Ignoring the Natives:

The HIV/AIDS Epidemic in Indigenous Peoples of North Central USA & Canadian

Introduction

Historically, indigenous peoples have suffered greatly at the hands of microscopic enemies. Smallpox and Tuberculosis were known as killers of the past, brought to native peoples through exposure to new people and their new host of diseases. In modern day, interactions with the global community have spread Diabetes, Hypertension, and Heart Disease rampantly through indigenous communities. Despite experts’ efforts to warn against modern infiltration of secluded cultures for this reason, current climates like that of the reservation system in Northern United States and Southern Canada, make it impossible to isolate new disease from spreading to native populations. Through this paper, the historical and present climate of the HIV/AIDS epidemic within American Natives (AN) in Montana and Southern Canadian provinces will be discussed. While immense amounts of focus have been directed towards the HIV/AIDS crisis internationally, Canadian and US governments have very little data or intervention surrounding this retrovirus on an indigenous level. First, the origin and historical spread of the AIDS/HIV virus will be explained to establish historical context. Expanding on this will be a specific epidemiological analysis of native tribal peoples within the Northern United States and Southern Canadian regions. The symptomology and preferred treatments of such native populations will be examined through case studies and compares with efforts that have been made to assist with prevention and treatment. These analyses will uncover a large level of ignorance and neglect by the global community of how the HIV/AIDS epidemic has affected indigenous populations.

Origins of HIV/AIDS

It is most likely very difficult to find individuals today who are not somewhat aware of the dangers surrounding HIV/AIDS. This once completely unheard-of retrovirus wasn’t named or popularized until 1983 and is still not fully understood to this day (Feldman and Miller). While there are several rumors surrounding the origins of the retrovirus itself, there are two theories which have persisted. Scenario one depicts a post-World War II climate in which biological warfare had become an obsession. This scenario presents the idea that bio-chemical engineers of the 1950s developed the HIV retrovirus with use of a similar animal pathogen. Here, it is said the retrovirus “accidentally” escaped the lab and evolved into a sexually transmitted virus. Scenario two presents a more biological perspective, focusing on the similarity of the Simian Virus (SIV) to HIV. SIV was said to have been present in “old world monkey and apes” in Western Africa (Feldman and Miller 6). Theorists who believe this origin story believe that interspecies contamination between a SIV positive primate and a human would have been responsible for the first human infection. From here, SIV would have evolved into HIV-2, a rapid spreading sexually transmitted virus. This theory also includes the possibility of the virus originating in West African tribal communities before spreading to large African cities and then eventually “gay men in Northern America” (Feldman and Miller 10). Remembering that both of these theories are quite dated in their conception, I will pose one more possible scenario proposed by biologist Paul Ewald. Ewald proposes that the HIV virus has been within the human population for decades as a dormant retrovirus. He believes that the accelerated interconnectedness of the 1950s and 60s paired with increased injection drug use (IDU) and reduction of sexual taboo cultivated the perfect climate for HIV’s evolution. With so many newly available hosts, Ewald believe HIV found it evolutionary beneficial to leave dormancy and develop into AIDS, slowly destroying victims’ immune systems until death. However, there is no sure answer to how HIV/AIDS was brought to the human race.

