges of HIV in the future.

For Canada is leading the way in another area of the HIV epidemic and that is in the rates of HIV diagnoses. Canada has inordinately high rates of HIV among Inuit, Metis and First Nations peoples that far surpasses those in countries such as Australia and New Zealand.

These three countries share much in common with regard to indigenous populations, health disparities and HIV. Similar experiences of colonisation, marginalisation and dispossession have contributed to significant health disparities in all three countries.

But when it comes to HIV, the disparities between indigenous and non-indigenous peoples in Canada are stark and way ahead of those in the other two countries. A study that compared standardised rates of HIV diagnoses in the three countries found that Canada’s rates were almost 200 per 100,000 compared with about 50 for Australia and slightly less for New Zealand.

Already, Canada has major challenges dealing with the impact of HIV on indigenous Canadians and these challenges are likely to intensify as rates of HIV diagnoses continue to increase.

Canada’s example also provides salient lessons for Australia, New Zealand and other countries with vulnerable indigenous populations.

The lead up to AIDS 2014 in Melbourne in July next year provides opportunities to reflect on these lessons and apply them to national and international initiatives to prevent the transmission of HIV among indigenous populations.

Clive Aspin is Maori (Ngati Maru) and currently lives in Sydney, Australia. He is an Indigenous Research Fellow at Bullana, The Poche Centre for Indigenous Health at the University of Sydney. He has worked for many years in the area of HIV in New Zealand and Australia and is particularly interested in helping to develop strategies to protect indigenous peoples from HIV.