title: The Complexities of Accessing Care and Treatment: Understanding Alcohol Use by Aboriginal Persons Living with HIV and AIDS.
abstract: The role of alcohol in the transmission of HIV and access to health services for persons living with HIV/AIDS is relatively unexamined across the globe. Our team's community-based, mixed methods study examined both of these questions from the perspectives of Aboriginal persons living in Canada with HIV/AIDS (APHA) and service providers (SP). A bilingual national survey was undertaken with APHAs and SPs and the findings were followed up on in peer interviews. A complex relationship was identified between alcohol use, perceptions of alcohol use and access to services. Nearly half of APHAs surveyed reported that alcohol played a role in their becoming HIV positive. APHAs and SPs differed in their assessment of the impact of alcohol in the lives of Aboriginal persons once diagnosed, with a far greater proportion of SPs identifying it as problematic. Both SPs and APHAs associated the misuse of alcohol with diminished health. Nearly half of the APHAs surveyed shared they had been told they were drinking by a SP when they were not, while over one-third reported ever being denied services because of drinking when in fact they were not. Both SPs and APHAs identified physical health and discrimination as key reasons. Notwithstanding these results that point to shortcomings in service provision, the data also reveal that most APHAs are recieving care in which their choices are respected and from providers they trust. The findings point to the need for a nuanced strategy to solidify the strengths and address the shortcomings in APHA's service provision.
authors.affiliation: Renée Masching (MA) is First Nations from Southern Ontario and is the Director of Research and Policy with the Canadian Aboriginal AIDS Network.
authors.forename: Renée
authors.initials: R
authors.lastname: Masching
authors.affiliation: Colleen Anne Dell (PhD) is a Professor and Research Chair in Substance Abuse at the University of Saskatchewan in the Department of Sociology and School of Public Health. She is also a Senior Research Associate with the Canadian Centre on Substance Abuse.
authors.forename: Colleen A
authors.initials: CA
authors.lastname: Dell
authors.affiliation: John P Egan (PhD) is a Canadian community-based researcher based at the University of Auckland in Auckland, New Zealand.
authors.forename: John P
authors.initials: JP
authors.lastname: Egan
authors.affiliation: Nancy Gros-Louis McHugh (BA) is Huronne-Wendat from Wendake, and works as the research coordinator for the First Nations of Quebec and Labrador Health and Social Services Commission.
authors.forename: Nancy Gros-Louis
authors.initials: NG
authors.lastname: McHugh
authors.affiliation: David Lee (1962-2013) was a Sekani Person living with HIV/AIDS from McLeod Lake First Nations in northern BC and spent more than 15 years working on the front lines in the Downtown Eastside of Vancouver.
authors.forename: David
authors.initials: D
authors.lastname: Lee
authors.affiliation: Tracey Prentice is a PhD Candidate in Population Health at the University of Ottawa.
authors.forename: Tracey
authors.initials: T
authors.lastname: Prentice
authors.affiliation: Lyanna Storm is a Service Provider with the Vancouver Native Health Society, and a community facilitator at the Positive Women's Network and Dr. Peter Centre.
authors.forename: Lyanna
authors.initials: L
authors.lastname: Storm
authors.affiliation: Cliff Thomas (Elder) is originally from Pegwis First Nations, Manitoba and now lives in Ottawa, Ontario. He is a past National Research Advisory Committee member and an Elder for the Aboriginal HIV & AIDS Community-Based Research Collaborative Centre (AHA Centre).
authors.forename: Cliff
authors.initials: C
authors.lastname: Thomas
authors.affiliation: Amy McGee (PhD) is a community-based researcher and midwife living in Ottawa and owner of Drawing Insight.
authors.forename: Amy
authors.initials: A
authors.lastname: McGee
authors.affiliation: Hugh Dale-Harris (BEd) is a teacher, researcher, adventurer and father and also co-owner of Drawing Insight.
authors.forename: Hugh
authors.initials: H
authors.lastname: Dale-Harris