Two-Eyed Seeing is an Indigenous research framework that calls for bringing the strengths of Indigenous and Western knowledge systems into view at the same time. Rooted in Mi’kmaq tradition and introduced to the health sciences by Mi’kmaq elders Albert and Murdena Marshall and Dr. Cheryl Bartlett, the approach is associated with Etuaptmumk, or the “gift of multiple perspectives.” In this study, it was more than a method for combining information sources: it shaped who defined the research questions, how participants were approached, which questions were asked, how findings were interpreted and how researchers were asked to examine their own positions.

The authors describe the framework as a way to move away from research practices that dismiss Indigenous knowledge or reproduce colonial power relations. The underlying project focused on aging trajectories and what it means to age well with HIV. The researchers deliberately moved away from a narrow definition of “successful aging,” which they argued can marginalize Indigenous Two-Spirit and LGBTQ+ people and people living with chronic conditions such as HIV by privileging a standardized idea of a worthwhile or healthy life.

Working with the Community Advisory Board, the first author developed a culturally adapted life-review interview to explore participants’ accounts of HIV and what it means to age well. The guide included challenging questions, such as what is hardest about aging, alongside affirming ones, such as what excites someone about aging. The opening question, “Tell me your story of HIV,” was also developed with the board.

The interview guide was treated as a living document and revised through continued feedback from board members and observations from interviews. Relationship building began before recruitment and continued throughout the project. The first author attended the San Francisco Bay Area American Indian Two-Spirits Powwow, the International Two-Spirit Gathering, Two-Spirit Pride events and the Two-Spirit Dry Lab, as well as regular check-ins with community partners.

These activities created opportunities to meet potential participants and other Two-Spirit researchers, Elders, activists and leaders outside the conventional research setting. The researchers established a Community Advisory Board that included Indigenous Two-Spirit and LGBTQ+ Elders, advocates and people with HIV. The board helped shape recruitment, the interview guide, preliminary analysis and the presentation of findings to community members.

Its guidance was grounded in the “four Rs”: respect, relevance, reciprocity and responsibility when engaging with tribal partners. Indigenous and non-Indigenous organizations also supported the work. By the end of the study period, the project had established five community partnerships.

Partners supported recruitment by posting flyers, sharing information through email lists and promoting infographics on social media, while the researcher maintained contact through online meetings and in-person meetings when possible. Land acknowledgements, attention to relationality and Pendleton blanket gifting for participants who completed the study formed part of the approach. Those relationships produced 15 Indigenous Two-Spirit and LGBTQ+ people with HIV from more than 17 distinct Indigenous Nations during the first eight months of the study, an outcome the authors contrast with the conventional description of these communities as difficult to recruit.

The researchers attribute the recruitment to support from the advisory board, word-of-mouth referrals, transparent communication about the study’s goals, regular contact with community partners and researchers’ willingness to listen without judgment. Participants said the gap was not necessarily a lack of willingness to participate. Some described feeling ignored or overlooked by researchers, particularly those who made no sustained effort to build relationships.

One participant in their 40s, a transgender Two-Spirit person who had lived with HIV for about 15 years, said they were grateful for advocacy because Indigenous Two-Spirit people often remain “a shadow” in HIV work, with few advocates prioritizing them. Advisory-board participation also transformed how the lead researcher understood the study itself. During a meeting, the first author used the term “vulnerable” to describe Indigenous Two-Spirit and LGBTQ+ people living with HIV.

The exchange led the researcher to place greater emphasis on community strength and thrivance rather than vulnerability. This mentorship was not limited to practical advice: it reshaped the study’s conceptual orientation and strengthened the researcher’s connection to the community. The authors characterize the guidance from Indigenous Knowledge Holders and advisory-board members as transformative and argue that it made relational accountability—being answerable to the people and communities affected by the research—more explicit.

Critical reflexivity was another central element. The first author gave positionality statements before interviews, outreach activities and collaborations, describing the dual role of doctoral researcher and Indigenous community member. These declarations were intended to make the study’s assumptions, motives and power relations open to discussion rather than treating the researcher as a neutral observer.

Memo-taking and narrative analysis supported reflexivity throughout the investigation. After hearing the researcher’s position and being invited to ask questions, one participant in their 40s, a Two-Spirit man who had lived with HIV for about 11 years, explained that seeing the work led by a Two-Spirit person and intended to benefit IndigiQueer and Two-Spirit people aligned his own interests with the project. Participants subsequently became advocates for the study and shared it within their networks, supporting recruitment in additional locations.

The authors say this transparency helped reduce barriers between researcher and participants, although their analysis is based on qualitative reflections rather than a controlled comparison of research designs. The perspective also identifies tensions that researchers should not treat as solved by simply placing two knowledge systems side by side. The article therefore presents Two-Eyed Seeing as an ongoing requirement for self-examination, not a checklist that makes a study culturally safe by itself.

The authors distinguish it from community-based participatory research while arguing that it can strengthen and Indigenize that model by more deliberately centering Indigenous paradigms, relationships and authority. They also call for clearer documentation of how the framework is interpreted and applied, noting that reviews of Indigenous HIV research have found inconsistencies despite the approach’s growing use in Canada. Because the article is a methodological perspective rather than a clinical trial or outcome study, it does not show that Two-Eyed Seeing improves HIV outcomes, health-care access or treatment adherence.

Its evidence comes from a qualitative study with 15 participants, advisory-board involvement, community observations and the lead researcher’s reflexive accounts. The authors say the findings suggest that the framework can support culturally responsive questions, safer opportunities to share experiences without pathologization, collaborative analysis and more reciprocal knowledge production. They also propose that similar principles could inform clinical services for Indigenous Two-Spirit and LGBTQ+ people, but future research would need to examine how colonial structures and power imbalances affect implementation.

Within those limits, the study’s central finding is clear: respectful relationships, community governance and continual examination of the researcher’s position were not decorative additions to HIV research, but conditions that changed who participated, what was asked and how the results were understood.

Subject of Research: Methodological lessons from Two-Eyed Seeing in Indigenous Two-Spirit and LGBTQ+ HIV and aging research

Article Title: Two-Eyed Seeing in LGBTQ+ aging research: critical lessons from research with Two-Spirit and Indigenous LGBTQ+ people aging with HIV

Article References: Bryer, C. M., Lewis, J. P., Collins, A. B., Agénor, M., Jackson, T., Jeffries, I., Goulet, P., Lachowsky, N., McQuoid, J., Berry, J., Wayland, S., & Proulx, J. (2026). Two-Eyed Seeing in LGBTQ+ aging research: critical lessons from research with Two-Spirit and Indigenous LGBTQ+ people aging with HIV. Frontiers in Public Health, 14, Article 1965121. https://doi.org/10.3389/fpubh.2026.1965121

Image Credits: AI Generated

DOI: 10.3389/fpubh.2026.1965121

Keywords: Two-Eyed Seeing, Indigenous health research, Two-Spirit people, LGBTQ+ aging, HIV research, qualitative study, community advisory boards, research reflexivity, decolonizing methods, health equity, Two-Eyed, Seeing