Epidemiology: CDC Fact Sheet
Risk Factors and Barriers to Prevention
Race and ethnicity are not, by themselves, risk factors for HIV infection.
However, American Indians and Alaska Natives are likely to face challenges associated
with risk for HIV infection, including the following.
Sexual Risk Factors
The presence of a sexually transmitted disease can increase
the chance of contracting or spreading HIV [3]. High rates of Chlamydia trachomatis
infection, gonorrhea, and syphilis among American Indians and Alaska Natives
suggest that the sexual behaviors that facilitate the spread of HIV are relatively
common among American Indians and Alaska Natives. According to 2005 surveillance
data by race/ethnicity, the 2nd highest rates of gonorrhea and Chlamydia trachomatis
infection were those for American Indians and Alaska Natives. The 3rd highest
rate of syphilis was that for American Indians and Alaska Natives [4, 5].
Substance Use
Persons who use illicit drugs (casually or habitually) or who abuse alcohol are
more likely to engage in risky behaviors, such as unprotected sex, when they
are under the influence of drugs or alcohol [6]. Results of the 2005 National
Survey on Drug Use and Health indicate that
the rate of current illicit drug use was higher among American Indians and Alaska
Natives (12.8%) than among persons of other races or ethnicities [7].
Cultural
Diversity
To be effective, HIV/AIDS prevention interventions must be tailored to specific
audiences. The American Indian and Alaska Native population makes up 562 federally
recognized tribes plus at least 50 state-recognized tribes [8]. Because each
tribe has its own culture, beliefs, and practices and these tribes may be subdivided
into language groups, it can be challenging to create programs for each group.
Therefore, prevention programs that can be adapted to individual tribal cultures
and beliefs are critically important. Current programs emphasize traditional
teachings and the importance of the community.
Socioeconomic Issues
Issues related to poverty (for example, lower levels of education and poorer
access to health care) may directly or indirectly increase the risk for HIV infection
[9]. Socioeconomic factors, such as poverty, coexist with epidemiologic risk
factors for HIV infection in American Indian and Alaska Native communities. During
2002–2004, approximately one quarter (24.3%) of American Indians and Alaska
Natives - about twice the national average (12.4%) - were living in poverty
[10]. The proportion of the American Indian and Alaska Native population with
a high school diploma (66%) in 1990 was less than the national average (75%)
[11].
Life expectancy for American Indians and Alaska Natives is shorter than that
for persons of other races/ethnicities in the United States; the rates of many
diseases, including diabetes, tuberculosis, and alcoholism, are higher; and access
to health care is poorer [12, 13]. These indicators demonstrate the vulnerability
of American Indians and Alaska Natives to additional health stress, including
HIV infection.
HIV Testing Issues
Access to HIV testing and issues concerning confidentiality are important for
many American Indians and Alaska Natives. For example, at the time of AIDS diagnosis,
more American Indians and Alaska Natives, compared with persons of other races/ethnicities,
resided in rural areas [14].
Those who live in rural areas may be less likely
to be tested for HIV because of limited access to testing. Also, American Indians
and Alaska Natives may be less likely to seek testing because of concerns about
confidentiality in close-knit communities, where someone who seeks testing is
likely to encounter a friend, a relative, or an acquaintance at the local health
care facility.
During 1997–2000, 50.5% of American Indians and Alaska Natives
who responded to the Behavioral Risk Factor Surveillance System survey reported
that they had never been tested for HIV. This percentage was higher in the southwestern
United States, where 58.1% of the American Indians and Alaska Natives reported
never having been tested [15].
Data Limitations
Current data regarding HIV infection and AIDS among American Indians and Alaska
Natives have limitations.
- Incomplete surveillance data. Not all states with large
American Indian and Alaska Native populations have been conducting HIV surveillance.
For example, California began HIV surveillance only during the past few years
and thus is not included in these data.
- Racial misclassification and underreporting.Even though
the numbers of diagnoses for American Indians and Alaska Natives are relatively
low, these numbers may be affected by racial misclassification. Studies in Alaska
and Los Angeles have shown that the degree of misclassification differs geographically.
