AIDS and Behavior

, Volume 23, Issue 4, pp 984–1003 | Cite as

Experiences of the HIV Cascade of Care Among Indigenous Peoples: A Systematic Review

  • Kate JongbloedEmail author
  • Sherri Pooyak
  • Richa Sharma
  • Jennifer Mackie
  • Margo E. Pearce
  • Nancy Laliberte
  • Lou Demerais
  • Richard T. Lester
  • Martin T. Schechter
  • Charlotte Loppie
  • Patricia M. Spittal
  • For the Cedar Project Partnership
Substantive 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.


Systematic review Indigenous peoples HIV/AIDS Cascade of care Treatment 



We are grateful for the guidance of the Cedar Project Partnership: Elders Violet Bozoki (Lheidli T’enneh) and Earl Henderson (Métis/Cree); Vancouver Native Health Society; Red Road HIV/AIDS Network; Canadian Aboriginal AIDS Network; Carrier Sekani Family Services; Positive Living North; Prince George Friendship Centre; All Nations Hope; Splatsin, Neskonlith and Adams Lake Indian Bands. Thank you also to Ursula Ellis, reference librarian at UBC's Woodward Library, for help developing the search strategy.

Compliance with Ethical Standards

Conflict of interest

There are no conflicts of interest.

Ethical Approval

This article involves a review of published studies and therefore does not contain any studies with human participants performed by any of the authors for this publication. Author CL was an author involved in two of the 93 articles selected for inclusion, both of which were conducted in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Supplementary material

10461_2018_2372_MOESM1_ESM.pdf (130 kb)
Supplementary material 1 (PDF 130 kb)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Kate Jongbloed
    • 1
    Email author
  • Sherri Pooyak
    • 2
    • 3
  • Richa Sharma
    • 1
  • Jennifer Mackie
    • 4
    • 5
  • Margo E. Pearce
    • 1
  • Nancy Laliberte
    • 1
    • 6
  • Lou Demerais
    • 6
    • 7
  • Richard T. Lester
    • 8
  • Martin T. Schechter
    • 1
  • Charlotte Loppie
    • 9
    • 10
  • Patricia M. Spittal
    • 1
    • 11
  • For the Cedar Project Partnership
  1. 1.School of Population and Public HealthUniversity of British ColumbiaVancouverCanada
  2. 2.CreeVictoriaCanada
  3. 3.Aboriginal HIV and AIDS Community-Based Research Collaborative CentreVictoriaCanada
  4. 4.Nak’azdli Whut’enVancouverCanada
  5. 5.Peter A. Allard School of LawUniversity of British ColumbiaVancouverCanada
  6. 6.Cree and MétisVancouverCanada
  7. 7.Vancouver Native Health SocietyVancouverCanada
  8. 8.Division of Infectious DiseasesUniversity of British ColumbiaVancouverCanada
  9. 9.Mi’kmaqVictoriaCanada
  10. 10.School of Public Health and Social Policy, Faculty of Human and Social DevelopmentUniversity of VictoriaVictoriaCanada
  11. 11.BC Children’s Hospital Research InstituteVancouverCanada

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