Overcoming Stigma: The treatment and prevention of HIV in Indian Country

President Trump stated that ending the HIV epidemic in the U.S. is one of the nation’s top priorities, he included $25 million for IHS to expand HIV screening and care

WASHINGTON D.C. — Half of all new HIV cases occurred in only 48 counties in 2016 and 2017, Washington, D.C., and San Juan, Puerto Rico. A lot of those counties have higher populations of Native communities like Maricopa County, Arizona.

According to the Centers for Disease Control and Prevention, “In the 50 states and the District of Columbia, an estimated 3,600 American Indian/Alaska Natives had HIV in 2016 and 82% of them had received a diagnosis. Of those American Indian/Alaska Natives with HIV in 2015, 60% received HIV care, 43% were retained in care, and 48% had achieved viral suppression.”

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The terms male-to-male sexual contact and male-to-male sexual contact and injection drug use are used in the CDC surveillance systems. They indicate the behaviors that transmit HIV infection, not how individuals self-identify in terms of their sexuality. (CDC Graph)

As he stated in his State of the Union address, President Donald Trump stated that ending the HIV epidemic in the U.S. is one of the nation’s top priorities. In his recently released 2020 budget, he included $25 million in appropriations for Indian Health Services to expand HIV and Hepatitis C screening and care.

Since Congress appropriates funding, not the president, the IHS is now hoping Congress will appropriate this $25 million to helping fight the HIV epidemic with increased screening, community outreach and expansion of the use of PrEP, a medication that prevents HIV infection, to those who are “high risk.”

People who are considered “high risk” are those who engage in sex work, men who have unprotected sex with men, anyone who’s been diagnosed with an STI over the last year, people who use intravenous drugs and transgender women.

Since last year the IHS has increased its efforts to encourage people to get on PrEP and to engage with communities to address the stigma around HIV.

What is PrEP

Partnership, prevention, and treatment

“We know that in partnership with Native communities we can end the HIV epidemic in Indian Country by strategically focusing our efforts on communities most impacted,” said Rear Admiral Michael Toedt, who is the chief medical officer for IHS. “We want to make sure everyone is aware of their infection and receives the treatment they need.”

“IHS has really been on the cutting edge of the program around HIV education, prevention, and care,” Rick Haverkate, the National HIV/AIDS Prevention Director for Indian Health Services, said.

Thanks to advances in HIV care, those who are diagnosed and receive treatment can be virtually unable to transfer the virus to others. Half of patients diagnosed with HIV are virally suppressed, which creates a decreased risk of sexually transmitting HIV.

The Stigma of HIV

According to Dr. Toedt, one of the biggest barriers, especially in Indian Country, when it comes to HIV prevention, is the stigma related to the disease.

“It’s a debilitating barrier preventing someone living with HIV or at risk of HIV from receiving health care services,” Dr. Toedt said. “And from receiving the respect they need and deserve. This initiative will create environments in which all people, no matter their cultural background or risk profile, will feel welcome for prevention and treatment.”

Currently, the health department has been funding programs to help reduce the stigma around HIV/AIDS in Indian Country. One of those organizations overseen by the Northwest Portland Area Indian Health Board is “We R Native,” a comprehensive health resource for Native youth. Over the last year, the organization has been utilizing social media to spread awareness about sexual health.

On March 20th, We R Native promoted the importance of March 20 as National Native HIV/AIDS Awareness Day. They tweeted:

“Today is National Native HIV/AIDS Awareness Day, an opportunity to increase awareness about the impact of #HIVinIndianCountry on American Indians, Alaska Natives, and Native Hawaiians. #NNHAAD

For resources to protect your sexual health, visit: http://ow.ly/OP3N50nF4pS

The Trump Administration’s plan

One initiative addressed by President Trump at the State of the Union Address, “Ending the HIV Epidemic: A Plan for America.” As cited by Alex Azar, Secretary of the Department of Health and Human Services on HHS.gov, President Trump’s initiative “will work to reduce new infections by 75 percent in the next five years and by 90 percent in the next ten years.”

Indian Health Service representatives say they would like to continue and expand these types of programs in Indian Country.

Azar stated in the article that communities hardest hit will benefit from “the additional expertise, technology, and resources required to address the HIV epidemic in their communities.”

“Since the late 1980s, enormous progress has been made in the fight against HIV, but there is still work to be done. The U.S. government spends more than $20 billion annually in direct health expenditures for HIV prevention and care. National interventions have driven the number of new HIV infections down to approximately 40,000 per year – the lowest level ever. But not everyone is benefiting equally from these advances. New infections are highly concentrated among men having sex with men; minorities, especially African Americans, Hispanics/Latinos, and American Indians and Alaska Natives; and those who live in the southern United States.”

Azar says the plan will fund three major areas of action:

  1. Increasing investments in geographic hotspots through our existing, effective programs, such as the Ryan White HIV/AIDS Program, as well as a new program through community health centers that will provide medicine to protect persons at highest risk from getting HIV.
  2. Using data to identify where HIV is spreading most rapidly and guide decision-making to address prevention, care and treatment needs at the local level.
  3. Providing funds for the creation of a local HIV HealthForce in these targeted areas to expand HIV prevention and treatment.

For more information, visit these sites:

We R Native 

https://www.wernative.org

Centers for Disease Control and Prevention / HIV and American Indians and Alaska Natives 

https://www.cdc.gov/hiv/group/racialethnic/aian/index.html

HHS blog on HIV prevention and Treatment with the “Ending the HIV Epidemic: A Plan for America,” initiative.

https://www.hhs.gov/blog/2019/02/05/ending-the-hiv-epidemic-a-plan-for-america.html

What is ‘Ending the HIV Epidemic: A Plan for America’? on HIV.gov

https://www.hiv.gov/federal-response/ending-the-hiv-epidemic/overview

Indian Health Services - HIV/AIDS Statistics

https://www.ihs.gov/hivaids/stats/

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Pauly Denetclaw, Diné, is a fellow with Indian Country Today. She is a staff reporter for the Navajo Times. Her work is supported by a grant from the Bay and Paul Foundations.

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