“Because of COVID…”: The impacts of COVID-19 on First Nation people accessing the HIV cascade of care in Manitoba, Canada

• Published in: PLOS ONE
• Main Authors: Larcombe, Linda, Ringaert, Laurie, Restall, Gayle, McLeod, Albert, Hydesmith, Elizabeth, Favel, Ann, Morris, Melissa, Payne, Michael, Souleymanov, Rusty, Keynan, Yoav, MacDonald, Kelly, Singer, Matthew, Star, Jared, Orr, Pamela
• Other Authors: Adesina, Miracle Ayomikun, Canadian Institute of Health Research
• Format: Article in Journal/Newspaper
• Language: English
• Published: Public Library of Science (PLoS) 2023
• Subjects: First Nations
• Online Access: http://dx.doi.org/10.1371/journal.pone.0288984; https://dx.plos.org/10.1371/journal.pone.0288984

Background The COVID-19 pandemic (March 2020-May 2023) had a profound effect around the world with vulnerable people being particularly affected, including worsening existing health inequalities. This article explores the impact of the pandemic on health services for First Nations people living with HIV (FN-PWLE) in Manitoba, Canada. This study investigated perceptions of both health care providers and FN-PWLE through qualitative interviews occurring between July 2020 and February 2022 to understand their experience and identify lessons learned that could be translated into health system changes. Methods Using a qualitative, participatory-action, intentional decolonizing approach for this study we included an Indigenous knowledge keeper and Indigenous research associates with lived experience as part of the study team. A total of twenty-five [25] in-depth semi-structured interviews were conducted with eleven healthcare providers (HCPs) and fourteen First Nation people with lived HIV experience (FN-PWLE). In total, 18/25 or 72% of the study participants self-identified as First Nation people. Results The COVID-19 pandemic negatively impacted health services access for FN-PWLE, a) disrupted relationships between FN-PWLE and healthcare providers, b) disrupted access to testing, in-person appointments, and medications, and c) intersectional stigma was compounded. Though, the COVID-19 pandemic also led to positive effects, including the creation of innovative solutions for the health system overall. Conclusions The COVID-19 pandemic exaggerated pre-existing barriers and facilitators for Manitoba FN-PWLE accessing and using the healthcare system. COVID-19 impacted health system facilitators such as relationships and supports, particularly for First Nation people who are structurally disadvantaged and needing more wrap-around care to address social determinants of health. Innovations during times of crisis, included novel ways to improve access to care and medications, illustrated how the health system can quickly ...