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

9 Substance Abuse

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

Like poverty, substance abuse is common in many Native communities. It is a major way of transmitting HIV for both men and women. Recent research concluded that AI/AN drug users are at increased risk for HIV because of their drug risk behaviors.39,40,41,42 Hawaii leads the nation in methamphetamine (meth) addiction and use.43 Drug and alcohol use impair judgment, lower inhibitions, and lead to risky sexual behavior. Indeed, drug use places men, women, and youth at risk through increased exposure to assault and rape, the exchange of sex for drugs, and unsafe sexual practices.

Studies show high rates of substance use among adolescent Native girls and high death rates from drug use among Native women.44,45,46 Intravenous drug use is becoming more common in urban, rural, and reservation communities. A 2000 study showed that Alaska Native women were at high risk because a high percentage of their sex partners were injection drug users and condom use was very limited.47,48,49 Also, according to research, Native women engage in more sexual risk behaviors than Native men.50 These behaviors place women at extreme risk for HIV/AIDS infection.

Native youth also have unique concerns related to substance abuse and HIV/AIDS. Generally, Native American youth follow trends for youth nationwide, although their consumption rates are higher.51 According to studies, reasons for drinking include a sense of complete hopelessness and previous childhood traumas. Alcohol and drug abuse are frequently tied to childhood trauma. Depression, low self-esteem, suicide, and other long-term effects of colonization still impact Native youth today. Many Native youth turn to substance abuse as a means to cope with these issues.

  • What are the most common substances used/abused by Native people in your community?

  • What prevention/intervention methods and programs are already in place to combat substance abuse in your community?

39Rolf JE, Nansel TR, Baldwin JA, Johnson JL, Benally CC. HIV/AIDS and alcohol and other drug abuse prevention in American Indian communities: Behavioral and community effects. In: Mail PD, Heurtin-Roberts S, Martin SE, Howard J, eds. Alcohol Use Among American Indians and Alaska Natives: Multiple Perspectives on a Complex Problem. Bethesda: NIH Publication; 2002:295-319.

40Walters K, Simoni J. Trauma, substance use and HIV risk among urban American Indian women. Cultural Diversity and Ethnic Minority Psychology. 1999;5:236-248.

41Baldwin JA, Trotter RT, Martinez D, Stevens SJ, John D, Brems C. HIV/AIDS risks among Native American drug users: Key findings from focus group interviews and implications for intervention strategies. AIDS Education and Prevention. 1999;11:279-292.

42Baldwin JA, Maxwell CJ, Fenaughty AM, Trotter RT, Stevens SJ. Alcohol as a risk factor for HIV transmission among American Indian and Alaska Native drug users. American Indian and Alaska Native Mental Health Research: The Journal of the National Center. 2002;9:1-14.

43Wellspring Newspaper; April 2006.

44Stevens SJ, Estrada AL, Estrada BD. HIV drug and sex risk behaviors among American Indian and Alaska Native drug users: Gender and site differences. American Indian and Alaska Native Mental Health Research: The Journal of the National Center. 2000;9:33-46.

45Walters KL, Simoni JM, Evans-Campbell T. Substance use among Indians and Alaska Natives: Incorporating culture in an “indigenist” stress-coping paradigm. Public Health Reports. 2002;117:S104-S117.

46Howard M, Walker RD, Walker P, Rhoades ER. Alcoholism and substance abuse. In: Rhoades ER, ed. American Indian Health: Innovations in Health Care, Promotion, and Policy. Baltimore, Maryland: The Johns Hopkins University Press; 2000:281-298.

47Stevens SJ, Estrada AL, Estrada BD. HIV drug and sex risk behaviors among American Indian and Alaska Native drug users: Gender and site differences. American Indian and Alaska Native Mental Health Research: The Journal of the National Center. 2000;9:33-46.

48Fisher DG, Fenaughty AM, Paschane DM, Cagle HH. Alaska Native drug users and sexually transmitted disease: Results of a five-year study. American Indian and Alaska Native Mental Health Research: The Journal of the National Center. 2000;9:47-57.

49Fenaughty AM, Fisher DG, Cagle HH, Stevens S, Baldwin JA, Booth R. Sex partners of Native American drug users. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology. 1998;17:275-282.

50Stevens SJ, Estrada AL, Estrada BD. HIV drug and sex risk behaviors among American Indian and Alaska Native drug users: Gender and site differences. American Indian and Alaska Native Mental Health Research: The Journal of the National Center. 2000;9:33-46.

51Beauvais F, Jumper-Thurman P, Plested B. Prevention of Alcohol and other drug abuse among American Indian adolescents: An examination of current assumptions. In: Mail PD, Heurtin-Roberts S, Martin SE, et al, eds. Alcohol Use among American Indians and Alaska Natives: Multiple Perspectives on a Complex Problem. Bethesda, MD: NIH Publication; 2002:187-209.