Historical Epidemiology

The first case which was can be recognized as a HIV/AIDS related incident in the US was in Los Angeles 1979. A young male who had participated in male to male sexual intercourse (MSM) and IDU (MSM/IDU) was diagnosed with Kaposi’s Sarcoma (KS) and Pneumocystis Crinni (PSP), diseases common only to elderly men at the time. Between October of 1980 and May of 1981, 5 more cases of young males were diagnosed with PCP in LA, two died within a year of diagnosis. All of these patients reported MSM/IDU behavior and were previously diagnosed with Cytomegalovirus (CMV). By July 1981, six more patients had been diagnoses in LA, and four in San Francisco. All patients were between ages 25 and 46. At this time physicians had no clue what was going on but began reporting the phenomenon to the Center for Disease Control and Prevention (CDC) in hopes of uncovering the source of the epidemic. Four years after the first reported case, 1,300 cases had been reported in the United States, 50% of which were newly diagnosed within the past year. Most cases were fatal 82% having died post diagnosis, regionally restricted to California and New York, and diagnosed in young, males reporting having participated in MSM, IDU, or MSM/IDU behaviors. Physician’s frustrations cause the homosexual male to become a scapegoat for the spread of this unknown killer, some saying that “the bloodier the homosexual act, the greater the risk” (Felder and Miller 25). California placed a quarantine on HIV/AIDS positive patients in 1986 as an unsuccessful attempt to slow the spread. By 1987, Aids was recognized by the World Health Organization (WHO) as a global epidemic. Despite awareness and heavy research, frequency of incidence continued to rise, reaching nearly 30,000 deaths from HIV/AIDS by 1991. At this point, medications such as AZT were in use, and proving to slow degradation of the immune system, but not enough to curb infection and mortality rates.

Statistical Data

As briefly mentioned in the previous section, young males associated with MSM, IDU and MSM/IDU behaviors have been strongly linked with higher levels of HIV/AIDS infection. For this reason, many studies historically have focused on LGBTQA communities for AIDS/HIV statistics, but this unfortunately reduced focus on other marginal communities greatly affected. By 2006, 1 million people in the US had been infected with HIV, and yet, since 1992 there have been decreasing rates of infection in the US and Canadian white populations, falling nearly 50% in Northern US regions (Vernon, Sondag and Strike, & Canadian Public Health Agency). Simultaneously, there has been a steady increase of HIV/AIDS diagnosis in indigenous populations within Montana and Canada. In 2008, 8% of the entire HIV affected population of Canada is indigenous, despite them only making up 3.8% of the entire Canadian population. A particularly interesting observation is that between 2003 and 2008, the percentage of indigenous AIDS cases within Canadian population rose from 13.9% to 21.7%, far overrepresenting this tiny population. In the early 2000s, Irene Vernon reports that the death rate from HIV/AIDS in US Indigenous populations is twice that of their white counter parts and that 54% of all AIDS cases in the US were people of color (POC). This could be related to the statistic the native peoples diagnosed with HIV are 3.6 times as likely to develop AIDS and progresses nearly twice as fast as those who associate with being white (Canada Public Health Agency). In the United stated, 48% of all HIV positive AN cases developed into AIDS within 12 months of HIV diagnosis, where only 40% non-AI HIV cases reported the same. Those demographics most at risk for HIV infection and AIDS development are indigenous females participating in IDU behavior, under the age of 30, having been or presently incarcerated and making on average $19,000 annual income. Canadian studies show that out of all racial groups, indigenous peoples have the highest level of new diagnosis accounting for 24% of all new HIV cases and 3.1% of new AIDS cases (2008). AN females are 48.1% of all indigenous HIV diagnoses, representing 27% of all reported AIDS cases between 2001 and 2006. Of these cases, 53.7% reported IDU behaviors, and 32.4% were under the age of 30. Furthermore, 88% of AN females incarcerated in youth facilities and 32% in federal facilities are HIV positive. Poverty is perhaps the most significant co-factor, as poor diet, weakened immune systems from exposure, and minimal access to health facilities result in 3.3 times the rate of early deaths in AN populations as in non-AN populations (Vernon).

