Today, on the second annual National Native HIV/AIDS Awareness Day, we reflect on the significant toll of HIV/AIDS on native people, including American Indians, Alaska Natives and Native Hawaiians. The estimated rate of HIV/AIDS diagnoses for American Indians and Alaska Natives in 2005 was 18 percent higher than the rate for whites.(1) In the same year, women in those native groups had two and a half times the estimated HIV/AIDS case rate of white women.(1) An estimated 3,238 American Indians and Alaska Natives in the United States have been diagnosed with AIDS since the epidemic began, and the time between AIDS diagnosis and death is shorter for American Indians and Alaska Natives than for any other U.S. racial group.(1) Moreover, Native Hawaiians represent a significant proportion of the people in Hawaii who have been diagnosed with HIV/AIDS.(2)
The National Institute of Allergy and Infectious Diseases, part of the National Institutes of Health, joins with native communities in mourning those who have died from AIDS and salutes the individuals who assist people living with HIV in these communities and who provide the services needed to help prevent further infections.
Many native people already face significant health challenges because of higher poverty rates than those of the general U.S. population; limited access to health care in rural areas; and, in some settings, high rates of diabetes, obesity, and social and behavioral risk factors for acquiring HIV.(3) These risk factors include sexually transmitted infections, sexual activity among teenagers, domestic violence and substance abuse.(3) For example, among female American Indians and Alaska Natives in 2005, injection drug use or sex with an injection drug user accounted for 30 percent of reported HIV cases and 43 percent of reported AIDS cases--rates at least 65 percent higher than those for American women overall.(1) When possible, incorporating HIV/AIDS prevention messages into intervention programs for these other health issues confronting native communities should be considered.
Another challenge to preventing HIV/AIDS in native communities is the significant stigmatization of men who have sex with men, which likely discourages many men from getting tested for HIV and seeking counseling and treatment.(3) Delaying HIV testing and treatment places these men at increased risk for becoming extremely sick and for spreading the virus further. In 2005, more than 63 percent of reported cases of AIDS in male American Indians and Alaska Natives were attributed to male-to-male sexual contact or male-to-male sexual contact with concomitant injection drug use.(1) These data underscore the importance of efforts by native communities--and indeed all communities--to overcome this stigma by promoting the acceptance of all people.
Native cultural traditions also may play an important role in HIV treatment for many native people. It has been suggested that incorporating cultural healing practices into HIV treatment plans promotes trust between patient and caregiver and adherence to treatment regimens.(3) Given the very limited number of Native American health care professionals, the National Native American AIDS Prevention Center has created a medical provider training program to convey culturally relevant information to non-native health care providers of native HIV/AIDS patients.(4) The extraordinary diversity among the 561 federally recognized tribal groups in the United States makes it likely that the successful development of culturally sensitive approaches to HIV/AIDS prevention and treatment will also involve collaboration with the specific native communities that individual health care providers serve.(3),(5)
On this commemorative day, we as a nation must examine ways to reduce the burden of disease, including HIV/AIDS, on native people. I encourage native communities to continue addressing the problems of stigma and substance abuse that exacerbate the HIV/AIDS epidemic wherever they occur. And I urge health care professionals to consider native traditions when providing care to HIV-infected American Indians, Alaska Natives and Native Hawaiians.
(1) CDC. 2007. HIV/AIDS Surveillance Report, 2005 Vol. 17. Rev ed. Atlanta: U.S. Department of Health and Human Services, CDC: 12, 14, 25, 39, 43, 45. (2) Hawai`i State Department of Health. 2008. HIV/AIDS Epidemiology in Hawai`i. Accessed March 12, 2008. (3) Hamill and Dickey. 2005. Cultural Competence: What is Needed in Working with Native Americans with HIV/AIDS? Journal of the Association of Nurses in AIDS Care 16(4):64-69. (4) National Native American AIDS Prevention Center. 2007. Medical Provider Training. Accessed March 11, 2008. (5) U.S. Department of the Interior, Bureau of Indian Affairs. 2007. Indian entities recognized and eligible to receive services from the United States Bureau of Indian Affairs. Federal Register 72(55):13648-13652.
Dr. Fauci is director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health in Bethesda, Maryland.
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