Academic journal article Social Work

Risk and Protective Factors for HIV/AIDS in Native Americans: Implications for Preventive Intervention

Academic journal article Social Work

Risk and Protective Factors for HIV/AIDS in Native Americans: Implications for Preventive Intervention

Article excerpt

There are 4.1 million American Indian and Alaska Natives who self-identified on the 2000 U.S. census. This is a highly heterogeneous group representing over 500 federally recognized tribes and speaking over 300 distinct languages (Duran & Walters, 2004). Although there are cultural distinctions among tribes, there is a common experience of social and cultural oppression, including "removal from tribal lands, ethnocide, genocide, racism, poverty and alcoholism" (Simoni, Sehgal, & Walters, 2004, p. 33). In addition, Native American children have been forcibly removed and placed in boarding schools and non-Indian custodial care. Indians have been forced to relocate to urban settings, where over 60 percent now live (Duran & Walters, 2004; Walters & Simoni, 1999).

Experiencing this trauma has led to a cumulative and intergenerational effect characterized as a "soul wound" among Native American people. Duran and Walters (2004) reported that "many researchers have concluded from anecdotes, community-based observations, and preliminary evidence that historically traumatic events might be related to poor mental health outcomes among Native people such as 'historical trauma response'; posttraumatic stress disorder; alienation; depression; alcohol abuse; and HIV risk" (pp. 194-195). In addition to historical trauma, Native Americans currently face higher rates of interpersonal violence at a rate of 2.5 times the national average (Simoni et al., 2004; Vernon & Jumper-Thurman, 2005). Historical trauma and trauma from interpersonal violence contribute to risk factors for HIV infection.

The number of Native Americans diagnosed with HIV has grown more rapidly than in any other ethnic group, increasing over 900 percent from 1990 (223 cases) to 2001 (2,537 cases; see Mitchell, Kaufman, Beals, & Pathways Choice and Healthy Ways Project Team, 2004). Native Americans are .9 percent of the U.S. population, yet they account for 6 percent of newly diagnosed HIV cases (Mitchell, Kaufman, & Pathways Choice and Healthy Ways Project Team, 2002). Moreover, these statistics may be conservative because of a lack of testing, misclassification of the race of the person being tested, and inadequate reporting (McNaughten, Neal, & Fleming, 2005; Speier, 2005; Vernon & Jumper-Thurman, 2005). A study reported that HIV cases in Native American people are more likely to be reported from geographic areas with populations under 50,000 than from all HIV cases combined, reflecting the distribution of Native Americans in the United States (Diamond, Davidson, Sorvillo, & Buskin, 2001). However, over half of the Native American HIV/AIDS cases are diagnosed in urban areas with populations of more than a million. In this study, Indian cases were diagnosed at a younger age than were non-Native Americans and were more likely to be female (Diamond et al., 2001).

Native Americans are at a high risk of contracting HIV because of behaviors such as alcohol and substance abuse in combination with biological, economic, and social factors. Alcohol and substance abuse can cause protective behaviors to be forgotten or ignored; for example, alcohol reduces the perception of risk and decreases inhibitions (Vernon, 2001). Other risk factors include high rates of sexually transmitted diseases (STDs) in tribal communities. It has been reported that "when a person is infected with an STD, he/she is two to five times more likely to become infected with HIV" (Vernon, 2001, p. 5). Poverty is an important cofactor in relation to the risk for HIV infection--31.6 percent of Native Americans live below the poverty line in stark relief to the 13.1 percent of other races in the United States (Vernon, 2001). Poverty is tied to inequality, which limits prevention materials, good health care, and proper medical treatment, as well as access to testing.

Other risk factors are tied to the historical context in which Native Americans live. …

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