Native Americans & HIV: The Hidden Epidemic

There is a minority group in America that is displaying alarming rates of HIV infection, far higher than the white majority. This group is beset by long-held prejudice from the outside and the curse of treating HIV as a stigma on the inside.

No, it's not African Americans or Latinos. It's Native Americans and Alaskan Natives (jointly called "Indians" here for brevity). Their rate of HIV infection is right behind the blacks and Latinos -- 30 percent higher than white Americans, according to the U.S. Department of Health and Human Service's Office of Minority Health. The chance that HIV-positive Indians will develop full-blown AIDS is 50 percent higher. What's even worse, once they have received a diagnosis of AIDS, they have the shortest life span of any race or ethnicity.

Even these numbers, as bad as they are, don't present the whole picture. The Centers for Disease Control estimates that fully one-third of HIV-positive Indians have been lost because they were misclassified as "white" or "Hispanic." Not only that, the lack of healthcare and an unwillingness to get tested probably means that even more are carrying the virus, don't know it, and are infecting others.

On the one hand, it's easy to see why: Unlike blacks and Latinos, the media has underreported -- or ignored, if you will -- this pandemic. Numbering only a few million, Indians are barely 1.5 percent of the U.S. population. But there may be other, subtler, reasons based in history.

Since the advent of Europeans in the Western Hemisphere, native populations have been ravaged and, in some cases, completely erased by the introduction of diseases for which they have no immunity -- sometimes, many believe, intentionally. While HIV is an "equal opportunity" killer, it is only the latest in a long list of illnesses like smallpox and measles that Indians were ill prepared to confront.

Out of Sight, Out of Mind

There is also the issue of visibility. Many Indians still live on reservations, far from the large population centers.

America's dealings with the people who first populated its lands are, by any standard, shameful. The traditional American attitude was summed up by the widely attributed quote of a U.S. general that "the only good Indian is a dead Indian," but few know that in 1851, the governor of California told the state's legislature that "a war of extermination" was necessary "until the last redskin of these tribes has been killed."

If the prevailing attitude has softened, for most Americans it's still "out of sight, out of mind" for the long-beleaguered original Americans.

Indian reservations continue to suffer from neglect. They are among the poorest places in America. Unemployment is rife, as is alcoholism and drug abuse. Intravenous drugs account for well over a third of all HIV cases -- nearly double that of any other group.

Further complicating the issue, the 556 individual tribes speak 200 languages. Unlike the stereotype in Westerns, Indians are as culturally diverse as the nations of Europe, with differences as marked as those between the Irish of County Donegal and Sicilians, or between the Transylvanians of Romania and the Finns of the Turku region.

A May 2013 report from the Indian Health Service shows how profoundly HIV is affecting one tribe, the Navajo. The number of reported cases rose 20 percent from 2011 to 2012, up nearly fivefold since 1999. As with other tribes, since the 1980s, infected Navajos often sought treatment after HIV had blossomed into full-blown AIDS. Most HIV-positive Navajos do not disclose their status, according to the Navajo AIDS Network.

Men who have sex with men account for as much as three-quarters of new infections. As with people who live in isolated rural areas, many of these men are reluctant to seek treatment on the reservation, since they probably know employees at the clinic and fear disclosure.

Understandably, like most Indians, they retain a healthy distrust of a healthcare system funded by the same government that promulgated near-genocidal policies. To help fight this perception, some clinics are incorporating traditional medicine in treating HIV. In Gallup, N.M., medicine men offer prayers, herbal remedies and ancient healing techniques in the Indian Medical Center.

Indian counsel or tribe

For gay Indians, having their sexuality exposed brings the specter of rejection by their families and the entire tribe. If anyone knew they were HIV-positive, that would put an end to any possibility of reconciliation. Living on the down low, however, has far-reaching consequences. Indians have higher rates of other STDS than any group other than African-Americans.

The problems run deep. In a 2011 CDC, nearly half of Indian men who had sex with men reported having been raped, assaulted or stalked by a partner. An abused partner is usually in no condition to refuse sex without a condom.

After Isadore Boni tested positive, the Apache tribe to which he belonged shunned him. He described years of living on the streets in Phoenix to The Aboriginal News. He has since become an HIV activist and managed to get his reservation to pass a law protecting the confidentiality of test results -- an all-too-rare example of someone enacting change.

The stigma against LGBT members of their own tribe is especially tragic, considering the long widespread tradition among native tribes of the two-spirit people, or berdaches, a "third gender" that allowed some men and women to cross-dress and assume many functions of the other sex.

Anthropologists have identified the two-spirit tradition across the continent. Far from being shunned, these men were often considered to have special powers, such as healing or the ability to tell fortunes. They would be consulted when parents were naming their children, and served as matchmakers.

As for women, a September 2013 study found that only 18 percent used condoms all the time. They reported being embarrassed asking for condoms within their tribe. They used condoms actually more frequently with casual sex partners than those they met through friends or family. Many of them abused alcohol or drugs and had been the victims of domestic violence.

What Is To Be Done?

To fight the epidemic of HIV infections, several tribes have instituted service organizations, such as Minnesota's Indigenous People's Task Force, which are more attuned to cultural nuances and mores. Project Red Talon provides tribal-based education programs. The Native VOICES Adaptation Project works closely with tribal leaders to implement HIV and STD prevention programs for young adults 15 to 29 years old.

In 1987, Indian activists, healthcare professionals and social workers founded the National Native American AIDS Prevention Center. The New York State Department of Health and the National Institute of Mental Health studied ways to incorporate the two-spirit tradition into HIV education and prevention.

That such initiatives are needed goes without saying. That they have thus far been ineffectual in preventing skyrocketing rates of infection shows how much yet needs to be done.

It would be tragic if HIV managed to do what other diseases, forced relocations, endless wars with the U.S. Army and neglect failed to accomplish: Relegate the remaining Indian tribes to footnotes, like extinct tribes such as the Pawtuckets, Yazoos and Wampanoag, and dozens of others.

We who are the children of immigrants have the burden of history weighing down upon us. Nor will history look kindly on us if we continue to ignore the plight of Native Americans at such a moment in time.

Steve Weinstein has been a regular correspondent for the International Herald Tribune, the Advocate, the Village Voice and Out. He has been covering the AIDS crisis since the early '80s, when he began his career. He is the author of "The Q Guide to Fire Island" (Alyson, 2007).

This story is part of our special report: "HIV Minority Report". Want to read more? Here's the full list.