HIV and American Indians and Alaska Natives

American Indians/Alaska Natives (AI/AN) represent about 1.3%^a of the United States population, and about 0.5% of the HIV diagnoses in 2018.  However, the number of HIV diagnoses has increased over time.

The Numbers

HIV Diagnoses^b

New HIV Diagnoses Among AI/AN in the US and Dependent Areas by Transmission Category and Sex, 2018 ^d

Source: CDC. Diagnoses of HIV infection in the United States and dependent areas, 2018 (Preliminary) pdf icon[PDF – 10 MB]. HIV Surveillance Report 2019;30.

From 2010 to 2017, the annual number of HIV diagnoses increased 39% among AI/AN overall, but trends varied by age and gender:

HIV Diagnoses Among AI/AN in the 50 States and the District of Columbia, 2010-2017*

*Changes in populations with fewer HIV diagnoses can lead to a large percentage increase or decrease.
Source: CDC. NCHHSTP AtlasPlus. Accessed April 27, 2020.

Living With HIV

Adult and Adolescent AI/AN With HIV in the 50 States and the District of Columbia

Source: CDC. Estimated HIV incidence and prevalence in the United States 2010–2016 pdf icon. HIV Surveillance Supplemental Report 2019;24(1).
Source: CDC. Selected national HIV prevention and care outcomes  pdf icon(slides).

Deaths

During 2017, 39 AI/AN with diagnosed HIV died in the US and dependent areas. These deaths may be due to any cause.

Prevention Challenges

Sexually transmitted diseases (STDs). From 2014 to 2018, AI/AN had the second highest rates of chlamydia and gonorrhea among all racial/ethnic groups. Having another STD increases a person’s risk for getting or transmitting HIV.

Awareness of HIV status. It is important for everyone to know their HIV status. People who do not know they have HIV cannot take advantage of HIV care and treatment and may unknowingly pass HIV to others.

Cultural stigma and confidentiality concerns. AI/AN gay and bisexual men may face culturally based stigma and confidentiality concerns that could limit opportunities for education and HIV testing, especially among those who live in rural communities or on reservations.

Difficult to create prevention programs. There are more than 574 federally recognized AI/AN tribes and many different languages. Because each tribe has its own culture, beliefs, and practices, creating culturally appropriate prevention programs for each group can be challenging.

Socioeconomic issues. Poverty, including limited access to high-quality housing, directly and indirectly, increases the risk for HIV infection and affects the health of people who have and are at risk for HIV infection. Compared with other racial/ethnic groups, AI/AN have higher poverty rates, have completed fewer years of education, are younger, are less likely to be employed, and have lower rates of health insurance coverage.

Alcohol and illicit drug use. Alcohol and substance use can impair judgment and lead to behaviors that increase the risk of HIV. Injection drug use can directly increase the risk of HIV through sharing contaminated needles, syringes, and other equipment. Compared with other racial/ethnic groups, AI/AN tend to use alcohol and drugs at a younger age and use them more often and in higher quantities.

Data limitations. Racial misidentification of AI/AN may lead to the undercounting of this population in HIV surveillance systems and may contribute to the underfunding of targeted services for AI/AN.

What CDC Is Doing

CDC is pursuing a high-impact HIV prevention approach to maximize the effectiveness of HIV prevention interventions and strategies. Funding state, territorial, and local health departments and community-based organizations (CBOs) to develop and implement tailored programs is CDC’s largest investment in HIV prevention. This includes longstanding successful programs and new efforts funded through the Ending the HIV Epidemic initiative. In addition to funding health departments and CBOs, CDC is also strengthening the HIV prevention workforce and developing HIV communication resources for consumers and health care providers.

• Under the integrated HIV surveillance and prevention cooperative agreement, CDC awards around $400 million per year to health departments for HIV data collection and prevention efforts. This award directs resources to the populations and geographic areas of greatest need, while supporting core HIV surveillance and prevention efforts across the US.

• In 2019, CDC awarded $12 million to support the development of state and local Ending the HIV Epidemic plans in 57 of the nation’s priority areas. To further enhance capacity building efforts, CDC uses HIV prevention resources to fund the National Alliance of State and Territorial AIDS Directors (NASTAD) $1.5 million per year to support strategic partnerships, community engagement, peer-to-peer technical assistance, and planning efforts.
• In 2020, CDC will award around $109 million per year to support the implementation of state and local Ending the HIV Epidemic plans with a five-year funding program.
• Under the flagship community-based organization cooperative agreement, CDC awards about $42 million per year to community organizations. This award directs resources to support the delivery of effective HIV prevention strategies to key populations.

• In 2019, CDC awarded a cooperative agreement to strengthen the capacity and improve the performance of the nation’s HIV prevention workforce. New elements include dedicated providers for web-based and classroom-based national training, and technical assistance tailored within four geographic regions.

• Through its Let’s Stop HIV Together campaign, CDC offers resources about HIV stigma, testing, prevention, and treatment and care. This campaign is part of the Ending the HIV Epidemic.

In addition, CDC works with tribal governments to tribal support activities to help ensure that AI/AN communities receive public health services that keep them safe and healthy.

^a Percentage of AI/AN reporting only one race. The US Census Bureau’s population estimates include the 50 states, the District of Columbia, and Puerto Rico.
^b HIV diagnoses refers to the number of people who received an HIV diagnosis during a given time period, not when the people got HIV infection.
^c Unless otherwise noted, the term United States includes the 50 states, the District of Columbia, and the 6 dependent areas of American Samoa, Guam, the Northern Mariana Islands, Puerto Rico, the Republic of Palau, and the US Virgin Islands.
^d The terms male-to-male sexual contact and male-to-male sexual contact and injection drug use are used in the CDC surveillance system. They indicate the behaviors that transmit HIV infection, not how individuals self-identify in terms of their sexuality.