Background and Objective:
Vancouver, Canada was one epicenter of the HIV pandemic with severe waves in the 1980s and 1990s. Community-driven activism combined with innovative interventions led to the elimination of HIV as a major public health threat and demonstrated the power of a community-driven pandemic response. We aimed to assess perceptions within the urban Indigenous community in Vancouver of the appropriateness and effectiveness of the COVID-19 response through the lens of Vancouver’s response to the HIV crisis.

Methods:
We conducted semi-structured interviews with 15 representatives of Indigenous community-based organizations providing health and social services to Indigenous peoples in Vancouver’s inner city. Thematic and interpretive analysis of the transcripts identified relevant themes.

Results:
Indigenous Peoples in Vancouver are disproportionately impacted by the syndemics of opioid overdose and COVID-19 due to ongoing effects of colonialism. Community connection and cultural traditions are critical to the health and wellbeing of Indigenous Peoples. Indigenous service providers felt that disruption to community supports due to public health restrictions have caused suffering and lack of critical health and social supports to Indigenous People. Participants called for an Indigenous-specific and Indigenous-led pandemic response to future public health emergencies.

Conclusions:
The lessons of the HIV pandemic have not translated to a robust community-focused pandemic response for Indigenous Peoples in Vancouver. Early on, several rural Indigenous communities imposed strict, culturally appropriate measures beyond the governmental public health measures that initially kept COVID-19 away, demonstrating the value of self-determination and Indigenous knowledge. However, the later sharp rise in COVID-19 infections in Indigenous communities are attributed to persistent social inequities and significant racism in the health system. We need Indigenous-led approaches to pandemic planning and multidisciplinary perspectives to interpret the social context of the pandemic in Indigenous communities and guide the development of an effective pandemic response.