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ObjectivesIndigenous leaders and child and family advocates are deeply concerned about the health impacts of the child welfare system, including HIV vulnerability. The objectives of this study were to describe the prevalence of having been apprehended into the child welfare system and associated HIV vulnerabilities among young Indigenous people who use drugs.MethodsThe Cedar Project is a cohort of young Indigenous people ages 14-30 years who use illicit drugs in Vancouver and Prince George, British Columbia. Multivariable logistic regression modeling determined associations between a history of involvement in the child welfare system and vulnerability to HIV infection.ResultsOf 605 participants, 65% had been taken from their biological parents. Median age of first apprehension was 4 years old. Having been sexually abused, having a parent who attended residential school and being HIV-positive were all independently associated with having been involved in the child welfare system. Participants who had been involved in the child welfare system were also more likely to have been homeless, paid for sex, diagnosed and hospitalized with mental illness, self-harmed, thought about suicide, and attempted suicide. Among participants who used injection drugs, those who had been involved in child welfare were more likely to have shared needles and overdosed.ConclusionThis study has found compelling evidence that young Indigenous people who use drugs in two cities in BC are experiencing several distressing health outcomes associated with child welfare involvement, including HIV infection. Jurisdictional reforms and trauma-informed programs that use culture as intervention are urgently needed.

Prior to the arrival of European missionaries and settlers, Indigenous families and communities supported healthy, independent children through spiritual connection to lands, traditions, language and culture. (1) However, traditional styles [...], OBJECTIVES: Indigenous leaders and child and family advocates are deeply concerned about the health impacts of the child welfare system, including HIV vulnerability. The objectives of this study were to describe the prevalence of having been apprehended into the child welfare system and associated HIV vulnerabilities among young Indigenous people who use drugs. METHODS: The Cedar Project is a cohort of young Indigenous people ages 14-30 years who use illicit drugs in Vancouver and Prince George, British Columbia. Multivariable logistic regression modeling determined associations between a history of involvement in the child welfare system and vulnerability to HIV infection. RESULTS: Of 605 participants, 65% had been taken from their biological parents. Median age of first apprehension was 4 years old. Having been sexually abused, having a parent who attended residential school and being HIV-positive were all independently associated with having been involved in the child welfare system. Participants who had been involved in the child welfare system were also more likely to have been homeless, paid for sex, diagnosed and hospitalized with mental illness, self-harmed, thought about suicide, and attempted suicide. Among participants who used injection drugs, those who had been involved in child welfare were more likely to have shared needles and overdosed. CONCLUSION: This study has found compelling evidence that young Indigenous people who use drugs in two cities in BC are experiencing several distressing health outcomes associated with child welfare involvement, including HIV infection. Jurisdictional reforms and trauma-informed programs that use culture as intervention are urgently needed. KEYWORDS: Child welfare; HIV; substance-related disorders; Indians; North American La traduction du resume se trouve a la fin de l'article. OBJECTIFS: Les dirigeants autochtones et les defenseurs des enfants et des familles sont profondement preoccupes par les effets du systeme de protection de la jeunesse sur la sante, notamment sur la vulnerabilite au VIH. Notre etude vise a decrire la prevalence de la prise en charge par un organisme de protection de la jeunesse et des vulnerabilites au VIH connexes chez les jeunes autochtones qui consomment de la drogue. METHODE: Le Cedar Project est une cohorte de jeunes autochtones de 14 a 30 ans consommant de la drogue a Vancouver et a Prince George (Colombie-Britannique). Un modele de regression logistique multivariee a determine les associations entre les antecedents de prise en charge par un organisme de protection de la jeunesse et la vulnerabilite a l'infection a VIH. RESULTATS: Sur 605 participants, 65 % avaient ete retires a leurs parents biologiques. L'age median a la premiere prise en charge etait de 4 ans. Le fait d'avoir ete victime d'agression sexuelle, d'avoir un parent ayant frequente un pensionnat et d'etre seropositif pour le VIH etaient trois variables independamment associees a la prise en charge par un organisme de protection de la jeunesse. Les participants ayant ete pris en charge par un organisme de protection de la jeunesse etaient aussi plus susceptibles d'avoir ete sans abri, d'avoir ete payes pour un rapport sexuel, d'avoir ete diagnostiques et hospitalises pour une maladie mentale, de s'etre automutiles, d'avoir songe au suicide et d'avoir fait une tentative de suicide. Parmi les participants utilisant des drogues par injection, ceux ayant ete pris en charge par un organisme de protection de l'enfance etaient plus susceptibles d'avoir partage des aiguilles et fait une surdose. CONCLUSION: Nous avons des preuves convaincantes que dans deux villes de la C.-B., les jeunes autochtones qui consomment de la drogue presentent plusieurs resultats de sante troublants, notamment l'infection a VIH, associes a la prise en charge par des organismes de protection de la jeunesse. Il existe un besoin urgent d'amorcer des reformes du systeme judiciaire et d'etablir des programmes eclaires par les traumatismes en utilisant la culture comme outil d'intervention. MOTS CLES: protection de l'enfance; VIH; troubles lies a une substance; Indiens d'Amerique Nord doi: 10.17269/CJPH.106.5026

Author(s): Angela Russolillo *, Akm Moniruzzaman, Julian M. Somers Introduction Overdoses and deaths caused by opioids have been declared a public health emergency in North America. The rising prevalence of [...], Background Individuals with criminal histories have high rates of opioid dependence and mortality. Excess mortality is largely attributable to overdose deaths. Methadone maintenance treatment (MMT) is one of the best evidence-based opioid substitution treatments (OSTs), but there is uncertainty about whether methadone treatment reduces the risk of mortality among convicted offenders over extended follow-up periods. The objective of this study was to investigate the association between adherence to MMT and overdose fatality as well as other causes of mortality. Methods and findings We conducted a retrospective cohort study involving linked population-level administrative data among individuals in British Columbia (BC), Canada with a history of conviction and who filled a methadone prescription between January 1, 1998 and March 31, 2015. Participants were followed from the date of first-dispensed methadone prescription until censoring (date of death or March 31, 2015). Methadone was divided into medicated (methadone was dispensed) and nonmedicated (methadone was not dispensed) periods and analysed as a time-varying exposure. Hazard ratios (HRs) with 95% CIs were estimated using multivariable Cox regression to examine mortality during the study period. All-cause and cause-specific mortality rates were compared during medicated and nonmedicated methadone periods. Participants (n = 14,530) had a mean age of 34.5 years, were 71.4% male, and had a median follow-up of 6.9 years. A total of 1,275 participants died during the observation period. The overall all-cause mortality rate was 11.2 per 1,000 person-years (PYs). Participants were significantly less likely to die from both nonexternal (adjusted HR [AHR] 0.27 [95% CI 0.23-0.33]) and external (AHR 0.41 [95% CI 0.33-0.51]) causes during medicated periods, independent of sociodemographic, criminological, and health-related factors. Death due to infectious diseases was 5 times lower (AHR 0.20 [95% CI 0.13-0.30]), and accidental poisoning (overdose) deaths were nearly 3 times lower (AHR 0.39 [95% CI 0.30-0.50]) during medicated periods. A competing risk regression demonstrated a similar pattern of results. The use of a Canadian offender population may limit generalizability of results. Furthermore, our observation period represents community-based methadone prescribing and may omit prescriptions administered during hospital separations. Therefore, the magnitude of the protective effects of methadone from nonexternal causes of death should be interpreted with caution. Conclusions Adherence to methadone was associated with significantly lower rates of death in a population-level cohort of Canadian convicted offenders. Achieving higher rates of adherence may reduce overdose deaths and other causes of mortality among offenders and similarly marginalized populations. Our findings warrant examination in other study centres in response to the crisis of opiate-involved deaths.

