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.

  1. CDC. Behavioral and clinical characteristics of persons with diagnosed HIV infection—Medical Monitoring Project, United States, 2018 cycle (June 2018–May 2019) pdf icon[PDF – 905 KB]. HIV Surveillance Special Report 2020;25.
  2. CDC. Diagnoses of HIV infection in the United States and dependent areas, 2018 (updated). HIV Surveillance Report 2020;31.
  3. CDC. Estimated HIV incidence and prevalence in the United States, 2014-2018. pdf icon[PDF – 3 MB] HIV Surveillance Supplemental Report 2020;25(1).
  4. CDC. High-impact HIV prevention: CDC’s approach to reducing HIV infections in the United States pdf icon[PDF – 400 KB].
  5. CDC. HIV infection risk, prevention, and testing behaviors among persons who inject drugs—National HIV Behavioral Surveillance: injection drug use, 23 U.S. Cities, 2018 pdf icon[PDF – 2 MB].  HIV Surveillance Special Report 2020;24.
  6. CDC. Improving HIV surveillance among American Indians and Alaska Natives in the United States pdf icon[PDF – 553 KB].
  7. CDC. Monitoring selected national HIV prevention and care objectives by using HIV surveillance data—United States and 6 dependent areas, 2018 pdf icon[PDF – 4 MB]. HIV Surveillance Supplemental Report 2020;25(2).
  8. CDC. Selected national HIV prevention and care outcomespdf icon (slides). Accessed April 14, 2021.
  9. 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, 1984–2002. Public Health Rep2007;122(3):382-92. PubMed Abstractexternal icon.
  10. Bureau of Indian Affairs. Indian entities recognized and eligible to receive services from the United States Bureau of Indian Affairsexternal iconFed Regist2020;85(20):5462-67.
  11. Kaiser Family Foundation. Key facts on health and health care by race and ethnicityexternal icon. Accessed April 14, 2021.
  12. Kaiser Family Foundation. Poverty rate by race/ethnicityexternal icon. Accessed April 14, 2021.
  13. National Center for Education Statistics. Status and trends in the education of racial and ethnic groupsexternal icon. Accessed April 14, 2021.
  14. United States Bureau of Labor Statistics. Labor force characteristics by race and ethnicity, 2019external icon. Accessed April 14, 2021.
  15. United States Census Bureau. QuickFacts United States: American Indians and Alaska Natives. external iconAccessed April 14, 2021.
  16. 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 Rep2002;117(1):s104-17. PubMed Abstractexternal icon.

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.