First Nations People Living With HIV: Results From a Qualitative Study Through a Two-Eyed Seeing Approach

First Nations people living with the human immunodeficiency virus (HIV) in Canada face a range of complex barriers during a time when infection rates are increasing. The Northern HIV Journey Mapping Project explored this issue from the perspectives of both First Nations people living with HIV and the health care service providers who support them. Drawing from an Indigenous-led, decolonizing methodology, this study adopted the philosophies of Two-Eyed Seeing and Ethical Research Space. A total of 18 First Nations people living with HIV and 11 health care providers from throughout the province of Manitoba participated in semi-structured interviews that explored the barriers and facilitators present at each of the six milestones of the HIV care cascade. Three interrelated themes emerged across all milestones and from both participant groups: (1) Intersectional stigmas operate throughout the entire HIV journey, both within the health care systems and in the lives of community members; (2) Privacy and confidentiality related to HIV status and other health care information is difficult to maintain in rural, remote, and northern care contexts; and (3) Knowledge gaps related to HIV and sexual health are common. Results were interpreted by both First Nations and non-First Nations team members, including the project Elder, showing that each theme reflects legacies of colonization. Recommendations include developing an Indigenous-led strategy that included peer-based education and support programs that address each theme simultaneously to improve the well-being of First Nations people living with HIV in Manitoba.