AIDS and Behavior

, Volume 15, Issue 1, pp 214–227 | Cite as

HIV Incidence and Prevalence Among Aboriginal Peoples in Canada

  • Katrina C. Duncan
  • Charlotte Reading
  • Alexandra M. Borwein
  • Melanie C. M. Murray
  • Alexis Palmer
  • Warren Michelow
  • Hasina Samji
  • Viviane D. Lima
  • Julio S. G. Montaner
  • Robert S. Hogg
Original Paper


We examined incidence, prevalence, and correlates of HIV infection in Aboriginal peoples in Canada and found that among most risk groups both Aboriginal and non-Aboriginal participants showed similar levels of HIV prevalence. Aboriginal peoples who use illicit drugs were found to have higher HIV incidence and prevalence when compared to their non-Aboriginal drug-using peers. Aboriginal street youth and female sex workers were also found to have higher HIV prevalence. Among Aboriginal populations, correlates of HIV-positive sero-status include syringe sharing and frequently injecting drugs, as well as geographic and social factors such as living in Vancouver or having a history of non-consensual sex. This study is relevant to Canada and elsewhere, as Indigenous populations are disproportionately represented in the HIV epidemic worldwide.


Aboriginal peoples Indigenous populations HIV incidence HIV prevalence Injection drug use Canada 



RSH and VL conceived and designed this review. KCD, AMB, MCM and WM analysed and interpreted the data. KCD, AMB, and MCM drafted the manuscript. RSH, JSGM, VL, AP, WM and CR critically revised the manuscript for content. All authors saw and approved the final manuscript. We are grateful to the Cedar Project Partnership, Eirikka Brandson, Steve Kanters, and Nadia O’Brien for their help with data acquisition, data quality and content editing. We thank the Canadian Institutes of Health Research (CIHR) for its continuing support. KCD thanks the CIHR Translational Research in Infectious Disease grant for its support. VDL acknowledges the Michael Smith Foundation in Health Research and the CIHR for two fellowships. JSGM is supported by the Ministry of Health Services and the Ministry of Healthy Living and Sport, from the Province of British Columbia; through a Knowledge Translation Award from the CIHR; and through an Avant-Garde Award (No. 1DP1DA026182-01) from the National Institute of Drug Abuse, at the US National Institutes of Health. He also received funding from Merck, Gilead and ViiV to support research into Treatment as Prevention.

Conflict of Interest

KCD, CR, AMB, MCM, AP, WM, HS, VDL, JSGM, and RSH declare they have no conflict of interest.

Supplementary material

10461_2010_9792_MOESM1_ESM.doc (56 kb)
Supplementary material 1 (DOC 56 kb)


