HIV/AIDS continues to disproportionately affect minorities. While American Indians, Alaska Natives (AI/ANs), and Native Hawaiians (NHs) make up only 1% of the U.S. population, they historically suffer higher rates of health disparities, including HIV/AIDS.1,2 Factors that increase the risk of HIV infection among Natives include poverty, substance abuse, and sexually transmitted infections. Native populations also regularly deal with health and social issues that make it hard to address HIV/AIDS. These include health and psychological legacies of contact and colonization, homophobia, discrimination, poor communication, biological vulnerabilities in women, and lack of adequate funding. (You can read more about these issues in Module 2: Historical and Socioeconomic Health Risks.)
The number of AI/ANs currently living with HIV/AIDS is increasing, as it is for all other racial/ethnic groups.3 This is due to a combination of factors. Rapid HIV testing allows for individuals to learn their HIV status at an earlier stage in the disease. (You can read more about rapid HIV testing here.) Also, as healthcare and medications improve, many people live longer with HIV before it progresses to AIDS.
AI/AN people represent a small proportion of the total number of HIV/AIDS cases reported to the HIV/AIDS Surveillance System. Through December 2003, AI/ANs made up 0.3% of reported AIDS cases and 0.4% of reported HIV cases. In terms of population, AI/ANs make up 0.8% of the United States (and 1.5% if you include persons who are at least partially AI/AN).4,5 The 330 AIDS cases among NH represent 12% of the total number of AIDS cases reported in Hawaii, while NHs made up 13% of the state’s population in 1990.6 In Alaska, however, where Alaska Natives account for 17% of the state’s population, Native people represent 22% of HIV cases reported between 1996-2003. 7
There are a variety of factors that put NHs at high risk for HIV and AIDS. NHs have high incidences of substance use and sexually transmitted diseases, such as gonorrhea, chlamydia, and urinary tract infections. Socioeconomic factors—such as poverty, low levels of literacy, stigma, fear, and other cultural issues—also put NHs at high risk of HIV infection. In addition, cultural factors—stigma, shame, and fear of the unknown—often result in the under-use of services such as HIV testing, which then results in inaccurate data. Reported data for HIV and AIDS among Native people does not accurately reflect the need for resources, HIV testing, and culturally appropriate services. In fact, reported data for NHs shows that while NHs represent a small portion of the population (only 13% of the total population), 12% of the total NH population has AIDS—that is, 1/8 of the total NH population has AIDS. 8
1 Bertolli J, McNaghten AD, Campsmith M, et al. Surveillance systems monitoring HIV/AIDS and HIV risk behaviors among American Indians and Alaska Natives. AIDS Education and Prevention. 2004; 16:218-237.
2 Ogunwole S. The American Indian and Alaska Native Population: 2000. Census 2000 Brief. U.S. Census Bureau; 2002.
3 Centers for Disease Control and Prevention. HIV/AIDS Surveillance Report, 2005 (Vol. 17). Atlanta: U.S. Department of Health and Human Services, CDC; 2006.
4 U.S. Census Bureau. 2005 American Community Survey. U.S. Census Bureau; 2005. Available at: U.S. Census Bureau. Accessed February 12, 2007.
5 U.S. Census Bureau. American Indians by the Numbers. Information Please Database; Pearson Education, Inc.; 2006. Available at: http://www.infoplease.com/spot/aihmcensus1.html. Accessed February 12, 2007.
6 Hawaii Department of Health, STD/AIDS Prevention Branch. Epidemiology of HIV/AIDS in Hawaii, September 2004. Honolulu: Hawaii Department of Health, HIV/AIDS Surveillance Program; September 2004.
7 State of Alaska. HIV Infection in Alaska through 2003. Epidemiology Bulletin No. 10.
8 Hawaii Department of Health, STD/AIDS Prevention Branch. HIV/AIDS Surveillance Program: Epidemiology of HIV/AIDS in Hawaii. Available at: http://www.hawaii.gov/health/healthy-lifestyles/std-aids/aboutus/prg-aids/hivaids-epi-data.html. Accessed April 4, 2007.