Aboriginal leadership, communities and organizations in Canada are increasingly concerned about the sexual and reproductive health of their young people. (1) The present-day health disparities faced by Aboriginal people in [...], Objectives: Very few studies in Canada address the sexual health of young Aboriginal people who use drugs; the focus in established literature has been on parenteral risks. This study sought to identify the risk factors associated with inconsistent condom use in a cohort of young Aboriginal people who live in British Columbia and use drugs. Methods: This analysis includes baseline questionnaire data from October 2003 to April 2005. Multivariable modeling stratified by gender identified independent demographic, traumatic, sex and drug use risk factors associated with inconsistent condom use. Results: Of the 292 women and 313 men at baseline, prevalence of inconsistent condom use during insertive sex was 59% and 46%, respectively. In multivariable logistic regression, after adjusting for age and location, inconsistent condom use among women was significantly associated with ever being enrolled in a drug/alcohol treatment program (AOR: 1.95, 95% CI: 1.06-3.60), and ever being sexually abused (AOR: 1.80, 95% CI: 1.01-3.20). Among men, inconsistent condom use was significantly associated with having more than 20 lifetime sex partners (AOR: 2.06, 95% CI: 1.24-3.44). Conclusion: Our study demonstrates high rates of inconsistent condom use among young Aboriginal people who use drugs, highlighting their vulnerability to contracting sexually transmitted infections. Culturally tailored sexual health interventions must be made a priority and need to incorporate the reality of gendered differences in the context of multigenerational trauma, including non-consensual sex. Key words: Aboriginal people; condoms; drug use; British Columbia Objectifs: Tres peu d'etudes au Canada abordent la sante sexuelle des jeunes autochtones qui consomment de la drogue; les travaux publies portent plutot sur les risques de transmission parenterale de maladies. Nous avons voulu cerner les facteurs de risque associes a l'utilisation irreguliere du preservatif dans une cohorte de jeunes autochtones consommateurs de drogue vivant en Colombie-Britannique. Methode: Nous avons analyse les donnees d'un questionnaire de reference administre entre octobre 2003 et avril 2005. Une modelisation multivariee stratifiee selon le sexe a permis de cerner des facteurs de risque independants (caracteristiques demographiques, traumatismes, relations sexuelles et consommation de drogue) associes a l'utilisation irreguliere du preservatif. Resultats: Chez les 292 femmes et les 313 hommes recenses au depart, la prevalence de l'utilisation irreguliere du preservatif durant les relations sexuelles avec penetration etait de 59 % et de 46 %, respectivement. Apres une regression logistique multivariee, en tenant compte de l'age et du lieu, l'utilisation irreguliere du preservatif chez les femmes presentait une correlation significative avec le fait d'avoir deja suivi un programme de traitement des toxicomanies ou de l'alcoolisme (RCa : 1,95, IC de 95 % : 1,06-3,60), et d'avoir deja ete victime d'agression sexuelle (RCa : 1,80, IC de 95 %: 1,01-3,20). Chez les hommes, l'utilisation irreguliere du preservatif presentait une correlation significative avec le fait d'avoir eu plus de 20 partenaires sexuels dans sa vie (RCa : 2,06, IC de 95 % : 1,24-3,44). Conclusion: Notre etude fait etat de taux eleves d'utilisation irreguliere du preservatif chez les jeunes autochtones qui consomment de la drogue, d'oU leur vulnerabilite aux infections transmissibles sexuellement. Des interventions en sante sexuelle culturellement adaptees doivent etre menees en priorite, et elles doivent tenir compte de la realite des differences sexospecifiques dans le contexte des traumatismes multigenerationnels, y compris les rapports sexuels non consensuels. Mots cles: Indiens d'Amerique nord; condom; consommation de drogue; Colombie-Britannique La traduction du resume se trouve a la fin de l'article. Can J Public Health 2012;103(6):413-16.

