How the Fly Saved the River

Many, many years ago when the world was new, there was a beautiful river. Fish in great numbers lived in this river, and its water was so pure and sweet that all the animals came there to drink. A giant moose heard about the river and he too came there to drink. But he was so big, and he drank so much, that soon the water began to sink lower and lower. The beavers were worried. The water around their lodges was disappearing. Soon their homes would be destroyed. The muskrats were worried, too. What would they do if the water vanished? How could they live? The fish were very worried. The other animals could live on land if the water dried up, but they couldn't.

All the animals tried to think of a way to drive the moose from the river, but he was so big that they were too afraid to try. Even the bear was afraid of him. At last the fly said he would try to drive the moose away. All the animals laughed and jeered. How could a tiny fly frighten a giant moose? The fly said nothing, but that day, as soon as the moose appeared, he went into action. He landed on the moose's foreleg and bit sharply. The moose stamped his foot harder, and each time he stamped, the ground sank and the water rushed in to fill it up. Then the fly jumped about all over the moose, biting and biting and biting until the moose was in a frenzy. He dashed madly about the banks of the river, shaking his head, stamping his feet, snorting and blowing, but he couldn't get rid of that pesky fly. At last the moose fled from the river, and didn't come back. The fly was very proud of his achievement, and boasted to the other animals, "Even the small can fight the strong if they use their brains to think."1

Throughout history, Native people have encountered and survived much trauma, disease, and discrimination. Today American Indians, Alaska Natives, and Native Hawaiians face a new challenge: preventing HIV/AIDS from spreading and wiping out whole Native communities.

After two decades of AIDS work, many Native communities now realize that prevention does make a difference. In the story above, the tiny fly drives away the moose despite great doubt from the other animals. Similarly, Native people—though small in numbers compared to other ethnic groups—must overcome the beast of HIV/AIDS.

There are over five hundred tribes and villages nationwide, with a variety of languages, ceremonies, and social, political, and economic systems. Native people call for HIV/AIDS prevention programs that address the unique needs of these diverse communities. Effective programs for Native people must address women, men, youth, and Two-Spirits. They must be culturally appropriate and should include all genders, ages, and sexual orientations. Native people must work together to create culturally specific prevention strategies and programs that stress community input and participation, Native spirituality, and cultural norms and values.

HIV Prevention Toolkit for Native Communities

NNAAPC created this HIV Prevention Toolkit for Native Communities to help its participants better serve Native communities in the public health area of HIV/AIDS. With this toolkit, we hope to enhance your knowledge, skills, abilities, attitudes, and behaviors as they pertain to HIV/AIDS prevention among Native peoples. The toolkit is intended for program/project coordinators and managers, health educators, social and health service providers, and grant writers.

The HIV Prevention Toolkit for Native Communities is composed of six stand-alone modules. You can use individual modules to improve a specific area of your agency’s program, to learn more about a section of HIV/AIDS prevention, and/or to learn more about Native people and healthcare. As a set, the modules progress from basic concepts to more complex strategies for HIV/AIDS prevention. We encourage you to access the toolkit for your specific needs. In each module, you will find links to key terms, websites of health and Native-focused organizations, and other useful resources.

The National Native American AIDS Prevention Center (NNAAPC) has been serving American Indians, Alaska Natives, and Native Hawaiians since 1987. NNAAPC works to address the impact of HIV/AIDS on Native populations through culturally appropriate advocacy, research, education, and policy development. NNAAPC offers capacity-building assistance and training programs for organizations that serve Native communities. If you need further assistance with your program beyond this toolkit, please contact NNAAPC at


We offer many thanks to the contributing writers and editors who made this toolkit possible.  Through their efforts, we hope Native communities and Native serving organizations are better prepared to create and deliver effective, culturally appropriate interventions and programs.

Erin Hayes
Jay Macedo, MA

Barbara Aragon, MSW
Rose L. Clark, PhD
Anno Nakai, MA
Deborah Scott, MPH
Antony Stately, PhD
Irene Vernon, PhD
Janis Weber, PhD

Design and Layout
Mathew Barkhausen
Frank Wang


  • Module 1: Native Cultural Diversity
  • There are many layers of diversity within any culture. When learning about Native cultures, it is important to acknowledge the differences between various tribes, nations, villages, and islands. These differences can occur among groups within a single geographical region or across various regions. Although it is impossible to learn the unique characteristics of each Native entity, it is possible to recognize and study a specific group’s customs, norms, beliefs, and values in order to gain a distinct cultural perspective.

    Goal of Module 1: To provide a cultural background for your HIV/AIDS prevention and intervention program.

  • Module 2: Historical and Socioeconomic Health Risks
  • Addressing HIV/AIDS is not an easy task in itself. Addressing HIV/AIDS among Native populations is even more difficult. It involves the health and psychosocial effects of many other issues: a traumatic history, homophobia and discrimination, poor communication, poverty, and substance abuse. In order to address HIV/AIDS among Native populations, it is essential to understand and respond to these historical and social barriers.

    Goal of Module 2: To examine the historical and sociological factors that put Native communities at increased risk for HIV infection.

  • Module 3: Epidemiology of HIV/AIDS among Native Communities
  • Epidemiology is the study of the ways in which a disease progresses through a population. In order to plan and carry out an effective intervention, you must understand how and why people in your community become infected with and spread HIV.

    In this module, you will find:

    • Fast Facts that offer useful statistics and information
    • an article on epidemiology as it relates to American Indians, Alaska Natives, and Native Hawaiians
    • exercises that provide steps toward learning about epidemiology in your community
    • resources for further research on the epidemiology of HIV/AIDS

    Goal of Module 3: To help you identify how and why HIV/AIDS spreads in your Native community in order to strengthen your intervention.

  • Module 4: Foundation of a Prevention Program
  • In order to provide an effective HIV prevention intervention for Native people, you will need to lay a strong community foundation and apply intervention programs in a culturally meaningful way. One option is to tailor existing interventions to fit the unique needs of your Native community. This module includes an overview of program components, information on CDC’s Advancing HIV Prevention Initiative, descriptions of evidence-based interventions, and an introduction to storytelling as a prevention strategy.

    Goal of Module 4: To provide methods, examples, and tools with which to carry out your HIV/AIDS prevention program.

  • Module 5: Conducting a Community Services Assessment
  • This module contains the fundamentals for the systematic gathering of knowledge to better understand the needs and strengths in your community as they relate to HIV. The knowledge gathered will help to build a strengths-based and community-driven HIV prevention intervention program which responds to community needs. The model used is based on the Community Services Assessment (CSA). This module will take you through the steps of a CSA: needs assessment, resource inventory, and gap analysis.

    Goal of Module 5: To provide Community Services Assessment steps, tools, and resources for the development of an HIV/AIDS prevention intervention program.

  • Module 6: HIV Program Evaluation for Native Communities

    To provide an effective HIV prevention intervention for Native people, you will need to ensure that a solid, culturally relevant evaluation plan informs your program from beginning to end. Program evaluation can help determine whether your HIV prevention intervention program is accomplishing what it set out to accomplish. This module includes an overview of helpful cultural components that effect evaluation, hands-on considerations, evaluation steps and tools, and avenues to share lessons learned to help you build an effective evaluation for your HIV prevention intervention program.

    Goal of Module 6: To provide an evaluation framework for your HIV prevention intervention program.

  • 1How the fly saved the river. Native Lore Index page. Available at: Accessed March 1, 2007.