  1. 1.
    Health Canada. HIV and AIDS in Canada. Surveillance report to June 30, 2002. Ottawa: Health Canada; 2002.Google Scholar
  2. 2.
    Public Health Agency of Canada. Summary: estimates of HIV prevalence and incidence in Canada, 2008. Ottawa: Health Canada; 2008.Google Scholar
  3. 3.
    Health Canada. First Nations and Inuit Health, 2006. Ottawa: Health Canada; 2006.Google Scholar
  4. 4.
    Public Health Agency of Canada. HIV/AIDS among Aboriginal persons in Canada: a continuing concern. In: HIV/AIDS epi updates, November 2007. Ottawa: Health Canada; 2007.Google Scholar
  5. 5.
    Public Health Agency of Canada. HIV/AIDS epi updates, November 2007. Ottawa: Public Health Agency of Canada; 2007.Google Scholar
  6. 6.
    Health Canada. Understanding the HIV/AIDS epidemic among Aboriginal peoples in Canada: the community at a glance. Ottawa: Health Canada; 2004.Google Scholar
  7. 7.
    De P, Singh AE, Wong T, Kaida A. Predictors of gonorrhea reinfection in a cohort of sexually transmitted disease patients in Alberta, Canada, 1991–2003. Sex Transm Dis. 2007;34:30–6.CrossRefPubMedGoogle Scholar
  8. 8.
    Romanowski B, Preiksaitis J, Campbell P, Fenton J. Hepatitis C seroprevalence and risk behaviours in patients attending sexually transmitted disease clinics. Sex Transm Dis. 2003;30:33–8.CrossRefPubMedGoogle Scholar
  9. 9.
    Shields SA, Wong T, Mann J, et al. Prevalence and correlates of chlamydia infection in Canadian street youth. J Adolesc Health. 2004;34(5):384–90.PubMedGoogle Scholar
  10. 10.
    Moher D, Cook DJ, Eastwood S, Olkin I, Rennie D, Stroup DF. Improving the quality of reports of meta-analyses of randomised controlled trials: the QUOROM statement. Quality of Reporting of Meta-analyses. Lancet. 1999;354(9193):1896–900.CrossRefPubMedGoogle Scholar
  11. 11.
    Public Health Agency of Canada. Inventory of HIV incidence and prevalence studies in Canada, August 2006. Ottawa: Public Health Agency of Canada; 2006.Google Scholar
  12. 12.
    Pagano M, Gauvreau K. Principles of biostatistics. 2nd ed. Pacific Grove, CA: Duxbury; 2000.Google Scholar
  13. 13.
    Clopper CJ, Pearson ES. The use of confidence or fiducial limits illustrated in the case of the binomial. Biometrika. 1934;26(4):404–13.CrossRefGoogle Scholar
  14. 14.
    Strathdee SA, Patrick DM, Currie SL, et al. Needle exchange is not enough: lessons from the Vancouver injecting drug use study. AIDS. 1997;11(8):F59–65.CrossRefPubMedGoogle Scholar
  15. 15.
    Schecter M, Heath K, Strathdee SA, Palepu A, O’Shaughnessy MV. Determinants of HIV infection in a cohort of native Canadian injection drug users. In: XIIth international AIDS conference, June 28–July 3, 1998, Geneva, Switzerland (abstract).Google Scholar
  16. 16.
    Miller CL, Tyndall M, Li K, Laliberte N, Spittal P, Schechter M. High rates of HIV positivity among young injection drug users. Can J Infect Dis. 2001;12(suppl B):340 (abstract).Google Scholar
  17. 17.
    Miller CL, Spittal P, Laliberte N, et al. Females experiencing sexual and drug vulnerabilities are at elevated risk for HIV infection among youth who use injection drugs. J Acquir Immune Defic Syndr. 2002;30(3):335–41.PubMedGoogle Scholar
  18. 18.
    Spittal PM, Craib KJP, Wood E, et al. Risk factors for elevated HIV incidence rates among female injection drug users in Vancouver. Can Med Assoc J. 2002;166(7):894–9.Google Scholar
  19. 19.
    Craib KJP, Spittal PM, Wood E, et al. Risk factors for elevated HIV incidence among Aboriginal injection drug users in Vancouver. Can Med Assoc J. 2003;168(1):19–24.Google Scholar
  20. 20.
    Tyndall MW, Currie S, Spittal P, et al. Intensive injection cocaine use as the primary risk factor in the Vancouver HIV-1 epidemic. AIDS. 2003;17(6):887–93.CrossRefPubMedGoogle Scholar
  21. 21.
    O’Connell JM, Kerr T, Li K, et al. Requiring help injecting independently predicts incident HIV infection among injection drug users. J Acquir Immune Defic Syndr. 2005;40(1):83–8.CrossRefPubMedGoogle Scholar
  22. 22.
