What is the program?
The Medicine Bundle program distributes Medicine Bundles that contain HIV self-test kits along with Indigenous medicines, sexual health supplies and other resources (e.g., sexual health pamphlets) to people who identify as Indigenous (i.e., First Nations, Métis, Inuit).
The Medicine Bundle program is run by the Two-Spirit Program at the Community-Based Research Centre (CBRC) in Vancouver, British Columbia, and is funded by the Public Health Agency of Canada and the First Nations Health Authority in B.C. CBRC promotes the health of people of diverse sexualities and genders through research and intervention development.
Why was the program developed?
Conversations around sexuality and sexual health have been stifled and limited in Indigenous communities because of the impact of colonization. Sex is natural and the exchange that occurs between bodies should be honoured in all its consensual forms. The Medicine Bundle program was developed to bring sacredness back to sex and aims to reduce the stigma around sexuality, HIV and sexual health.
Medicine Bundles, also known as sacred bundles, hold deep meaning among many Indigenous groups across Turtle Island. Recognizing that advances in modern medicine can benefit Indigenous peoples, the Two-Spirit Program at CBRC developed the Medicine Bundle program to weave biomedical resources with traditional medicines.
The Medicine Bundle program was made by and for the Two-Spirit, queer and trans Indigenous community. This program was developed specifically with Two-Spirit people in mind because of continued erasure of this community. Through the support of Two-Spirit people in leadership positions and at the forefront of this initiative, the Two-Spirit Program aimed to increase awareness and representation of Two-Spirit people more broadly. The Two-Spirit Program recognized their positionality in working with distinct Indigenous populations in B.C. and the importance of working collaboratively and meaningfully with local Two-Spirit people, understanding that they are experts of their own cultures, communities and regions.
The pilot phase of the Medicine Bundle program emerged from nearly two years of consultation and engagement with Elders, activists, researchers and members of the Two-Spirit community in B.C., some of whom went on to form a Guidance Committee. This committee provided guidance on culturally sensitive and intentional ways to reduce stigma around sexuality, HIV and sexual health in Indigenous communities and address disparities in access to HIV testing and sexual health resources. All parts of the Medicine Bundle pilot program were discussed with the Guidance Committee before implementation. The program has had three phases, starting with the pilot phase during which kits were exclusively mailed out in B.C. from June to August 2022. The current phase of the program was launched in October 2023, with kits now being distributed nationally.
How does the program work?
The program mails a Medicine Bundle including HIV self-test kits, Indigenous medicines, safer sex supplies and sexual health resources to Two-Spirit, queer and trans Indigenous people upon request.
To be eligible to receive a Medicine Bundle, an individual must:
- identify as Indigenous (i.e., First Nations, Métis, Inuit); and
- be a resident of what is colonially referred to as Canada.
To access the Medicine Bundle, individuals visit a website and complete a short order form. The Medicine Bundles are packed in Vancouver. The contents of the bundles were chosen with the guidance of Indigenous community members. All bundles contain the following items (some medicines may not be available at certain times of the year):
- 2 HIV self-test kits (more than two kits can be requested)
- Indigenous medicines
- sage
- sweetgrass
- tobacco
- cedar
- lavender
- Labrador tea
- bear grease
- devil’s club salve
- sexual health supplies (i.e., condoms and quality lube)
Additionally, all Medicine Bundles also contain the following resources:
- a pamphlet that was created by the Two-Spirit Program to provide context about the bundles and the intent of the program (see Program materials section)
- a pamphlet to support the use of Indigenous medicines that describes each medicine, what it is used for and how to use it (e.g., how much is too much)
- information about the Two-Spirit Program and related activities (e.g., community events, research summaries)
Individuals can also select several additional sexual health resources they would like to include in their Medicine Bundle by checking boxes on the order form. Resources are created by a partner organization (e.g., CATIE). Indigenous resources are prioritized for inclusion. Sexual health resources include (but are not limited to) information on undetectable = untransmittable, HIV prevention (e.g., pre-exposure prophylaxis [ PrEP]) and HIV testing.
