What are barriers to prevention?

What are barriers to prevention?

HIV is often rendered invisible within AI/AN communities that are facing many other severe and more visible health and social problems such as alcoholism, diabetes and unemployment. As a result, there is often great denial about HIV as a problem in AI/AN communities.

Like in many other tight-knit communities, confidentiality can be difficult to maintain in AI/AN communities, especially in rural areas. This can be a barrier to important prevention activities such as testing for HIV, discussing sexual practices with health care providers, obtaining drug treatment, or buying condoms in local stores.

Prevention services for AI/AN MSM are severely underfunded, and those that exist may not reach MSM at risk. AI/AN MSM have a wide range of identities, from “gay” to “two-spirit” and may not access services addressed to urban gay men. (13) AI/AN MSM may feel isolated and not seek out needed services because of stigma and denial about homosexuality in some AI/AN communities.

The AI/AN population is highly diverse, with over 550 federally-recognized tribes. AI/AN consider themselves to belong to Indian nations that are sovereign, with complex relationships between tribal, state and federal governments. Many state and local governments erroneously assume that the IHS is solely responsible for the health- related needs of AI/AN. Less than 1% of IHS budget goes to urban populations, yet more than half of all AI/AN in the US live in urban areas. As a result, AI/AN tribes and organizations are often denied funding opportunities available to other citizens.

What's being done?

To address the rising rates of STDs and HIV among adolescents in a rural Arizona Indian tribe, tribal health educators, school officials and public health officials collaborated to establish several programs including school health clinics, Native American HIV+ speakers, peer-produced educational dramas, community educational meetings and radio and newspaper ads. Cases of STDs and HIV peaked in 1990 and slowly declined over the next six years, for a 69% overall reduction in STDs. (14)

The Indigenous People's Task Force (IPTF) in Minneapolis, MN, promotes health and education for Native persons. Their Ogitchidag Gikinooamaagad (warrior/teachers) peer education/theater program provides youth with a comprehensive HIV/AIDS prevention curriculum, theater instruction and traditional teachings. IPTF's programs have been acknowledged by the US Surgeon General. (15)

The Indian Health Care Resource Center (IHCRC) of Tulsa, OK provides a biweekly social group for two-spirit Native American men to help build a sense of community, self-esteem and reduce risk behaviors. IHCRC also hosts a relationship skills-building workshop which focuses on helping the participants determine what they want out of relationships, managing triggers to risk behavior and increasing negotiating skills. Each year, IHCRC offers a 4-day retreat with social, cultural and educational activities including traditional meals, a Powwow and stomp dancing. (16)