In 2016, American Indian and Alaska Native (AI/AN) people had the fourth-highest rate of HIV diagnosis among seven racial and ethnic groups — 10.2 per 100,000 — and diagnoses among them rose 70%, from 143 in 2011 to 243 in 2016. Yet little had been published about AI/AN people in HIV care, because samples are small and AI/AN identity is often undercounted in data.
The study
CDC analyzed the Medical Monitoring Project (MMP), which surveys the experiences and needs of people with diagnosed HIV, for AI/AN adults in HIV medical care from June 2011 to May 2015.
- A three-stage sample — states and territories (100% took part), facilities (83–85%) and patients (49–55%) — with interviews and medical records, weighted for selection and non-response.
- AI/AN meant anyone who self-identified as AI/AN, alone or with other races, and of any ethnicity.
- 666 AI/AN patients — 3.6% of the MMP population.
Who they were
| More than one race | 65% |
| Hispanic or Latino | 29% |
| Male / female / transgender | 74% / 23% / 3% |
| Age 50 or older | 43% |
| At or below the federal poverty guideline | 51% |
| Homeless in the past 12 months | 12% |
| Incarcerated in the past 12 months | 6% |
| Internalized HIV stigma | 78% |
| Discrimination in health care since testing positive | 37% |
Health and behavior
| Symptoms of depression (past 2 weeks) | 27% |
| Dissatisfied with social support | 12% |
| Binge drinking (past 30 days) | 20% |
| Non-injection drug use (past 12 months) | 32% |
| Injection drug use (past 12 months) | 5% |
| Current cigarette smoking | 46% |
| Condomless sex with a partner of negative or unknown status while not sustainably suppressed | 8% |
| Adherent to antiretroviral therapy | 86% |
| Sustained viral suppression (under 200 copies/mL on every test in 12 months) | 64% |
| Suppressed at the most recent test | 76% |
Mental health and HIV peer support services received and needed. CDC.
- Peer support groups: 17% received them; 11% needed but didn't get them.
- Mental health services: about a third received them; 8% needed but didn't get them.
What it means
- Viral suppression fell short of the national goal of 80%, though sustained suppression was similar to that of White patients (66%) and higher than among Black (49%) and Hispanic/Latino (59%) patients.
- Poverty was higher than in other groups; depression (27% vs 25%) and stigma (78% vs 79%) were similar to all adults in HIV care.
- These burdens may stem partly from racial and historical inequities and are not intrinsic to AI/AN cultures.
- Culturally appropriate mental health and peer support could ease depression and strengthen support — and some patients needed but lacked them.
Responses: HIV providers and clinics should screen for poverty, depression, stigma and substance use and offer referrals. CDC works with the Indian Health Service and tribal leaders on prevention, supports programs such as Project Red Talon for a coordinated Northwest tribal response, and runs the Let's Stop HIV Together campaign against stigma. Community-based and tribal organizations can help people reach culturally appropriate services.
Limitations: years had to be pooled (too few AI/AN patients per year to study trends); the sample excluded Indian Health Service facilities, tribal lands and some areas with many AI/AN residents (though most AI/AN people don't live on tribal lands); and answers were self-reported.
Sources
Based on Baugher AR, Beer L, Bradley HM, Evans ME, Luo Q, Shouse RL, "Behavioral and Clinical Characteristics of American Indian/Alaska Native Adults in HIV Care — Medical Monitoring Project, United States, 2011–2015," MMWR Morbidity and Mortality Weekly Report, volume 67, Centers for Disease Control and Prevention; a work of the United States government in the public domain.
Licence: CC0 1.0 (public domain) · Adapted from www.cdc.gov
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