HIV rates are soaring on First Nations reserves in Canada, even as they gradually decline in most of the country.

Stigma, government inaction and the harsh legacy of Canada's residential school system are to blame for this national health crisis, says Mona Loutfy, an infectious disease specialist with Women's College Hospital in Toronto.

The most recent Health Canada data show 63.6 new infections per 100,000 people on certain Saskatchewan reserves — a rate 10 times higher than the Canada-wide 5.9 infections per 100,000 people.

The problem is spreading to other First Nations, Loutfy noted.

"It's moved into Manitoba and that's been documented. And it's suspected to be moving into Ontario, too," she said.

An estimated 4,300 to 6,100 aboriginals had HIV/AIDS in 2008, a 24% increase from the 2005 estimate, according to the Public Health Agency of Canada.

A big part of the infection rate is the high prevalence of intravenous drug use, which Loutfy says is the result of the "multi-generational trauma" from residential schools and the mass adoption of aboriginal children into white families, known as the "Sixties Scoop."

"So there's a lot of trauma and post-traumatic stress disorder, depression and anxiety and so (people) self-medicate with injection drugs."

Many leaders on reserves aren't reaching out for help dealing with HIV, Loutfy said, but the federal government — which has jurisdiction over aboriginal health — also isn't coming in to offer it.

Loutfy said only four or five Saskatchewan reserves have implemented HIV testing programs, while the other 70 don't even know their infection rates.

"We need to reach out to the reserves and the chiefs and start looking into the issue to see how we can work with them to roll out HIV testing and care under their terms and using their cultural practices to make it a safe and trusting situation for them."

With the newest medical treatments, Loutfy said, people with HIV can have life expectancies on par with the general population and are even able to safely have children without passing the virus on.

— With files from Kristy Brownlee