HIV in Indian Country

1
HIV in Indian Country

• Presented by
• Warren Jimenez
• Executive Director
• National Native American AIDS Prevention Center
• April 10, 2008
• American Bar Association
• National Conference on HIV/AIDS Law and Practice
  From Local Client to Global Workforce

2
NNAAPCs Mission

• To address the impact of HIV/AIDS on American
  Indians, Alaska Natives and Native Hawaiians
  through culturally appropriate advocacy,
  research, education and policy development in
  support of healthy indigenous people.

3
National Native American AIDS Prevention Center

• Since 1987, NNAAPC has been the only national
  organization solely devoted to prevention of
  HIV/AIDS in the Native American community
• It has chronicled the HIV epidemic and responded
  by attempting to educate and empower the Native
  community

4
In the United States

• Approximately one million people are infected
  with HIV
• Over 40,000 new cases of AIDS diagnosed each year
• In 2005, there were approximately 17,000
  HIV/AIDS-related deaths in the United States

5
HIV/AIDS In Indian Country1

• By 12/05, an estimated 3,238 American Indians /
  Alaska Natives had been diagnosed with HIV/AIDS
• An estimated 1,657 American Indians and Alaska
  Natives with AIDS have already passed away
• Over 51 had passed away

1 Centers for Disease Control and Prevention.
HIV/AIDS Surveillance Report, 2005. Vol. 17. Rev
ed. Atlanta U.S. Department of Health and Human
Services, Centers for Disease Control and
Prevention 2007
6
HIV/AIDS in 2005

• An estimated 1,581 AI/AN were living with AIDS
• HIV/AIDS was diagnosed for an estimated 195
  American Indians and Alaska Natives
• Women accounted for 29 of diagnoses among AI/AN

7
It Is Only The Beginning

• American Indians and Alaska Natives have the
  third highest rate of HIV/AIDS diagnosis
• Cumulatively, 10.4 per 100,000
• 3rd highest rate respectively for both male
  (19.1) and female (7.5) per 100,000
• These rates are continuing to rise

8
Transmission Categories for American Indian and
Alaska Natives living with HIV/AIDS at the end of
2005
Note Based on data from 33 states with
long-term, confidential name-based HIV reporting.
9
Much Needs to Be Done

• American Indians and Alaska Natives are diagnosed
  later and die earlier than all other reported
  ethnic groups, except African-Americans

10
Risk Co-FactorsSTDs

• 2nd highest rate of chlamydia
• In some places more than 4 times the national
  rate, per 100,000
• 2nd highest rate of gonorrhea
• 3rd highest rate of syphilis

11
Risk Co-Factors Substance Use

• Rate of current illicit drug use was higher for
  Native American and Alaska Natives (12.8) than
  among persons of other races and ethnicities
  (CDC, Mar, 2007)
• More likely to have used an illicit drug in past
  month
• Youth illicit drug use rising (declining for
  other groups)
• Methamphetamine abuse increasing
• Native Americans have the highest prevalence of
  substance abuse and dependence (American Journal
  of Public Health, Aug, 2006)
• Alcoholism related deaths 770 higher than
  National average
• 33 of deaths before age 45 are related to
  substance abuse
• Youth have highest alcohol rates compared with
  all other groups

12
More Risk Co-Factors

• Mental Health
• More than 1/3 of the demands on IHS involve
  mental health concerns
• 180 higher rates of suicide, with highest rate
  in 15 to 34 olds
• Healthcare
• Overloaded Indian Health Service
• Competing IHS and tribal facilities
• Distrust of Western medicine
• SES
• 12 unemployment (2x national average)
• 42 have high school diploma

13
Additional Barriers Surveillance

• Low testing rates
• Misclassification by providers
• Tribal data collection systems inadequate
• Jurisdictional confusion over who to report to

14
Additional Barriers National HIV Prevention
System

• Based upon Federal and State Funding
• Access to funding
• Access to training
• Sophistication of HIV prevention
• Western theories and models

15
Additional Barriers Cultural Amplifiers

• Confidentiality issues
• Realistic coping mechanism of paranoia
• Modesty
• Increased homophobia
• Disease taboo
• Communication style
• Circular migration

16
Additional Barriers Prioritization

• Native communities have placed other issues at
  higher priority levels
• Substance use
• Diabetes
• Economic development
• Rightfully so

17
Additional BarriersLow Self Regard

• Overwhelming sense of low self-esteem /
  self-regard
• An individual manifestation of a cultural
  phenomenon
• Generations of mixed trauma, discrimination and
  societal reactions
• Resulting in low health preservation and seeking
  behaviors

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It is too easy to focus on the negative

• We have assets and values related to health
• Experiences with epidemics
• Different view of pathology in an individual and
  the community
• Relationship with family and community
• Understandings of medicine
• Prayer Ceremony
• Beliefs in overall wellness and balance

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And most importantly

• Value placed upon youth and the future generations

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What is currently happening

• Adapting prevention intervention
• Creating interventions
• Community Health Representative programs
• Peer education programs
• Integrated school curriculums
• Traditional and cultural services

21
What else needs to happen?

• Funding for Native-specific research
• Protective factors
• Interventions
• Increased counseling testing efforts
• Proactive outreach to urban populations
• Cultural competency
• For agencies (materials and space)
• For providers
• Syncretic prevention and treatment services

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National Native HIV/AIDS Awareness Day

• March 20th
• Local and national events to call attention to
  the epidemic in indigenous communities

23
National Native HIV/AIDS Awareness Day
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Resources Available

• NNAAPC (www.nnaapc.org)
• Center for Applied Studies in American Ethnicity,
  CSU (http//www.colostate.edu/Depts/CASAE/)
• Indian Health Service
• National Minority AETC (www.nmaetc.org)
• MPAETC (www.mpaetc.com)
• Association of American Indian Physicians
  (www.aaip.org)
• Local community and resources
• Elders and healers

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Thank you for your attention and your commitment!!

• Warren Jimenez
• National Native American AIDS Prevention Center
• 720 S. Colorado Blvd., Suite 650-S
• Denver, CO 80246
• 720-382-2244
• rfoley_at_nnaapc.org