Kotawêw: indigenous doulas in the HIV care continuum in Canada

Indigenous women, two-spirit, transgender, and gender-diverse people in Canada experience disproportionate HIV and sexually transmitted and blood-borne infection (STBBI) inequities shaped by colonial violence and systemic racism. While Indigenous doula work is resurging as reproductive justice, its application to HIV/STBBI prevention and care remains underexplored. We examined how Indigenous HIV/STBBI doula care is envisioned and what competencies are needed to support implementation.This community-based study was guided by an Indigenous Community Guiding Circle of people living with HIV/STBBI and anchored in cultural protocols and ceremony. We conducted 40 in-depth interviews with Indigenous community members living with HIV/STBBI (n = 20), relatives (n = 7), helpers/service providers (n = 8), and Elders/Knowledge Holders (n = 5). Interviews were analyzed using thematic analysis guided by Indigenous storywork principles.Participants described doulas as kin and "helpers" who: (1) provide sustained, nonjudgmental presence across diagnosis, parenting, substance use, and grief; (2) reconnect people to culture, land-based healing, and ceremony; (3) offer peer mentorship rooted in lived experience; (4) deliver practical HIV/STBBI education and stigma reduction; and (5) enact structural advocacy across healthcare, justice, housing, and child welfare systems.Indigenous HIV/STBBI doula care offers a culturally grounded, peer-led model with potential to strengthen engagement across the HIV/STBBI care cascade.