November 17, 2010
For our World AIDS Day 2010 section, we wanted to capture the diversity of the AIDS community. So, we reached out to people across the world -- mostly those who have never written for us before -- and asked them to guest blog. These columns are written by people who are living with HIV, have been affected by HIV, or work in the field.
American Indian, Alaska Natives, and Native Hawaiians, like other communities of color, are experiencing a significant HIV/AIDS disparity. Native Hawaiians/Other Pacific Islanders (NHOPIs) and American Indians/Alaska Natives (AI/ANs) have the third and fourth highest rates of new HIV infections, respectively. In 2008, the rate was 22.8 per 100,000 persons for NHOPIs and 11.9 per 100,000 for AI/ANs. Of persons diagnosed with AIDS, AI/ANs had the shortest overall survival time.
These statistics represent the only available national HIV/AIDS surveillance data for Native communities, which are collected from the Centers for Disease Control and Prevention (CDC). Unfortunately, CDC's latest annual report contains data from only 37 states. The actual numbers may be much higher as some states not included in the report contain large populations of AI/ANs and NHOPIs (i.e., California, Washington, Oregon, Hawaii, and Montana). When data from all states, reservations, and villages are accurately reported, undoubtedly the rates will rise.
It is therefore very important to get an accurate picture of how Native communities are affected by HIV/AIDS. This is what the National HIV/AIDS Strategy for the United States (NHAS) calls for, to "address HIV prevention in Asian American and Pacific Islander (AAPIs) and American Indian and Alaska Native populations" by stating that "Federal and State agencies should consider efforts to support surveillance activities to better characterize HIV among smaller populations such as AAPIs and AI/ANs."
And while the inclusion of this strategy is a valuable and needed step, there is just one recommended action specifically directed towards Native populations.
The lack of adequate surveillance data is not the only barrier impacting prevention work in Native communities. The unequal allocation of funding and resources, sparse access to quality care and treatment, and lack of culturally competent, Native-specific programming being supported by funders are all overarching systematic issues. In addition, community-based stigma, taboos around sex and substance use, and co-factors like high rates of poverty, drug and alcohol use, and mental health issues all continue to drive the epidemic at local levels.
The NHAS fails Native communities by not addressing these topics and de-prioritizing the epidemic's effects on Native people.
Recently the National Native American AIDS Prevention Center (NNAAPC) crafted a response to the NHAS, in collaboration and solidarity with organizations and people who represent American Indian, Alaska Native, Native Hawaiian, Asian American and Pacific Islander populations, outlining specific recommendations for how government agencies could address the needs of these populations more effectively.
We cannot wait until statistics prove Native communities to be a priority population, or until the high risk behaviors and co-factors create an explosion of HIV incidences. Where the National Strategy fails, the Federal Implementation Plan and operational plans can take up the slack.
The Indian Health Service (IHS) needs to be included as a lead agency in carrying out the actions of the Federal Implementation Plan. For example, IHS needs to be included in the step that asks for increased residency and training opportunities for doctors and nurses to specifically study HIV and AIDS. This will prevent Native people living on reservations from driving hours to the nearest infectious disease doctor. IHS also needs to be involved when strategies for improving surveillance efforts are tackled, as they are a major provider of HIV testing in Indian Country.
Currently, the CDC does not fund specific HIV prevention interventions or strategies that have been designed or researched by or for Native populations. This action item in the NHAS requires a plan for creating and evaluating homegrown HIV prevention interventions in Native communities. Native people bear unique cultural heritages, different even across each community, and distinct communication styles, methods of knowledge transfer, and behavior change. Interventions for the dominant society do not easily translate. Native communities will continue to be overlooked in HIV prevention, until the government supports research to create Native specific interventions.
The federal government should also draw upon the strengths of Native people in order to empower them to combat this disease. For instance, a holistic approach to health can help those who are at risk for HIV, as well as those living with it. Native people often do not consider health as just physical. Comprehensive aspects of life are interrelated, including mental, emotional, physical and spiritual wellness; however Native expertise in creating and utilizing holistic health models is not brought forward by the Implementation Plan.
These are just a few places where the NHAS falls short. For the complete NNAAPC response, please visit www.nnaapc.org. In the meantime, we need to ask ourselves how we can help state and local implementation plans achieve the goals of the strategy, reconfigure state or local Community Planning Group plans, or the federal government talk directly to Native leaders and HIV prevention workers.
Steps need to be taken to ensure that no person or community infected or affected by HIV/AIDS is overlooked.Robert Foley is the Executive Director and Hannabah Blue (Navajo) is a Capacity Building Assistance Specialist for the National Native American AIDS Prevention Center (NNAAPC).