HIV/AIDS Takes Tragic Toll on American Indians

By Anthony S. Fauci, M.D. | Director, NIH Institute of Allergy and Infectious Diseases

HIV/AIDS has left no segment of American society untouched. On the third annual National Native HIV/AIDS Awareness Day, we highlight the impact of this scourge on American Indians, Alaska Natives and Native Hawaiians, and we intensify our commitment to fight the HIV/AIDS epidemic in these multifaceted communities.

Lack of access to basic health care services, stigma associated with homosexuality and HIV/AIDS, barriers to effective mental health care, and high rates of substance abuse, sexually transmitted infections and poverty all increase the risk of HIV/AIDS in native communities and create obstacles to HIV prevention and treatment. Consequently, as a proportion of their population, more American Indians and Alaska Natives became infected with HIV than whites in 2006. American Indians and Alaska Natives acquired new HIV infections at a rate of 14.6 cases per 100,000 people, while whites became newly infected at a rate of 11.5 cases per 100,000.[1] Moreover, American Indian and Alaska Native women became infected with HIV at more than three times the rate of white women in 2006.[2]

In addition, American Indians, Alaska Natives and Native Hawaiians who are diagnosed with AIDS die sooner after their diagnosis than members of any other ethnic or racial group, suggesting that they are diagnosed late in the course of infection, after the point when antiretroviral drugs would have the most benefit.[3] This is unacceptable. We as a nation must take bold action to promote the prompt diagnosis and treatment of all people with HIV, including members of native communities in the United States.

American Indians, Alaska Natives and Native Hawaiians most often acquire HIV through unprotected sex with an HIV-infected male partner, and a significant proportion of these HIV-infected men do not know they have the virus. An estimated 26 percent of HIV-infected American Indians and Alaska Natives are unaware of their infection[4] -- more than the proportion of HIV-infected Americans overall who are undiagnosed (21 percent).[5] This means that many American Indians and Alaska Natives with HIV are not receiving proper counseling and care, placing them at risk for becoming extremely ill and for spreading the virus further. The National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, strongly endorses testing for HIV during routine medical care for adolescents, adults and pregnant women, as the Centers for Disease Control and Prevention and the American College of Physicians recommend.

The stigma often associated with HIV/AIDS and homosexuality may discourage many American Indians, Alaska Natives and Native Hawaiians from getting tested for HIV and seeking counseling and treatment. NIAID applauds those who are fighting this stigma in native communities. Limited access to health care services may also obstruct the way to HIV testing for American Indians, Alaska Natives and Native Hawaiians. As our nation works to broaden access to health care, it is my hope that more native communities will gain access to testing and treatment facilities for HIV as well as other sexually transmitted infections that increase the risk of acquiring and spreading HIV and are highly prevalent among native peoples.

Substance abuse tears at the seams of American Indian and Alaska Native communities and contributes significantly to the HIV epidemic among them. In 2007, 32 percent of all American Indian and Alaska Native women living with HIV/AIDS had become infected through illicit injection drug use -- a greater proportion of people than in any other minority gender group.[6] In addition, the combination of injection drug use and male-to-male sexual contact accounted for a higher percentage of male HIV/AIDS cases among American Indians and Alaska Natives than among any other racial or ethnic group.[7] Injection drug use can lead to HIV infection directly when contaminated syringes or other paraphernalia are shared; many kinds of substance abuse also contribute to sexual HIV transmission by impairing judgment, leading to risky behavior. I encourage native communities to integrate HIV prevention messages into culturally appropriate substance abuse treatment programs and to support needle exchange programs, which will help reduce the spread of HIV among injection drug users.

Native Americans, Alaska Natives and Native Hawaiians are making commendable efforts to raise awareness about HIV/AIDS in their communities and to increase the proportion of people who get tested for HIV.[8] Culturally attuned HIV/AIDS prevention and treatment programs can limit the spread of this devastating disease among native peoples. We at NIAID stand side by side with native communities in our mission to sponsor and conduct biomedical research to prolong and improve the quality of life of people living with HIV and to end the HIV/AIDS epidemic.



1. Hall et al. 2008. Estimation of HIV incidence in the United States. JAMA 300(5):525.
2. Centers for Disease Control and Prevention (CDC). 2009. HIV/AIDS Surveillance Report, 2007. Vol. 19. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, p. 14.
3. Ibid., p. 29.
4. Campsmith et al., 2009. Undiagnosed HIV prevalence in the United States at the end of 2006. Poster presentation 1036, 16th Conference on Retroviruses and Opportunistic Infections (CROI), Montreal.
5. CDC. 2008. HIV prevalence estimates-United States, 2006. MMWR 57(39):1075.
6. CDC. 2009, p. 22.
7. Ibid.
8. See, for example,


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