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The dead eye of the storm

A look at HIV/AIDS prevention in Indian country

The disease of AIDS is kind of like those old Western movies. You know, where the gun-slinging Texan shoots down 10 Indians with one bullet. Even Dick Cheney can't do that! What enemies are out there shooting down our first Americans? What risky behaviors can take down 10 Indians in one careless night? A little knowledge about the risk of HIV/AIDS would help us from playing Russian roulette with our health.

All people from the four directions need to find a common ground and wage war against an enemy worthy of a pre-emptive strike. A sovereign mind knows how formidable the adversary of HIV/AIDS is. We must go into this battle with the equipment and tools needed: knowledge of the enemy and using more than a child's squirt gun to put out this fire.

The HIV virus, the incurable virus that leads to the disease of AIDS, is attacking our people throughout Indian country. American Indians and Alaska Natives have the third-highest rate (above whites) of AIDS diagnoses, despite representing a very small number in the population of the United States. On this battlefield, we can sometimes be our own worst enemy. There was a time when American Indian communities were severely uncomfortable speaking to issues of substance abuse, domestic violence or mental health. We behaved as if the good, the bad and the ugly were in someone else's closet. Not talking about HIV/AIDS is an injustice to ourselves and those we love.

We can overcome HIV/AIDS in Indian country by rekindling the power of who we are: a Native people. In traditional times, tribal nations addressed our health as a team effort. They must have had good communication skills to accomplish that. Our health, the strength of our mind and spirit, was the greatest weapon in our arsenal. Contemporary times offer a level of dysfunction as we sometimes speak to our health challenges as if we're trying to hide dirty laundry. Some people hide from these health challenges because they were taught to accept intolerance and denial as a coping skill.

Could you walk in an AIDS patient's moccasins and survive the intolerance and discrimination of two cultures? Could you survive the daily effects of powerful AIDS drugs that must be taken diligently? Those suffering through chemotherapy could easily testify to the harsh and invasive medical procedures and powerful drug treatments have on the human body. Sometimes they have to poison you to treat your sickness. The disease is no longer a death sentence, but it can drastically influence the quality of your life. Do you think this could never happen to you? If you answered yes, you've taken one blind step towards potential risk for the infection.

Why wouldn't you want to unite against an enemy that already has taken healthy lives hostage in your own community? We did not mobilize when the first alarm of HIV/AIDS was sounded. In the 1980s, the evening news, politicians and dealers of stigma sold the American public on the idea that HIV was isolated to gay and two-spirit communities. Stigma and lack of the government's trust responsibility to Indian country has kept us passive in our fight to address this preventable chronic disease.

AIDS goes down to the core of who we are as American Indians. It is a disease that attacks the sovereignty of our blood, the sovereignty of minds and spirit. It gives others the opportunity to define our demise through their misguided perceptions of who we are as Native peoples. What is involved is so sacred that many are blinded by the power of it all. The power of this disease is rooted in the blood, and many people are afraid of blood. The American mentality is to fear what it does not understand.

Statistics don't count tears. There's no profit margin in that. So they label the American Indian as a victim just by the sheer numbers of our health challenges and poverty levels. We need our tribal leaders to question why the mechanisms to challenge HIV/AIDS have outright failed. It should be unacceptable that HIV rates among Natives in states like South Dakota are 15 percent of the overall infection rate, yet we represent only 8 percent of the overall state population. That's a 25 percent increase from 2001. The first Americans are left without the proper equipment and tools needed to aggressively battle this disease. Success through process will never happen so long as Indian country continues to be treated as incapable of its own solutions.

The federal response to HIV prevention in Indian country has been lethargic at best. It outsources trust responsibility to state health departments. This process promotes parity, inclusion and representation, yet it ignores tribal sovereignty. It gives state health departments jurisdiction over Centers for Disease Control and Prevention HIV prevention-dollars needed for Indian country. Who can explain how that empowers Native communities to buy into the concept of HIV prevention? This scenario limits our capacity to address HIV/AIDS in the culturally, tribally directed manner needed for success. If nothing else, it authorizes tribal governments to question what services are provided towards HIV prevention to Indian country. Are they accountable to the needs? Do they meet the state's HIV prevention responsibility to all constituents within tribal jurisdictions? All 562 federally recognized tribes in the United States face these issues.

Leaders within Indian country need to build self-sustaining approaches to overall wellness. No one's going to do it for us. Addressing the whole of the person has been successful in meeting other health challenges that Indian country has faced. It's time for Indian country to exercise our sovereignty and push for realistic prevention/intervention services on and off the reservation to our tribal members. Science does not always validate what Natives may define as ''realistic.'' Natives know what will work to address HIV/AIDS within tribal communities, yet we are held hostage by systems that keep paternal control over our sovereign approaches. Shame on us for tolerating the institutional and bureaucratic abuse that we put up with. We've been played against each other for too long; the urban Indian against the rural. Health care funding for the American Indian is unrealistically minimal in the Federal budget thus becoming a tool for conquer and divide. It offers band-aids to a trauma victim.

How did we miss our relatives dying around us? Too many watched as those who identified as two-spirit and those who remained on the down-low passed on to the spirit world, their lives cut short to HIV/AIDS without enough having been said. Did we help our relatives in need? Did they mourn in silence when they really wanted to scream and shout? It doesn't help knowing that some don't hurt, not so much from the disease as from the pain they feel from not having a strong support system.

The single-parent father of a preschool child was turned away from a tribal domestic violence shelter. He was being beaten up by other family members on a regular basis and his child ridiculed because the parent is HIV positive. The shelter told them that they don't provide services for this type of abuse.

The elementary school girl does not understand what all the playground teasing and bullying are about, even by children related by blood. She doesn't understand the whispers behind her or why teachers have quit working because they're afraid of her mother. She just knows that her mommy has a disease called AIDS and each day with her mother is a blessing. How many of us are willing to stand with our relatives who endure these types of brutal behavior? In a perfect world, there would be no stigma involved in addressing the challenges of a chronic illness. The stigma and intolerance shown thus far around HIV/AIDS is far more damaging to American society than the disease will ever be.

Why wait for Thanksgiving to talk about American Indians? Why wait for March 21, National Native American HIV/AIDS Awareness Day, to talk openly about this disease?

The conversation should start with questioning your own risk and the risk to loved ones. Do our daughters know how to protect themselves when out on Friday nights with friends? Do our young men know how to respect women, even in thought? Domestic and teen dating violence, crystal methamphetamine and alcohol are variables that can lead us to a path of AIDS infection. We can respect ourselves and those we love by speaking to our health challenges in an open and unthreatening way. Knowledge truly is power in the fight against HIV/AIDS.

We must move past our comfort zones and keep HIV/AIDS from being the smallpox-infected blankets once used to thin out tribal populations. The life force of our future generations depends on our ability to step up to the enemy of HIV/AIDS. There is no time to waste.

Andrew Catt-Iron Shell is Eastern Cherokee/Sicangu Lakota. He serves as a community organizer for the Western South Dakota Native American Organizing Project with advocacy to welfare reform and issues affecting American Indian populations. He can be contacted at