Program supports
The pilot phase of the program launched with the support of Trusted Messengers, who were Two-Spirit people and Indigenous women in five health authorities in B.C. These individuals worked within their communities to provide sexual health guidance, HIV self-testing support, and share knowledge with, and provide support for, community members. By supporting Two-Spirit people to take the lead in their respective regions as Trusted Messengers, the Trusted Messengers were able to create more effective pathways and access to the Medicine Bundle. This is a shining example of the "nothing about us, without us” principle in action. After the pilot phase, funding was no longer available to support the Trusted Messengers.
Currently, people who receive a Medicine Bundle can receive support through the HIV self-testing process from the CBRC’s Test Now Buddies (the availability of this service is contingent on continued funding for the Test Now program). Test Now Buddies are peers who are available by phone, text and email to offer peer support and guidance about how to use the HIV self-test correctly. Buddies can also connect people to resources for HIV and sexually transmitted and blood-borne infection (STBBI) prevention and care (e.g., confirmatory testing, PrEP) and other relevant resources, like mental health support.
Additional HIV self-testing resources can also be accessed on the CBRC website, including videos on how to use an HIV self-test.
Required resources
- A website where people and organizations can order the Medicine Bundle
- Staff to make the Medicine Bundles and mail them out
- Manager or director to oversee the program
- Peers to provide support and guidance about how to use the HIV self-test kit (i.e., CBRC Test Now Buddies)
- Guidance Committee
- HIV self-test kits
- Indigenous medicines:
- sage
- sweetgrass
- tobacco
- cedar
- lavender
- Labrador tea
- bear grease
- Devil’s club salve
- Safer sex supplies (i.e., two to four condoms [at least one internal] and quality lube)
- Safer sex resources (e.g., PrEP pamphlet)
- Information on: Indigenous medicines; the intent of the Medicine Bundle program; and the Two-Spirit Program and related activities
Challenges
- Several folks did not use their legal name when ordering online and this meant that people could have issues trying to pick up their mail.
- The need to use proper packaging, manage order forms and set up an account with Canada Post to support the large volume of mailouts made the shipping process challenging.
- Because the bundles were packed by humans, sometimes items were missing from the packages that participants received; participants would follow up with the program to request the items they were missing, which would then have to be sent out separately.
- Although the Trusted Messengers were utilized during the program’s pilot phase, funding was not available after the pilot for the continued support of the Trusted Messengers.
- Funding for the program has been a challenge and has ended twice leading to the need to relaunch the program. A lack of stable funding has made it a challenge to provide peer and community support (e.g., Trusted Messengers), in-person consultations with the Guidance Committee and honoraria to support the work.
Lessons learned
- During the pilot phase of the program, community organizations were able to request multiple Medicine Bundles for distribution. Currently, organizations are able to order only a few Medicine Bundles because of a lack of capacity to support the associated training needs (e.g., providing the staff of these organizations with education on how to use the HIV self-test).
- In the pilot phase of the program, participants were able to choose the specific medicines that they wanted to include in their Medicine Bundle, but it was challenging to customize bundles. Currently, all bundles are packed with the same medicines, sexual health supplies and HIV self-test kits.
- Program participants shared that they needed more information on the medicines that were included in the Medicine Bundle, so an information sheet was developed and is now included with each bundle.
- It is important to ship Medicine Bundles in discreet packaging.
- Participants shared that too much information collected in the pilot phase of the program and therefore subsequent phases of the program have included less data collection (i.e., only basic demographic information).
- Some community members have not been reached by the program, particularly Inuit folks. Supporting use of the Medicine Bundle in the North and for Inuit communities is a priority going forward. Additionally, new assessments will look at the types of medicines that are relevant to communities outside of B.C. (e.g., in the North and East).
- For the program to succeed, the community needs to be involved every step of the way, even if that adds time or delays program implementation. The community is the reason this program worked and grew. If the Medicine Bundles program is adapted for use in another location, consultation within local Indigenous communities is essential.
- The Medicine Bundle program distributed over 1,200 HIV self-tests in its pilot phase, reaffirming the importance of offering culturally safe sexual health resources that are developed by and for the community.
Program materials
The Medicine Bundle: An Indigenous approach to HIV self-testing (CATIE blog)
Contact information
Jessy Dame, RN (he/him)
Director, Two-Spirit Health
Community-Based Research Centre
1007-808 Nelson St
Vancouver, BC
Canada, V6Z2H2
jessy.dame@cbrc.net