1. HIV in Indian Country Presented by: Warren Jimenez Executive Director National Native American AIDS Prevention Center April 10, 2008 American Bar Association National Conference on HIV/AIDS Law and Practice: From Local Client to Global Workforce

2. NNAAPC’s Mission: To address the impact of HIV/AIDS on American Indians, Alaska Natives and Native Hawaiians through culturally appropriate advocacy, research, education and policy development in support of healthy indigenous people.

3. National Native American AIDS Prevention Center Since 1987, NNAAPC has been the only national organization solely devoted to prevention of HIV/AIDS in the Native American community It has chronicled the HIV epidemic and responded by attempting to educate and empower the Native community

4. In the United States… Approximately one million people are infected with HIV Over 40,000 new cases of AIDS diagnosed each year In 2005, there were approximately 17,000 HIV/AIDS-related deaths in the United States

5. HIV/AIDS In Indian Country 1 By 12/05, an estimated 3,238 American Indians / Alaska Natives had been diagnosed with HIV/AIDS An estimated 1,657 American Indians and Alaska Natives with AIDS have already passed away Over 51% had passed away 1 Centers for Disease Control and Prevention. HIV/AIDS Surveillance Report, 2005. Vol. 17. Rev ed. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2007

6. HIV/AIDS in 2005 An estimated 1,581 AI/AN were living with AIDS HIV/AIDS was diagnosed for an estimated 195 American Indians and Alaska Natives Women accounted for 29% of diagnoses among AI/AN

7. It Is Only The Beginning… American Indians and Alaska Natives have the third highest rate of HIV/AIDS diagnosis –Cumulatively, 10.4 per 100,000 –3 rd highest rate respectively for both male (19.1) and female (7.5) per 100,000 These rates are continuing to rise…

8. Transmission Categories for American Indian and Alaska Natives living with HIV/AIDS at the end of 2005 Note: Based on data from 33 states with long-term, confidential name-based HIV reporting.

9. Much Needs to Be Done… American Indians and Alaska Natives are diagnosed later and die earlier than all other reported ethnic groups, except African-Americans Between 2001-2005 Cumulatively since 1996 >12 months>24 months>36 months>9 yrs 86%82%77%65%

10. Risk Co-Factors: STD’s 2nd highest rate of chlamydia –In some places more than 4 times the national rate, per 100,000 2nd highest rate of gonorrhea 3rd highest rate of syphilis

11. Risk Co-Factors: Substance Use Rate of current illicit drug use was higher for Native American and Alaska Natives (12.8%) than among persons of other races and ethnicities (CDC, Mar, 2007) –More likely to have used an illicit drug in past month –Youth illicit drug use rising (declining for other groups) –Methamphetamine abuse increasing Native Americans have the highest prevalence of substance abuse and dependence (American Journal of Public Health, Aug, 2006) –Alcoholism related deaths 770% higher than National average –33% of deaths before age 45 are related to substance abuse –Youth have highest alcohol rates compared with all other groups

12. More Risk Co-Factors Mental Health –More than 1/3 of the demands on IHS involve mental health concerns –180% higher rates of suicide, with highest rate in 15 to 34 olds Healthcare –Overloaded Indian Health Service –Competing IHS and tribal facilities –Distrust of Western medicine SES –12% unemployment (2x national average) –42% have high school diploma

13. Additional Barriers: Surveillance Low testing rates Misclassification by providers Tribal data collection systems inadequate Jurisdictional confusion over who to report to

14. Additional Barriers: National HIV Prevention System Based upon Federal and State Funding –Access to funding –Access to training Sophistication of HIV prevention –Western theories and models

15. Additional Barriers: Cultural Amplifiers Confidentiality issues Realistic coping mechanism of paranoia Modesty Increased homophobia Disease taboo Communication style Circular migration

16. Additional Barriers: Prioritization Native communities have placed other issues at higher priority levels –Substance use –Diabetes –Economic development Rightfully so

17. Additional Barriers: Low Self Regard Overwhelming sense of low self- esteem / self-regard –An individual manifestation of a cultural phenomenon –Generations of mixed trauma, discrimination and societal reactions Resulting in low health preservation and seeking behaviors

18. It is too easy to focus on the negative We have assets and values related to health –Experiences with epidemics –Different view of pathology in an individual and the community –Relationship with family and community –Understandings of medicine –Prayer & Ceremony –Beliefs in overall wellness and balance

19. And most importantly… Value placed upon youth and the future generations

20. What is currently happening Adapting prevention intervention Creating interventions Community Health Representative programs Peer education programs Integrated school curriculums Traditional and cultural services

21. What else needs to happen? Funding for Native-specific research –Protective factors –Interventions Increased counseling & testing efforts Proactive outreach to urban populations Cultural competency –For agencies (materials and space) –For providers Syncretic prevention and treatment services

22. National Native HIV/AIDS Awareness Day March 20 th Local and national events to call attention to the epidemic in indigenous communities

23. National Native HIV/AIDS Awareness Day

24. Resources Available NNAAPC (www.nnaapc.org)www.nnaapc.org Center for Applied Studies in American Ethnicity, CSU (http://www.colostate.edu/Depts/CASAE/)http://www.colostate.edu/Depts/CASAE/ Indian Health Service National Minority AETC (www.nmaetc.org)www.nmaetc.org MPAETC (www.mpaetc.com)www.mpaetc.com Association of American Indian Physicians (www.aaip.org)www.aaip.org Local community and resources –Elders and healers

25. Thank you for your attention and your commitment!! Warren Jimenez National Native American AIDS Prevention Center 720 S. Colorado Blvd., Suite 650-S Denver, CO 80246 720-382-2244 rfoley@nnaapc.org