I am a citizen of the Cherokee Nation of Oklahoma living within the 14-county jurisdiction of the tribe in Grove, Oklahoma, and I am one of the authors of the Community Readiness Model. This model is used internationally to build community capacity to address concerns about prevention or intervention with HIV, STDs and Hepatitis C as well as related issues such as violence, child abuse, teen pregnancy, substance use, etc. It has been used successfully in over 300 Native communities and organizations to develop action planning for HIV prevention.
I am committed to this work because I am a Native woman who wants to see our communities find their strength to build a healthier way of life for our children and our future. Although I am not living with HIV, I support the more than one million people in the United States who are, because HIV affects all of us. Without efforts to raise awareness and reduce stigma we will never reach the goal of an AIDS-free generation for Native Americans and Alaska Natives.
HIV touches every corner of American society, yet too many Americans do not recognize the magnitude of HIV in this country. Approximately 50,000 Americans become infected with HIV each year, and it affects American Indians and Alaska Natives in ways that are not always obvious because of our smaller population size. In 2010, 210 American Indians and Alaska Natives were diagnosed with HIV and, compared with other races/ethnicities, American Indians and Alaska Natives have poorer survival rates after an HIV diagnosis. The nation’s sense of urgency has waned since the early days of the epidemic, and ongoing stigma about HIV or the risk of infection continues to prevent far too many from seeking testing or treatment.
The National HIV/AIDS Strategy specifically identifies tribes as a targeted group, but it also notes that efforts will be directed toward communities of higher prevalence. Unfortunately, our tribal communities don’t reflect what is considered to be “higher prevalence.” However, the data used comes from the Centers for Disease Control and Prevention and there is great concern that tribal data is not included in the surveillance data and therefore the HIV/AIDS surveillance reports do not correctly reflect the state of HIV infection in the Native community. Most Native people are misclassified if tested in state facilities and tribal data is not given to the CDC. Therefore it’s important for us, as Natives people, to consider the related data. We can rely on co-factors that reflect high risk for HIV in Natives: rates of chlamydia, gonorrhea and syphilis that are 1.2 to 4.3 times higher than the white population; domestic violence is a risk factor for unprotected sex and one in three Indian women experience partner violence—the highest rate in the U.S.
Of the Native women who have been admitted for substance use treatment, over 80 percent report having been abused physically or sexually and many are admitted with Hepatitis C and other sexually transmitted infections. In 2011, American Indians and Alaska Natives were twice as likely to develop an infection of Hepatitis C compared to the white population. These are just some of the co-factors that are an absolute testament to higher HIV infection and risk for Native people.
We also know that our MSM/Two-Spirit community is disproportionately affected by HIV/AIDS. According to CDC, 72 percent of recently diagnosed cases of HIV/AIDS are Native males and of that, over 83 percent are Native men who have sex with men or the male-bodied Two-Spirit individuals. This group bears the brunt of this infection and yet, there is little to no funding or support being directed to this community.
In addition to my work throughout the United States, I am also a Native participant in the Let’s Stop HIV Together campaign created by the Centers for Disease Control and Prevention to combat stigma and complacency around HIV in the United States. This campaign encourages everyone to take part to help reduce the risk and spread of HIV by knowing the facts, getting tested and getting involved. Let’s Stop HIV Together gives voice to people who are living with and affected by HIV.
I want to remind Native Americans and Alaska Natives that we can be a part of the solution. By working together, we can stop HIV!
Pamela Jumper Thurman, Ph.D., a Western Cherokee, is a senior research scientist serving as Retired Senior Affiliate Faculty at Colorado State University. She has 25 years of experience in mental health, substance abuse/epidemiology research, and HIV/AIDS capacity building assistance, as well as 35 years in the provision of direct treatment and prevention services and community work. She is a co-developer and co-author of the Community Readiness Model and has applied the model in over 4,000 communities throughout the U.S. as well as over 44 communities internationally. She has published extensively on a variety of topics in various books chapters, newspapers, newsletters, and journals.