Experiences of the HIV cascade of care among indigenous peoples: A systematic review

Indigenous leaders remain concerned that systemic oppression and culturally unsafe care impede Indigenous peoples living with HIV from accessing health services that make up the HIV cascade of care. We conducted a systematic review to assess the evidence related to experiences of the HIV care cascade among Indigenous peoples in Australia, Canada, New Zealand, and United States. We identified 93 qualitative and quantitative articles published between 1996 and 2017 reporting primary data on cascade outcomes disaggregated by Indigenous identity. Twelve involved data from Australia, 52 from Canada, 3 from New Zealand and 26 from United States. The majority dealt with HIV testing/diagnosis (50). Relatively few addressed post-diagnosis experiences: linkage (14); retention (20); treatment initiation (21); adherence (23); and viral suppression (24). With the HIV cascade of care increasingly the focus of global, national, and local HIV agendas, it is critical that culturally-safe care for Indigenous peoples is available at all stages

• Determinants of Health
  • Social support
  • Stigma/discrimination
  • Abuse
• Population(s)
  • Men who have sex with men
  • Women
  • Children or Youth (less than 18 years old)
  • Transgender communities
  • People who use drugs
  • Indigenous communities
  • General HIV+ population
• Engagement and Care Cascade
  • Linkage/engagement in care
  • Retention in care
  • Treatment
• Testing
  • Testing
• Substance Use
  • Alcohol
  • Nonmedicinal drugs
• Mental Health
  • Depression
  • Psychiatric disorders