Symptoms and Preferred Methods of Action

HIV can often go undiagnosed, as it will often not drastically affect the physical functions of an infected individual until it develops into AIDS. As it’s more vicious form, HIV/AIDS retroviruses attack the immune system of an infected person, putting them at risk for PCP, KS, CMV, and hundreds of other fatal illnesses. The combined reduction of immune strength can lead in frequent infections, skin lesions, muscular atrophy, and loss of organ functions. HIV/AIDS frequently is diagnosed alongside previous STD/STI exposure, substance abuse, and factors which weaken the immune system. The Canadian Public Health Agency finds that 80% of all patients diagnosed with HIV/AIDS were previously diagnosed with one of the following: Hepatitis C, various STIs, Tuberculosis, or Type 2 Diabetes. Due to the common occurance of multiple illnesses, prevention, testing, and treatment methods among indigenous populations is very difficult. In a case study conducted within Montana observing tribes such as the Blackfeet, it was revealed that the best methods for prevention and treatment are regulation of HIV testing through creating safe spaces, and education. Studies conducted showed drastic increases in testing when incentives were provided such as offering free tests with yearly physicals, shifting from 18% testing without incentives to 53% testing with incentives (Sondag and Strike). Seeing as majority of indigenous nations being studied here live in densely populated urban, or reservations where disease is easily spread, testing and diagnosis is the most important step to prevention. Additionally, creating a space where the staff is perceived as trustworthy and non-judgmental increases probability of testing. As many AN communities are tight knit, providing staffing from within a community for HIV/AIDS facilities can actually deter testing from fear of societal stigma associated with HIV/AIDS. However, staffing these facilities with Indian Health Services (HIS) or CDC personnel breeds distrust as many AN communities do not believe these government departments have their best interest at heart. Staffing of facilities must be carefully done as to create a safe space promoting healthy testing habits. Finally, educating these populations on HIV/AIDS prevalence, prevention, and facilities is dire. The number one barrier reported by Sondag and Strike of Montanan native populations is the belief that they are not at risk. Because of this, many avoid educating themselves on risk factors, health care facilities or testing habits. It is estimated the 53% of AN HIV patients diagnosed was not aware of their partner’s positive HIV/AIDS status, and 90% of AN individuals participated in risk behaviors, but only 39% of native were tested in 2007. It is estimated that 21% of HIV patients are currently undiagnosed Therefore, safe testing, and education surrounding the importance of testing are the most important areas of attack for the AN HIV/AIDS crisis.

Efforts to This Date

Efforts to provide support to AN within Montanan and Canadian populations have been minimal to date. The first official meeting between the CDC and National Institutions of Health (NIH) to discuss the HIV/AIDS impact on native communities was in 2003, 24 years after the initial spread of the epidemic, and 11 years after the national declining rate of infections in US and Canada (Center for Disease Control and Prevention). During the period of 2003-2004, the NIH and CDC conducted interviews with native nations’ HIV/AIDS prevention leaders from Alaska, and Nevada, the largest presence being of the Navajo nation. It was not until late 2004 when Montana and Wyoming indigenous leaders were invited to meet with the CDC, but topics of discussions addressed STD epidemiology, with little focus on HIV/AIDS. Additionally, there was minimal financial support awarded from any of these meetings, the most substantial grant being $253,800 solely to the Navajo nation. After these meetings, the CDC recognized the need to “correct AN racial misclassification in health data sets such as…reportable infectious diseases” (CDC). As a result, rapid HIV testing and HIV risk behavior observations were implemented for indigenous peoples within reservations. These measures ignore majority of indigenous populations outside of Alaska, Nevada and of the Navajo nation as well as neglect indigenous populations residing in urban settings. Taking matters into their own hands, Montana tribal peoples, sch as the students at the Blackfeet Community College are conduction their own initiatives and studies. This college received a $20 million grant from the NIH to carryout testing, research, and data collection specifically for Montanan tribal populations, both on and off reservations. Their research discovered that on average, every day 35 indigenous patients going to clinics report not having been seen in over 2 years. Studies found the cause of this was largely due to inaccessibility to clinics, and distrust of the federally funded clinics provided. The lack of address to violence, sexual assault, IDU epidemics, and high mortality rates in indigenous populations from the federal government breeds mistrust and perception of apathy for native livelihood. Blackfeet Community College health departments are now providing a safe space for indigenous peoples to be tested, as they were granted permission to administer HIV/AIDS and other various STD tests to the community. A student working in these labs tells the population “The samples are here, on our land, and you can trust us. Because we’re you” (Fraser). To assure the sense of interconnected western medicine and indigenous practices, these medical facilities also incorporate traditional medicines, such as sweat lodges, alongside modern pharmaceuticals. The most recent federal effort to aid in HIV/AIDS prevention by Obama in 2010 was nationally targeted and did not mention AN populations at all. Neglect like this furthers the epidemic in marginalized populations, leaving them at incredible risk of eradication.

