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Downe, Pamela J. (2021). **Collective Care: Indigenous Motherhood, Family, and HIV/AIDS.** Toronto: University of Toronto Press.

Reviewed by: Rhiannon Mottus, MacEwan University

Pamela J. Downe’s book, “Collective Care: Indigenous Motherhood, Family, and HIV/AIDS”, is an anthropologic, ethnographic study of the Indigenous people who access services at AIDS Saskatoon, an HIV-related service provider. Through interviews with people who access services at AIDS Saskatoon, Downe explores the reality of HIV/AIDS as not just an epidemic but a syndemic. She discusses how Indigenous families and their roles within them are influenced by an HIV+ diagnosis and places them within a more extensive, intersectional discussion. She places interviews within the not-too-distant historical context of Canada’s institutionalized cultural genocide of Indigenous people, as well as the current struggle between institutions that uphold Western cultural understandings of family and Indigenous families’ cultural understandings of family. She also holds a light up to the current stigma surrounding the HIV/AIDS syndemic and its impacts on the families. Throughout, Downe draws on the wealth of material written on and around the HIV/AIDS syndemic and points to the areas where research is pointedly absent. Downe’s work humanizes and brings to the forefront a heavily stigmatized illness made more complex by the social, economic, and racial factors surrounding it. The book chapters are separated into chapters that first explore family and the roles of motherhood and fatherhood as influenced
by HIV/AIDS, and then finish by discussing plainly the emotions that the study is saturated with:
loss and love.

Downe drives home the compounded stigma associated with the HIV/AIDS syndemic by showing the interwoven nature of her interviewees' experiences as Indigenous people, people of lower socioeconomic status, people with addictions, and people who are HIV+, and the overall influence of these factors on their families. She specifically defines HIV/AIDS as not an epidemic but as a syndemic, wherein social conditions interact in a way that is “multiplicative rather that additive” (p. 9). Each factor influences and is influenced by the others, adding to the already intense physical symptoms of HIV/AIDS and its treatments. This more holistic perspective adds an essential layer to the struggles faced by the interviewees, as it draws attention to the larger social issues surrounding HIV/AIDS. She notes that while the collective approach to family helps to support the children during times of hardship, it is often interrupted or made more complex by interactions with institutional authorities, who are often influenced by the stigma surrounding one or more of their identities. As well, it drives conflict and distance between the larger Saskatoon city population and the AIDS Saskatoon families, potentially threatening AIDS Saskatoon's ability to offer support unimpeded.

Of particular note within the HIV/AIDS syndemic, Downe discusses and dissects some of the differences between the way the Indigenous people who access services view family and mothering compared to the Western concepts. Indigenous cultural values of community, collective care, and chosen extended family are highly emphasized and continually referenced in the interviewees' day-to-day lives. She notes that interviewees typically defined family as “an emo-
tionally close network of people who have affection for, responsibilities to, and expectations of each other” (p. 14), a very different cultural view than the Western biological, nuclear family. Downe contrasts this definition with the two, united Western concepts of the biological, nuclear family and intensive mothering. She explores how these European, individualistic, middle-class-centred concepts exclude and further isolate the AIDS Saskatoon mothers whose culture and family values differ from the Western norm (p. 46). She also explores the ways in which the interviewees deliberately emphasize Indigenous culture and a sense of community in their everyday lives, by using Cree words for community concepts that are integral to Indigenous culture and working together to create community supports where there would otherwise be a lack. In doing so, Downe criticizes approaches to assist and work with people fighting against the HIV syndemic with an inflexible Eurocentric perspective.

In the face of overwhelming pressure to conform to Eurocentric, middle class, and individualistic norms, Downe discusses the ways in which Indigenous people who access services build and maintain their cultural values as a way to navigate the many factors of their lives influenced by the HIV syndemic, as well as how they navigate situations wherein they must be seen as conforming to Western norms in order to avoid discrimination. Differences between Indigenous and European cultural concepts result in many miscommunications between the Indigenous people who access services and people in positions of institutional authority, such as healthcare workers and social services workers. The misunderstandings and preconceived notions that these workers with institutional authority have compound the negative life circumstances and trauma that the AIDS Saskatoon families undergo. Downe notes that instead of being the commun-
ity support and protection that these workers are meant to be, they are often threats to an otherwise
functional family, of which Downe provides many direct, sobering examples from her
interviewees' lives. There are frequent situations where families have to "work together to emulate
the codified nuclear family" (p. 76) in order to avoid institutional biases. The various stigmas and
their social consequences affect even their parental roles within the family. Fathers view their
primary role to be teaching their children to stay out of trouble with the law (p. 79), where
Indigenous people are highly overrepresented. Stigma also affected parenting decisions, as parents
sought to protect their children from it, as it is seen as "a particular threat to their children" (p. 73).
Downe observes how interviewees and their families actively work to protect their children from
the potential effects of the stigmas surrounding their parents by shielding their children from drug
use as well as ensuring their children are well-educated on the realities of the HIV/AIDS syndemic
(p. 73).

Among the emphasis on community, Downe's study is filled with descriptions of home.
She centers the struggles and successes of the interviewees in their community, within AIDS
Saskatoon as well as Saskatoon the city itself. Her use of the photovoice components of her
interviews is especially poignant in contrast to the struggles and misconceptions people around the
interviewees have about the HIV syndemic. Downe discusses her interviewees' dreams, regrets,
and hopes for their children's future, showcasing a very different, more human side to the HIV
syndemic than what is typically shown. Throughout the book, family members worry about their
children's futures and the struggles of their fellow community and family members. They also
joke, and poke fun at one another. While undoubtedly affected by HIV/AIDS, Downe emphasizes
that these families are just that: families trying to do right by each other for each other.
Downe's book works not only a more holistic look at life with HIV/AIDS, but as the start of a conversation. This book is an excellent place to begin looking at what common assumptions we hold as a society about HIV/AIDS and the social factors surrounding it, and how the realities of living with HIV/AIDS are influenced and made more complex by those assumptions. The academic audience for this book is broad, excellent for sociologists and anthropologists, especially linguistic anthropologists, as well as those studying to enter areas centered on fieldwork such as social workers, psychologists, and health care professionals. The book was laid out thoughtfully, centering the interviewees' voices in the larger, historical context in a way that was engaging and thought-provoking. That being said, while she thoroughly explores motherhood within HIV/AIDS, on its own and in compliment to fatherhood, fatherhood is explored solely in its relation to motherhood. Given the general dearth of research done on it, a broader discussion on fatherhood would only add more weight to an already powerful book. "Collective Care: Indigenous Motherhood, Family, and HIV/AIDS" was a meaningful read, incredibly informative and unafraid to challenge common opinions on difficult topics. I would recommend this book to anyone, as the book's messages call us all to action.