HIVAIDS Impacts on Alaska Native Villages

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HIV/AIDS Impacts on Alaska Native Villages

• David D. Barney, PhD, University of Oklahoma
• Catlin C. Rosenthal, Rice University
• Tracy Speier, Alaska Native Tribal Health
  Consortium
• American Public Health Association Meeting,
  November 17, 2003

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Importance time of the study

• HIV was late arriving in rural (bush) Alaska
• Study occurred when first cases were identified
• During the decade of the 1990s

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Research question

• How does HIV/AIDS impact rural Alaska Native
  villages?

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Opportunity of study

• Examined two villages
• Small villages of 50-500 persons
• Not well connected to rest of the world
• Similar, but geographically isolated from each
  other
• Meaningful look at community related aspects of
  health

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Data sample

• Key informant interviews in both villages
• Tribal chiefs, tribal health workers, village
  residents, family members, non-Native health
  workers, and Native HIV-infected
• Interviews conducted in homes tribal facilities
• N 18
• Transcripts coded with askSam software

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Conceptual framework

• Does HIV/AIDS constitute a disaster for Alaska
  Native villages?
• Disaster defined an event, concentrated in time
  and space in which social structure and social
  functioning are disrupted
• Epidemics impact social structure function

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Vulnerability

• When is a disease a disaster?
• Answer must include vulnerability
• Pressure and Release Model (PAR)
• 1. Root causes
• 2. Dynamic pressures
• 3. Unsafe conditions (vulnerability)
• Blakie, Cannon, et al. 1994

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PAR applied to Alaska Native Villages

• Used to map needs vulnerabilities
• Identifies historical root causes
• Evolution of vulnerably should be examined
• Struthers Lowe, 2003
• Historical Trauma Response (HTR) documented
• Yellow Horse Brave Heart, 2003

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Historical Trauma for Alaska Natives

• Mohatt, Hazel Mohatt (2001) have found
• Trauma is fundamentally communal and often
  historical
• Current trauma can not be detached from past
  traumas including epidemics
• Villages are very small, traumas affect everyone,
  any trauma . . . Affects the community as a
  whole

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Limited Access to Resources

• Very limited medical care in village and care
  could not be effectively provided from Anchorage
  asked about the village clinic
• I think as a community when we allowed this one
  young man to die in the village, I felt like we
  were inadequate. We didnt have what we needed
  for him. And he didnt understand what he needed
  either. It was tough. And I felt like he was
  really shortchanged and I told him that.
• - tribal official

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Limited Access to Resources

• Lack of knowledge also limits community response
• At the time, we didnt know anything about HIV.
  We could hear it, maybe, just a little bit, that
  it was bad disease, but we didnt know who had it
  here.
• -
  brother of young man who died from AIDS

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Risky Behaviors

• HIV and alcohol are loving companions
• Alcohol links to child molestation
• Kids know the risks, but if someone is saying to
  them, well, Ill get you this alcohol if youll
  have sex with me, even though its an HIV
  positive person, the kids do it. It just kills
  me, to know that they do that.
• 
  - tribal official

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Social Conditions

• Lack of leadership
• Lack of empowerment feelings of helplessness
• Distrust frustration with available services
• Low self-esteem
• Lack of traditional coping mechanisms
• Denial lack of ownership of problem

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Root Causes of Vulnerability

• Physical and linguistic isolation
• Poverty
• Institutional and individual discrimination
• Trauma from past events
• Loss of tribal traditions

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Discrimination

• When first HIV/AIDS cases were reported,
  villagers felt like they were contaminated
• One big thing in . . . the early stages, when
  we were dealing with HIV/AIDS was how the outside
  world treated us as a whole. It wasnt as
  individuals, but as a whole. Everybody was lumped
  together. Everybody was HIV positive. Services
  were denied and people were afraid and fearful of
  going even out of the village to see a physician.
• 
  - Alaska
  Native villager

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Past Trauma

• Villagers identified HIV/AIDS with past
  historical traumas
• The Exxon disaster, I compared the two. Very
  closely, and how it impacted me as a person.
  Devastating, both of them . . . they affected me
  immensely.
• 
  
  - tribal official

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Loss of Tribal Tradition

• Loss of tribal culture lead to increase risk
  behaviors
• Theyre losing not only their cultural heritage
  and their personal insight, but in the process of
  losing that, theyre losing a sense of self, and
  theyre losing a sense of importance, to believe
  in themselves. So high-risk behaviors . . .
  alcoholism, HIV infection . . . all become kind
  of a self-fulfilling prophecy.
• 
  
  - case manager

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Conclusions

• Data fit well with the PAR model
• HIV/AIDS is likely to become part of the cycle of
  previous historical trauma
• HIV/AIDS interventions for Alaska Natives must
  include community development
• Community support needed for effective treatment
• Treatment is still difficult in this environment

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Additional information

• University of Oklahoma
• National American Indian and Alaska Native
  HIV/AIDS Technical Assistance Center
• www.ou.edu/hiv