HIV/AIDS

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# PURPOSE AND METHOD OF OPERATION

The Indian Health Service (IHS) is committed to the primary prevention
of HIV in American Indian and Alaska Native populations through
dissemination of appropriate information and the development and
nurturing of empowerment skills at both the individual and community
levels. These are the pivotal tasks for this program in order to
decrease and ultimately eliminate HIV-related risk taking behavior.
Related tasks include accurate and timely HIV seroepidemiology,
decreasing morbidity and mortality (secondary and tertiary prevention),
which is accomplished through the provision of state of the art clinical
and support services to HIV-seropositive American Indians, Alaska
Natives and their families. In addition, this enhances the capacity of
the Nation\'s public and private organizations at the national, state,
and local levels to deliver effective prevention, treatment, and related
health care programs to all citizens. To achieve the Indian Health
Service HIV/AIDS mission, the IHS has implemented programs that include
components of risk assessment, education, prevention and treatment
through collaborative agreements with other Federal agencies to assist
Indian Health Service.

The Indian Health Service AIDS program initiated a collaborative effort
with organizations that have expertise in areas of need concerning HIV
prevention. Currently collaborative efforts start at the Secretary level
by way of the Minority AIDS Initiative (MAI). Other collaborative
efforts and agreements are with the National Institutes of Health,
Substance Abuse and Mental Health Administration, Health Resources and
Services Administration, and Centers for Disease Control.

Indian Health Service AIDS Program funding, by Congressional mandate, is
for prevention services. The Hospitals and Health Clinics budget
provides treatment.

# 

# Surveillance

New HIV infection cases average 120 per year for males. The female HIV
infection rate continues to climb and will not stabilize for several
more years. In 2000 there were 33 new female HIV infections. End of year
(December 2001) there are 49 new HIV infections. The surveys of
prenatal, sexually transmitted diseases (STD), and alcohol and drug
abuse treatment programs have proved the presence of the virus in
virtually all remote Indian communities.

Each IHS Area Office has one full or part-time HIV/AIDS Coordinator that
networks with their respective State epidemiologist regarding HIV/AIDS
in AI/ANs to enhance surveillance, prevention and treatment efforts. All
programs must meet State-reporting requirements. Information is shared
with the States and the Centers for Disease Control and Prevention. IHS
has one National AIDS Coordinator at Headquarters.

# High Risk or Infected Persons

With funding from the Minority AIDS Initiative and support from the
Congressional Black Caucus, training is now being provided through HRSA
(Health Resources and Services Administration) to health care providers
of Indian Health Service, Tribally Administered Health Care Facilities
and Urban Indian health care health centers on the latest prevention and
treatment techniques in HIV and AIDS. This includes alcohol/substance
abuse counselors and mental health program staff in rehabilitation
facilities.

Risk assessment behavior screening is continuing among women seen in
prenatal and other clinics. Similar screening is being done on STD and
tuberculosis patients.

With the increased public awareness of the HIV virus, more individuals
are seeking counseling and requesting HIV testing. IHS provides
confidential testing at IHS health care facilities. Inquiry should be
made as to whether Tribally managed health care facilities and Urban
Indian Centers provide confidential and/or anonymous testing.

**[Prevention Services]{.underline}**

The IHS AIDS Program is focusing prevention activities in special
groups, such as women, tribal leaders, school age youth in BIA schools
and public schools with significant number of AI/AN children in those
public schools, and community leaders at specific community events such
as feasts, pow-wows, schools, health fairs, and rodeos.

**[Special Emphasis - Urban Prevention Program]{.underline}**

The Urban Indian Health programs received a special appropriation of
\$646,000 in FY 1993 for AIDS education and prevention services. Urban
Indian programs now provide testing for high-risk individuals. Some
continue to participate in the IHS surveillance. With MAI funding Urban
Indian health care providers are able to get up-to-date training in HIV
prevention and AIDS treatment.

The programs have developed culturally appropriate HIV prevention
materials, and have identified available resources for care. Initially,
the 37 urban Indian programs limited their activities to public
awareness campaigns, but are now involved in part-time HIV outreach,
intervention, and referral activities for high risked persons.

**[School and College Age Youth]{.underline}**

Limited data suggest that American Indian and Alaska Native youth
continue to engage in unprotected sex at an early age. Surrogate data
such as teen pregnancy and STD rates support this position. IHS provides
AIDS Prevention/Risk Reduction services to all reservation-based
schools, school boards, and educators, as well as Teen Clinics, Youth
Substance Abuse Treatment Centers, and other youth organizations.
Regular training sessions are offered to the Bureau of Indian Affairs
school administrators, teachers, and school board members. IHS personnel
are participating in school health programs and curriculum development.
Indian Health Service through collaboration with CDC Division of
Adolescent and School Health (DASH) provides training to teachers (BIA
and public schools) in the use of the, "Circle of Life, HIV/AIDS
Curriculum" and "Be Proud, Be Responsible" curriculums. These
curriculums were developed by the Indian Health Service and range from
kindergarten to 12^th^ grade.

**[Local Programs - Community Awareness]{.underline}**

The IHS has provided AIDS Prevention/Risk Reduction services to all
AI/AN communities. Nearly all of the IHS service population have heard
or seen an AIDS education message. Communities have established local
task forces to encourage greater community involvement and to assist
lifestyle changes.

**[Health Care Workers]{.underline}**

The local service units maintain continuing medical education programs
on HIV prevention for all health care workers. The IHS also provides
training on universal precautions and implementation of Center for
Disease Control ACTG Protocol 076 to prevent transmission of HIV from
infected mothers to uninfected newborn. In a collaborative effort with
Health Resources and Services Administration (HRSA) training is provide
to Indian Health Service, Tribal administered health care providers,
Indian urban centers and AI/AN community based HIV/AIDS treatment and
prevention centers in the most up-to-date treatment regimens. HRSA
provides these services throughout the United States.

**[Program Needs]{.underline}**

Funding is not keeping up with the increasing infection rate of HIV.
Tribal health care providers do not have enough funding to provide
adequate care to the person with HIV/AIDS; much less do prevention in
the community.

Each of the IHS/Tribal Areas has an HIV/AIDS Coordinator, but do not
have adequate funding to do prevention work in their respective Areas.
There is a need for funding to support additional staff and increase
services. Funding is so low that in many IHS/Tribal areas a salary
cannot be paid to an HIV/AIDS Coordinator. The average distribution of
HIV/AIDS funds when broken down comes to between \$8,000 and \$10,000.