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HIV and American Indians and Alaska Natives

American Indians and Alaska Natives (AI/AN) represent about 1.3%a of the U.S. population. Overall, diagnosed HIV infections among AI/AN are proportional to their population size, but HIV diagnoses have increased over time.

The Numbers

HIV and AIDS Diagnosesb

HIV Diagnoses Among American Indians/Alaska Natives
in the US and Dependent Areas by Transmission Category
and Sex, 2017c

Pie chart shows diagnoses of HIV Diagnoses Among American Indians/Alaska Natives in the US by Transmission Category and Sex, 2017:  Males N=167, Male-to-male sexual contact=75percent, Male-to-male sexual contact/IDU=11percent, IDU=10percent, Heterosexual Contact=4percent, Females N=45, Heterosexual contact=69, IDU=31percent
Pie chart shows diagnoses of HIV Diagnoses Among American Indians/Alaska Natives in the US by Transmission Category and Sex, 2017:  Males N=167, Male-to-male sexual contact=75percent, Male-to-male sexual contact/IDU=11percent, IDU=10percent, Heterosexual Contact=4percent, Females N=45, Heterosexual contact=69, IDU=31percent

The terms male-to-male sexual contact and male-to-male sexual contact and injection drug use are used in the CDC surveillance systems. They indicate the behaviors that transmit HIV infection, not how individuals self-identify in terms of their sexuality.

Source: CDC. Diagnoses of HIV infection in the United States and dependent areas, 2017. HIV Surveillance Report 2018;29.

  • Of the 38,739 HIV diagnoses in the United States in 2017, 1% (212) were among AI/AN.
  • From 2010 to 2016, the annual number of HIV diagnoses increased 46% (from 157 to 230) among AI/AN overall and 81% (from 90 to 163) among AI/AN gay and bisexual men.d

Living With HIV and Deaths

In the 50 states and the District of Columbia:

  • An estimated 3,600 AI/AN had HIV in 2016 and 82% of them had received a diagnosis.
  • Of AI/AN with HIV in 2015, 60% received HIV care, 43% were retained in care, and 48% had achieved viral suppression.e

graphic of a pill bottle

 

People with HIV who take HIV medicine as prescribed and get and keep an undetectable viral load (or stay virally suppressed) have effectively no risk of transmitting HIV to their HIV-negative sexual partners.

  • During 2016, 46 AI/AN with diagnosed HIV died in the US. These deaths may be due to any cause.

Prevention Challenges

  • Sexually transmitted diseases (STDs). From 2013 to 2017, AI/AN had the second highest rates of chlamydia and gonorrhea among all racial/ethnic groups. Having another STD increases a person’s risk for getting or transmitting HIV.
  • Awareness of HIV status. An estimated 8 in 10 AI/AN with HIV in 2016 had received a diagnosis. It is important for everyone to know their HIV status. People who do not know they have HIV cannot take advantage of HIV care and treatment and may unknowingly pass HIV to others.
  • Cultural stigma and confidentiality concerns. 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, creating culturally appropriate prevention programs for each group can be challenging.
  • Socioeconomic issues. Poverty, including limited access to high-quality housing, directly and indirectly increases the risk for HIV infection and affects the health of people who have and are 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.
  • Alcohol and illicit drug use. Alcohol and substance use can impair judgment and lead to behaviors that increase the risk of HIV. Injection drug use can directly increase the risk of HIV through sharing contaminated needles, syringes, and other equipment. Compared with other racial/ethnic groups, AI/AN tend to use alcohol and drugs at a younger age and use them more often and in higher quantities.
  • 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 targeted services for AI/AN.

What CDC Is Doing

CDC and its partners are pursuing a high-impact prevention approach to maximize the effectiveness of current HIV prevention methods and improve HIV data collection among AI/AN. Activities include:

  • Under the new integrated HIV surveillance and prevention cooperative agreement, CDC is awarding around $400 million per year to health departments for surveillance and prevention efforts. This award will direct resources to the populations and geographic areas of greatest need, while supporting core HIV surveillance and prevention efforts across the United States.
  • In 2019, CDC will award a new cooperative agreement to strengthen the capacity and improve the performance of the nation’s HIV prevention workforce. New elements include dedicated providers for web-based and classroom-based national training and technical assistance tailored within four geographic regions.
    • Ensuring that capacity-building assistance providers incorporate cultural competency, linguistics, and educational appropriateness into all services delivered.
  • Through its Let’s Stop HIV Together (formerly Act Against AIDS) campaigns and partnerships, CDC provides effective and culturally appropriate messages aimed at stopping HIV stigma and promoting HIV testing, prevention, and treatment. The stigma materials include stories and issues relevant to AI/AN, as do the following:
    • Doing It encourages all people to know their HIV status and protect themselves and their community by making HIV testing a part of their regular health routine.
    • Start Talking. Stop HIV. helps gay and bisexual men communicate about testing and a range of HIV prevention strategies.
    • HIV Treatment Works shows how people living with HIV have overcome barriers to stay in care and provides resources on how to live well with HIV.
  • Partnering and Communicating Together (PACT) to Act Against AIDS, a 5-year partnership with organizations such as the ASPIRA Association and AIDS United, is raising awareness about testing, prevention, and retention in care among populations disproportionately affected by HIV, including AI/AN.

