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

Reviewed by: Alishiya De Zilva, MacEwan University

Pamela J. Downe’s book, “Collective Care: Indigenous Motherhood, Family, and HIV/AIDS,” presents the pressing issue of Indigenous mothers, fathers, and families living with HIV/AIDS in Saskatoon, Saskatchewan. This book explores the HIV epidemic through a five-year study of ethnographic research conducted from in-depth interviews of participants living with HIV. Through the partnership with AIDS Saskatoon, twenty-three men and thirty women presented their experiences, challenges, and strength in persevering through systemic oppression, intergenerational trauma, collective motherhood, stigma, and more (p. 26). Downe captures readers’ attention through personal experiences and the realities of motherhood and family while living with HIV/AIDS. Through syndemic connection, Downe emphasizes the causes of marginalization, the high rates of Indigenous people living with HIV/AIDS, and the opioid crisis. This book used multiple lenses to highlight themes such as mothers and fathers living with HIV, the social environment, intergenerational trauma, collective kin-care, and maternal loss to bring awareness to healthcare practitioners, social workers, and those who work with Indigenous communities. Downe clearly illustrated an image of the strengths and challenges to this pressing issue that has been hidden for decades.
Downe explored the social environment and intergenerational trauma as a few of the leading causes that place Saskatchewan as the number one province to have the highest rates of HIV/AIDS in Canada (p. 3). High rates are clearly linked to the impacts of Canadian history and colonization that dehumanized Indigenous people resulting in ongoing collective grief and intergenerational trauma. Downe emphasized that HIV, HCV, Addiction, and injection use were the driving causes of poverty, intergenerational trauma, and decades of colonization. “The HIV/AIDS epidemic in Saskatchewan is fueled by addiction and injection drug use” (p. 35). Loss of culture, language, family, community, spirituality, and ways of living disrupted Indigenous people’s identities and sense of belonging, resulting in coping mechanisms such as addiction. The high rates of Indigenous homelessness, substance dependency, HIV/AIDS, children in care, suicides are direct results of Indigenous people living with trauma. Addiction is grounded and influenced by social environments (p. 10). Marginalization, lack of accessibility and acceptance in health programs/facilities, socioeconomic status, exposure to addiction, suicide, and more contribute to this community’s collective grief and colonial trauma.

Collective kin-care represents social interconnectedness where the community collectively cares for children and elders (p. 23). Through the experiences participants shared, collective care demonstrated resilience, love, and connection. Traditional kinship was lost due to forces of colonialism where western child-rearing practices came into place (p. 30). Western child-rearing practices promoted individualistic societies. Kinship systems demonstrate reciprocity, community connectedness, and transmission of culture and language. With the loss of traditional kinship, many lost a sense of belonging, purpose, and identity.
A mother living with HIV/AIDS faces many challenges and hardships, such as stigma, public
criticism, and incapacitating losses (p. 33). Downe captured the fear all mothers faced in raising
their children, the stigma their children would face, encounters with children's family services,
their health, and employment. These mothers had medications to manage, appointments to keep
track of, counseling to attend, addiction/trauma to manage while keeping up with their children's
day-to-day activities (p. 47). The participants in this study emphasized that the social workers did
not understand this or show any sympathy. Western society has created an unattainable myth of
motherhood that has raised expectations and continues to cause harm to mothers' health (p. 45).
Therefore, support workers have high expectations for the mother living with HIV; they fail to
acknowledge these mothers' challenges, fears, and resilience. "The role of extended kinship
relationships among children in Indigenous Communities is largely unrecognized by child welfare
system in Canada". The text emphasizes how history repeats itself to this day years ago; children
were taken to residential schools and were stripped of their culture, language, and identity. And
today, children and family services apprehend children, and many mothers face allegations of
being unfit mothers (p. 55). These children lose their culture, language, family, and identity as they
are moved into foster homes. Downe demonstrated that collective motherhood is a "kikosewin
thing" being with family, living in the community you grew up in brings a sense of safety and
belonging (p. 49).

Downe also explored fatherhood while living with HIV/AIDS and presented similarities and
differences between the two. Canada's incarceration rates for Indigenous adults are ten times
higher than non-Indigenous adults, where Indigenous men accounted for sixty-four percent of the
inmates at the Saskatchewan Penitentiary (p. 64). The father's shared that their main goal was to ensure their children did not end up in the criminal justice system. Downe demonstrated a separation of fathering and mothering; the fathers took on an expected masculine role of protecting their children from harm or running off with the wrong pack (p. 67). The fathers demonstrated dedication to fatherhood and stayed connected to the mothers of the children (p. 67). The experiences the fathers went through in surviving jail created a sense of fear that their children were bound to follow the same paths; this gave fathers incentive to ensure that they stick around to protect them. This text acknowledged that though fathers were expected to protect children from harm and mothers were to tend to their children's needs; roles would often be switched depending on the situation. "We gotta work hard, so the haters don't leave no mark on the kids. It is the work of love" (p. 68). A main connection between motherhood and fatherhood was established to protect families and children from HIV and addiction-related stigma.

"Mescinewin" means losing your whole family to the disease; first, it was smallpox, then it happened when families went off to TB hospitals, alcoholism, and now it is happening again with HIV and drugs (p. 82). Downe emphasized the loss and grief a mother, a father, a community faces in the apprehension of children, the disruption it causes in the family, the mother's and father's recovery, and a sense of purpose. The maternal loss was expressed in the profound grief that caused deprivation and deficiency in mothers when their children were removed from their care (p. 90). CFS and the government of Canada fail to use a strength-based, culturally sensitive lens to understand and learn collective mothering. Instead, they assume that Indigenous mothers living with HIV are unfit mothers who do not live up to individualistic mothering standards. "This creates
a significant and structural disadvantage for mothers who are already disadvantaged by the HIV
syndemic" (p. 92)

Downe uses photovoice, Cree language, and the experiences shared by the participants to bring awareness of the realities and challenges faced by Indigenous mothers, fathers, and families living with HIV. This perspective was intended to create sympathy and emotions of frustration and anger in efforts to change programs and policies that continue to cause harm to Indigenous people. As Downe concluded, "there is still much work to do, but these steps are important because they are guided by strengths, needs and cultural priorities of many of the same people who contributed to this research" (p. 127). The personal stories shared were linked to statistics and research that recognized the impacts of colonialism. An epigraph was also used to capture readers' attention by presenting the text's themes. The intended academic audience for this text is quite broad; those who study anthropology, gender studies, sociology, psychology, and Indigenous studies will benefit from this perspective. Social workers, healthcare workers, community development workers, and those who work in Indigenous communities will also benefit as this text further educates and promotes trauma-informed care, harm reduction, and cultural competency. This book presented insight to families, mothers, fathers, and communities living through an HIV/AIDS epidemic; however, it would have been interesting to gain perspective from the social workers.

Though Downe's primary purpose was to ensure readers understood collective motherhood and the realities of HIV/AIDS, perhaps exploring what happens to a child after apprehension as they move into the foster system, the loss and trauma faced could have been explored. "Collective Care: Indigenous Motherhood, Family, and HIV/AIDS" was an incredible and touching book that I believe all healthcare workers and social work students should read.