In Alaska, 3% of American Indians and Alaska Natives with HIV/AIDS were misclassified
as being of another race; in Los Angeles, 56% of American Indians and Alaska
Natives with AIDS were racially misclassified [16, 17].
Prevention
In the United
States, the annual number of new HIV infections has declined from a peak of more
than 150,000 during the mid-1980s and has stabilized since the late 1990s at
approximately 40,000. Persons of minority races/ethnicities are disproportionately
affected by the HIV epidemic. To reduce further the incidence of HIV infection,
CDC announced
Advancing HIV Prevention (AHP) in 2003.
This initiative comprises 4 strategies: making HIV testing a routine part of
medical care, implementing new models for diagnosing HIV infections outside medical
settings, preventing new infections by working with HIV-infected persons and
their partners, and further decreasing perinatal HIV transmission.
Through AHP,
CDC conducted demonstration projects in American Indian and Alaska Native communities
to examine ways to make voluntary HIV testing a routine part of medical care
and to implement new models for diagnosing HIV infections outside medical settings.
Preliminary data show that through these projects, over 2,000 American Indians
and Alaska Natives were tested for HIV. Demonstration projects were conducted
at the following sites:
- Salt Lake City, Utah, where a community-based organization (CBO) partnered
with the Indian Walk-In Center to offer routine testing—including rapid
testing at some sites—to 5 tribal entities and 11 reservations.
- Phoenix,
Arizona, where a CBO conducted routine HIV testing in nontraditional settings
(e.g., health fairs, powwows) through local outreach.
- Sault Ste. Marie, Michigan,
where the Sault Ste. Marie Tribe and the Chippewa Indian Sault Tribe Health Center
conducted routine HIV testing for clients aged 17 to 49. Rapid testing was conducted
simultaneously at 1 main health center and 4 satellite clinics as well as an
urgent care clinic.
CDC, through the Minority AIDS Initiative, supports efforts
to reduce the health disparities experienced in communities of persons of minority
races/ethnicities who are at high risk for HIV. These funds are used to address
high-priority HIV prevention needs in such communities. The following are some
CDC-funded prevention programs that state and local health departments and CBOs
provide for American Indians and Alaska Natives.
- Helping tribes develop or expand
HIV prevention services and improve services for persons infected with, or affected
by,
HIV/AIDS
- Building and strengthening the capacity of tribal organizations and urban
Indian health centers throughout the United States to develop effective HIV prevention
through intertribal networking and collaboration
- Providing HIV prevention education
in rural Alaska Native communities and implementing an evidence-based intervention,
Community PROMISE, in the Yukon-Kuskokwim delta and Maniilaq regions.
Understanding HIV and AIDS Data
AIDS surveillance: Through a uniform system, CDC receives reports of AIDS cases
from all US states and territories. Since the beginning of the epidemic, these
data have been used to monitor trends because they are representative of all
areas. The data are statistically adjusted for reporting delays and for the redistribution
of cases initially reported without risk factors. As treatment has become more
available, trends in new AIDS diagnoses no longer accurately represent trends
in new HIV infections; these data now represent persons who are tested late in
the course of HIV infection, who have limited access to care, or in whom treatment
has failed.
HIV surveillance: Monitoring trends in the HIV
epidemic today requires collecting information on HIV cases that have not progressed
to AIDS. Areas with confidentialname-based HIV infection reporting requirementsuse
the same uniform system for data collection on HIV cases as for AIDS cases. A
total of 33 states (Alabama, Alaska, Arizona, Arkansas, Colorado, Florida, Idaho,
Indiana, Iowa, Kansas, Louisiana, Michigan, Minnesota, Mississippi, Missouri,
Nebraska, Nevada, New Jersey, New Mexico, New York, North Carolina, North Dakota,
Ohio, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia,
West Virginia, Wisconsin, and Wyoming) have collected these data for at least
5 years, providing sufficient data to monitor HIV trends and to estimate risk
behaviors for HIV infection.
HIV/AIDS: This term is used to refer
to 3 categories of diagnoses collectively: (1) a diagnosis of HIV infection (not
AIDS), (2) a diagnosis of HIV infection and a later diagnosis of AIDS, and (3)
concurrent diagnoses of HIV infection and AIDS.
References
Refer to the Fact Sheet PDF PDF
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