Understanding the Impacts of COVID-19 on Services for Indigenous People Living with HIV Who Use Substances in Winnipeg, Manitoba through a Wholistic Health and Well-Being Framework

Background and Purpose: The existing social and health inequities Indigenous peoples face throughout Canada are a direct result of colonialism which continues to oppress today. Manitoba has the second highest rate of HIV throughout the country with over half of new infections resulting from injection drug use. Faced with a syndemic throughout the COVID-19 pandemic with rising HIV infections and increasing drug poisonings, understanding the impacts of COVID-19 on services in Winnipeg, Manitoba is essential for future planning in relation to harm reduction services. Social workers within these fields have an ethical responsibility to have a comprehensive understanding of the needs of Indigenous people living with HIV (IPLH) who use substances to provide meaningful supports and advocate for a more wholistic approach to care. Given the relevant teachings Indigenous people have for understanding these issues, their incorporation throughout the research process is imperative to responding in a culturally safe and meaningful way.

Methods: The Gigii-Bapiimin project was a community-based participatory research study that incorporated Etuaptmumk (Two-Eyed Seeing) and Indigenous Storywork as overarching decolonizing and Indigenous frameworks. Indigenous Wholistic theory grounded the research in a wholistic understanding of wellness within the IPLH community. Participants (N = 20) were recruited using printed flyers, social media, and peer recruiters. Both IPLH who use substances and services providers participated in semi-structured interviews. Data analysis utilized thematic analysis with considerations for applying Indigenous methodologies within this.

Results: The COVID-19 pandemic revealed deeply rooted systemic oppressions within colonial mainstream health and social services. Many service providers highlighted the inequity of care received for IPLH who use substances, noting negative stereotypes often playing a role in clinical judgement. Others noted the impact of service delivery varied depending on social status with many not having access to phones or computers. Participants with lived experience acknowledged long standing oppressive social policies which further marginalized those utilizing social systems throughout the pandemic. Despite these challenges, Indigenous ways of knowing, doing, and being prevailed. Organizations that remained grounded in relationality and encompassed a wholistic model of care were identified by community as providing effective care. Many of these organizations were Indigenous led. Both community and service providers distinguished differences in approach, one resulting in service delivery innovations while still adhering to public health orders and the other, from more mainstream systems, increasing restrictions.

Conclusions and Implications: Conceptualizing these findings within a wholistic understanding of health and well-being helps lead to advocacy within health and social services that is more aligned with social worker’s values and resists ongoing tokenizing policies and practices. Several calls of action have been made for both Government and policy makers in relation to increasing funding of Indigenous led organizations and increased capacity of the implementation of Indigenous knowledges into services. Future research is needed to evaluate long-term outcomes of Indigenous-led service models in Winnipeg, Manitoba to discover their effectiveness in addressing health inequities among IPLH. The expansion of these models should be further explored within other regions to enhance the wholistic support network for IPLH across Canada.