Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.
Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.
PLoS One. 2023 Aug 2;18(8):e0288984. doi: 10.1371/journal.pone.0288984. eCollection 2023.
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.
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.
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.
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 provide solutions to long-standing barriers, especially for geographical barriers. Lessons learned from the COVID-19 pandemic should be considered for improvements to the health system's HIV cascade of care for FN-PWLE and other health system improvements for First Nations people with other chronic diseases and conditions. Finally, this study illustrates the value of qualitative and First Nation decolonizing research methods. Further studies are needed, working together with First Nations organizations and communities, to apply these recommendations and innovations to change health care and people's lives.
COVID-19 大流行（2020 年 3 月至 2023 年 5 月）在全球范围内产生了深远影响，弱势群体受到的影响尤其严重，包括现有的健康不平等状况进一步恶化。本文探讨了 COVID-19 大流行对加拿大马尼托巴省感染艾滋病毒的第一民族（FN-PWLE）人群的卫生服务的影响。本研究通过 2020 年 7 月至 2022 年 2 月期间进行的定性访谈，调查了医疗保健提供者和 FN-PWLE 的看法，以了解他们的经验，并确定可以转化为卫生系统变革的经验教训。
本研究采用定性、参与式行动、有意去殖民化的方法，研究团队包括一名土著知识守护者和具有实际生活经验的土著研究助理。共对 11 名医疗保健提供者（HCPs）和 14 名具有实际 HIV 感染经验的第一民族（FN-PWLE）进行了 25 次深入的半结构化访谈。共有 18/25 名或 72%的研究参与者自我认定为第一民族人。
COVID-19 大流行对 FN-PWLE 的卫生服务获取产生了负面影响，a）破坏了 FN-PWLE 与医疗保健提供者之间的关系，b）阻碍了检测、面对面预约和药物的获取，c）交叉性耻辱感加剧。尽管 COVID-19 大流行也带来了积极影响，包括为整个卫生系统创造了创新解决方案。
COVID-19 大流行放大了马尼托巴省 FN-PWLE 获得和使用医疗保健系统的先前存在的障碍和促进因素。COVID-19 影响了卫生系统的促进因素，如关系和支持，特别是对那些在结构上处于不利地位、需要更多全面关怀来解决健康决定因素的第一民族人来说。危机时期的创新包括改善获得护理和药物的新途径，说明了卫生系统如何能够迅速为长期存在的障碍提供解决方案，特别是对于地理障碍。应考虑从 COVID-19 大流行中吸取的经验教训，以改进针对 FN-PWLE 的艾滋病毒护理连续体的卫生系统和针对其他慢性疾病和状况的第一民族人的其他卫生系统改进。最后，本研究说明了定性和第一民族去殖民化研究方法的价值。需要进一步研究，与第一民族组织和社区合作，将这些建议和创新应用于改变医疗保健和人们的生活。
