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AIDS crisis takes center stage

WASHINGTON - In late June thousands gathered at the United Nations in New York City to discuss the world AIDS crisis, an epidemic which will soon take its place as the greatest plague in human history.

Worldwide more than 22 million people have contracted AIDS, with 1 million Americans infected with the virus since 1981. But what about the virus' impacts on Native American people and what is being done to prevent the virus from spreading further in American Indian communities?

In recent years, HIV infection and AIDS has become a growing threat to the health of American Indian people and tribal communities. While the level of HIV/AIDS infection in Indian country remains unclear, the percentage of American Indians and Alaska Natives with HIV is incredibly disproportionate as compared to other populations.

Data from the National Native American AIDS Prevention Center show, American Indians and Alaska Natives comprise 6 percent of all new HIV infections, while they represent less than 1 percent of the population. The Center for Disease Control and Prevention (CDC) reported an increase in new HIV cases from 1999 to 2000 among American Indians and Alaska Natives, and as of June 2000, 34 areas reporting HIV cases report 2,223 cases of American Indians or Alaska Natives with HIV or AIDS.

Unfortunately, the response by tribal governments has not been adequate to meet this growing crisis, in large part because of historic under-funding in the Indian Health Service and a lack of proper statistics for tribes to gauge the scale of the problem.

"The number of American Indians living with HIV/AIDS continues to rise, although specific data is lacking," U.S. Surgeon General Dr. David Satcher said. "Because of shortcomings in our HIV surveillance systems, we cannot be certain of the full extent of the problem within Indian country, but we do know that it is a growing problem."

Currently, the IHS AIDS program plays only a minor role in funding HIV/AIDS projects and IHS Service Units and tribal clinics do not report AIDS case data to state health departments, leading to improper surveillance of the virus in Indian country.

The only other federal initiative which deals with HIV/AIDS and American Indian people is the Ryan White Care Act, a law passed in 1990 to provide federal funding and programs to address the AIDS crisis in America. However, the only area of the act that mentions Native Americans is the Special Projects of National Significance Program, a small program that is defined as temporary and research driven. Since 1990, this program has been the primary source of funds for Native American-specific care programs.

"Inadequate HIV/AIDS surveillance, the political invisibility of Native Americans within the AIDS community, and the complexities of jurisdictional issues often place Native Americans at a disadvantage for funding," said Jack Jackson Jr., a Navajo and public policy consultant for the National Native American AIDS Prevention Center and member of the Presidential Advisory Council on HIV/AIDS.

"More importantly, a lack of coordination among federal, state, and tribal governments greatly hinders efforts to deal with the HIV epidemic in Native American communities."

The other major issue for American Indians living with AIDS is the availability of drugs to treat the virus. While Congress has recognized the burden of costs on states by passing the AIDS Drug Assistance Program, or ADAP, to assist state health departments with underwriting the cost of drugs, Congress did not consider the costs on American Indian health care systems and excluded tribes.

The estimated cost of new and life-saving AIDS drug therapy is approximately $12,000 to $13,000 per individual per year, resulting in serious burdens on tribal and urban American Indian health budgets. Currently, the IHS does not ensure the availability of protease inhibitors and others drugs used to treat AIDS patients. It is an issue left to local service units, which must already contend with unrealistic pharmaceutical budgets.

"It is critical that the IHS become more involved than it has been with its own resources to treat IHS eligible Indian people with HIV/AIDS," Jackson said. "Both the ADAP program and the IHS must begin to assume responsibility for supplying needed drugs to Native people dealing with the virus."

The CDC estimates that approximately 200,000 or more people are infected with HIV and do not know it. HIV infection is one of the leading causes of death among American Indians and Alaska Natives within the 10 to 14 and 25 to 44 age groups. Experts say that efforts to increase knowledge about HIV among Natives are critical in order to prevent further spreading of the virus.