In addition, the Office for State, Tribal, Local, and Territorial Support (OSTLTS) serves as the primary link between CDC, the Agency for Toxic Substance and Disease Registry, and tribal governments. OSTLTS’s tribal support activities are focused on fulfilling CDC’s supportive role in ensuring that AI/AN communities receive public health services that keep them safe and healthy.

a Percentage of AI/AN reporting only one race. The US Census Bureau’s population estimates include the 50 states, the District of Columbia, and Puerto Rico.
b HIV diagnoses refers to the number of people who received an HIV diagnosis during a given time period, not when the people got HIV infection.
c Unless otherwise noted, the term United States includes the 50 states, the District of Columbia, and the 6 dependent areas of American Samoa, Guam, the Northern Mariana Islands, Puerto Rico, the Republic of Palau, and the US Virgin Islands.
dIncludes infections attributed to male-to-male sexual contact and injection drug use (men who reported both risk factors).
e People are considered retained in care if they get two viral load or CD4 tests at least 3 months apart in a year. (CD4 cells are the cells in the body’s immune system that are destroyed by HIV.) Viral suppression is based on the most recent viral load test.

Bibliography

  1. CDC. Estimated HIV incidence and prevalence in the United States, 2010–2016. HIV Surveillance Supplemental Report2019;24(1).
  2. US Census Bureau. QuickFacts United States: American Indians and Alaska Natives. Accessed February 5, 2019.
  3. CDC. Diagnoses of HIV infection in the United States and dependent areas, 2017. HIV Surveillance Report 2018;29. Accessed February 5, 2019.
  4. CDC. NCHHSTP AtlasPlus. Accessed February 21, 2019.
  5. CDC. High-impact HIV prevention: CDC’s approach to reducing HIV infections in the United States. Accessed February 5, 2019.
  6. CDC. Improving HIV surveillance among American Indians and Alaska Natives in the United States(https://www.cdc.gov/hiv/pdf/policies_strategy_nhas_native_americans.pdf). Accessed February 5, 2019.
  7. CDC. Monitoring selected national HIV prevention and care objectives by using HIV surveillance data—United States and 6 dependent areas—2015. HIV Surveillance Supplemental Report 2017;22(2). Accessed February 5, 2019.
  8. CDC. Selected national HIV prevention and care outcomes (slides). Accessed February 5, 2019.
  9. CDC. Sexually transmitted disease surveillance 2017 (slides). Accessed February 5, 2019.
  10. Burks DJ, Robbins R, Durtschi JP. American Indian gay, bisexual and two-spirit men: A rapid assessment of HIV/AIDS risk factors, barriers to prevention and culturally-sensitive intervention. Cult Health Sex 2011;13(3):283-98. PubMed Abstract.
  11. Bureau of Indian Affairs. Indian entities recognized and eligible to receive services from the United States Bureau of Indian Affairs. Fed Regist 2012;77(155):47868. Accessed February 5, 2019.
  12. James C, Schwartz K, Berndt J. A profile of American Indians and Alaska Natives and their health coverage. Menlo Park, CA: Henry J. Kaiser Family Foundation; 2009. Accessed February 5, 2019.
  13. Walters KL, Simoni JM, Evans-Campbell T. Substance use among American Indians and Alaska Natives: Incorporating culture in an ‘Indigenist’ stress-coping paradigm. Public Health Rep 2002;117(1):s104-17. PubMed Abstract.
  14. Bertolli J, Lee LM, Sullivan PS, American Indian/Alaska Native Race/Ethnicity Data Validation Workgroup. Racial misidentification of American Indians/Alaska Natives in the HIV/AIDS reporting systems of five states and one urban health jurisdiction, US, 1984–2000. Public Health Rep 2007;122(3):382-94. PubMed Abstract.
  15. CDC. Deaths: Final data for 2015. National Vital Statistics Reports 2017; 66(6). Accessed January 26, 2018.

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