Addressing HIV in Indigenous populations: Challenges, progress and paths forward

Darrell Tan is an infectious diseases physician and clinician-scientist at St. Michael’s Hospital and an Associate Professor of Medicine at the University of Toronto, Toronto, Canada. After earning his undergraduate degree at McGill University in Montréal, Quebec, he completed medical school and residency training (2007) and a PhD in clinical epidemiology (2012) at the University of Toronto. Darrell has dedicated his career to working on the HIV epidemic because of its profound impact on key historically marginalized communities in Canada and abroad, including sexual and gender minorities and racialized populations.

His research programme is focused on optimizing strategies for effective HIV prevention and addressing the overlapping epidemics of HIV and other sexually transmitted infections (STIs). He holds a Tier 2 Canada Research Chair in HIV Prevention and STIs, and has been principal investigator or co-principal investigator in multi-centre clinical trials and cohort studies related to pre- and post-exposure prophylaxis (PrEP and PEP), antiretroviral therapy, herpes simplex virus co-infection, syphilis screening and STI prophylaxis. In particular, Darrell has been a strong advocate for broader and more equitable roll out of PrEP since its inception. Accomplishments in this area include conducting Canada’s first PrEP demonstration project in 2014, initiating and co-chairing the development of evidence-based Canadian clinical guidelines on PrEP and PEP in 2017, and leading an ongoing implementation science project funded by the Canadian Institutes of Health Research (CIHR) on scaling up PrEP delivery among gay, bisexual and other men who have sex with men. In 2018, Darrell was honoured with the CAHR-CANFAR Excellence in Research Award in the Clinical Sciences.

Darrell has played an active leadership role in the Canadian HIV research community in many ways. He served as Co-Chair of the Canadian Association of HIV Research Conference in 2015 and is currently part of the Steering Committee of the CIHR Canadian HIV Trials Network (CTN) as the Co-Lead of the Prevention Core; he previously served on its scientific review committee for 11 years. With community leaders, he co-chaired the HIV Research Ethics Board at the University of Toronto from 2013 to 2018 and co-led the HIV prevention taskforce of Toronto To Zero, an initiative to end new HIV acquisitions in Canada’s largest city.

In the context of the COVID-19 pandemic, his work expanded to include COVID-19 prevention and treatment trials. He led a multi-centre COVID-19 PEP trial and is on the Steering Committee for the Canadian Treatments for COVID-19 (CATCO) trial, the Canadian arm of the global SOLIDARITY trial.

For the International AIDS Society, Darrell has been a conference abstract reviewer every year since 2006, co-chaired poster discussions and served as an organizing committee member for the pre-conference, “Understanding and Addressing the HIV and STI Syndemics”, in Amsterdam in 2018.

Trevor Stratton, a citizen of the Mississaugas of the Credit First Nation, is a prominent figure in the fight against HIV and AIDS, particularly within Indigenous communities. Diagnosed with HIV in 1990, Stratton has been a resilient advocate and leader in this field. He has been involved with CAAN Communities, Alliances & Networks for over 25 years. Trevor is now the Indigenous Leadership Policy Manager at CAAN. His work has extended to various roles including serving as the Board President of 2-Spirited People of the 1st Nations, and Board director and National Advocate for the Canadian Foundation for AIDS Research (CANFAR). He has also been a professional consultant since 2005 and has maintained active involvement in the Two-Spirit and HIV/AIDS community. Trevor Stratton's story is one of turning a personal challenge into a lifelong mission to support others and advocate for change in public health and awareness regarding HIV and AIDS.

Michelle Tobin, a Yorta Yorta woman and descendant of the Stolen Generations, has lived with HIV since 1990 and has dedicated her life to advocating for Aboriginal and Torres Strait Islander people living with HIV. A mother and grandmother, Michelle has serves on the boards of the ANWERKNHE National HIV Alliance, NAPWHA, and the Leichardt Women’s community health center in addition to serving as Convenor of the Positive Aboriginal and Torres Strait Islander Network (PATSIN). She advocates for better access to HIV treatments and prevention, particularly PrEP for women, and has worked on projects addressing health disparities in rural and Indigenous communities. With a Graduate Diploma in Indigenous Health Promotion, Michelle continues to break down barriers and amplify the voices of Indigenous people living with HIV.

Orellana, PhD, MPH, MSW, is a professor of social work and global health at the University of Washington (Seattle). Dr. Orellana is indigenous Maya, born and raised in Guatemala. He’s spent most of his life living in the ancestral lands of the Coast Salish and Chinook people in today’s Washington State and Oregon (USA). He has worked in HIV prevention research for more than two decades, working with diverse teams throughout the Americas. Currently his team is working together with Indigenous Traditional Healers and Indigenous LGTBQ+ people in Guatemala on reducing HIV-related intersectional stigmas.

Secretary of the Coalition of Indigenous Peoples of Latin America and the Caribbean. Integrated by leaders from Latin America and the Caribbean working for the recognition of our indigenous peoples and nations, influencing public policy in the fight against HIV.

Randy Jackson, an expert on HIV-positive Indigenous men, challenged research that often only pathologized Indigenous peoples. Working with communities, Jackson works to provide a more holistic understanding by centring strengths rooted in culture, spirituality, and relationships. Through community-based research, Jackson shows how Indigenous ways of knowing support successful living—physical, emotional, spiritual, and mental—and how culture shapes wellness and expands our understanding of human health.