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Women, girls, HIV and AIDS: The South Dakota perspective

On Dec. 1, the global community acknowledged World AIDS Day. This year's
theme -- "Stop AIDS. Keep the promise" -- holds international governments
and policy-makers accountable for the promises and commitments already made
to stop this preventable disease and challenges them to take the actions
necessary to follow through.

"Stop AIDS. Keep the Promise" grew out of campaign consultations that took
place in 2003, when "Women, Girls, HIV and AIDS" was chosen as the official
theme for 2004. What has changed for women and girls, particularly in
Indian country, since that time? How well have governments and
policy-makers kept their promise?

In 2005, women represented 30 percent of new HIV infections in the United
States. The statistics highlight the fact that many of these newly infected
are young women and girls, and most are members of racial and ethnic
minority communities. The majority of our vibrant American Indian
population (in South Dakota) is female.

In South Dakota, American Indians account for 10 percent of the overall
state population while accounting for 15 percent of all HIV/AIDS
infections. In 2002, American Indians in the Crazy Horse Monument state
accounted for 46 percent of reported chlamydia cases and 48 percent of
gonorrhea cases. Sexually transmitted disease rates are prime indicators of
high-risk sexual activity. Ten years ago there were approximately 15
million Americans infected with a sexually transmitted disease. There are
an estimated 19 million new cases of STDs each year in the United States.

According to the Centers for Disease Control and Prevention, American
Indians have the third-highest rate of HIV/AIDS cases in the nation. The
CDC has reported that there are more than one million Americans living with
the chronic disease of HIV/AIDS. Of those, American Indians and Alaska
Natives represent 2,300 known individuals. Due to low testing rates for
HIV/AIDS in Indian country, the infection rates in these populations are
thought to be much greater than is currently reported.

There are differences in examining the issues of HIV/AIDS between men and
women. Some are physiological and some are social. Women have a much higher
biological risk then men for contracting HIV through heterosexual
intercourse. In the United States, AIDS-related deaths among women was
estimated to have declined by 35 percent, while it declined by 64 percent
among men.

To speak to HIV/AIDS within American Indian populations, one must go beyond
the disease, beyond the mortality rates, and examine high-risk lifestyles
that may lead to a path of infection. These high-risk behaviors are often
expedited by the cycle of poverty, intergenerational trauma and lowered
self-esteem issues, which lead many to injection drug use and alcoholism.

Sexually transmitted diseases such as HIV/AIDS are not on the radar screen
of many Americans Indians. Experts note that most people who transmit STDs
are not aware that they themselves are even infected. Although the IHS
currently operates at 40 percent of funding needs, there has been great
improvement since 1985 in the way the IHS addresses sexually transmitted

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The greatest challenge is educating the public to the risks associated in
acquiring an STD and getting them into a medical facility for treatment.
American Indian women tend to access health care systems much more
frequently than men. In turn, women may receive treatment for an STD but
become re-infected due to lack of treatment for their partners, who do not
commonly access health care unless they go to medical facilities for issues
unrelated to STDs. For many American Indian women in South Dakota, sexual
safety is placed on the back burner to more imposing issues such as trying
to meet one's daily need for food, safe shelter and the basic necessities
of the family.

For American Indian women, there are more obvious variables that could lead
to an HIV/AIDS infection than their Caucasian counterparts. Native women
experience higher rates of domestic violence and sexual assaults than
mainstream Americans. These issues keep many Native women from having the
capacity to address their own sexual health. They may not be able to
negotiate such things as condom use when they live day-to-day with an
abusive partner.

The chances for Native women to re-experience violence during their
lifetime is double and even triple in some tribal communities compared to
women of other ethnicities. South Dakota leads all states in the number of
criminal investigations in Indian country, with Arizona second and New
Mexico a close third. The most common of these investigations involve
simple assault, aggravated assault, robbery, rape and sexual molestation.
These acts of physical and sexual violence are not isolated to American
Indian and Alaska Native women, but are disproportionably high for Native
children and elders as well.

Beyond the complex social and cultural challenges that American Indian
women face in HIV/AIDS self-prevention, there is a new and imposing threat.
Crystal methamphetamine is becoming an extremely volatile issue in the
lives of our Native communities. It expedites the decline of the
contemporary Native family and social structure. Meth users tend to
graduate to intravenous drug usage, thus increasing the risk of sharing
needles contaminated with the HIV virus or hepatitis C.

It is no longer uncommon to see a young mother deliver her newborn while
under the influence of crystal meth. Many Native women see crystal meth as
a means of losing weight or to be part of the "in" crowd in harsh
reservation environments. They do not always see the effect that this
highly addictive drug may have on their husbands and boyfriends.

Due in part to this new drug, there are more instances of men who don't
identify themselves as bisexual, acting out high-risk sexual activity while
under the influence of crystal meth with other men. Men who sleep with men
still the have the highest risk for HIV/AIDS infection in Native
populations, with intravenous drug users second.

There are many resources available for women currently living with the
HIV/AIDS virus and for those who want to live to avoid it. Every state has
an HIV/AIDS community planning group that addresses prevention efforts in
their respective areas. Every state's health department and the IHS offer
free and confidential HIV/AIDS testing. The National Native American AIDS
Prevention Center in Oakland, Calif., is one of several prominent advocates
in the area of Native HIV/AIDS prevention in the United States.

The resources are there, so there's no excuse not to be educated to this
100 percent preventable disease. If you are at risk, go get tested for the
HIV/AIDS virus. That's the ultimate form of self-respect.

Andrew Catt-Iron Shell serves as STD/HIV prevention coordinator for the
Rosebud Sioux Tribe in South Dakota. He also serves as an HIV/AIDS advisory
board member to the Office of Minority Health Resource Center. He can be
reached at