Because of our small numbers, our virtual invisibility, and the lack of public health outreach into our communities on almost any level, HIV has run rampant, and there is a real and immediate danger of a sweeping decimation of our People. Without clear information which is culturally sensitive, the combination of fear, ignorance and the resulting stigma threaten to just destroy our already physically fragile communities" (Native American Leadership Commission on Health and AIDS [NALCHA], 1994, p. 47). Comments such as these illustrate the alarm that some Native American people feel about HIV/AIDS. Even more distressing, however, is the fact that other Native Americans express virtually no concern about the disease. They firmly believe it is of little concern or danger to Native American people, who face more immediate issues of poverty, unemployment, racism, and violence.
Although statistics on Native Americans with HIV/AIDS have many limitations, Conway et al. (1992) and Metler, Conway, and Stehr-Green (1991) reported that the rate of HIV/AIDS infection is increasing more rapidly in the Native American population than any other ethnic group in the United States. It is imperative that social workers have an understanding of the impact of HIV/AIDS on Native Americans, including its prevalence and how cultural issues may influence attitudes toward HIV/AIDS and risk behaviors. The purpose of this article is to present current information on the prevalence of HIV/AIDS in the Native American population, including a discussion of the limitations of these statistics; to discuss general and culturally specific risk factors for this population; to discuss techniques for preventing and responding to HIV/AIDS in this population; and to provide social workers with information that will help them conduct culturally appropriate assessments and interventions with Native American clients. Brief anecdotes are used to illustrate various concepts related to HIV/AIDS and Native Americans and to include a human face along with the facts and statistics. Each story is true but is a composite from several individuals to preserve anonymity.
I have been involved with organizations concerned with HIV/AIDS among Native Americans since 1990. I was involved in early discussions about developing the first HIV/AIDS programs for Native Americans in New York City, and I am a member of a New York State-wide organization, the Native American Leadership Commission on Health and AIDS. This background gives me an insider's perspective on the cases discussed here. This perspective, coupled with the statistics and issues discussed, should enable non-Native American readers to understand better the phenomenon of HIV/AIDS as it exists within a Native American context.
NATIVE AMERICAN CULTURES AND HIV/AIDS
The term Native American refers to people from more than 500 distinct cultural groups indigenous to North America. Gender and family roles, attitudes toward sexual orientation, and health care beliefs vary across these cultural groups. It is imperative that social workers have an understanding of the belief system specific to the indigenous cultural group of their clients. In addition, variation exists in the cultural orientation of individuals within indigenous groups. Some indigenous people have assimilated the values and beliefs of the dominant society, while others hold firmly to traditional belief systems. Social workers must include a cultural dimension in the assessment process that explores how clients' cultures influence health behaviors. Some Native Americans may be reluctant to seek Western medical care, whereas others may have been exposed to Western practices as their primary source of care all their lives through organizations such as the Indian Health Service.
Stereotypes, Perceptions, and Beliefs
Stereotypes that non-Native Americans hold about Native Americans and about HIV/AIDS intersect to inhibit preventive measures, diagnosis, and treatment and to distort the facts about HIV/AIDS in this population. …