Today is the fifth annual National Native HIV/AIDS Awareness Day, a day dedicated to increasing understanding of the problem of HIV among Native Americans. To that end, I'd like to try to provide a few basic facts about HIV among America's Native population and to touch on a some of the issues Native Americans face when it comes to HIV. In addition, I'll offer a few links to relevant resources and introduce you to a Native American blogger and HIV activist.
Follow me below the fold for a bit more info.
I. National Native HIV/AIDS Awareness Day
The HIV/AIDS epidemic is entering its fourth decade, and the Centers for Disease Control and Prevention have documented (pdf) that HIV is a disease that disproportionately affects poor and marginalized communities. Like other HIV/AIDS Awareness Days, National Native HIV/AIDS Awareness Day is intended to draw attention to the particular challenges HIV poses for one community significantly affected by the epidemic.
According to the National Native American AIDS Prevention Center (NNAAPC):
The four seasons are highly respected in many cultures because they so closely represent the cycle of life. Spring represents a time of equality and balance. It is a time of profound change, new beginnings and birth. For these reasons, spring was chosen as the time to hold the first National Native HIV/AIDS Awareness Day in 2007.
This year, events marking the day will be held in twenty-five states and the District of Columbia. To find an event near you, just click on this map.
II. HIV Among Native Americans: Some Basic Facts
While Native Americans and Alaska Natives make up only 1.5% of the U.S. population and represent only 1% of reported HIV/AIDS cases, the CDC estimated in 2005 that they rank third in rates of HIV/AIDS diagnoses. According to the CDC:
HIV/AIDS was diagnosed for an estimated 195 American Indians and Alaska Natives (adults, adolescents, and children), representing 0.5% of the total number of HIV/AIDS diagnoses reported for that year.
The rate (per 100,000 persons) of HIV/AIDS diagnosis for American Indians and Alaska Natives was 10.4, compared with 71.3 for blacks, 27.8 for Hispanics, 8.8 for whites, and 7.4 for Asians and Pacific Islanders.
Women accounted for 29% of the HIV/AIDS diagnoses among American Indians and Alaska Natives.
In 2005, an estimated 1,581 American Indians and Alaska Natives were living with AIDS. From the beginning of the epidemic through 2005, an estimated 3,238 Native Americans and Alaska Natives had been diagnosed with AIDS, and in the same time period, an estimated 1,657 had died.
It's important to note that these data may not give us an accurate picture of HIV among Native Americans. The CDC's 2005 data come from only 33 states. Hannabah Blue and Robert Foley of NNAAPC explain that the CDC data does not include information from a number of states with substantial Native populations, like California, Washington, Oregon, Hawai'i, and Montana. Citing CDC data gathered from 37 states in 2008, they write that the rate of HIV diagnoses for Native Americans/Alaska Natives is 11.9 per 100,000, and that of persons diagnosed with AIDS, Native Americans/Alaska Natives had the shortest overall survival time.
Native American women appear to be particularly vulnerable to HIV infection. Kate Ditewig-Morris, Hannabah Blue and Jamie Folsom of NNAAPC explain:
As is true for most women, the majority of infections occur as a result of heterosexual sex; in the case of Native women, the figure is estimated at 66%. Women have unique vulnerabilities to HIV transmission due to biological and anatomical make-up, and having untreated sexually transmitted infections (STIs) makes them more vulnerable to HIV infection. This risk is compounded for Native women due to the high occurrences of domestic violence and sexual assault they face. Condom negotiation and other protective actions may be impossible for women in violent relationships.
Additionally, the percentage of HIV infection related to injection drug use is 32% -- the highest of all racial and ethnic groups. This is probably the most disturbing trend for Native women and one which is most linked to historical trauma: many women are forced into intolerable situations and often into unhealthy life choices.
The authors also identify other factors that impede effective responses to HIV in the Native American population. They note that the Indian Health Service, which provides health care to Native Americans is "flawed and underfunded." Perhaps more problematic is that fact that 67% of Native Americans live in urban areas away from their home reservations, and thus cannot access IHS health care.
Native Americans are also suffering from what I consider one of the key inadequacies in current HIV education and prevention programs. As is the case with other minority communities, public health officials haven't made sufficient efforts to create culturally appropriate HIV prevention education for Native Americans. The CDC at least recognizes the problem:
The American Indian and Alaska Native population makes up 562 federally recognized tribes plus at least 50 state-recognized tribes. 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 programs for each group. Therefore, prevention programs that can be adapted to individual tribal cultures and beliefs are critically important.
Blue and Foley (link above) highlight some of these issues:
Currently, the CDC does not fund specific HIV prevention interventions or strategies that have been designed or researched by or for Native populations. This action item in the [National HIV/AIDS Strategy] requires a plan for creating and evaluating homegrown HIV prevention interventions in Native communities. Native people bear unique cultural heritages, different even across each community, and distinct communication styles, methods of knowledge transfer, and behavior change. Interventions for the dominant society do not easily translate. Native communities will continue to be overlooked in HIV prevention, until the government supports research to create Native specific interventions.
What would such interventions look like? Well, NNAAPC already has one such program geared specifically to Native American women. Called "Native Women Speaking: Keeping Our Communities and Ourselves Strong," the program
uses culturally and gender-responsive approaches to facilitate behavior change and risk reduction by engaging Native women in a discussion of the conditions that affect their risk-taking behaviors, such as discrimination, substance abuse, cultural oppression and historical trauma. It is structured to help participants reclaim a sense of pride in their identities as Native women. Participants create a framework based in cultural and spiritual traditions that promotes holistic balance in their lives and helps them set a realistic HIV risk reduction goal.
I wish NNAAPC every success in this effort, and I hope they'll be able to convince the CDC and IHS to invest in HIV education programs that are tailored to the social and cultural needs of Native Americans.
III. Introducing Shana Cozad: Native American Blogger and Activist
As some of you know, I blog for a wonderful HIV web site called TheBody.com. And since it's National Native HIV/AIDS Awareness Day, I think it's appropriate to introduce you to TheBody's newest blogger, Shana Cozad. According to her bio, Shana is a full-blooded Native American enrolled with The Kiowa Tribe of Oklahoma. In her first post, Shana shares the story of her seroconversion, why she had trouble using condoms, and how she copes with the virus. I hope you'll all take the time to check it out.
IV. Links to Resources
Finally, here are some links to information about and resources for Native Americans and HIV:
Native Americans and HIV at TheBody.com (Index of articles and news stories)
NNAAPC Publications Page (Fact sheets and articles about HIV/AIDS and related issues in the Native American community)
American Indian Health (U.S. National Library of Medicine portal to HIV and health information concerning Native Americans)
Native American AIDS Project (San Francisco-based HIV/AIDS service organization serving Native Americans in California)
Project Red Talon (HIV prevention program of the Northwest Portland Area Indian Health Board, serving the 43 federally recognized tribes in Idaho, Oregon, and Washington)
CA7AE: HAPP (Project of Colorado State University in Fort Collins, Colorado)
Indigenous Peoples Task Force (Native American provider of HIV education and direct services to the Native community in Minnesota)
Thank you all for reading. Please use the comments section to share any insights and information you have on this topic.