Why Are American Indians and Alaska Natives Affected by HIV?
Race and ethnicity alone are not risk factors for HIV infection. However, AI/AN may face challenges associated with risk for HIV.
Lack of awareness of HIV status. Overall, approximately one in six (16%) adults and adolescents living with HIV infection in the United States at the end of 2010 were unaware of their HIV infection. However, by race/ethnicity, a greater percentage of adult and adolescent AI/AN (21%) were estimated to have undiagnosed HIV infection. This translates to an estimated 900 people in the AI/AN community living with undiagnosed HIV infection at the end of 2010.
Sexually transmitted infections (STIs). AI/AN have the second highest rates of chlamydia, gonorrhea, and syphilis among all racial/ethnic groups. STIs increase the susceptibility to HIV infection.
AI/AN gay and bisexual men may face culturally based stigma and confidentiality concerns that could limit opportunities for education and HIV testing, especially among those who live in rural communities or on reservations.
Cultural diversity. There are over 560 federally recognized AI/AN tribes, whose members speak over 170 languages. Because each tribe has its own culture, beliefs, and practices and can be subdivided into language groups, it can be challenging to create culturally appropriate prevention programs for each group.
Socioeconomic issues. Poverty, including lack of housing and HIV prevention education, directly and indirectly increases the risk for HIV infection and affects the health of people living with and at risk for HIV infection. Compared with other racial/ethnic groups, AI/AN have higher poverty rates, have completed fewer years of education, are younger, are less likely to be employed, and have lower rates of health insurance coverage.
Mistrust of government and its health care facilities. The federally funded Indian Health Service (IHS) provides health care for approximately 2 million AI/AN and consists of direct services delivered by the IHS, tribally operated health care programs, and urban Indian health care services and resource centers. However, because of confidentiality and quality-of-care concerns and a general distrust of the US government, some AI/AN may avoid IHS.
Alcohol and illicit drug use. Although alcohol and substance use do not cause HIV infection, they can reduce inhibitions and impair judgment and lead to behaviors that increase the risk of HIV. Injection drug use directly increases the risk of HIV through contaminated syringes and works. Compared with other racial/ethnic groups, AI/AN tend to use alcohol and drugs at a younger age, use them more often and in higher quantities, and experience more negative consequences from them.
Data limitations. Racial misidentification of AI/AN may lead to the undercounting of this population in HIV surveillance systems and may contribute to the underfunding of AI/AN-targeted services.
(Source: cdc.gov)












