The IHS Minority AIDS Inititative (MAI)

IHS MAI History (2000-2005)

Previous MAI funding supported initiatives that were to improve the surveillance data reported to CDC from the Indian Health Service, tribally administered healthcare facilities and urban Indian centers to state health departments. As state HIV reporting has increased, data now include states that did not previously report HIV. This included states where there is a significant number of our population, tribal land and rural areas within the IHS (examples include Alaska, California, and New York). Other funding supported demonstration projects in Urban Indian Health programs for implementation of rapid HIV testing, which began in FY05, was not proposed in FY06 and will be continued in FY07 (if funded) with the most recent set proposals (see below).

1. IHS/HRSA: HIV/AIDS Education and Training for Healthcare Providers Serving Tribal Areas and Communities

In July 2000, the Indian Health Service (IHS) and the Health Resources and Services

Administration (HRSA) signed an inter-agency agreement to assist in providing HIV/AIDS education and training to health care practitioners that provide HIV/AIDS health care services to American Indians and Alaska Natives (AI/AN). The HIV/AIDS Education and Training Centers (AETCs) for Healthcare Providers serving Tribal Areas and Communities provides didactic and skills building training to health care practitioners who are American Indian/Alaska Native or who provide care in Indian Health Service/Tribal/Urban settings who lack adequate access to training opportunities on HIV/AIDS standards of care and treatment. The targeted audience includes physicians, advanced practice nurses, physician assistants, pharmacists, nurses, community health workers, alcohol/substance abuse counselors, as well as other caregivers and staff located at the facilities where training is provided. The training curriculum was based on the needs expressed by the host training site and included didactic and skills building sessions on HIV risk management, counseling and testing, HIV pathogenesis and disease progression, review of clinical treatment guidelines, prevention and treatment of Indian communities and ethical and legal issues. This program is innovative in that it uses a model in which selected AIDS Education and Training Center (AETC) grantees 1) identify and partner with AI/AN and/or Indian Urban Center controlled primary healthcare and/or health and support service organizations; 2) develop and administer capacity building via train-the-trainer format for the partner organizations; and 3) subcontract with these partner organizations for the development and implementation of training programs for health care providers serving AI/AN. Using this model we were able to build clinical training skills and capacity in AI/AN organizations and ensure that training is presented in an appropriate cultural context.

2. IHS/CDC National Center of HIV, STD, AND TB Prevention (NCHSTP): Enhancing HIV/AIDS Surveillance Among American Indian and Alaska Native Populations

This intra-agency agreement between the Indian Health Service HIV/AIDS Program and

CDC NCHSTP was to enhance HIV/AIDS surveillance among AI/AN populations. Accurate and specific public health surveillance data describing patterns of HIV occurrence are critical for HIV prevention efforts. Public health surveillance data that describe the geographic and temporal pattern of HIV infection and the groups at highest risk are necessary to target prevention efforts, to tailor prevention messages and programs, and to evaluate program impact. In turn, the ability of HIV/AIDS surveillance systems to provide these key information elements depends on the participation of healthcare providers serving the populations of interest and the completeness of data they provide. Because undiagnosed cases are not detected by surveillance systems, the accuracy of surveillance data depends significantly on the extent to which the subpopulations at risk are receiving HIV testing. The IHS has collaborated with the CDC since 2000 on this initiative to enhance HIV/AIDS surveillance among AI/AN populations. This project first centered on assessing reporting practices of IHS. This involved developing a survey that can be filled out by clinics and hospitals which asks for information on HIV/AIDS reporting. The next survey was sent to tribally administered hospitals and clinics to ascertain their reporting practices. These surveys gave information on reporting of HIV/AIDS data or lack thereof. It will also give us information on how to improve reporting.

3. IHS/CDC Division of Adolescent and School Health (DASH)

Curriculum development and classroom teacher training and states’ outreach to American Indian/Alaska Native children and youth for the prevention of HIV, STDs, and unintended Pregnancy. With MAI funding, the CDC DASH and IHS HIV/AIDS Program worked with States, tribes, urban metropolitan areas to develop classroom HIV/AIDS prevention curriculums. Classroom teachers were taught how to use the curriculums in their classrooms. These teachers were from BIA and state public schools (state public schools that have a significant number of AI/AN children) throughout the United States. The original school HIV/AIDS prevention curriculum was developed by the Indian Health Service. This curriculum was called, “Circle of Life, HIV/AIDS Curriculum” (1995). This curriculum was developed for children in kindergarten to 6th grade. Since that time the curriculum has been expanded to include the 7th and 8th grade entitled, “Circle of Life HIV/AIDS and STD Prevention Curriculum: Wellness Education for American Indian and Alaska Native Middle School Students”. This curriculum was completed in December 2002. Another curriculum that was developed, “Be Proud, Be Responsible” is a product of a cooperative agreement between the Indian Health Service and the State of South Dakota. This HIV/AIDS prevention curriculum was developed for 1st through 12th grade. This curriculum will be used more in the upper-Midwest States, but can be used in any setting. The curriculum has been designed to be more culturally appropriate/specific for the Plains Indian tribes. Part of the funding will be used to supplement and strengthen the capacity of State Education Agencies (SEAs) to engage tribal nations and/or community based/youth-serving organizations representing predominately American Indian/Alaska Native youth in implementing programming to reduce risk behaviors among American Indian/Alaska Native youth that result in HIV infection, STDs, and unintended pregnancy. CDC and IHS requested that states perform, with these supplemental funds, the following:

Convene a task force with representatives from tribes and community-based organizations representing A/AN youth to establish, strengthen, or expand HIV prevention education for AI/AN youth.

Build the capacity of local tribes to identify, adapt, and/or implement effective

HIV prevention programs for AI/AN youth.

3. Collaborate with tribes and community-based organizations that represent AI/AN

youth and be inclusive of these populations when offering teacher training, disseminating newsletters, and providing technical assistance.

2002 was the third and final year that IHS HIV/AIDS Program and CDC DASH have collaborated in providing curriculum training to teachers and outreach to AI/AN children and youth. States that received grants to work with AI/AN children and youth in 2002 include Alaska, Arizona, California, Michigan, Minnesota, Montana, New Mexico, New York, North Carolina, North Dakota, Oklahoma, Oregon, South Dakota, Washington, and Wisconsin. In FY 2003 approximately fifteen awards will be made to States. These States received awards that ranged from $40,000 to $100,000 per state.

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