HIV/AIDS
ISSUE
American Indians and Alaska Natives (AI/AN) are ranked third in the nation in rate of new infections (incidence) of human immunodeficiency virus (HIV) compared with all other races and ethnicities. Health disparities and disproportionate co-risk factors (such as sexually transmitted infections, substance use, and stigma) among AI/ANs contribute both directly and indirectly to the risk of HIV transmission. HIV/AIDS is communicable, affects a younger population, and has no cure or vaccine. Primary prevention is associated with behavior change.
BACKGROUND
The Indian Health Service (IHS) HIV/ Acquired Immune Deficiency Syndrome (AIDS) Program is a culturally fluent effort based upon a comprehensive public health approach. Although IHS focuses primarily on care of individuals, it is necessary to facilitate a preventive, public health approach for HIV/AIDS. Available resources within the Indian health system to treat HIV/AIDS are sometimes limited, so it is important to aggressively pursue opportunities to establish more routine HIV testing, primary prevention messages, and behavior changes.
SITUATION
Through 2007, there were over 2200 reported cases and over 3000 estimated cases of HIV/AIDS among AI/ANs in the United States. The rate of HIV/AIDS diagnosis for AI/ANs was 12.8 per 100,000. Over the last three years, the prenatal screening rate has risen from 54 percent to nearly 80 percent IHS-wide. As well, over the last six years, HIV screening rates have more than tripled. According to a report by the Centers of Disease Control (CDC), the number of new cases of HIV/AIDS remained relatively stable among AI/ANs over a 6-year period; however, a steady rise in existing cases has been observed.
Risk factors that contribute to HIV/AIDS rates among AI/ANs include the disproportionate rates of sexually transmitted diseases (second highest rates of gonorrhea, chlamydia, and syphilis combined in the nation), alcohol and substance use, depression, domestic violence, and low socioeconomic status. Other factors include a greater proportion of young adults (as compared to other social groups), social stigma attached to the disease, and discrimination. Culture and tradition also play a significant role in setting sexual and social norms, often limiting open discussion.
AI/ANs are known to have the shortest time from AIDS diagnosis to death. Thus, screening plays an important role in early diagnosis, treatment, and surveillance of AI/ANs with HIV/AIDS. It is also known that AI/AN youth are only half as likely to use contraceptives as their non-Native peers, thereby increasing the risk of acquiring or spreading HIV. These risk factors contribute to the ongoing risk of a more serious epidemic.
OPTIONS/PLANS
The IHS HIV/AIDS Program goals include ensuring access to quality health care services for those at risk and those living with HIV, increasing individual awareness of personal HIV serostatus, increasing HIV testing, addressing social stigma and discrimination, implementing best practices, and continuing to provide quality care. The HIV Program continues to expand and implement new initiatives each year, including tribal policy projects, national screening initiatives, telehealth projects, and HIV clinical training. More information is available at the IHS HIV Web site at www.ihs.gov/medicalprograms/hivaids/.
ADDITIONAL INFORMATION
For referral to the appropriate spokesperson, contact
the IHS Public Affairs Staff at 301-443-3593.
June 2009 |
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