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HIV and AIDS in Indigenous Communities

Medically Reviewed by Jennifer Robinson, MD on April 13, 2022

All communities in the United States are affected by HIV and AIDS, including indigenous ones. The number of American Indian and Alaska Native people diagnosed with HIV is proportional to the group’s U.S. population size.

These communities are very diverse, geographically and culturally. But many of them share some challenges that can affect HIV diagnosis and treatment, such as poverty and access to health care.

How Many Indigenous People Have HIV?

About 1.3 percent of the U.S. population is American Indian or Alaska Native (AI/AN), and they make up less than 1 percent of new HIV diagnoses, according to the CDC. AIDS is the most advanced stage of HIV, so people with that diagnosis are included in HIV statistics.

The rate of HIV diagnoses in American Indian and Alaska Native people has been stable in recent years. And the percentage of AI/AN people living with diagnosed HIV has been steady, too.

The death rate of AI/AN people from HIV has gone down in recent years.

But American Indian and Alaska Native people with HIV may be undercounted in national data because they’re sometimes misidentified as another race in medical records. This can also cause HIV services for AI/AN people to be underfunded.

Risks and Causes of HIV

Your background doesn’t determine your risk of HIV on its own. Regardless of race or ethnicity, people usually get HIV through anal or vaginal sex, or by sharing needles and other drug injection equipment.

Most AI/AN men with HIV got it from male-to-male sexual contact. Diagnoses of AI/AN women were most often attributed to heterosexual contact.

What Are the Treatment Rates for These Communities?

With today’s medications (called antiretroviral therapy or ART), people with HIV can live healthy, long lives without spreading HIV to their sexual partners. With treatment, your HIV may not ever progress to AIDS.

Native American and Alaska Native people with HIV get medical care for their condition at about the same rate as people with HIV overall. Recent research shows that out of 100 AI/AN people with diagnosed HIV, 75 received some HIV care. Fifty-six were retained in care, meaning they had regular viral load tests to see how well their medication is working.

AI/AN people also have about the same rates of viral suppression as all other people with HIV. That means they’re taking their medication as prescribed, are healthy, and can’t transmit HIV to others. About 64 out of 100 AI/AN people with HIV were virally suppressed in 2018, according to the CDC.

The Challenges of Stigma and Poverty

Unfortunately, many people with HIV struggle with stigma around the disease. More than 3/4 of American Indian and Alaska Native people being treated for HIV say they feel internalized (self-perceived) stigma around their condition. That’s about the same as among all adults with HIV.

Stigma can prevent people from seeking treatment and can hurt their mental health. About a quarter of all AI/AN people with HIV have depression, which is also about the same number of people with HIV from any racial group.

About half of AI/AN people with HIV are dealing with poverty. This can make it hard to get HIV care since you might not have a stable place to live or reliable transportation. Problems like poverty, depression, and stigma can stem from the historical injustice and racial inequities that indigenous people have faced, according to the CDC.

Research shows that more AI/AN people are living in rural areas when they’re diagnosed with HIV than people in other racial or ethnic groups. People in rural areas can have a harder time getting HIV testing, with limited access or concerns about confidentiality in small communities.

Prevention of HIV

The basics of preventing HIV are the same for every racial and ethnic group. To reduce your risk, use a condom anytime you have sex. Don’t use injectable drugs, or use sterile equipment if you do. That includes needles, syringes, and injection equipment like cookers.

PrEP, which stands for pre-exposure prophylaxis, is medication you take every day to avoid getting HIV from sex or drug use. Ask your doctor if it’s a good choice for you.

Programs to spread the word about HIV prevention face extra hurdles because of the diversity of Native American communities. There are more than 574 federally recognized AI/AN tribes. They have unique cultures, languages, and geography, so prevention efforts need to be tailored to each community.

Where to Get Help

There are many ways to learn more about HIV and AIDS and to get help. Check out these resources:

  • Indian Health Service (IHS) National HIV/AIDS Program. The IHS is part of the federal Department of Health and Human Services and provides health services to American Indian and Alaska Native people. They have a program to prevent and treat HIV in Native American communities. Find out where to get tested, receive care and learn more about PrEP on their website.
  • HIV.gov. Learn about treatment and testing, and find support on this government website. Find reliable information about legal issues, housing, mental health services, and more.
  • State HIV/AIDS Help Lines. Find yours here. They can connect you with the services you need.
  • National Native HIV Network. This organization serves American Indians, Alaska Natives, and Native Hawaiians to promote testing, prevention, and treatment. Follow their social media accounts for learning opportunities and solidarity.
  • Urban Indian Health Institute. This organization focuses on urban Native communities. Find videos about sexual health, HIV stigma, and other topics on their website.
  • National Native HIV/AIDS Awareness Day. Commemorated on the first day of spring with community events, this day promotes education in all Native communities. Locate events on their website.

Show Sources

SOURCES:

CDC: “HIV: Populations at Greatest Risk.”

Indian Health Service: “HIV/AIDS Statistics.”

CDC: “HIV and American Indian/Alaska Native People.”

CDC : “AIDS and Opportunistic Infections.”

CDC: “Diagnoses of HIV Infection in the United States and Dependent Areas, 2018.”

CDC: “HIV Surveillance Report Supplemental Report: Estimated HIV Incidence and Prevalence in the United States 2014–2018.”

Public Health Reports: “Racial Misidentification of American Indians/Alaska Natives in the HIV/AIDS Reporting Systems of Five States and One Urban Health Jurisdiction, U.S., 1984–2002.”

HIV.gov: “About HIV and AIDS.”

CDC: “Behavioral and Clinical Characteristics of American Indian/Alaska Native Adults in HIV Care — Medical Monitoring Project, United States, 2011–2015.”

Indian Health Service: “American Indian & Alaska Native HIV Data Update.”

National Institutes of Health: “HIV Prevention.”

CDC: “HIV Basics: About PrEP.”

HIV.gov: “Working Together, We Can Make Progress.”

Indian Health Service: “About IHS.”

Indian Health Service: “HIV/AIDS.”

CDC: “Resources for People with HIV.”

National Native HIV Network.

Urban Indian Health Institute: “Urban Indian HIV and AIDS.”

National Native HIV/AIDS Awareness Day.

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