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Reservations face challenges fighting HIV/AIDS

The epidemics of diabetes, cancer and alcoholism within the Native American populace are the symptoms of our history with the now dominate culture. Our very existence and identity as America's original population is defined by how we deal with the symptoms of these diseases that have attacked the life force of our people. As it is said, without your health, you have nothing. So, it is clear that we must confront these diseases if we are to survive and be healthy.

Along with many other diseases impacting Native communities, HIV/AIDS has great potential for destruction. The advent of HIV/AIDS in addition to other adversities faced by tribal nations places them in great danger. If allowed to progress, HIV/AIDS will attack and destroy the core component of who we are as Native people. The progression that HIV takes in attacking the human immune system will be duplicated through the social and economic structure of Indian country. Just as HIV/AIDS diminishes human defense systems, it can also diminish the defenses that we hold precious in protecting our identity as a unique and valuable culture.

The new path set forth by the Bush administration prefers that funding for HIV/AIDS be directed toward HIV positives and prevention efforts be addressed in abstinence only format. Although the best protection against STDs including HIV is to abstain from sex or remain monogamous with an uninfected partner, it is critical that individuals are still educated on the benefits of condom use and other protective behaviors. Science continues to demonstrate that comprehensive HIV prevention cannot succeed when limited to an abstinence only format.

It seems that federal policy on HIV/AIDS enhances politically influential powers that have an ongoing agenda of dismantling, discrediting and just plain ignoring those populations and communities that are most at risk for HIV/AIDS. The cumulative effect of the new and improved government policy will be an increase in new HIV cases.

The American Indian struggles in designing a positive path to address the devastating probability of an AIDS epidemic in our populations.

There is a myth within the mainstream that the federal government provides funding for 100 percent of tribal health needs. This myth promotes immediate misunderstanding and adverse relationships with other federal, state, and private entities, making it difficult to secure adequate funding, especially in the area of HIV/AIDS. It is a reality that the Indian health care system will not support the surge of an HIV/AIDS epidemic. Medical, social and economic costs would exaggerate our Indian Health Service health care system, which has operated at 49 percent of need since its inception 50 years ago. Presently the IHS operates at a Priority 1 status to address only life or limb threatening situations.

Although HIV/AIDS is being seen as a chronic disease, since those infected are living very long lives, it is still a very dangerous disease. The danger of this disease was addressed in a 1997 memorandum from the director of the IHS to all area and associate directors. The director stated, "HIV infection may have a greater impact on American life and ultimately Native American life than any other communicable disease of this century. The impact that AIDS will eventually have on Native Americans, in terms of physical and emotional suffering and the cost of caring for its victims cannot be calculated, however, it must be assumed that this is the time to develop strategies which can lessen the human and financial toll."

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With the economic variable involved in health care, tribes must always be concerned that the underlying agenda of government policy is to force us into covering our health care costs by selling our lands and natural resources. The Emory University Rollins School of Public Health stated "failure to reduce new HIV infections in the United States by 50 percent in the next two years could cost the nation more than 18 billion dollars." Where will this money come from? Many times in our collective history the U.S. government has looked towards Indian country to cut funding, steal natural resources and most recently to tab tribal casino revenues to the point of extortion.

With the land being the foundation of the Native American spirit, we have the right to question the Congressional allocation of the bare minimum to meet their legal and moral responsibilities to Indian country in the area of health care. The health of our people is as dependent on our land base as it was for our ancestors.

As HIV/AIDS becomes more visible in Indian country, those who have been diagnosed with the disease have been forced to seek care outside tribal homelands. This is due to social stigma, discrimination, financial limitations of IHS service units, confidentiality issues, and clinical limitations. One primary concern is lack of direct access to Ryan White funding. Although tribes can apply for certain aspects of these funds, these resources are channeled through state and planning councils. The rationale of state councils has been to historically fund on numbers of HIV clients. This rationale can be a problem because HIV/AIDS is undefined in Indian country, hence, this funding structure is unproductive and helps promote an epidemic. Historical interactions between state and tribal governments have also proved ineffective. States continue to battle tribal nations over land, natural resources and jurisdiction.

Competitive grants can be applied for by the tribes, urban Indian health centers and tribal community based organizations but many Natives see this as a conquer and divide strategy. It is viewed as an elimination strategy. Grants do not have the same benefits as contracts. The concept of competitive grant distribution undermines self-determination and tribal sovereignty.

Despite overwhelming scientific data about the effectiveness and necessity of these intervention efforts, there is still an ongoing trend by influential components who cite their own moral standards and political agendas rather than utilizing basic common sense and proven science. The new initiatives fail to support comprehensive prevention strategies for at-risk populations, which include American Indians, women of color and the poor. These populations comprise a vast majority of new HIV infections in the U.S. each year and require comprehensive prevention interventions that reflect the reality of their lives. The CDC self acclaimed years ago, the fact that hard to reach populations like American Indian communities depend enormously on well-funded programs developed and implemented by community based organizations. That's good reasoning but little else without dollars to walk the talk.

Foremost in addressing HIV/AIDS within Indian country, tribal people have an inherent right to quality health care and a right to receive this care on their homelands. Although Native populations can receive assistance for HIV/AIDS issues in any state funded AIDS drug assistance program, these types of services should also be made available on tribal lands.

If we are to overcome the common threat of HIV/AIDS, all Americans must come together in one conscience mind and heart. We must use a common sense approach and direct our leadership on all levels to do what's best for the people. Sadly, the American Indian is a textbook example of the health disparities that arise when the band-aid fix mentality is used to address extreme health problems. The new federal policies on HIV/AIDS place the American Indian further behind. Only by holding our leaders accountable and coming together not only as fellow Americans but more rightly doing what's best to promote the beauty and well being of the human spirit will we conquer HIV/AIDS. Learn about HIV/AIDS and pass that accurate knowledge on so future generations of all nations can move forward.

Andrew Catt-Iron Shell is a health educator for the Rosebud Sioux Tribe Community Health Representative Program. His perspective on Native mobilization to HIV/AIDS was presented earlier this year to the National Native American AIDS Prevention Center as part of their Native Leadership Empowerment Advocacy Participation Program. Catt- Iron Shell can be reached at