The Cedar Project: Longitudinal health outcomes associated with childhood neglect among young Indigenous people who use drugs in British Columbia, Canada

Background: Indigenous leaders are concerned that historical and lifetime traumas contribute to the HIV/HCV epidemics among their young people. To our knowledge, no previous studies have addressed the longitudinal effects of... [ view full abstract ]

Background: Indigenous leaders are concerned that historical and lifetime traumas contribute to the HIV/HCV epidemics among their young people. To our knowledge, no previous studies have addressed the longitudinal effects of emotional neglect (EN) and physical neglect (PN) on HIV risk among young Indigenous people who use drugs.

Methods: The Cedar Project is a cohort of young Indigenous people (aged 14-30) who use drugs in Vancouver, Prince George, and Chase, BC. We used the Childhood Trauma Questionnaire (CTQ) to determine experiences and severity levels (none; low/moderate; severe) of childhood EN and PN. Generalized linear mixed effects models explored associations between severity of EN and PN with HIV risk between 2003-2012, adjusting for confounders.

Results: Overall, 266 participants (53% women; mean age 23 years) completed the CTQ and at least one follow-up. For EN, 28.4% reported none, 51.1% reported low/moderate, and 17.8% reported severe experiences. For PN, 20.8% reported none, 36% reported low/moderate, and 39.4% reported severe experiences. Severe PN was associated with having a parent who had attended residential school (p=0.002). In multivariate analyses, an increase of one level of EN severity was associated with being involved in sex work (AOR: 1.88; 95% CI: 1.041-3.412), and injection drug use (AOR: 2.0; 95% CI: 1.113-3.849). A one level increase of PN severity was associated with homelessness (AOR: 1.33; 95% CI: 1.014-1.740); binge drinking (AOR: 1.5; 95% CI: 1.094-2.098); blacking out while drinking (AOR: 1.5; 95% CI: 1.082-2.105); inconsistently using condoms (AOR: 1.52; 95% CI: 1.025-2.258), and; binge injection (AOR: 1.64; 95% CI: 1.164-2.325).

Conclusion: Childhood neglect continues to negatively impact the health of young Indigenous people and contributes significantly to their vulnerability to HIV and HCV infection. The urgent need to develop public health responses that incorporate both historical trauma and cultural strengths to reduce risks cannot be overstated.