Cedar Project: Resilience in the face of HIV vulnerability among young Indigenous people who use drugs in three Canadian cities

We sought to identify cultural factors that protect against HIV and buffer the effects of historical/lifetime trauma among young Indigenous people who use drugs.

 The Cedar Project is a cohort study of young Indigenous people who use illicit drugs in Vancouver, Prince George, and Chase, BC. Participants completed the Childhood Trauma Questionnaire and the Connor-Davidson Resilience Questionnaire between 2011-2012. Adjusted linear mixed effects models (LME) estimated the effect of the size (B) and 95% confidence intervals (CI) of study variables on mean change in resilience scores.

Among 191 eligible participants; 51% were women, the mean age was 28.9; 48% had a parent who attended residential school, 71% had been in foster care. Only 8% reported no childhood maltreatment, while 39% reported severe sexual abuse, 41% severe physical abuse, 33% severe emotional abuse, 20% severe emotional neglect, and 39% severe physical neglect. Factors associated with diminished resilience scores included severe emotional neglect (B=-13.34, 95%CI:-21.25, -5.42), smoking crack daily or more (B=-5.42, 95%CI:-10.66, -0.18), sexual assault (B=14.4, 95%CI:-28.09, -0.76), and having blackouts from drinking (B=-6.19, 95%CI:-11.62, -0.75). Factors associated with higher resilience scores included having a family that often/always lived by traditional culture (B=7.70, 95%CI:2.53-12.86) or often/always spoke their traditional language (B=10.52, 95%CI: 5.72-15.33). Participants who were currently often/always living by traditional culture (B=6.50, 95%CI:0.86-12.14) knew how to speak a traditional language (B=13.06, 95%CI:4.85-21.26), and had sought drug/alcohol treatment (B=4.84, 95%CI: .35-9.33) also had higher resilience scores.

Cultural foundations continue to protect young Indigenous people from severe health outcomes, including HIV infection.