    Spittal PM, Craib KJ, Schechter MT, Medd L, Barney L, Baylis C. HIV and HCV prevalence and risk factors among young Aboriginal drug users in Vancouver and Prince George, British Columbia. Can J Infect Dis Med Microbiol. 2005;16(suppl A):191 (abstract).Google Scholar
  23. 23.
    Corneil TA, Kuyper LM, Shoveller J, et al. Unstable housing, associated risk behaviour, and increased risk for HIV infection among injection drug users. Health Place. 2006;12(1):79–85.CrossRefPubMedGoogle Scholar
  24. 24.
    Craib KJP, Moniruzzaman A, Schechter MT, Spittal PM. HIV and HCV prevalence and risk factors among Aboriginal youth that use injection drugs. Can J Infect Dis Med Microbiol. 2006;17(suppl A):356 (abstract).Google Scholar
  25. 25.
    Miller CL, Strathdee SA, Spittal PM et al. Elevated rates of HIV infection among young Aboriginal injection drug users in a Canadian setting. Harm Reduct J. 2006;3:9.CrossRefPubMedGoogle Scholar
  26. 26.
    Tyndall MW, Wood E, Zhang R, Lai C, Montaner JSG, Kerr T. HIV seroprevalence among participants at a supervised injection facility in Vancouver, Canada: implications for prevention, care and treatment. Harm Reduct J. 2006;3:36.CrossRefPubMedGoogle Scholar
  27. 27.
    Maas B, Fairbairn N, Kerr T, Li K, Montaner JSG, Wood E. Neighborhood and HIV infection among IDU: place of residence independently predicts HIV infection among a cohort of injection drug users. Health Place. 2007;13(2):432–9.CrossRefPubMedGoogle Scholar
  28. 28.
    Spittal PM, Craib KJP, Tegee M, et al. The Cedar Project: prevalence and correlates of HIV infection among young Aboriginal people who use drugs in two Canadian cities. Int J Circumpolar Health. 2007;66(3):226–40.PubMedGoogle Scholar
  29. 29.
    Wood E, Lloyd-Smith E, Li K, et al. Frequent needle exchange use and HIV incidence in Vancouver, Canada. Am J Med. 2007;120(2):172–9.CrossRefPubMedGoogle Scholar
  30. 30.
    Marshall BDL, Kerr T, Livingstone C, Li K, Montaner JSG, Wood E. High prevalence of HIV infection among homeless and street-involved Aboriginal youth in a Canadian setting. Harm Reduct J. 2008;5:35.Google Scholar
  31. 31.
    Mehrabadi A, Craib KJP, Patterson K, et al. The Cedar Project: a comparison of HIV-related vulnerabilities amongst young Aboriginal women surviving drug use and sex work in two Canadian cities. Int J Drug Policy. 2008;19(2):159–68.CrossRefPubMedGoogle Scholar
  32. 32.
    Mehrabadi A, Paterson K, Pearce M, et al. Gender differences in HIV and hepatitis C related vulnerabilities among Aboriginal young people who use street drugs in two Canadian cities. Women Health. 2008;48(3):235–60.CrossRefPubMedGoogle Scholar
  33. 33.
    Pearce ME, Christian WM, Patterson K, et al. The Cedar Project: historical trauma, sexual abuse and HIV risk among young Aboriginal people who use injection and non-injection drugs in two Canadian cities. Soc Sci Med. 2008;66(11):2185–94.CrossRefPubMedGoogle Scholar
  34. 34.
    Pearce ME, Christian WM, Patel SH, et al. The Cedar Project: experience of foster care and HIV risk among young Aboriginal people who use injection and non-injection drugs in two Canadian cities. Can J Infect Dis Med Microbiol. 2008;19(suppl A):262 (abstract).Google Scholar
  35. 35.
    Schechter MT, Craib KJ, Clement K, et al. The Cedar Project: factors associated with HIV seroconversion among Aboriginal people who use injection and non-injection drugs in Vancouver and Prince George, British Columbia. Can J Infect Dis Med Microbiol. 2008;19(suppl A):266 (abstract).Google Scholar
  36. 36.
    Wood E, Montaner JSG, Li K, et al. Burden of HIV infection among Aboriginal injection drug users in Vancouver, British Columbia. Am J Public Health. 2008;98(3):515–9.CrossRefPubMedGoogle Scholar
  37. 37.
    DeBeck K, Kerr T, Li K, et al. Smoking of crack cocaine as a risk factor for HIV infection among people who use injection drugs. Can Med Assoc J. 2009;181(9):585–9.CrossRefGoogle Scholar
  38. 38.
    Rothon DA, Mathias RG, Schechter MT. Prevalence of HIV infection in provincial prisons in British Columbia. Can Med Assoc J. 1994;151(6):781–7.Google Scholar
  39. 39.
