‘Experience talks, resilience shapes’ revisiting historic trauma: impact on treatment in indigenous males living with HIV/AIDS in British Columbia

There is an over-representation of HIV incidence, prevalence and mortality rates in the Indigenous population of Canada. Further, many do not adhere to HAART partly because of unresolved historic trauma (HT). Most research on HIV/AIDS therapy has focused on “maladaptive” characteristics of Aboriginal males and less on their adaptive, life-maintaining practices. This study explored the impact of HT on treatment among Indigenous males living with HIV/AIDS in BC, with a focus on adaptive/life maintaining practices, i.e., how the experience of HT positively affects male survivors’ ability to adhere to treatment, and the HT impact on treatment outcomes across age groups and residential school survivor status. Using interpretive description incorporating a cultural safety lens as the methodological framework, data was collected through one-to-one interviews, a focus group, and a few Life Story Board sessions. Thirty-six HT survivors told their lived experience stories, discussed how HT affected their adherence to HAART, and explained how they build resilience. Three main themes resulted from data analysis: 1) facilitators of choice or actions leading to HAART adherence; 2) factors leading to HAART non-adherence; and 3) comparative survivor responses on health, services, stigma and the historic trauma effect. Adherence choices and actions are promoted by psychological support, cultural services, religion and spirituality, structural services, resilience, strictness and discipline metered on indirect survivors through their parents. Negative choice or actions resulted from; personal reasons, cultural restrictiveness, lack of structural support and services, spiritual and religion-related factors, and intergenerational historic trauma effects. Finally, comparative responses of survivors’ views noted included the view of health with respect to resilience, availability of and access to services on-and off-reserve, stigma and confidentiality, and the effect of historic trauma through generations and across survivor status. The findings demonstrate how complex the experience and expression of HT is and that most Indigenous men can be resilient to stay on HAART and have better health and wellbeing. Cultural-safety informed recommendations are offered to better address HT, improve treatment-adherent behaviour and resilience, foster healing and reduce deaths due to HIV/AIDS. This study suggests promising resilience factors that have implications for both research and practice.