Overview

Globally, Indigenous leaders remain concerned about elevated rates of HIV and blood-borned infections among their young people, particularly those who use drugs and those affected by conflict. Further, addressing barriers to engagement in health care for these key populations remains an urgent global priority.

The Cedar Project involves young Indigenous people in Canada who use drugs at risk of and living with HIV and Hepatitis C. The Cango Lyec Project involves Acholi people in Northern Uganda at risk of or living with HIV in the aftermath of a long rebel-led civil war. These two CIHR-funded studies trace clear links between multigenerational cycles of distress and trauma with current impacts on risk behaviour, morbidity and mortality including HIV and other explosive epidemics. This work has been and continues to be done in full partnership with the respective communities to ensure that the research is relevant and that the findings are implemented.

Currently our team is focused on development of high-impact prevention and treatment approaches for those most adversely affected by HIV and other epidemics. These findings are expected to have significant impact on reducing health care inequities, with the ultimate aim of improving health care and outcomes in Canada and globally.

Research

THE CANGO LYEC PROJECT
The Cango Lyec study is a CIHR-funded cohort involving 2448 conflict-affected Acholi people aged 13-49 in Northern Uganda. It was initiated by Dr. Spittal and a team of Ugandan and Canadian collaborators in response to the need for evidence addressing war-related trauma and HIV vulnerability.

A newly initiated Cango Lyec sister study focuses specifically experiences of girls and young women 13-24 years old. Girls and young women account for 71% of new HIV infections among young people in sub-Saharan Africa, with 380,000 young women newly infected each year. Lack of power, coerced first sex, early marriage, limited health services, extreme poverty, and sexual violence underpin the disproportionate burden of HIV among young women. In addition, they remain a key population experiencing multiple barriers to engagement in HIV care. Our goal is to investigate HIV vulnerability of young women in Northern Uganda and address the individual, socio-cultural, and structural factors associated with their resilience, psychological wellbeing, and barriers to engagement in HIV care. Findings will provide evidence for interventions that address HIV risk and support the strengths of young women experiencing complex adversities of war and its aftermath.

THE CEDAR PROJECT
The Cedar Project uses a community-driven approach to respond to the crises of HIV and Hepatitis C infection and contribute to the health and healing of young Indigenous people who use drugs. Since its inception, The Cedar Project Partnership, an independent body of Indigenous Elders, leaders, and health/social service experts, and researchers, has governed the entire research process. The Partnership provides protection, leadership, support, and ensures that self-determining principles of Ownership, Control, Access and Possession (OCAP) and Indigenous knowledges are respected. To date, we have had 14 years of continuous funding from CIHR.

We have recently initiated a new Cedar Project initiative to provide culturally-safe, strengths-based case management for the delivery of optimal Hepatitis C care and treatment among Indigenous people who use drugs in Vancouver and Prince George, British Columbia. Hepatitis C infection is a critical public health issue that disproportionately impacts Indigenous people who use drugs. Indigenous leaders, community service providers, and health experts are justifiably concerned about the complex barriers that impede Indigenous people’s access to life-saving HCV treatments. Recent advances in direct acting antiviral (DAA) therapies are dramatically changing the landscape of HCV treatment, as they offer shorter treatment durations, higher rates of sustained viral response, and greater tolerability. However, improving HCV treatment uptake among Indigenous people who use drugs will require care that acknowledges the impact of colonization and historical trauma and supports strength and survival in the face of complex adversities. We anticipate that this research will make essential contributions regarding the delivery of HCV treatments among Indigenous people who use drugs in Canada, including demonstrating feasibility and informing best practices.

Grants

CIHR Project Grant (2017-2020): Designing targeted interventions to address HIV vulnerabilities and improve clinical outcomes among conflict affected adolescent girls and young women under 25 in Northern Uganda (PI: Spittal, Malamba, Muyinda, Sewankambo)

CIHR Foundation Grant (2016-2022): Reducing HIV risk, increasing access to treatment and promoting resilience in Indigenous communities in Canada and globally (PI: Schechter)

CIHR Project Grant (2016-2019): The Cedar Project: Providing culturally-safe, strengths-based case management for the delivery of optimal hepatitis C care and treatment among Indigenous people who use drugs in Vancouver and Prince George, BC (PI: Spittal, Yoshida)

Honours & Awards

UBC Faculty of Medicine Distinguished Achievement Award for Service to the University and Community (2017)

Nominee, U.S. Embassy International Visitors Leadership Program on Indigenous Health (2016)

Ranked First for meritorious activity among UBC School of Population and Public Health faculty (2015)

Research Group Members

Margo Pearce, Research Co-ordinator
Kate Jongbloed, Graduate Research Assistant
April Mazzuca, PhD Student
Richa Sharma, Research Coordinator
Anton Friedman, Research Assistant, Cedar Project
David Zamar, Statistician, Cedar Project
Lisa Ritland