Module 2: Historical and Socioeconomic Health Risks

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

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.


10 Healthcare Funding for Native Communities

This module discusses the impact of HIV/AIDS on Native Americans and the health and psychological legacies of contact and colonization.

Topics include:

  1. History and Trauma

  2. Impacts of Contact and Colonization

  3. Discrimination and Homophobia

  4. Effective Communication

  5. Biological Factors

  6. Poverty

  7. Violence and Powerlessness

  8. Trust and Lack of Confidence

  9. Substance Abuse

  10. Healthcare Funding for Native Communities

  11. Structural Barriers to Intervention/Prevention

Increased funding for Native Health services is necessary to provide adequate and quality prevention, education, and care. One primary source of healthcare funding for Native communities is the Indian Health Service (IHS), which has not been well funded.52,53 The IHS’s annual per capita spending for Indian health is $1,430 while the US average is $3,766. Other forms of healthcare funding for Native programs have not been stable enough to provide adequate healthcare services. Inadequate funding and services can result in an array of negative outcomes such as incorrect diagnosis, delay of treatment, and sometimes denied services.

The lack of funding and inability to deliver effective HIV/AIDS programs place thousands of Native people at great risk and creates an ideal situation for the virus to go unchecked. Ways to address this problem include ensuring that the tribes and urban Native communities continue a strong relationship with Congress since they provide the IHS and other public health agencies with monetary appropriations.

Today the majority of Native people live in urban areas and often must travel for health services. There is a crisis occurring with urban Indian funding. In 2003 urban Indian health programs received $31.3 million, a mere 1.1 percent of the total IHS budget.54 In 2005, urban Indian health programs were slated to be cut from the federal budget entirely. As tribal and urban Native communities continue to work with Congress, the tight budgetary constraints require them to work collaboratively with other organizations and agencies on both the tribal, local, state, and federal levels.

Without adequate funding, program development, program delivery, long range health planning, appropriate healthcare, and resources for research are problematic. At the same time, some tribes have shown that while funding limitations and under-funding are a barrier to quality healthcare, “tribally managed, community controlled, or IHS health facilities provided quality care, despite limited funding.” 55 Native prevention/intervention programs continue to develop although they face many barriers.

52Smedley BD, Stith AY, Nelson AR, eds. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington DC: The National Academies Press; 2003.

53Vernon I. Killing Us Quietly: Native Americans and HIV/AIDS. Lincoln: University of Nebraska Press; 2001:28.

54US Commission on Civil Rights. A Quiet Crisis: Federal Funding and Unmet Needs in Indian Country. Washington DC: Government Publication; 2003.

55Joe JR. The rationing of healthcare and health disparity for the American Indians/Alaska Natives. In: Smedley BD, Stith AY, Nelson AR, eds. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington DC: The National Academies Press; 2003:528-551.