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.
Contents

11 Structural Barriers to Effective Intervention/Prevention

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

For more than five hundred years, Native people have overcome oppressive policies, cultural disruptions, and deadly diseases. The current challenges that HIV/AIDS presents are difficult but not insurmountable. However, there are unique structural barriers in Indigenous Country.

The relationship between Native tribes and the United States government is one of these barriers. The historical relationship has resulted in the recognition of tribal sovereignty but with a unique trust relationship whereby the US government has certain responsibilities to tribes and individual Native Americans. This relationship has clear consequences for Native health, particularly as it controls who can and cannot receive Indian health services. Also, through agreement, treaties, and statutes, the US government is required to provide healthcare to tribes (although, in many ways, it is a shared responsibility with tribes). Many tribes are utilizing their sovereign status to chart their own health future, but their ability to do so and the degree of governmental participation varies from tribe to tribe. Another structural factor that can prevent tribes’ ability to utilize their sovereign status to plan their health future is the undefined and often tenuous relationship between state governments and tribal governments. Depending on the state and the tribe, this can limit or expand the sovereign rights of a tribe to plan their healthcare vision or to obtain funding. Indian health services are managed by IHS or the tribes themselves, and this complex relationship can be problematic and may impact the creation of culturally relevant and effective prevention/intervention programs.56

Another structural barrier unique to many Native communities, and similar to rural communities, is the need for transportation. Indigenous Country consists of isolated villages and reservations where the need for transportation to healthcare and services is extremely high. In Alaska, for example, an airplane may be the only way to access healthcare and on some reservations poorly maintained roads can be a problem.

56Kicking Bird K, Rhoades ER. The relations of Indian nations to the US government. In: Rhoades ER, ed. American Indian Health: Innovations in Health Care, Promotion, and Policy. Baltimore, Maryland: The Johns Hopkins University Press; 2000:61-73.

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