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The public and governmental response to rising HIV infection rates among minority populations in the United States, such as Hispanics or African-Americans, may have been a little late. The virus had already caused a high rate of infection among this population before various groups began focused and consistent prevention and testing campaigns. This is why the public and government should begin now to reach and teach native Americans about HIV prevention, says Eric Goosby, MD, director of HIV/AIDS Policy for the U.S. Department of Health & Human Services and deputy director for the Office of National AIDS Policy in Washington, DC.
"Native Americans have participated historically in behavior patterns that are of high risk for transmitting HIV: alcoholism and injection drug use," Goosby says.
Native Americans have high rates of sexually transmitted diseases (STDs) and teen pregnancy, both indicators of unprotected sexual activity. In 1997, the rate of gonorrhea among Native American males was 67 per 100,000 population. This is compared with 19.5 per 100,000 white males. Among Native American females, the gonorrhea rate was 131.4 per 100,000, compared with a rate of 32.3 per 100,000 among white females. Syphilis infection rates also were close to four times higher for Native American men and women than they were for white men and women.
Data from the Centers for Disease Control and Prevention in Atlanta show that more than 2,000 American Indian/Alaskan Natives in the United States and its territories were diagnosed with AIDS as of 1999. This figure is a 24% increase over the number of AIDS cases among Native Americans only two years earlier. The cumulative HIV infection cases had increased by 33% to 632 in that same period. AIDS deaths among Native Americans totaled 1,035 through December 1998.
"All you’re waiting for is the introduction of the virus to that situation," Goosby says. "The only thing that has prevented a rapid seroconversion in Native American communities is that the virus has not been introduced to any great degree, and that’s why this is a special opportunity."
Goosby spoke about the risk of HIV infection at a meeting with Native American tribal leaders in November. His talk was given at the 57th Annual Session of the National Congress of American Indians (NCAI), the largest organization of tribal governments in the United States. Goosby says the NCAI, which he describes as being like a United Nations with each tribe being a sovereign entity, was interested in the HIV discussion and surprised by the information Goosby presented.
"They understood that when you put those high-risk elements together with HIV, you run the risk of rapid transmission," Goosby says. "They have HIV literature, but we need to provide them with targeted prevention messages."
It’s crucial that Native Americans, particularly youths, learn how to eliminate their high-risk behaviors before HIV is introduced, because once that happens, it could spread very rapidly and become a crisis, Goosby says. "Our office has taken the lead in establishing the response to minority disparity in HIV infection," he says. "We’ve gone to 16 epicenters where there are disproportionate numbers of minorities with HIV and have worked with city public health departments to target minorities."
Goosby says his office also worked with black churches to help make their prevention efforts more effective. "We are attempting to engage the Native American leadership along those lines," he adds. "And we’re doing our best to get coordinated prevention efforts into the Native American, Pacific Islander, and Hispanic populations."