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

7 Violence and Powerlessness

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

New studies link violence to HIV risk because many people in abusive relationships do not make healthy sexual choices.25,26,27,28 Condom use is a complex issue tied to poverty, self-esteem, desire to preserve good family relations, physical abuse, rejection, and abandonment.29 Evidence suggests that a person must have some degree of power in order to negotiate monogamous relationships and the use of condoms. Studies show that younger people with older sexual partners have problems negotiating condom use and are at higher risk for HIV infection.30,31,32 Because poverty also contributes to lack of power, condom use is especially problematic for poor people in violent relationships.

Violence is common in tribal communities. The violent crime rate among Native people is 2.5 times the national rate, and the rate for Native women is the highest of all ethnic groups.33 Individuals at risk for violence are demographically similar to those at risk for HIV infection. This includes people who are poor, have low self-esteem, and have little education. Childhood violence results in a variety of behaviors that increase the risk of HIV infection. These include greater number of sexual partners, more unprotected sex involving drugs, early use of intravenous drugs, inability to negotiate condom use, and engagement in unwanted sexual activity.34,35,36,37,38
  • Brainstorm ways to instill a sense of power in your HIV prevention materials. How can you communicate that people are in control of their own health?

  • Learn about violence in your Native community. Where does it occur most often?

  • Study condom distribution methods in your community. Are condoms made available to everyone? Are other health materials and information distributed with them?

25Pulerwitz J, Amaro H, De Jong W, Gortmaker SL, Rudd R. Relationship power, condom use and HIV risk among women in the USA AIDS Care. 2002;14:789-800.

26Cohen M, Deamant C, Barkan S, et al. Domestic violence and childhood sexual abuse in HIV-infected women and women at risk for HIV. American Journal of Public Health. April 2000;90:560-565.

27Garcia Moeno C, Watts C. Violence against women: Its importance for HIV/AIDS. AIDS. 2000;14:S253-S265.

28Vernon IS. Violence, HIV/AIDS, and Native American women in the twenty-first century. American Indian Culture and Research Journal. 2002;26:115-133.

29Roth NL, Fuller LK, eds. Women and AIDS: Negotiating Safer Practices, Care, and Representation. New York: Haworth Press; 1998.

30Vernon I. Killing Us Quietly: Native Americans and HIV/AIDS. Lincoln: University of Nebraska Press; 2001:72-73.

31Centers for Disease Control. National data on HIV prevalence among disadvantaged youth in the 1990s. Division of HIV/AIDS Prevention, CDC; September 1998.

32American Association for World Health. I Care…Do You? Youth and AIDS in the 21st Century. Washington DC: American Association for World Health Organization; 2001.

33US Department of Justice, Office of Justice Programs, Bureau of Justice Statistics. American Indians and Crime. Washington DC: Government Printing Office. February 1999;2:4.

34Cohen M, Deamant C, Barkan S, et al. Domestic violence and childhood sexual abuse in HIV-infected women and women at risk for HIV. American Journal of Public Health. April 2000;90:560-565.

35O’Leary A, Purcell S, Remien RH, Gomez C. Childhood abuse and sexual transmission risk behavior among HIV-positive men who have sex with men. AIDS Care. February 2003;15:17-26.

36Hobfoll SE, Bansal A, Schurg R, et al. The impact of perceived child physical and sexual abuse history on Native American women’s psychological well-being and AIDS risk. Journal of Consulting and Clinical Psychology. 2002;70:252-257.

37Walters K, Simoni J. Trauma, substance use and HIV risk among urban American Indian women. Cultural Diversity and Ethnic Minority Psychology. 1999;5:236-248.

38Vernon I, Bubar R. Child sexual abuse and HIV/AIDS in Indian Country. Wicazo Sa Review. Spring 2001;16:47-63.