March 20 is National Native HIV/AIDS Awareness Day (NNHAAD). NNHAAD is a national effort to raise awareness about how HIV/AIDS affects American Indian/Alaska Native (AI/AN) and Native Hawaiian people and to promote testing.
- HIV infection affects AI/AN in ways that are not always apparent because of their small population size.
- The rate of HIV infection is 30 percent higher and the rate of AIDS is 50 percent higher among AI/AN compared with white Americans, according to HHS’ Office of Minority Health.
- Compared with other races/ethnicities, AI/AN have poorer survival rates after an HIV diagnosis.
- AI/AN face special HIV prevention challenges, including poverty and culturally based stigma.
The following five videos give us a window into the HIV/AIDS crisis facing Native Americans.
Recognizing and Combatting Stigma: HIV & AIDS Impacting Indian Country
Advocating for Tribal HIV/AIDS Education and Legislation: A Success Story
HIV/AIDS in the Two-Spirit Community – A Hidden Crisis: Conversations with AIDS.gov
HIV+ Diagnosis: Sharon – A Native American Living with HIV
Get Tested: Native Women Public Service Announcement
- The ~5.2 million AI/AN represent about 1.7% of the US population.
- AI/AN represented less than 1% of estimated new HIV infections in 2010. According to the CDC, in 2010 AI/AN accounted for less than 1% (210) of the estimated 47,500 new HIV infections in the United States. However, these numbers are likely underestimated as American Indians are often misclassified as white or Hispanic in public health HIV surveillance systems.
- AI/AN HIV infection rates are higher than those of whites and Asians.
- AI/AN men accounted for 76% and AI/AN women accounted for 24% of the estimated 212 AI/AN diagnosed with HIV infection in 2011.
- 75% of the estimated HIV diagnoses among AI/AN men in 2011 were attributed to male-to-male sexual contact. Sixty-three percent of the estimated HIV diagnoses among AI/AN women were attributed to heterosexual contact.
- By the end of 2010, an estimated 1,945 AI/AN with an AIDS diagnosis had died in the United States.
Prevention Challenges (source: CDC)
- Sexually transmitted diseases (STIs). AI/AN have higher rates of chlamydia, gonorrhea, and syphilis than whites and Hispanics and are second only to blacks. STIs increase the susceptibility to HIV infection.
- AI/AN gay and bisexual or “two-spirit” men may face culturally based stigma and confidentiality issues that may limit opportunities for education and HIV testing, especially among those who live in rural communities or on reservations.
- Cultural diversity. There are 566 federally recognized AI/AN tribes, whose members speak some 200 languages. Because each tribe has its own culture, beliefs, and practices and these tribes may be subdivided into language groups, it can be challenging to create culturally appropriate prevention programs for each group. Tribal and cultural differences regarding gender and sexuality within the AI/AN community must be considered in developing culturally appropriate prevention strategies.
- Socioeconomic issues. Poverty, including limited access to high-quality health care, housing, and HIV prevention education, directly and indirectly increases the risk for HIV infection and affects the health of people living with and at risk for HIV infection. Compared with other racial/ethnic groups, AI/AN have higher poverty rates, have completed fewer years of education, are younger, are less likely to be employed, and have lower rates of health insurance coverage.
- Mistrust of government and its health care facilities. The federally funded Indian Health Service (IHS) provides health care for approximately 2 million AI/AN and consists of direct services delivered by the IHS, tribally operated health care programs, and urban Indian health care services and resource centers. However, because of confidentiality and quality-of-care issues and a general distrust toward the US government, some AI/AN may avoid IHS.
- Alcohol and illicit drug use. Substance use can lead to sexual behaviors that increase the risk of HIV infection. Although alcohol and substance abuse does not cause HIV infection, it is an associated risk factor because of its ability to reduce inhibitions and impair judgment. Compared with other racial/ethnic groups, AI/AN tend to use alcohol and drugs at a younger age, use them more often and in higher quantities, and experience more negative consequences from them.
- Lack of awareness of HIV status. ~25% of HIV positive AI/AN were undiagnosed in 2009 compared to 18% of the general U.S. population. This translates to approximately 1,100 people in the AI/AN community living with undiagnosed HIV infection.
- Data limitations. Racial misidentification of AI/AN may lead to the undercounting of this population in HIV surveillance systems and may contribute to the underfunding of AI/AN-targeted services.
Patrick Aitcheson is the Communications and Logistics Administrator for the Diverse Elders Coalition (DEC). The opinions expressed in this article are those of the author and do not necessarily reflect those of the Diverse Elders Coalition.