In 2010, American Indians and Alaska Natives (AIANs) accounted for < 1% of the estimated 47,500 new cases of human immunodeficiency virus (HIV) infection in the U.S. However, that proportion is misleading. When population size is taken into account for 2011, AIANs ranked fifth in rates of HIV/AIDS (acquired immunodeficiency syndrome) diagnoses. And the rate of AIDS diagnosis for this group has been higher than that for whites since 1995, according to the Centers for Disease Control and Prevention (CDC).
Also, AIANs diagnosed with HIV/AIDS die sooner: Between 2003 and 2007, only 81% lived longer than 36 months after being diagnosed. In 2010, HIV infection was the ninth leading cause of death among AIAN men and women aged 25 to 34 years.
Race and ethnicity are not, by themselves, risk factors for HIV infection, the CDC says. American Indian and Alaska Natives also have high rates of Chlamydia trachomatis infection, gonorrhea, and syphilis—sexually transmitted diseases are a warning signal of contracting or spreading HIV. Substance abuse is another risk factor: Current illicit drug use is higher among AIANs (12.8%) than in other races or ethnicities.
Lack of access to appropriate health care is another crucial factor, especially in the extremely poor AIAN communities, where between 2002 and 2004 about twice the national average was living in poverty. An estimated 1 in 5 AIAN adults living with HIV/AIDS at the end of 2009 were unaware of their infection. And while 75% of those who found out they were living with HIV in 2010 were linked to medical care within 3 months, this was the lowest proportion of any group surveyed.
Effective prevention interventions, the CDC says, must be tailored to the population. But the AIAN population comprises 562 federally recognized tribes and at least 50 state-recognized tribes, with different culture, beliefs, practices, and languages. Further, at the time of AIDS diagnosis, more AIANs lived in rural areas and may have been less likely to be tested for HIV because of limited access to testing. They also may have been less likely to seek testing because of concerns of confidentiality in a small and close-knit community. More than half of AIANs who responded to the Behavioral Risk Factor Surveillance System survey during 1997-2000 said they had never been tested for HIV.
The Indian Health Service (IHS) created a video to promote testing, “Facing HIV/AIDS in Native Communities,” available at http://www.ihs.gov/hivaids. Promotional materials include radio public service announcements, and training kits. Information on reaching out through social media and other emerging technology can be found at http://www.aids.gov/using-new-media.
“We have shown the positive impact of focused HIV/AIDS screening, education, treatment, and prevention in a group of IHS facilities,” says IHS Chief Clinical Consultant for Infectious Diseases Dr. Jonathan Iralu. “Now is the time to offer the opportunity to have an ‘AIDS Free Generation’ to all American Indian and Alaska Native communities that we serve.”