HIV Among American Indians and Alaska Natives in the United States

• Of the 39,782 HIV diagnoses in the United States in 2016, 1% (243) were among AI/AN. Of those, 81% (198) were men, and 19% (45) were women.
• Of the 198 HIV diagnoses among AI/AN men in 2016, most (77%; 152) were attributed to male-to-male sexual contact.^d,^e
• Most of the 45 HIV diagnoses among AI/AN women in 2016 were attributed to heterosexual contact (69%; 31).
• From 2011 to 2015, the annual number of HIV diagnoses increased 38% (from 143 to 197) among AIs/ANs overall and 54% (from 74 to 114) among AI/AN gay and bisexual men.
• In 2016, 102 AIs/ANs were diagnosed with AIDS. Of them, 75% (77) were men and 24% (24) were women.

HIV Diagnoses Among American Indians/Alaska Natives
in the US by Transmission Category and Sex, 2016

Source: CDC. Diagnoses of HIV infection in the United States and dependent areas, 2016. HIV Surveillance Report 2017;28.

Living With HIV and Deaths

• An estimated 3,500 AI/AN were living with HIV in 2015, and 81% of them had received a diagnosis.
• Of AI/AN who were living with HIV in 2014, 58% received HIV care during 2014, 45% were retained in care, and 47% had achieved viral suppression.^f
• During 2015, 53 AI/AN died from HIV disease.

Prevention Challenges

• Sexually transmitted diseases (STDs). From 2012 to 2016, AI/AN had the second highest rates of chlamydia and gonorrhea among all racial/ethnic groups. Having another STD increases a person’s risk for getting or transmitting HIV.
• Awareness of HIV status. An estimated 81% of AI/AN living with HIV in 2015 had received a diagnosis. It is important for everyone to know their HIV status. People who do not know they have HIV cannot take advantage of HIV care and treatment and may unknowingly pass HIV to others.
• Stigma. AI/AN gay and bisexual men may face culturally based stigma and confidentiality concerns that could limit opportunities for education and HIV testing, especially among those who live in rural communities or on reservations.
• Cultural diversity. There are over 560 federally recognized AI/AN tribes, whose members speak over 170 languages. Because each tribe has its own culture, beliefs, and practices, creating culturally appropriate prevention programs for each group can be challenging.
• Socioeconomic issues. Poverty, including limited access to high-quality housing, directly and indirectly increases the risk for HIV infection and affects the health of people living with and at risk for HIV infection. Compared with other racial/ethnic groups, AI/AN have higher poverty rates, have completed fewer years of education, are younger, are less likely to be employed, and have lower rates of health insurance coverage.
• Alcohol and illicit drug use. Alcohol and substance use can impair judgment and lead to behaviors that increase the risk of HIV. Injection drug use can directly increase the risk of HIV through sharing contaminated needles, syringes, and other equipment. Compared with other racial/ethnic groups, AI/AN tend to use alcohol and drugs at a younger age and use them more often and in higher quantities.
• Data limitations. Racial misidentification of AI/AN may lead to the undercounting of this population in HIV surveillance systems and may contribute to the underfunding of targeted services for AI/AN.

What CDC Is Doing

CDC and its partners are pursuing a high-impact prevention approach to maximize the effectiveness of current HIV prevention methods and improve HIV data collection among AI/AN. Activities include:

• Working with the Indian Health Service (IHS) and tribal leaders of the CDC Tribal Consultation Advisory Committee to discuss methods for developing and implementing scalable, effective prevention approaches that reach those at greatest risk for HIV, including young gay and bisexual AI/AN men.
• Providing support and technical assistance to health departments and community-based organizations to deliver effective prevention interventions.
• Ensuring that capacity-building assistance providers incorporate cultural competency, linguistics, and educational appropriateness into all services delivered.
• Providing capacity-building assistance directly to the IHS so it can strengthen its support for HIV activities, including HIV testing capacity; We R Native, a comprehensive health resource for Native youth; and the Red Talon Project, which works to achieve a more coordinated national and Northwest tribal response to STDs/HIV.
• Collaborating with National Association of State and Territorial AIDS Directors to release an issue brief, Native Gay Men and Two Spirit People: HIV/AIDS and Viral Hepatitis Programs and Services.
• Raising awareness through the Act Against AIDS campaigns, including
  • Start Talking. Stop HIV., which helps gay and bisexual men communicate about safer sex, testing, and other HIV prevention issues;
  • Let’s Stop HIV Together, which raises HIV awareness and fights stigma among all Americans and provides many stories about people living with HIV; and
  • HIV Treatment Works, which highlights how men and women who are living with HIV have overcome barriers. The campaign provides resources and encourages people living with HIV to Get In Care, Stay In Care, and Live Well.

In addition, the Office for State, Tribal, Local, and Territorial Support (OSTLTS) serves as the primary link between CDC, the Agency for Toxic Substance and Disease Registry, and tribal governments. OSTLTS’s tribal support activities are focused on fulfilling CDC’s supportive role in ensuring that AI/AN communities receive public health services that keep them safe and healthy.

^a Percentage of AI/AN reporting only one race.
^b Hispanics/Latinos can be of any race.
^c HIV and AIDS diagnoses indicate when a person is diagnosed with HIV infection or AIDS, but do not indicate when the person was infected.
^d The term male-to-male sexual contact is used in CDC surveillance systems. It indicates a behavior that transmits HIV infection, not how individuals self-identify in terms of their sexuality. This fact sheet uses male-to-male sexual contact to describe behavior and gay and bisexual men to describe the population of men engaging in that behavior. ^eThis fact sheet include infections attributed to male-to-male sexual contact only, not those attributed to male-to-male sexual contact and injection drug use.
^f People are considered retained in care if they get two viral load or CD4 tests at least 3 months apart in a year. (CD4 cells are the cells in the body’s immune system that are destroyed by HIV.) Viral suppression is based on the most recent viral load test.