Cultural Barriers to Treatment and Testing

There are several cultural factors which interplay to create barriers between indigenous populations and HIV/AIDS treatment and prevention. All of the most commonly reported barriers have a theme surrounded social stigmas which create shame surrounding diagnosis. As stated by Fraser, Sondag and Strike, and Vernon, the high association with HIV/AIDS being an MSM, IDU or MSM/IDU related illness causes patients to not want to know their diagnosis for fear of being discriminated against by their community. Intense levels of homophobia have been reported in various Montanan and Canadian reservation cultures, as well as urban indigenous cultures. Such prejudices cultivate anxiety surrounding sexual taboos in a community, and therefore cause individuals to distance themselves as much as possible from anything which could link them to such behaviors. Small communities result in fast spreading information, just like that of viruses, meaning that an individual receiving testing often has the fear of being recognized by acquaintances which could spread intimate information to your inner-circle. This is compounded upon by the lack of trust in the federal governments permeating through Canadian and Montanan indigenous populations. Distrust causes education initiatives to go unheard, and federally funded clinics to be avoided. The indigenous are not wrong to distrust their governments, however, as they have been left behind all other racial groups in the efforts to contain the HIV/AIDS epidemic.

Conclusion

Tribal peoples in Canada and Montana are suffering at an increasing rate from the HIV/AIDS epidemic. The lack of financial access, political attention, and research conducted on these communities prevents accurate summary of the exact impact this retrovirus has had on indigenous populations. Despite modern evidence of steady increase in AIDS/HIV rates in indigenous populations, Canadian and US governments have not increased any funding to these communities in assistance, but rather have been reporting overall decline in incidents. High association with IDU, MSM, and IDU/MSM behavior as risk factors for HIV/AIDS creates a social stigma and barrier surrounding testing in indigenous populations which already have minimal access to testing and educational resources. It is imperative that more thorough studies be conducted on indigenous populations as the CDC recommended in 2004 so that the eradication of AN communities can be prevented. Without the creation of well-funded safe spaces in which education and treatment can occur for indigenous populations, the HIV/AIDS rates are expected to increase from 24% to 38% by 2020.

Works Cited

Canada. Publich Health Agency of Canada. Population-Specific HIV/AIDS Status Report: Aboriginal Peoples. Her Majesty the Queen in Right of Canada, 2010. Print.

Feldman, Douglas A., and Miller, Julia Wang. The Aids Crisis: A Documentary History. Greenwood Press. London and Connecticut, 1998.

Fraser, Jayme. “Montana Tribes Taking Health Issues Into Their Own Hands.” Indian Health Services, 2016. Online.

Sonda, Ann k. and Strike, Carrie. “HIV/AIDS Among American Indiands/Alaska Natives Living in Montana: A Descriptive Study” American Indian and Alaska Native Mental Health Research, vol, 18, no. 1, pp. 1-22, 2011.

United States of America. Center for Disease Control and Precention. DEPARTMENT OF HEALTH AND HUMAN SERVICES FISCAL YEAR 2004 ANNUAL REPORT ON TRIBAL CONSULTATION. HHS Operating/Staff Division, 2004. Electronic Document.

Vernon, Irene S. Killing Us Quietly, University of Nebraska Press, Lincoln and London, 2001.

Yehia, Baligh and Frank, Ian. “Battling AIDS in America: an evaluation of the National HIV/AIDS Strategy” American journal of public health vol. 101,9 (2011): e4-8.