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

3 Discrimination and Homophobia

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

Traditionally, many Native cultures accepted alternative genders and sexual orientations.9,10,11,12, Some Native communities still show respect for gay, lesbian, bisexual, transgender (GLBT), and Two-Spirit people. Unfortunately, Native communities also have homophobia, discrimination, and violence against people who engage in same-sex behaviors. GLBT and Two-Spirit people may avoid HIV/AIDS education, services, testing, and care because of this.

GLBT and Two-Spirit people have the highest infection rates among Native populations. These groups make up 81 percent of the reported AIDS cases.13 Compared to heterosexual youth, GLBT youth are twice as likely to use drugs. This places them at a higher risk for HIV infection.14 In the past, GLBT and Two-Spirit Native people have faced racial discrimination in some “white-urban” health facilities.15 Conversely, GLBT and Two-Spirit Native people have also experienced homophobia in some Native urban and tribal health clinics. Such treatment may discourage them from seeking necessary medical services and testing.
  • How is homophobia present in your community? Identify some local examples of discrimination against GLBT and Two-Spirit people. Under what circumstances did this discrimination occur?
  • Identify possible areas of discrimination in your healthcare practices and facilities. Do your educational materials use words that include all genders and sexual orientations? Is your staff trained in cultural competency and diversity?
  • Brainstorm ways to make GLBT and Two-Spirit Natives feel more welcome in your healthcare facilities.

DEFINING TWO-SPIRITS

The term Two-Spirit (or Two-Spirited) first gained recognition in 1990 by Native participants at the third International Gathering, a Native gay and lesbian conference in Winnipeg. Originating in a traditional term for middle-gender persons (generically referred to as “berdache” by some anthropologists and scholars), it describes a masculine spirit and feminine spirit living in the same body. Over time, the term has come to signify contemporary Native American individuals who may identify as gay, lesbian, or bisexual; traditions in which multiple gender categories and sexualities are institutionalized in Native American tribal cultures; transvestites, transsexuals, and transgendered people; and drag queens and butches.10

NNAAPC developed a multi-module training curriculum called Addressing Two-Spirits in the American Indian, Alaskan Native, and Native Hawaiian Communities. The curriculum is intended for people and programs providing services to Two-Spirits. Among other topics, it addresses better holistic service, homophobia in Native communities, and empowering Two-Spirits to stand tall in their communities. You can access the instructor and participant manuals here.       
9Brown LB, ed. Two Spirit People: American Indian Lesbian Women and Gay Men. New York: Haworth Press; 1997.

10Jacobs S, Thomas W, Lang S, eds. Two-Spirit People: Native American Gender Identity, Sexuality, and Spirituality. Chicago: University of Illinois Press; 1997.

11Lang S. Men as Women, Women as Men: Changing Gender in Native American Cultures. Austin: University of Texas Press; 1998.

12Roscoe W. Changing Ones: Third and Fourth Gender in Native North America. New York: St. Martin’s Press; 1998.

13Centers for Disease Control and Prevention. HIV/AIDS Surveillance Report, Year-End Edition. Atlanta: US Department of Health and Human Services, CDC. December 2001;13:16.

14Roseman D, Lindera K. Issues at a glance: HIV/STD prevention and young men who have sex with men. Advocates for Youth. Washington DC: Advocates for Youth; 1999.

15Vernon I. Killing Us Quietly: Native Americans and HIV/AIDS. Lincoln: University of Nebraska Press; 2001:28.