Together We Must Face the Challenge of HIV/AIDS in Native American Communities

March 20, 2010 is the fourth annual National Native HIV/AIDS Awareness Day.  It is a day to renew our commitment to fighting HIV/AIDS and to challenge the stigma surrounding the disease by increasing awareness of the risk factors for infection.  I know that many people are uncomfortable talking about HIV and AIDS, but progress in the fight against HIV/AIDS depends on our knowing the basic facts about transmission as well as on increasing American Indian and Alaska Native (AI/AN) access to HIV testing and comprehensive health services. 

Even though AI/AN HIV/AIDS cases comprise less than 1 percent of total cases in the U.S., AI/AN communities are disproportionately impacted by the disease.  American Indians and Alaska Natives have a 40% higher rate of AIDS than non-Hispanic white Americans, and the AIDS rate among Native women is 2.8 times that of non-Hispanic white women.  AI/AN communities experience significant health disparities and face high rates of substance abuse and sexually transmitted infections, which increase the risk of HIV transmission.  Additionally, many American Indians and Alaska Natives, like other Americans, do not know that they are infected and are therefore more likely to spread the disease.  Together, we must continue to expand access to confidential testing in both urban and rural areas.  As a Nation and within our Indian health system, our promotion of routine HIV screening combined with AI/AN community acceptance is helping to reduce stigma and confidentiality concerns.

To be effective, HIV/AIDS prevention programs must also be culturally sensitive.  Current programs in Indian Country, therefore, are focusing on traditional teachings and the importance of community.  The Phoenix Indian Medical Center, Gallup Indian Medical Center and Alaska Native Medical Center are just a few examples of comprehensive HIV/AIDS programs involving HIV prevention programs and treatment and care services.  Smaller service units and urban facilities such as Pine Ridge, SD and South Dakota Urban Indian Health are also expanding HIV testing services and experiencing positive community acceptance - a much needed effect to help reduce stigma surrounding HIV. 

In addition to increasing the availability of culturally sensitive HIV testing and prevention programs in rural communities, we must work to overcome the barriers keeping American Indians and Alaska Natives from obtaining needed care and treatment.  Towards that effort, the Indigenous HIV/AIDS Research Training (IHART) program, designed specifically for Indigenous and other underrepresented ethnic minority (UREM) scholars, mentors and trains AI/AN and UREM scholars to design culturally grounded research that will contribute to ameliorating health disparities among American Indians and Alaska Natives in the areas of HIV/AIDS, other sexually transmitted infections, and mental health.  The IHART program nurtures the grant making skills of AI/AN tribal, community, and university-based scholars and incorporates culturally specific Native epistemologies, methodologies, and research protocols.  Increasing the ranks of AI/AN and UREM scientists conducting culturally grounded research will generate information that can guide effective future prevention and intervention programs.

The White House Office of National AIDS Policy (ONAP) is also joining the fight against the epidemic.  ONAP is currently developing a National HIV/AIDS Strategy with input from the public and from agency partners, including the Indian Health Service, to more effectively address the epidemic.  Participation from stakeholders, including tribal leaders, will be necessary to ensure that all affected populations benefit from the implementation of the National Strategy.  Together we must confront the high rates of poverty, drug use, mental health issues, high-risk sexual behaviors, and violence, which increase the risk of HIV transmission and limit individuals’ ability to access services.

Raising awareness about HIV/AIDS is only the first step in overcoming this public health crisis.  Today, we honor the efforts of those working to improve the lives of AI/AN people living with HIV/AIDS, including the dedicated staff at IHS, tribal, and urban Indian health facilities. 

As we move forward, it is important that we continue to empower AI/AN communities in rural and urban areas to reduce new infections and increase the availability and accessibility of culturally competent care.

Kimberly Teehee is Senior Policy Advisor of Native American Affairs for the White House Domestic Policy Council