Are American Indians /
Alaska Natives at Risk for HIV?
Yes. American Indians and
Alaska Natives represent a unique population within the US, not only because of
the oppression suffered in the development of the country, but also because of
their ongoing struggle to gain recognition in the HIV/AIDS epidemic. AI/AN’s
are so unique, however, that they are protected from the same behaviors that
put all people at risk for HIV infection.
Further, AI/AN are often misclassified in terms
of race/ethnicity on data collection forms, due to assumptions about names, skin
color, residence and even intentionally misleading self reporting a study of STD
data in Oklahoma found that 35% of Chlamydia and over 60% of Gonorrhea cases
among American Indian and Alaska Natives had been incorrectly attributed as
Hispanic or white.
The high degree of movement
of first nations people between inner cities and rural on-reserve areas may
bring the risk of HIV infection to even the most remote first nations reserves
leadership unsympathetic to AIDS and HIV may govern some reservations. Cases where
HIV infected 2-spirited men have been unable to return to their reserve for
holistic treatments have been reported.
What Puts American Indians / Alaska Natives at Risk?
One study of Alaska Native
drug users found that alcohol use was the factor that put them at greatest risk
for HIV. Many individuals reported blacking out while drinking and later
learned that they had unprotected sex with complete strangers or persons they
would not otherwise accept as partners.
Physical and sexual
assaults and histories of childhood sexual abuse are alarmingly high among women
with or at high risk of HIV/AIDS. Native American women are particularly
vulnerable given the high rates of violence (16%) and severe violence (7%)
reported in marital relationships among Native Americans.
What Are Barriers To Prevention?
Like many other tight-knit
communities, confidentiality can be difficult to maintain in AI/AN communities,
especially in rural areas. This can be a barrier to important prevention
activities such as testing for HIV, discussing sexual practices with health care
providers, obtaining drug treatment, or buying condoms in local stores.
Social economic problems
such as poverty, alcoholism and substance abuse and low self esteem may
interfere with the ability of many Native Americans to seek preventive care,
particularly when it is delivered by culturally insensitive providers and the
services are located at great distances.
Infected Native Americans
may not have easy access to a clinic to be tested for HIV or to obtain drugs for
treatment. As a result, a person with HIV can spend years passing the disease
to others. “As Native people, it’s important to focus on our traditions and
culture in prevention. It’s not all about sex. We need to teach
about the circle of life, being in balance, building pride in who we are and where we’ve been.
That helps build self-esteem. When we build pride in ourselves then we want to
take care of ourselves.
Statistics
Native Americans have the
fourth highest AIDS case rate per 100,000 populations among adults and
adolescents.
A higher proportion of
Native Americans with AIDS resided in rural areas with populations less than
50,000 compared to all persons with AIDS.
Of heterosexual
transmission cases, 50% were due to sex with an injecting drug user, and 50% were
due to having sex with an HIV person whose risk was not reported/identified.
What Can Be Done To Help?
HIV/AIDS must be made
visible in Native American communities to prevent the spread of HIV. Visibility
can be increased by collecting reliable HIV/AIDS data including Native Americans
in the design and delivery of HIV prevention programs, addressing Native
American stigma about homosexuality and drug use, and linking STD, violence,
unattended pregnancy and alcohol and drug abuse prevention programs.
Communities must take an
active role in the education of their children and members about the dangers of
unprotected sex and other risk associated behaviors. Governments and other
agencies must respond to HIV/AIDS in first nations communities by ensuring that
resources and services are culturally appropriate with access to counseling and
HIV testing.
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