Native American Women and HIV/AIDS: Building Healthier Communities

Abstract

Native American Women and HIV/AIDSBuilding Healthier Communities Irene S. Vernon (bio) and Pamela Jumper Thurman (bio) I think the most important issue we have as a people is what we started, and that is to begin to trust our own thinking again and believe in ourselves enough to think that we can articulate our own vision of the future and then work to make sure that that vision becomes a reality. Wilma Mankiller, “Rebuilding the Cherokee Nation” Chief Mankiller’s quote asks Natives to focus on their strengths and wisdom; for those in the health field, it motivates us to create a vision of health parity and community wellness. In following her lead we share general information about the health of Natives, focus on the health of Native women and their risk factors for contracting HIV/AIDS, and offer a model for change—the Community Readiness Model (CRM). We believe the CRM will build a healthy environment that can develop culturally responsive HIV/AIDS interventions and preventions for Native women and their communities. Native men and women have a shorter life expectancy and higher rates of diseases than the general population. Disturbingly, Native people are 770 percent more likely to die from alcoholism, 650 percent more likely to die from tuberculosis, 420 percent more likely to die from diabetes, 280 percent more likely to die from accidents, and 52 percent more likely to die from pneumonia or influenza than the rest of the United States, including White and minority populations.1 Clearly, Natives bear a disproportionate burden of illness compared to other populations in the United States. [End Page 352] Native women rank low in health indicators compared to other races. Between 1989 and 2004 Native mothers who were pregnant had the highest rates of smoking compared with mothers of any other race.2 Native women were also more likely to be diagnosed with advanced breast cancer tumors than whites and faced a 10–70% greater risk of dying of breast cancer after diagnosis than white women.3 Given the health disparities found among Native women, it is clear that the time has come to follow Wilma Mankiller’s words and “articulate our own vision of the future and then work to make sure that that vision becomes a reality.”4 The need for health parity is important because the people most impacted by health disparities live in environments with violence, low income, inequalities, and discrimination, the same cofactors that allow HIV/AIDS to spread.5 Native Women and HIV/AIDS Natives represent less than 1% of the total HIV/AIDS cases reported to the Centers for Disease Control (CDC), but the low number is held suspect because surveillance data for Natives are flawed due to racial misclassification and poor surveillance system reporting between federal, state, and Indian Health Service (IHS) agencies.6 When one considers population size, however, the impact of HIV/AIDS among Natives tells a story different from the less than 1% HIV/AIDS cases. Natives collectively and Native women specifically rank third in estimated rates of HIV/AIDS diagnosis (per 100,000) after blacks and Hispanics. The rate of AIDS diagnosis for Natives has been higher than whites since 1995.7 The appearance of low overall numbers must not be ignored, and the information on HIV-positive Natives cannot be relegated to the “other” category for statistical purposes. The representation of HIV/AIDS among Natives as relevant only in proportion to the rest of the U.S. population (a flat graph line of less than 1%) does not accurately represent its significance and sends a message that Natives are unimportant and are not at risk for HIV; reporting HIV/AIDS among Natives as a proportion of the total population does not allow for tribes and policy makers to set priorities and allocate resources appropriately. Upon closer examination, a steady climb of HIV/AIDS can be seen over the past fifteen years. The story within the “flat line” is anything but flat, particularly if one thinks about how some Native communities can be as few as one hundred and [End Page 353] Click for larger view View full resolution Table 1. Rates (per 100,000...