Cedar Project

Cedar Project
Name	Cedar Project
Type	Indigenous-led longitudinal cohort study
Established	1998
Location	Western Canada

Cedar Project is a longitudinal cohort study and community-driven research initiative focused on the health and social well-being of young Indigenous people who use drugs in Western Canada. The initiative combines epidemiology, public health, Indigenous governance, and participatory action research to document patterns of infection, substance use, trauma, and resilience across urban and rural settings. Its work intersects with public health agencies, Indigenous organizations, academic institutions, and legal and policy fora to shape prevention, care, and reconciliation efforts.

Overview

The project operates at the intersection of public health surveillance and Indigenous-led participatory research, engaging communities affected by HIV, hepatitis C, substance use, and colonial-era policies. It partners with First Nations, Métis, and urban Indigenous organizations, academic centres, and service providers to align evidence generation with cultural safety, trauma-informed practice, and rights-based approaches. The study produces longitudinal epidemiologic data, qualitative findings, and policy-relevant analyses that inform clinical programs, outreach services, and legal advocacy across British Columbia and neighbouring jurisdictions.

History

Initiated near the turn of the 21st century, the project emerged amid rising concern about injection-related infections, overlapping epidemics of HIV and hepatitis C, and the legacies of residential schools and child apprehension in Canada. Early collaborations involved Indigenous community leaders, frontline harm reduction practitioners, and researchers from regional universities and health authorities. Over time, governance shifted toward community oversight with advisory councils, cultural protocols, and Indigenous co-investigators shaping study design. The project has responded to policy shifts such as safer supply debates, criminal justice reforms, and federal reconciliation initiatives, adapting recruitment, retention, and dissemination strategies accordingly.

Objectives and Scope

Primary objectives include documenting incidence and prevalence of blood-borne infections, mapping social determinants of health among young Indigenous people who use drugs, and evaluating interventions to reduce morbidity and mortality. The scope spans urban centres, remote settlements, and mid-sized municipalities, examining pathways linking childhood trauma, foster care experiences, and adult substance use. Secondary aims encompass capacity building within Indigenous organizations, informing legal challenges related to child welfare and criminalization, and contributing to global discussions in Indigenous health research.

Methods and Data Collection

The project employs mixed methods: prospective cohort enrollment, structured interviews, biological sampling, and community-based qualitative inquiry. Epidemiologic tools include serologic testing for HIV and hepatitis C, molecular assays in collaboration with clinical laboratories, and standardized instruments for substance use patterns, mental health screening, and exposure histories. Qualitative components use narrative interviews, photovoice, and sharing circles facilitated by Indigenous knowledge-keepers and cultural advisors. Data linkage with provincial health administrative databases, hospital records, and mortality registries enhances outcome ascertainment while governance protocols regulate access and use. Ethical oversight integrates Indigenous research ethics, community ownership of data, and institutional review by university and health authority boards.

Key Findings and Impact

Findings have highlighted disproportionate burdens of HIV, hepatitis C, overdose, and incarceration among young Indigenous participants, and strong associations with childhood trauma, foster care placement, and discrimination in health services. Research outputs have informed harm reduction scale-up, culturally grounded peer navigation programs, and targeted screening initiatives in urban shelters and rural clinics. Results have been cited in policy submissions to legislative committees, presentations at clinical conferences, and advocacy by Indigenous legal organizations challenging punitive approaches to substance use. The project has also contributed to methodological advances in community-based participatory epidemiology and influenced training curricula in nursing, social work, and public health programs.

Community Engagement and Ethics

Community engagement is central: governance structures include Elders' councils, community advisory boards, and peer research teams who co-design protocols and lead recruitment and follow-up. Ethical practice emphasizes ceremony, reciprocity, cultural safety, and data sovereignty, drawing on Indigenous legal traditions, national research ethics bodies, and university human research ethics boards. Consent processes accommodate trauma-informed approaches, and compensation and support services are provided to participants. Dissemination prioritizes community reports, visual exhibits, and capacity-building workshops rather than solely academic publication.

Funding and Governance

Funding sources have included federal research agencies, provincial health programs, philanthropic foundations, and institutional grants, with in-kind contributions from Indigenous service organizations. Governance blends community ownership with academic partnership: steering committees feature Indigenous leaders, clinicians, and investigators from universities and hospitals. Memoranda of understanding and data-sharing agreements codify responsibilities, and financial stewardship is subject to auditing and community oversight. The governance model seeks to align accountability to participants, Indigenous communities, and funders while protecting participant confidentiality and promoting culturally rooted translation of findings.

Category:Indigenous health Category:Epidemiology Category:Harm reduction