HIV and American Indian/Alaska Native People: Prevention Challenges

There are more than 574 federally recognized AI/AN tribes and many different languages. Because each tribe has its own culture, beliefs, and practices, creating culturally appropriate prevention programs for each group can be challenging. Additionally, racial misidentification of AI/AN people may lead to the undercounting of this population in HIV surveillance systems and may contribute to the underfunding of targeted services for AI/AN people.

Some AI/AN people experience social, cultural, and economic barriers such as stigma, confidentiality concerns, and poverty. These issues could limit opportunities for HIV testing, treatment, and other prevention services, especially among AI/AN people who live in rural communities or on reservations. Addressing these barriers and encouraging supportive communities can help improve health outcomes for AI/AN people.

Other factors that can increase the chances of getting or transmitting HIV include:

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Sexually transmitted diseases (STDs). In 2018, AI/AN people 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.

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Knowledge of HIV status. It is important for everyone to know their HIV status. People who do not know they have HIV can’t take advantage of HIV care and treatment and may unknowingly pass HIV to others.

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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 if a person shares needles, syringes, and other drug injection equipment—for example, cookers—with someone who has the virus. Compared with other racial/ethnic groups, AI/AN people tend to use alcohol and drugs at a younger age and use them more often and in higher quantities.

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a Adult and adolescent AI/AN people aged 13 and older.
b Percentage of AI/AN people reporting only one race. The US Census Bureau’s population estimates include the 50 states, the District of Columbia, and Puerto Rico.
c American Samoa, Guam, the Northern Mariana Islands, Puerto Rico, the Republic of Palau, and the US Virgin Islands.

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