HIV/AIDS among American Indians and Alaska Natives
HIV/AIDS is a growing problem among
American Indians and Alaska Natives.
Even though the numbers of HIV and AIDS
diagnoses for American Indians and Alaska
Natives represent less than 1% of the total
number of HIV/AIDS cases reported to CDC�s
HIV/AIDS Reporting System, when population
size is taken into account, American Indians
and Alaska Natives in 2005 ranked 3rd in
rates of HIV/AIDS diagnosis, after blacks
(including African Americans) and Hispanics .
American Indians and Alaska Natives make up
1.5% (4.1 million people) of the total US
. The rate of AIDS
diagnosis for this group has been higher
than that for whites since 1995.
HIV/AIDS in 2005
(The following bullets refer to
the 33 states with long-term, confidential
name-based HIV reporting. See the
before the References section, for a list of
the 33 states.)
- HIV/AIDS was diagnosed for an estimated 195 American Indians and
Alaska Natives (adults, adolescents, and children), representing
0.5% of the total number of HIV/AIDS diagnoses reported for that
- The rate (per 100,000 persons) of HIV/AIDS diagnosis for
American Indians and Alaska Natives was 10.4, compared with 71.3 for
blacks, 27.8 for Hispanics, 8.8 for whites, and 7.4 for Asians and
- Women accounted for 29% of the HIV/AIDS diagnoses among American
Indians and Alaska Natives .
Race/ethnicity of persons (including children) with HIV/AIDS diagnosed during 2005
Note: Based on data from 33 states with long-term, confidential name-based HIV reporting.
Transmission categories for American Indian and Alaska Native adults and adolescents living with HIV/AIDS at the end of 2005
Note: Based on data from 33 states with long-term, confidential name-based HIV reporting.
AIDS in 2005
(See the box, before the References section for explanation of AIDS data.)
- The estimated rate (per 100,000) of AIDS diagnosis for American
Indian and Alaska Native adults and adolescents was 9.3, the 3rd
highest after the rates for black adults and adolescents (68.7) and
Hispanic adults and adolescents (24.0). The estimated AIDS diagnosis
rate was 6.9 for white adults and adolescents and 4.3 for Asian and
Pacific Islander adults and adolescents .
- AIDS was diagnosed for an estimated 182 American Indians and
Alaska Natives, representing approximately 0.4% of all AIDS
diagnoses in 2005 . These data include persons
whose HIV infection had been diagnosed earlier.
- An estimated 1,581 American Indians and Alaska Natives were
living with AIDS .
- An estimated 81 American Indians and Alaska Natives with AIDS
died in 2005, representing approximately 0.5% of all deaths of
persons with AIDS for that year .
- From the beginning of the epidemic through 2005, AIDS was
diagnosed for an estimated 3,238 American Indians and Alaska Natives
- From the beginning of the epidemic through 2005, an estimated
1,657 American Indians and Alaska Natives with AIDS had died .
In comparison, 235,879 whites, 211,559 blacks, 77,125 Hispanics, and
3,383 Asians and Pacific Islanders with AIDS had died.
- Of persons who had received a diagnosis of AIDS during 1997�
2004, American Indians and Alaska Natives had survived for a shorter
time than had Asians and Pacific Islanders, whites, or Hispanics.
After 9 years, 67% of American Indians and Alaska Natives were
alive, compared with 66% of blacks, 74% of Hispanics, 75% of whites,
and 81% of Asians and Pacific Islanders .
- From the beginning of the epidemic through 2005, AIDS had been
diagnosed for an estimated 32 American Indian and Alaska Native
children (younger than 13 years) .
Race/ethnicity of adults and adolescents living with HIV/AIDS, 2005
Note: Based on data from 33 states with long-term, confidential name-based HIV reporting. Because of rounding, percentages may not add to 100.
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 . 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].
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 . 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 .
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 .
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.
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 . 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 . 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%) .
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 . 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
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
- 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,
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
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
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
- Helping tribes develop or expand HIV
prevention services and improve services
for persons infected with, or affected
- 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
Understanding HIV and AIDS Data
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 confidential name-based HIV infection
reporting requirements use 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.
HIV/AIDS Surveillance Report, 2005. Vol. 17.
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