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HIV/AIDS
ISSUE
American Indians and Alaska Natives (AI/AN) are ranked third in the nation in the rate of Acquired Immune Deficiency Syndrome (AIDS) diagnosis 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, has no cure or vaccine, and prevention is associated with behavior change. Therefore, education and quality prevention and care initiatives in AI/AN population are imperative.
BACKGROUND
The Indian Health Service (IHS) HIV/AIDS program is a multi-health sector collaborative and culturally senstive effort based upon a comprehensive public health approach. Although IHS focuses primarily on care of individuals, it is necessary to also take a preventive, public health approach with HIV/AIDS. Estimates suggest that the average yearly cost of HIV/AIDS care is roughly $16,000per patient, and the estimate of lifetime costs per patient is over $385,000, mostly due to the costs of pharmaceuticals. The IHS per capita personal health care expenditure for AI/AN patients is $1944 per year. Resources within the Indian system to treat HIV/AIDS are sometimes limited, so it is of substantial importance to aggressively pursue opportunities to establish more routine HIV testing, primary prevention messages, and behavior changes.
SITUATION
Through 2006, there were over 2100 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 8.8 per 100,000. 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 and domestic violence, a greater proportion of young adults (as compared to other social groups), socioeconomic status, 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.
Prenatal screening also plays an important role in early diagnosis and sentinel 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, along with the need for increased funding for HIV screening and care, contribute to the ongoing risk of a more serious epidemic. .
OPTIONS/PLANS
The IHS HIV Program is strengthening the IHS HIV infrastructure through strategic planning, collaboration and integration of initiatives. Goals include ensuring access (and linkages) to quality healthcare services for those at risk and those living with HIV, increase individual awareness of personal HIV serostatus, increase HIV testing, address stigma and discrimination, implement best practices, and continue to provide quality care.
ADDITIONAL INFORMATION
For referral to the appropriate spokesperson, contact the IHS Public Affairs Staff at 301-443-3593.
June 2008