    Buxton JA, Rothon D, Durigon M, et al. Hepatitis C and HIV prevalence using oral mucosal transudate, and reported drug use and sexual behaviours of youth in custody on British Columbia. Can J Public Health. 2009;100(2):121–4.PubMedGoogle Scholar
  40. 40.
    Martin JD, Mathias RG, Sarin C, Byrne SE. HIV and hepatitis B surveillance in First Nations alcohol and drug treatment centres in British Columbia, Canada, 1992–2000. Int J Circumpolar Health. 2002;61(2):104–9.PubMedGoogle Scholar
  41. 41.
    Callaghan RC, Cull R, Vettese LC, Taylor L. A gendered analysis of Canadian Aboriginal individuals admitted to inpatient substance abuse detoxification: a three-year medical chart review. Am J Addict. 2006;15(5):380–6.CrossRefPubMedGoogle Scholar
  42. 42.
    Heath KV, Cornelisse PGA, Strathdee SA, et al. HIV-associated risk factors among young Canadian Aboriginal and non-Aboriginal men who have sex with men. Int J STD AIDS. 1999;10(9):582–7.CrossRefPubMedGoogle Scholar
  43. 43.
    Ogilvie GS. Trends in care for HIV positive pregnant women in British Columbia, 1994–1999. Vancouver: University of British Columbia; 2001 (thesis).Google Scholar
  44. 44.
    Money D, van Schalkwyk J, Maan E, et al. Perinatal outcomes in a cohort of ART treated HIV positive pregnant women in British Columbia. Can J Infect Dis Med Microbiol. 2007;18(suppl B):31 (abstract).Google Scholar
  45. 45.
    Rekart ML, Chan S, Barnett J, Lawrence C, Manzon L. HIV and North American Aboriginal peoples. In: VIIth international AIDS conference, June 16–21, 1991, Florence, Italy (abstract).Google Scholar
  46. 46.
    Hogg RS, Strathdee S, Kerr T, Wood E, Remis R. HIV prevalence among Aboriginal British Columbians. Harm Reduct J. 2005;2:26.CrossRefPubMedGoogle Scholar
  47. 47.
    Shannon K, Bright V, Gibson K, Tyndall MW, the MAKA Project Partnership. Sexual and drug-related vulnerabilities for HIV infection among women engaged in survival sex work in Vancouver, Canada. Can J Public Health. 2007;98(6):465–9.PubMedGoogle Scholar
  48. 48.
    Calzavara L, Ramuscak N, Burchell AN, et al. Prevalence of HIV and hepatitis C virus infections among inmates of Ontario remand facilities. Can Med Assoc J. 2007;177(3):257–61.CrossRefGoogle Scholar
  49. 49.
    Liu J, Remis RS, Myers T, Husbands W, Ogunnaike-Cooke S, Archibald CP. Ethno-racial variation in sexual behaviour and HIV infection among men who have sex with men (MSM): results from the Lambda study. Can J Infect Dis Med Microbiol. 2010;21(suppl B):22 (abstract).Google Scholar
  50. 50.
    Linton AB, Singh MD, Turbow D, Legg TJ. Street youth in Toronto, Canada: an investigation of demographic predictors of HIV status among street youth who access preventive health and social services. J HIV AIDS Soc Serv. 2009;8(4):375–96.CrossRefGoogle Scholar
  51. 51.
    Romanowski B, Campbell PJ, Preiksaitis JK, Fonseca K. Human immunodeficiency virus seroprevalence and risk behaviours in patients attending sexually transmitted disease clinics in Alberta. Sex Transm Dis. 1997;24(8):487–94.CrossRefPubMedGoogle Scholar
  52. 52.
    Houston S, Mashinter L, Rowe B, Joffe M, Preiksaitis JK, Jhangri G. An anonymous unlinked seroprevalence study of HIV in urban Canadian Emergency Departments. Can J Infect Dis Med Microbiol. 2010;21(suppl B):62 (abstract).Google Scholar
  53. 53.
    Wylie JL, Shah L, Jolly AM. Demographic, risk behaviour and personal network variables associated with prevalent hepatitis C, hepatitis B, and HIV infection in injection drug users in Winnipeg, Canada. BMC Public Health. 2006;6:229.Google Scholar
  54. 54.
    Siushansian J, Archibald CP, Lior LY, et al. Northern exposures: HIV and HCV spread among injection drug users in a small Canadian community. In: XIIIth international AIDS conference, July 9–14, 2000, Durban, South Africa (abstract).Google Scholar
  55. 55.
    Weber AE, Chan K, George C, et al. Risk factors associated with HIV infection among young gay and bisexual men in Canada. J Acquir Immune Defic Syndr. 2001;28(1):81–8.PubMedGoogle Scholar
  56. 56.
    Hankins C, Hum L, Tran T, et al. Low HIV prevalence among childbearing women of Aboriginal origin. AIDS. 1997;11(7):945–7.PubMedGoogle Scholar
