Abstract
BackgroundSince 2005, the Tłįchǫ Community Services Agency (TCSA) in Canada's Northwest Territories (NT) has addressed rising rates of sexually transmitted infections (STI). In 2009, STI rates in the NT were ten times higher than the national rate and Tłįchǫ regional rates were nearly four times that of the NT – 91 cases per 1000 people. We describe a social audit process that assessed the impact of an evidence-based community-led intervention.MethodsA baseline survey of sexual health knowledge, attitudes and behaviours in 2006/07 provided evidence for a Community Action Research Team (CART) to develop and to put in place culturally appropriate interventions in the Tłįchǫ region. A follow-up study in 2010 sought to assess the impact of CART activities on condom use and underlying conscious knowledge, attitudes, subjective norms, intention to change, sense of agency and discussions related to condom use and STI risks. We report the contrasts using Odds Ratios (OR) and 95% confidence intervals (CI).ResultsOne in every three follow-up respondents (315/808) participated in at least one CART activity. Participation in highly ranked interventions was associated with increased condom use during the last sexual encounter (OR 1.45, 95%CI 1.07-1.98). Those exposed to three or more activities were more likely to talk openly about condoms (OR 2.08, 95%CI 1.41-3.28), but were also less likely to be monogamous (OR 0.49, 95%CI 0.29-0.90).ConclusionsThe measurable impact on condom use indicates a strong beginning for the Tłįchǫ community intervention programmes. The interventions also seem to generate increased discussion, often a precursor to action. The Tłįchǫ can use the evidence to improve and refocus their programming, increase knowledge and continue to improve safe condom use practices.
Highlights
Since 2005, the Tłįchǫ Community Services Agency (TCSA) in Canada’s Northwest Territories (NT) has addressed rising rates of sexually transmitted infections (STI)
Due to the variation in the intervention content, length and degree of participant interaction, we examined the associations of Community Action Research Team (CART) exposure from three different perspectives: participation in any activity, levels of increasing participation, and community assigned a priori rankings
The same proportion of baseline (90%) and follow-up participants (91%) reported they did not have more than one sexual partner in the past month (Table 2a)
Summary
Since 2005, the Tłįchǫ Community Services Agency (TCSA) in Canada’s Northwest Territories (NT) has addressed rising rates of sexually transmitted infections (STI). Despite many well-intentioned health programmes and policies, the burden of illness among rural Aboriginal communities in northern Canada continues to grow [1,2]. Established by the new Tłįchǫ Government in 2005, the Tłįchǫ Community Services Agency (TCSA) is part of an Intergovernmental Services Agreement between the Government of Canada, the Government of the Northwest Territories (GNT) and the Tłįchǫ Government. In year three of a ten-year transition period, an early step in the transfer was to integrate education, health and social services programmes and professional services to embody traditional community values under the umbrella of TCSA
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