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Within the Hidden Epidemic: Sexually Transmitted Diseases and HIV/AIDS among American Indians and Alaska Natives.
Sex Transm Dis 2007; 34(10):767-777.
Kaufman CE, Shelby L, Mosure DJ, Marrazzo J, Wong D, de
Ravello L, Craig Rushing S, Warren-Mears V, Neel L, Jumping Eagle
S, Tulloch S, Romero F, Patrick S, Cheek J.
Abstract
OBJECTIVES: To review the epidemiology, research, and prevention programs
for sexually transmitted diseases in American Indians and Alaska Natives (AI/ANs).
STUDY DESIGN: We reviewed the current national and regional trends in sexually
transmitted diseases (STDs) for AI/ANs from 1998-2004, peer-reviewed studies
from January 1996, through May 2006, and reports, unpublished documents, and
electronic resources addressing AI/AN STD prevention and control. RESULTS:
STD prevalence among AI/ANs remains high. For example, the case rate of C.
trachomatis in the North Central Plains AI/AN populations is 6 times the overall
US rate. Trends for C. trachomatis also show sustained increases. Little research
exists on STDs for this population, and most is focused on HIV/AIDS. Fear
of compromised confidentiality, cultural taboos, and complex financial and
service relationships inhibit effective surveillance, prevention, and management.
CONCLUSIONS: Recommendations for STD control in this population include improved
local surveillance and incorporation of existing frameworks of health and
healing into prevention and intervention efforts. Research defining the parameters
of cultural context and social epidemiology of STDs is necessary.