Abstract：
BACKGROUND: Within Manitoba and Saskatchewan, pre-existing health inequities amongst Indigenous groups were intensified during the COVID-19 pandemic. Service disruptions in the health and social service sector-combined with the effects of intersectional stigma-disproportionately impacted Indigenous peoples living with HIV (IPLH). IPLH experience structural violence and necropolitical exclusion through systemic forms of stigma situated within Canada\'s expansive colonial history. Utilizing the theoretical foundations of structural violence and necropolitics, this qualitative study examines how the COVID-19 pandemic amplified preceding states of inequity for IPLH.
METHODS: Semi-structured interviews were conducted with 60 participants. The sample comprised of those with lived experience (n = 45) as well as those who provided services for IPLH (n = 15). Indigenous Storywork guided the data collection and analysis process. Topics explored within each interview included access to health and social services, harm reduction, substance use, and experiences in providing services during COVID-19 pandemic. Thematic analysis was used to identify common themes throughout each story.
RESULTS: Our results indicate that the COVID-19 pandemic exposed and amplified pre-existing forms of structural violence and necropolitical logics for IPLH within Manitoba and Saskatchewan. Specifically, we describe how structural violence and necropolitics are manifested via three main avenues- (i) restrictions and removal of care, (ii) bureaucracy and institutional care politics, and (iii) discrimination and systemic racism within the Canadian healthcare system.
CONCLUSIONS: The COVID-19 pandemic within Manitoba and Saskatchewan sparked massive changes in service provision within settler-colonial and neoliberal institutions of care. For those services that remained open to IPLH, masking requirements, questionnaire requirements, scheduling requirements, and a lack of in-person services acted as only some of the barriers described by community members as detrimental to care access. Increased experiences of discrimination in health care on the basis of substance use or HIV status further limited access to needed services.
METHODS: Semi-structured interviews were conducted with 60 participants. The sample comprised of those with lived experience (n = 45) as well as those who provided services for IPLH (n = 15). Indigenous Storywork guided the data collection and analysis process. Topics explored within each interview included access to health and social services, harm reduction, substance use, and experiences in providing services during COVID-19 pandemic. Thematic analysis was used to identify common themes throughout each story.
RESULTS: Our results indicate that the COVID-19 pandemic exposed and amplified pre-existing forms of structural violence and necropolitical logics for IPLH within Manitoba and Saskatchewan. Specifically, we describe how structural violence and necropolitics are manifested via three main avenues- (i) restrictions and removal of care, (ii) bureaucracy and institutional care politics, and (iii) discrimination and systemic racism within the Canadian healthcare system.
CONCLUSIONS: The COVID-19 pandemic within Manitoba and Saskatchewan sparked massive changes in service provision within settler-colonial and neoliberal institutions of care. For those services that remained open to IPLH, masking requirements, questionnaire requirements, scheduling requirements, and a lack of in-person services acted as only some of the barriers described by community members as detrimental to care access. Increased experiences of discrimination in health care on the basis of substance use or HIV status further limited access to needed services.
摘要：
背景：在曼尼托巴省和萨斯喀彻温省，在COVID-19大流行期间，土著群体之间先前存在的健康不平等现象加剧。卫生和社会服务部门的服务中断，再加上相互污名化的影响，对感染艾滋病毒的土著人民（IPLH）造成了不成比例的影响。IPLH通过位于加拿大广阔的殖民历史中的系统形式的污名经历结构性暴力和坏死的政治排斥。利用结构性暴力和坏死政治的理论基础，这项定性研究调查了COVID-19大流行如何放大了IPLH不平等的先前状态。
方法：对60名参与者进行了半结构化访谈。样本包括有生活经验的人（n=45）以及为IPLH提供服务的人（n=15）。土著故事指导了数据收集和分析过程。每次面试中探讨的主题包括获得健康和社会服务，减少危害,物质使用,以及在COVID-19大流行期间提供服务的经验。主题分析用于确定每个故事中的共同主题。
结果：我们的结果表明，COVID-19大流行暴露并放大了曼尼托巴省和萨斯喀彻温省IPLH的结构性暴力和坏死政治逻辑。具体来说,我们描述了结构性暴力和坏死政治是如何通过三个主要途径表现出来的-(I)限制和取消护理，(二)官僚主义和机构关怀政治,和（iii）加拿大医疗保健系统内的歧视和系统性种族主义。
结论：曼尼托巴省和萨斯喀彻温省的COVID-19大流行引发了定居者殖民地和新自由主义护理机构内服务提供的巨大变化。对于那些对IPLH仍然开放的服务，掩蔽要求,问卷要求，调度要求，缺乏当面服务只是社区成员所描述的不利于获得护理的一些障碍。基于药物使用或艾滋病毒状况的医疗保健歧视的经验增加，进一步限制了获得所需服务的机会。
方法：对60名参与者进行了半结构化访谈。样本包括有生活经验的人（n=45）以及为IPLH提供服务的人（n=15）。土著故事指导了数据收集和分析过程。每次面试中探讨的主题包括获得健康和社会服务，减少危害,物质使用,以及在COVID-19大流行期间提供服务的经验。主题分析用于确定每个故事中的共同主题。
结果：我们的结果表明，COVID-19大流行暴露并放大了曼尼托巴省和萨斯喀彻温省IPLH的结构性暴力和坏死政治逻辑。具体来说,我们描述了结构性暴力和坏死政治是如何通过三个主要途径表现出来的-(I)限制和取消护理，(二)官僚主义和机构关怀政治,和（iii）加拿大医疗保健系统内的歧视和系统性种族主义。
结论：曼尼托巴省和萨斯喀彻温省的COVID-19大流行引发了定居者殖民地和新自由主义护理机构内服务提供的巨大变化。对于那些对IPLH仍然开放的服务，掩蔽要求,问卷要求，调度要求，缺乏当面服务只是社区成员所描述的不利于获得护理的一些障碍。基于药物使用或艾滋病毒状况的医疗保健歧视的经验增加，进一步限制了获得所需服务的机会。
