ESTABLISHING A SENTINEL SURVEILLANCE SYSTEM FOR HIV-ASSOCIATED RISK BEHAVIOURS AMONG ABORIGINAL POPULATIONS IN CANADA

Objectives: Available data from routine surveillance systems are unable to adequately explain the current status and trends of HIV infection and related risk behaviours among Aboriginal peoples; additional data sources are required. This paper outlines the framework to establish a sentinel HIV surveillance system among Aboriginal (First Nations, Metis, Inuit) peoples in Canada. Methods:The Public Health Agency of Canada is working with Aboriginal representatives to develop A-Track, a second-generation HIV/AIDS surveillance system. Work is underway to finalize the surveillance instruments and to identify pilot site(s) in consultation with the A-Track Working Group. Results: A national enhanced HIV surveillance system among Aboriginal populations envisages biological and behavioural surveillance via repeated cross-sectional surveys with consistent sampling strategy, data collection methods and indicators to monitor trends in HIV- related risk behaviours, HIV-testing history, and knowledge and attitudes about HIV/AIDS, over time. The biological component will be optional, and testing for pathogens other than HIV is subject to validity of specimen collection and testing methods. The system underscores Aboriginal involvement at all stages, recognizes Aboriginal peoples' shared control over jurisdictional data and respects Aboriginal customs. The pilot survey will be launched in 2009-10. Conclusions: Successful design and implementation of a sentinel HIV surveillance system among Aboriginal peoples entails community engagement, utilization of existing infrastructures and enhanced Aboriginal capacity-building. A better understanding of HIV-related risk behaviours and HIV prevalence over time will facilitate improved policy and program interventions at the local, provincial/territorial and federal levels in order to prevent and control HIV infection among Aboriginal populations.