Recent Indigenist scholarship has situated high rates of traumatic life experiences, including sexual abuse, among Indigenous peoples of North America within the larger context of their status as colonized peoples. Sexual abuse has been linked to many negative health outcomes including mental, sexual and drug-related vulnerabilities, There is a paucity of research in Canada addressing the relationship between antecedent sexual abuse and negative health outcomes among Aboriginal people including elevated risk of HIV infection. The primary objectives of this study were to determine factors associated with sexual abuse among participants of the Cedar Project, a cohort of young Aboriginal people between the ages of 14 and 30 years who use injection and non-injection drugs in two urban centres in British Columbia, Canada; and to locate findings through a lens of historical and intergenerational trauma. We utilized post-colonial perspectives in research design, problem formulation and the interpretation of results. Multivariate modeling was used to determine the extent to which a history of sexual abuse was predictive of negative health outcomes and vulnerability to HIV infection. Of the 543 eligible participants, 48% reported ever having experienced sexual abuse; 69% of sexually abused participants were female. The median age of first sexual abuse was 6 years for both female and male participants. After adjusting for sociodemographic variables and factors of historical trauma, sexually abused participants were more likely to have ever been on the streets for more than three nights, to have ever self-harmed, to have suicide ideation, to have attempted suicide, to have a diagnosis of mental illness, to have been in the emergency department within the previous 6 months, to have had over 20 lifetime sexual partners, to have ever been paid for sex and to have ever overdosed. The prevalence and consequences of sexual abuse among Cedar Project participants are of grave concern. Sexual trauma will continue to impact individuals, families and communities until unresolved historical trauma is meaningfully addressed in client-driven, culturally safe programming. Keywords: Sexual abuse Historical trauma Aboriginal young people Canada Substance dependence HIV Cedar Project

Abstract Background Factors associated with HCV incidence among young Aboriginal people in Canada are still not well understood. We sought to estimate time to HCV infection and the relative hazard of risk factors associated HCV infection among young Aboriginal people who use injection drugs in two Canadian cities. Methods The Cedar Project is a prospective cohort study involving young Aboriginal people in Vancouver and Prince George, British Columbia, who use illicit drugs. Participants’ venous blood samples were drawn and tested for HCV antibodies. Analysis was restricted to participants who use used injection drugs at enrolment or any of follow up visit. Cox proportional hazards regression was used to identify independent predictors of time to HCV seroconversion. Results In total, 45 out of 148 participants seroconverted over the study period. Incidence of HCV infection was 26.3 per 100 person-years (95% Confidence Interval [CI]: 16.3, 46.1) among participants who reported using injection drugs for two years or less, 14.4 per 100 person-years (95% CI: 7.7, 28.9) among participants who had been using injection drugs for between two and five years, and 5.1 per 100 person-years (95% CI: 2.6,10.9) among participants who had been using injection drugs for over five years. Independent associations with HCV seroconversion were involvement in sex work in the last six months (Adjusted Hazard Ratio (AHR): 1.59; 95% CI: 1.05, 2.42) compared to no involvement, having been using injection drugs for less than two years (AHR: 4.14; 95% CI: 1.91, 8.94) and for between two and five years (AHR: 2.12; 95%CI: 0.94, 4.77) compared to over five years, daily cocaine injection in the last six months (AHR: 2.47; 95% CI: 1.51, 4.05) compared to less than daily, and sharing intravenous needles in the last six months (AHR: 2.56; 95% CI: 1.47, 4.49) compared to not sharing. Conclusions This study contributes to the limited body of research addressing HCV infection among Aboriginal people in Canada. The HCV incidence rate among Cedar Project participants who were new initiates of injection drug use underscores an urgent need for HCV and injection prevention and safety strategies aimed at supporting young people surviving injection drug use and sex work in both cities. Young people must be afforded the opportunity to provide leadership and input in the development of prevention programming.

Abstract: Aims: To estimate and test the difference in rates of violent and non‐violent crime during medicated and non‐medicated methadone treatment episodes. Design, Setting and Participants: The study involved linkage of population level administrative data (health and justice) for all individuals (n = 14 530) in British Columbia, Canada with a history of conviction and who filled a methadone prescription between 1 January 1998 and 31 March 2015. Methadone maintenance treatment was the primary independent variable and was treated as a time‐varying exposure. Each participant's follow‐up (mean: 8 years) was divided into medicated (methadone was dispensed) and non‐medicated (methadone was not dispensed) periods with mean durations of 3.3 and 4.6 years, respectively. Measurements: Socio‐demographics of participants were examined along with the main outcomes of violent and non‐violent offences. Findings: During the first 2 years of treatment (≤ 2.0 years), periods in which methadone was dispensed were associated with a 33% lower rate of violent crime [0.67 adjusted hazard ratio (AHR), 95% confidence intervals (CI) = 0.59, 0.76] and a 35% lower rate of non‐violent crime (0.65 AHR, 95% CI = 0.62, 0.69) compared with non‐medicated periods. This equates to a risk difference of 3.6 (95% CI = 2.6, 4.4) and 37.2 (95% CI = 33.0, 40.4) fewer violent and non‐violent offences per 100 person‐years, respectively. Significant but smaller protective effects of dispensed methadone were observed across longer treatment intervals (2.0 to ≤ 5.0 years, 5.0 to ≤ 10.0 years). Conclusions: Among a cohort of Canadian offenders, rates of violent and non‐violent offending were lower during periods when individuals were dispensed methadone compared with periods in which they were not dispensed methadone. [ABSTRACT FROM AUTHOR]