  57. 57.
    Mai N, Patrick D, Houston S, et al. HIV among aboriginal people in Canada: injection drug use is a main concern. In: XIIth international AIDS conference, June 28–July 3, 1998, Geneva, Switzerland (abstract).Google Scholar
  58. 58.
    Forbes J, Alimenti A, Ayers D, et al. Perinatal HIV therapy and vertical transmission in Aboriginal mother-infant pairs living in Canada: data from the Canadian Perinatal HIV Surveillance Program (CPHSP) 1997–2008. Can J Infect Dis Med Microbiol. 2010;21(suppl B):28 (abstract).Google Scholar
  59. 59.
    Mill JE, Jackson RC, Worthington CA, et al. HIV testing and care in Canadian Aboriginal youth: a community based mixed methods study. BMC Infect Dis. 2008;8:132–45.CrossRefPubMedGoogle Scholar
  60. 60.
    McInnes CW, Druyts E, Harvard SS, et al. HIV/AIDS in Vancouver, British Columbia: a growing epidemic. Harm Reduct J. 2009;6:5.CrossRefPubMedGoogle Scholar
  61. 61.
    Druyts EF, Rachlis BS, Lima VD, et al. Mortality is influenced by locality in a major HIV/AIDS epidemic. HIV Med. 2009;10(5):274–81.CrossRefPubMedGoogle Scholar
  62. 62.
    Joy R, Druyts EF, Brandson EK, et al. Impact of neighborhood-level socioeconomic status on HIV disease progression in a universal health care setting. J Acquir Immune Defic Syndr. 2008;47(4):500–5.CrossRefPubMedGoogle Scholar
  63. 63.
    Larkin J, Flicker S, Koleszar-Green R, Mintz S. HIV risk, systemic inequities, and Aboriginal youth: widening the circle for HIV prevention programming. Can J Public Health. 2007;98(3):179–82.PubMedGoogle Scholar
  64. 64.
    Sinha MM. Sex, structural violence, and AIDS: case studies of Indian prostitutes. Women’s Stud Q. 1999;27(1/2):65–72.Google Scholar
  65. 65.
    Waldram JB, Herring DA, Young TK. Aboriginal health in Canada: historical, cultural, and epidemiological perspectives. Toronto: University of Toronto Press; 1995.Google Scholar
  66. 66.
    Canada Mortgage and Housing Corporation. 2001 census housing series issue 6: revised Aboriginal households. Canada: CMHC; 2001.Google Scholar
  67. 67.
    Fenton L. Preventing AIDS through poverty reduction: the only sustainable solution? Lancet. 2004;364(9440):1186–7.CrossRefPubMedGoogle Scholar
  68. 68.
    Shelton JD, Cassel MM, Adetunji J. Is poverty or wealth the root of HIV? Lancet. 2005;366(9491):1057–8.CrossRefPubMedGoogle Scholar
  69. 69.
    Stillwaggon E. HIV/AIDS in Africa: fertile terrain. J Dev Stud. 2002;38(6):1–22.Google Scholar
  70. 70.
    Larkin JA. Women, poverty and HIV infection. Can Womens Stud. 2000;20(3):137–41.Google Scholar
  71. 71.
    Des Jarlais DC, Semaan S. HIV prevention for injecting drug users: the first 25 years and counting. Psychosom Med. 2008;70(5):606–11.CrossRefPubMedGoogle Scholar
  72. 72.
    Oetzel J, Duran B. Intimate partner violence in American Indian and/or Alaska native communities: a social ecological framework of determinants and interventions. Am Indian Alsk Native Ment Health Res. 2004;11(3):49–68.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Katrina C. Duncan
    • 1
    • 2
  • Charlotte Reading
    • 3
    • 4
    • 5
  • Alexandra M. Borwein
    • 1
    • 6
  • Melanie C. M. Murray
    • 7
  • Alexis Palmer
    • 1
  • Warren Michelow
    • 1
  • Hasina Samji
    • 8
  • Viviane D. Lima
    • 1
    • 7
  • Julio S. G. Montaner
    • 1
    • 7
  • Robert S. Hogg
    • 1
    • 6
  1. 1.Division of Epidemiology and Population HealthBritish Columbia Centre for Excellence in HIV/AIDSVancouverCanada
  2. 2.Faculty of ScienceUniversity of British ColumbiaVancouverCanada
  3. 3.School of Health and Human PerformanceDalhousie UniversityHalifaxCanada
  4. 4.Department of Human and Social DevelopmentUniversity of VictoriaVictoriaCanada
  5. 5.Centre for Aboriginal Health ResearchUniversity of VictoriaVictoriaCanada
  6. 6.Faculty of Health SciencesSimon Fraser UniversityBurnabyCanada
  7. 7.Division of AIDS, Faculty of MedicineUniversity of British ColumbiaVancouverCanada
  8. 8.Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA

Personalised recommendations