American Indians, Alaska Natives, and HIV/AIDS in the United States
American Indians and Alaska Natives (AI/ANs) make up 0.8 percent of the U.S. population and constitute hundreds of diverse tribes and cultures.1,2 Approximately one-half of all AI/ANs in the United States live in just 10 States; California, Oklahoma, and Arizona have the largest AI/AN populations. Historically, AI/AN populations have suffered high rates of many health problems, reflecting widespread lack of access to health care and related information.
Surveillance
Among AI/ANs, there were an estimated 148 new AIDS diagnoses in 2004.3 A total of 1,506 AI/ANs were estimated to be living with AIDS at the end of 2004.4
Men
- For AI/AN men living with AIDS at the end of 2004, men who have sex with men (MSM) was estimated to be the most common exposure category (56 percent)—lower than for White men (75 percent) and Asian/Pacific Islander (A/PI) men (72 percent), but higher than for other minority populations. Injection drug use (IDU) was the exposure category in 17 percent of cases, and MSM/IDU accounted for another 17 percent. Heterosexual contact was the exposure category in 8 percent of cases.4
- The estimated AIDS rate for AI/ANs was 9.9 per 100,000 population in 2004, higher than the rate among Whites (7.1) and A/PIs (4.4) but much lower than the rate among Blacks (72.1) and Hispanics (25.0).5
Women
At 39 percent, AI/AN women estimated to be living with AIDS at the end of 2004 were more likely than women in any other minority population to have IDU as the exposure category. Heterosexual contact was the exposure category in 58 percent of cases; in comparison, heterosexual contact was the exposure category for 65 percent of His-panic and 76 percent of A/PI women living with AIDS.4
Children
The estimated AIDS case rate in 2004 was twice as high for AI/AN children (0.2 per 100,000 population) than for Hispanic and A/PI children (0.1 per 100,000 population).5
CRITICAL ISSUES
AI/AN life spans are shorter than those of the average U.S. population by approximately 10 years. This difference is related to significantly higher rates of alcoholism, tuberculosis, diabetes, pneumonia, and influenza. One-third of all AI/ANs who die before age 45 do so because of drug and alcohol abuse. Drug and alcohol abuse, in combination with high poverty rates, creates barriers to sufficient HIV care among AI/ANs.6
AI/ANs may have higher incidence of late AIDS diagnosis caused by delayed reporting; underreporting due to misclassification of AI/ANs into other racial/ethnic groups is not uncommon.6 Additionally, AI/ANs may refrain from accessing available services because they lack transportation and relevant information. AI/ANs have identified inconvenient office hours and inability to pay for services as barriers to care.
From 2002 to 2004, an average of 24.3 percent of AI/ANs lived in poverty, a rate comparable to that of Blacks (24.4 percent) but much higher than that of Whites (10.5 percent).7 An average of 29 percent of AI/ANs lacked health insurance.7 Poverty and lack of health insurance are associated with poor access to disease prevention and health care services.
Most Indian Health Service (IHS) providers live near tribal lands in rural areas; however, 62 percent of AI/ANs do not live in those areas. Frequent travel to visit family and friends and to participate in ceremonies and religious events can further complicate consistent adherence and access to health care.6
A 5-year study on HIV diagnosis in 25 States showed that AI/ANs living in the areas studied had an average rate of HIV diagnosis 1.5 times higher than that of Whites and nearly 2.5 times higher than that of A/PIs.8
AI/ANs and the Ryan White CARE Act
The Ryan White Comprehensive AIDS Resources Emergency (CARE) Act Special Projects of National Significance American Indian/Alaska Native Initiative is funding six grantees (and an evaluation center) to develop integrated mental health, substance abuse treatment, rehabilitation, and HIV ambulatory medical care models. Grantees have incorporated cultural, spiritual, and traditional medicine practices of Native Americans into their approaches. This initiative began in 2003 and will end in 2007.
The Health Resources and Services Administration (HRSA) report Native Americans and HIV Disease: Summary of Ongoing Special Projects of National Significance describes successful models for serving the AI/AN population and is available through the HRSA Information Center (888-ASK-HRSA).
AI/ANs can receive CARE Act services even if they are eligible for care from other sources (e.g., through IHS, tribal, or urban Indian health programs and services). Information about IHS facilities’ eligibility for CARE Act grants is available at http: //hab.hrsa.gov/l/notice0001.htm.
The results of the publication Improving Care for HIV-Positive Men of Color Who Have Sex With Men: Barriers and Recommendations are shaping the process through which HRSA and the Centers for Disease Control and Prevention (CDC) are collaboratively responding to the epidemic among young MSM of color.
To increase access to quality care for minorities and respond to the need for additional minority providers of state-of-the-art HIV/AIDS care in underserved communities, the CARE Act funds the National Minority AIDS Education and Training Center program to expand clinical expertise in minority communities. More information is available at www.nmaetc.org.
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References
1 U.S. Census Bureau. 2004 American Community Survey Data Profile Highlights. Washington, DC; 2004. Available at: http: //factfinder.census.gov.
2 Ogunwole SU. The American Indian and Alaska Native Population: 2000. Census 2000 Brief C2KBR/01-15. Washington, DC: U.S. Census Bureau; 2002. Available at: www.census.gov/prod/
2002pubs/c2kbr01-15.pdf.
3 Centers for Disease Control and Prevention. (CDC). HIV/AIDS Surveillance Report. 2004;16(1): 12. Table 3.
4 CDC. HIV/AIDS Surveillance Report. 2004;16(1):21. Table 11.
5 CDC. HIV/AIDS Surveillance Report. 2004;16(1):14. Table 5a.
6 Ashman JJ, Perez-Jimenes D, Marconi K. Health and support service utilization
patterns of American Indians and Alaska natives diagnosed with HIV/AIDS. AIDS Education and Prevention. 2004;16(3): 238-249.
7 U.S. Census Bureau. Income, Poverty, and Health Insurance in the United States: 2004. Washington, DC; August 2005. Table 8. Available at:
www.census.gov/prod/
2005pubs/p60-229.pdf. Accessed December 2005.
8 Bertolli J, et al. Surveillance systems monitoring HIV/AIDS and HIV risk
behaviors among American Indians and Alaska natives. AIDS Educ Prev. 2004; 16(3):218-37.
9 CDC. HIV/AIDS Surveillance Report. 2004;16(1):34. Table 19.
10 CDC. HIV/AIDS Surveillance Report. 2004;16(1):36. Table 21. |
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