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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. NNAAPC’s Mission:.
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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
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.
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
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
HIV/AIDS In Indian Country1 • 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
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
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 • 3rd highest rate respectively for both male (19.1) and female (7.5) per 100,000 • These rates are continuing to rise…
Transmission Categories forAmerican 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.
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
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
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
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
Additional Barriers: Surveillance • Low testing rates • Misclassification by providers • Tribal data collection systems inadequate • Jurisdictional confusion over who to report to
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
Additional Barriers: Cultural Amplifiers • Confidentiality issues • Realistic coping mechanism of paranoia • Modesty • Increased homophobia • Disease taboo • Communication style • Circular migration
Additional Barriers: Prioritization • Native communities have placed other issues at higher priority levels • Substance use • Diabetes • Economic development • Rightfully so
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
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
And most importantly… Value placed upon youth and the future generations
What is currently happening • Adapting prevention intervention • Creating interventions • Community Health Representative programs • Peer education programs • Integrated school curriculums • Traditional and cultural services
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
National Native HIV/AIDS Awareness Day • March 20th • Local and national events to call attention to the epidemic in indigenous communities
Resources Available • NNAAPC (www.nnaapc.org) • Center for Applied Studies in American Ethnicity, CSU (http://www.colostate.edu/Depts/CASAE/) • Indian Health Service • National Minority AETC (www.nmaetc.org) • MPAETC (www.mpaetc.com) • Association of American Indian Physicians (www.aaip.org) • Local community and resources • Elders and healers
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