Associations between Wildfire Exposure and Other Hazardous Socio- Environmental Factors with HIV Prevention Outcomes Among Northern and Indigenous Adolescents in the Northwest Territories, Canada

Background and Purpose: Extreme weather events (EWE) have been associated with poorer sexual health outcomes, including sexual and gender-based violence and HIV vulnerabilities, through multi-level pathways including changes in relationship dynamics and gender norms. While EWE such as wildfires have been linked with increases in sexual and gender-based violence, limited research has explored wildfire exposure and its association with relational-level sexual health outcomes such as condom use self-efficacy. Condom use self-efficacy, encompassing knowledge, relational dynamics, and sexual agency, facilitates youth sexual health promotion and HIV prevention engagement. We applied an ecosocial lens to consider how hazardous environments, such as those wrought by climate change and EWE, social marginalization, and socio-economic inequities, affect condom use self-efficacy. In 2023, the Northwest Territories, Canada experienced its warmest summer and sixth-warmest year on record, with 300 wildfires burning 4.16 million hectares of land due to high temperatures, minimal rainfall, and severe drought. Two-thirds of NWT’s 46,000 residents were displaced. We examined associations between ecosocial factors, including EWE exposure to the 2023 wildfires, and condom use self-efficacy among Northern and Indigenous adolescents in the Northwest Territories (NWT), Canada.

Methods: This community-based study conducted in collaboration with a Northern and Indigenous youth sexual health agency collected cross-sectional survey data (2023-2024) with a purposive sample of adolescent secondary school students aged 13-18 in 17 NWT communities. We conducted structural equation modeling (SEM) using maximum likelihood estimation to examine pathways from a latent construct of ecosocial factors (gender [cisgender girls vs. cisgender boys]), sexually diverse identity [vs. heterosexual], Indigenous identity [vs. non-Indigenous], rurality [vs. urban], food insecurity, 2023 NWT wildfire exposure [Traumatic Exposure Severity Scale]) to condom use self-efficacy. Self-esteem was tested as a mediating variable in this relationship.

Results: The sample comprised n=290 participants (mean age: 13.68 years, standard deviation: 1.69; cisgender girls: 57%, n=137; cisgender boys: 50.35%, n=145; gender diverse: 2.09%, n=6; sexually diverse [gay, lesbian, bisexual, queer, or other]: 18.37%, n=52). Most participants identified as Indigenous (68.79%, n=194) and lived in rural communities outside of the urban centre of Yellowknife (79.10%, n=212). Over half (n=134, 54.47%) reported EWE exposure to the 2023 wildfires. The final SEM model demonstrated good fit (Chi²=26.08, p=0.128; CFI=0.971; RMSEA=0.052 [90% CI = 0.001–0.681]; SRMR=0.060). Ecosocial factors were significantly associated with lower condom use self-efficacy (β= -0.149, p<0.05), with self-esteem partially mediating this effect (β= -0.117, p<0.05).

Conclusion: Findings reveal that among Northern and Indigenous adolescents in the NWT, ecosocial factors, including exposure to the 2023 NWT wildfires, socially marginalized identities (Indigeneity, sexual diversity, gender, rurality), and socio-economic disparities (food insecurity), were associated with reduced condom use self-efficacy, in part via reduced self-esteem. This signals the importance of better understanding relational-level pathways such as condom use self-efficacy in pathways from EWE to sexual health promotion and HIV prevention, as well as strategies to bolster self-esteem during and following EWE with climate-affected youth. Multi-level climate-informed interventions that centre social equity and mental health are needed to advance sexual health promotion and HIV prevention with Northern and Indigenous NWT adolescents and youth.