By Andrew Russell

Amid soaring rates of HIV and syphilis in Canada – with Indigenous communities in the Prairies being hardest hit – a team of Indigenous leaders and HIV advocates, researchers, health care workers and people with lived experiences, including HIV, have created The Ayaangwaamiziwin Centre.

This Centre is a ground-breaking initiative to “test, treat and link to culturally safe care” 10,000+ people at risk for HIV and/or syphilis in the Prairies and an additional 2,500+ people in Yukon, Nunavut and Northwest Territories.

Launched on March 5, the Ayaangwaamiziwin Centre – an Ojibwe word for “carefulness and preparedness” – will consist of a constellation of organizations working together to provide access to testing, preventative care, harm reduction and treatment for HIV and syphilis in underserved and remote communities across the regions.

Co-led by Dr. Sean B. Rourke, director of REACH Nexus at the MAP Centre for Urban Health Solutions at St. Michael’s Hospital, the Ayaangwaamiziwin Centre is a collaborative effort involving leaders from community, the health system, public health, and regional governments in the Prairies and northern Territories. Following an initial $4 million in funding secured in 2024 from CIHR, Indigenous Services Canada (ISC), Staples Canada through the Even the Odds partnership, Jackman Foundation, and other foundations, the Ayaangwaamiziwin Centre recently received an additional $3.75 million from CIHR to expand its intervention work to support northern communities.

“HIV and infectious syphilis are public health emergencies in Canada, sweeping across communities, particularly in Alberta, Saskatchewan and Manitoba. The more people we can reach to test, diagnose and treat with HIV and syphilis, the faster we can help end these health crises,” said Dr. Rourke, director of REACH and a MAP scientist at St. Michael’s Hospital.

“This is a historic Canadian health partnership – involving the community, health care system and public health sectors.”

But none of this will make an impact on the people and communities most affected, without the leadership, expertise and commitment from Communities, Alliances & Network (CAAN) and Indigenous Services Canada (ISC) and the following agencies and organizations: StreetWorks, Radius Community Health and Healing, Northreach Society, and Alberta Health Services in Alberta; The Wellness Wheel Medical Clinic, the Northern Inter-Tribal Health Authority, and All Nations Hope Network in Saskatchewan; Nine Circles Community Health Centre, Ka Ni Kanichihk, Siloam Mission, and the Manitoba Harm Reduction Network in Manitoba; and One Yukon Coalition, the Chief Public Health Officers in Northwest Territories and Nunavut.

“Indigenous-led, culturally-grounded, trauma-informed, and community-oriented health services are an essential part of reducing the spread of sexually transmitted and blood borne infections in First Nations, Inuit and Métis communities,” said Dr. Tom Wong, Chief Medical Officer of Public Health, Indigenous Services Canada.

“We will continue to work alongside partners and leaders to support safe spaces for Indigenous Peoples to seek holistic care in their healing journey.”

Everyone in Canada has the right to access health services and to thrive, but for many this isn’t happening. Underserved and marginalized communities – especially First Nations, Inuit and Métis – have faced a history of colonization, residential schools, racism, stigma,  discrimination, overcrowding, food insecurity and other social determinants of health that have created significant systemic barriers (over decades) leading to progressive, profound and persistent health disparities.

The latest data from the Public Health Agency of Canada shows in 2023:

• New HIV diagnoses climbed more than 35 percent since 2022.
• In Saskatchewan, the rate of HIV was 19.4 per 100,000 people and in Manitoba it was 19.3 – more than three times the national rate.
• In 2022, there were nearly 14,000 reported syphilis cases, with rates increasing by 109 per cent overall compared to 2018.
• In Alberta, Manitoba, Saskatchewan rates have risen 105 percent, 123 per cent and over 1,400 percent respectively. In the Yukon, infectious syphilis rates jumped by an astounding 2,344 per cent during that time period, while N.W.T. saw an 844 percent increase.
• Congenital syphilis cases have seen a seven percent increase from 2021 and a nearly 600 per cent increase from 2018. Consequences of congenital syphilis for mother and unborn infant can be severe, resulting in miscarriage, stillbirth, and death shortly after birth, in 20-30% of cases.

Searching for a solution

In March 2024, over 100 collaborators – who had been meeting for more than a year virtually – came together for a landmark two-day meeting in Winnipeg to address this dire health crisis.

Their goal: to develop innovative and pragmatic actions to address the health crises of HIV, syphilis and other sexually transmitted and blood-borne infections (STBBIs) in the Prairies and in the Yukon, Northwest Territories and Nunavut. The late Roger Roulette, an Ojibwe Language Specialist from Manitoba, shared the Ojibwe philosophy, ayaangwaamiziwin – carefulness:preparedness, with team member Elder Albert McLeod. In addressing HIV-STBBI’s, this ancient tradition, ethic and value is highlighted in all aspects of the work that this project is undertaking in Canada. 

At the heart of this initiative is the holistic and community-centred approach of our interventions and knowledge mobilization efforts involving people with lived and living experiences. Through a “Two-Eyed Seeing” approach, our teams in Alberta, Manitoba and Saskatchewan are working closely with Indigenous leaders, with Indigenous-led and non-Indigenous-led community-based HIV, harm reduction and health agencies, and with affected communities.

Together, along with Indigenous Ways of Knowing and Doing, the initiative is building a shared vision of a culturally responsive, community-driven healthcare model to reach people who might be at risk for HIV and/or syphilis. The initiative will provide options for treatment and care with community-based health care practitioners who can help to engage those affected in spaces of trust, empathy and safety.

“This community-centered initiative is a transformative approach to addressing health disparities among Indigenous populations,” said Nikki Williamson, a Registered Nurse with the Wellness Wheel Medical Clinic in Sask. “By integrating testing and treatment for multiple diseases, including HIV and syphilis, into a single, accessible framework, this initiative demonstrates the power of community-driven healthcare. Grounded in trusted partnerships and culturally safe care spaces, this initiative offers a scalable, syndemic-focused solution that can be adapted to improve healthcare access and outcomes in underserved communities nationwide.”

Over the next five years, Ayaangwaamiziwin Centre will continue expanding our engagement bringing on more frontline agencies, people with lived experiences, and building community-driven partnerships in the Prairies and the northern Territories to reach those who have been failed by our traditional health care systems.

This new testing, care and prevention initiative is critical towards ending the HIV and syphilis epidemics in Canada.

“The Ayaangwaamiziwin Centre changes the conversation and ways of reaching Indigenous peoples and other communities and key populations affected, and provides a new pathway for people who might have gone through trauma or faced discrimination when accessing the traditional health care system,” said Albert McLeod. “This new way forward is about giving people more choices and options to reclaim their health and wellbeing.”