The Fostering Open eXpression among Youth (FOXY) and Strength, Masculinities, and Sexual Health (SMASH) programs conducted land-based Peer Leader Retreats (PLRs) in the Northwest Territories (NWT) between 2016 and 2021 to support HIV and sexually transmitted infection (STI) prevention among Northern and Indigenous youth. PLRs included multiple arts-based activities (e.g., photography, digital storytelling) and land-based approaches (e.g., education about the land, Elder teachings). Participants in the PLRs were Northern and Indigenous youth aged 13–17 years who lived in the NWT, Yukon or Nunavut. This study found that the approach was successful in improving post-test knowledge of HIV and STIs and safer sex self-efficacy scores among Northern and Indigenous youth participants. Focus groups with youth participants supported these findings, with youth reporting that they became more aware of safer sex and better able to navigate conversations on this topic.
Program description
The FOXY and SMASH programs provide sexual health education to Northern and Indigenous youth in the NWT. FOXY was designed for young women and gender-diverse people, while SMASH focuses on young men and gender-diverse people. Both programs use school- and land-based retreats to build knowledge about how to prevent HIV and STIs.
As part of these programs, PLRs were introduced to support learning and engagement. The land-based PLRs incorporated both arts-based and land-based activities to foster environments where youth could develop both technical (e.g., safer sex practices) and transformative communication (e.g., discussing sexual consent) skills. These retreats aimed to support the creation of environments conducive to knowledge and skills building with respect to the prevention of HIV and STIs.
PLRs were held annually for nine days in the summers between 2016 and 2021. Participants were 13 to 17 years old and recruited through social media, schools and community agencies, as well as existing peer networks. PLRs were held at a fly-in location at Blachford Lake Lodge, NWT, and in Yellowknife, NWT. PLRs were facilitated by community members, researchers, a healthcare provider, a mental health provider, volunteer apprentices who had previously attended the retreat, and peer facilitators aged 14–21 years who were past participants serving as staff members.
PLRs included multiple arts-based learning approaches, including:
- hand-drumming
- visual and theatre-based arts activities
- digital storytelling
- traditional Indigenous storytelling and teachings
- photography and journaling
- education about HIV and STIs, including a focus on healthy relationships
- developing community leadership projects
Specific land-based approaches included:
- Indigenous knowledge keeper and Elder teachings
- ceremonies
- education about the land
- recreational activities (e.g., hiking)
- traditional Northern games
What is land-based education?
Land-based education centres Indigenous knowledge and interconnectedness. It acknowledges that being on the land can create connection to community, culture and self through activities that include traditional storytelling, ceremony and drumming. Land-based learning focuses on relationality and reciprocity and fosters a holistic approach that may increase resilience. Land-based retreats aim to build self-esteem, self-efficacy and confidence, which can be helpful in realizing overall well-being, including sexual well-being.
Results
Between 2016 and 2022, 353 youth participated in PLRs and completed a survey and/or participated in a focus group. The 353 participants had the following characteristics:
- the mean age was 14 years
- 70.5% were Indigenous
- 66.2% were adolescent girls, 31% were adolescent boys and 2.8% were gender diverse
- 31.7% identified as sexually diverse (including lesbian, bisexual, gay, queer)
- 79.5% participated in FOXY retreats and 30.6% participated in SMASH retreats
In addition, focus groups were conducted with 252 facilitators, including youth apprentices and peer facilitators.
Pre- and post-test surveys with youth participants
Pre- and post-test surveys were conducted to collect information on participants’ knowledge of HIV and STIs and safer sex self-efficacy (SSE), which measured participants’ ability to negotiate safer sex practices. Of the 353 participants who attended PLR workshops, 277 (78.5%) completed the pre- and post-test STI/HIV knowledge survey and 326 (92.4%) completed the pre- and post-test SSE survey. Scores for the STI/HIV knowledge survey ranged from 0 to 15, where a score of 1 was given for each correct answer. Scores for the SSE ranged from 5 to 25, with higher scores indicating higher SSE. Participants had significantly higher STI/HIV knowledge scores after participating in a PLR workshop (pre-test: 7.10 vs. post-test: 13.23), with a mean pre/post-test score increase of 6.13. Participants’ SSE scores were higher after PLR workshop participation (pre-test: 15.64 vs. post-test: 17.78), with a significant score increase of 2.14.
Post-PLR focus groups with youth participants
In the focus groups, participants described an increase in their technical knowledge of HIV and STIs and how to practise safer sex. They also described learning the importance of knowing a partner’s STI status and feeling less afraid of discussing safer sex options.
Quotes from participants:
“I think what I learned is, when you’re comfortable, you’re able to say no [to sex]. Now like I feel like I’ll be able to say ‘no’ to him.” (youth participant, FOXY, 2017)
“I learned a lot new stuff about consent. Like, the ‘informed.’ I'm like that you have to ask to, you have to inform them about what you're going to do. I always knew consent was like a major part of sex and stuff.” (youth participant, SMASH, 2021)
With regard to transformative communication, three important findings emerged from the focus groups:
- increased comfort and confidence discussing sex, including sex positivity and enthusiasm for discussing sex
- increased awareness of and willingness to discuss sexual consent and boundaries, including young women being more empowered to say no to sex
- increased awareness of how to negotiate healthy relationships and use coping mechanisms to deal with emotions
Post-PLR focus groups with facilitators
Facilitators, apprentices and peer leaders participated in separate focus groups and indicated that the PLRs were “youth-friendly” and that they “facilitated learning” by providing fun ways to learn in a sex-positive and non-judgmental space that used role modelling.
What does this mean for service providers?
The use of PLRs can create environments that foster HIV and STI prevention education by supporting participants to develop technical skills as well as transformative communication skills. Arts-based and land-based approaches have the potential to support skills and knowledge development in Northern and Indigenous youth.
The use of role modelling by peers and Elders in PLRs was key to the success of this program. The authors of the study suggest that addressing the social determinants of health, in particular food insecurity, may help to improve participants’ ability to negotiate safer sex, as would addressing the potential stigma faced by gender-diverse participants. An intersectional approach that considers the broader contexts and overlapping barriers faced by youth could help to create environments that make it easier for youth to adopt approaches to prevent HIV and STIs.
Related resources
Fostering Open eXpression among Youth (FOXY) – CATIE evidence brief
HIV Positive Youth Peer Engagement (HYPE) – CATIE case study
FOXY and SMASH research summaries – website
Reference
Logie, CH, Lys CL, Taylor SB et al. Land‑based retreats as a method for building enabling environments for HIV prevention with Northern and Indigenous adolescents in the Northwest Territories, Canada: mixed‑methods findings. AIDS and Behavior. 2024;28:3112-3127.