Hepatitis C/HIV in Native 

American Populations

Persons with Hepatitis C (HCV) die about two decades earlier than 

persons without this infection

THE FACTS

Hepatitis C and HIV are serious public health issues 

among American Indians and Alaska Natives (AI/ANs). 

Hepatitis C or “broken spirit” is a contagious disease 

that leads to inflammation of the liver. The illness can 

be mild and short-term (acute) or can become serious 

and long-term (chronic), leading to scarring of the liver 

and liver cancer. Approximately 3.2 million persons in 

the United States have chronic Hepatitis C; however, 

most people do not know they are infected because they 

don’t look or feel sick. In 2009, AI/ANs were almost 

twice as likely to be diagnosed with Hepatitis C 

compared to Caucasians.1 Additionally, persons without

Hepatitis C live nearly 20 years longer than those with 

the infection.

Human Immunodeficiency Virus (HIV) is the virus that

can lead to Acquired Immune Deficiency Syndrome

(AIDS) if it is untreated. Nearly 50,000 people in the

United States become infected with the virus every year;

AI/ANs represent less than one percent. In 2011, almost

1.2 million people in the US were living with HIV; about

14 percent did not know their status. Yet, AI/ANs have

the highest percentages of diagnosed HIV infections due

to injection drug use (IDU) among all racial/ethnicities.2

Furthermore, the rate of HIV diagnosis for AI/AN 

women is nearly three times the rate for white females.3

percent of HIV-infected persons who inject drugs are 

also infected with HCV. Among people living with 

HIV, liver disease due to HCV is the most common

cause of non-AIDS related death.

Co-infection of HIV and HCV is more common among 

persons who inject drugs. Approximately 50 to 90 

RISK FACTORS

Substance use and mental disorders can also 

contribute to HIV/AIDS and HCV risk. Drugs and 

alcohol alter judgment and may result in high risk drug 

use and sexual behaviors that contribute to spread of 

HIV. Alcohol and drug abuse are also linked to poor 

treatment response and a more rapid progression of 

HIV. Additionally, previous reports have indicated that 

persons with severe mental illness have an elevated risk 

of contracting HIV and HCV compared with the general 

population.4

Most people become infected with HCV by sharing 

needles or other equipment to inject drugs.5

 Injection 

drug users (IDUs) have high rates of viral hepatitis 

infection with an estimated 64 percent chronically 

infected with HCV.6

 Alcohol abuse also contributes to 

Hepatitis C with between 14 percent and 36 percent of 

alcohol abusers infected with HCV.7

SYMPTOMS

Symptoms of all types of viral hepatitis can include one 

or more of the following: fever, fatigue, loss of appetite, 

nausea, vomiting, abdominal pain, gray-colored bowel 

movements, joint pain, and jaundice (yellow color 

1. http://www.uihi.org/wp-content/uploads/2012/01/Epidemiology-of-HIV-STD-and-Hepatitis-C-Among-AIAN-Populations.pdf

2. http://www.cdc.gov/HIV/risk/racialEthnic/aian/index.html

3. U.S. Department of Health and Human Services. Indian Health Surveillance Report: Sexually Transmitted Diseases. Atlanta: 

DHHS/CDC/IHS; 2007. p. 2009.

4. Essock SM, Dowden S, Constantine NT, Katz L, Swartz MS, Meador KG, et al. (2003). Risk factors for HIV, hepatitis B, and hepatitis C among persons with severe mental 

illness. Psychiatric Services, 54:836–841.

5. http://www.cdc.gov/hepatitis/C/cFAQ.htm#cFAQ13

6. Grebely and Dore. Prevention of Hepatitis C Virus in Injecting Drug Users: A Narrow Window of Opportunity J Infect Dis. (2011) 203 (5): 571-574.doi: 10.1093/infdis/jiq111

7. Bhattacharya R, Shuhart MC. Hepatitis C and alcohol: Interactions, outcomes, and implications. J Clin Gastroenterol. 2003; 36:242–252.
in skin or eyes). If you are experiencing any of these 

symptoms, contact a healthcare provider to get tested.

HIV Symptoms are initially similar to those experienced 

with influenza; however as the disease progresses, 

infections such as tuberculosis and other opportunistic 

diseases are common. When HIV progresses to AIDS, 

pneumonia, severe weight loss, and a certain type of 

cancer may appear.

TREATMENT

Controlling the epidemic of viral hepatitis infection in 

injection drug users requires:

• The development and implementation of

prevention interventions

• Engagement strategies that will result in retaining

individuals in care such as increased access to

medication-assisted treatment both for treatment

of substance use disorders and for treatment of

viral hepatitis

Treatment for an acute HCV infection consists of 

antivirals and supportive treatment. If the illness is 

chronic, regular monitoring for signs of liver disease 

progression is necessary and treatment with antiviral 

drugs may be recommended. Similarly, HIV treatment 

consists of antiretroviral treatment (ART).

With treatment and monitoring, people who have 

mental and substance use disorders can have rates 

of adherence to hepatitis treatment and successful 

outcomes comparable to those who do not have 

these disorders.8

 Optimal results are obtained when 

coordinated substance use and mental disorders 

treatment occurs before and during treatment for HCV.9

TESTING

HCV Testing Is Recommended for the Following Persons:

• One-time HCV testing for everyone born

between 1945 and 1965

• Current and former injection drug users

(including those who injected once or a few

times many years ago)

Note: For persons who might have been exposed to 

HCV within the past 6 months, testing for the HCV 

antibody (ribonucleic acid) commonly known as the 

HCV RNA test is recommended.

HIV Testing Is Recommended for the Following Persons:

You should get tested for HIV every at least every year

if you:

• Share needles/syringes or other equipment

(“works”) for injecting drugs

• Have a history of sexually transmitted infections

(STIs)

• Have had unprotected sex (vaginal, anal, or oral)

with multiple or anonymous partners. Or if you

have had unprotected sex with a partner who did

not know their own HIV status.

SAMHSA SUPPORT

SAMHSA addresses the issues of HIV/AIDS, and 

viral hepatitis by providing grant opportunities to 

support coordinated mental health and substance use 

disorder treatment services including:

• HIV testing with pre- and post-test counseling

• Referrals for treatment

• Integrated medical, HIV/AIDS, and behavioral

health care

• Testing for other infectious diseases

Examples of these efforts include, but are not limited 

to, the following:

• Native American Health Center’s Ekwahness (“To

Hold Tightly”)

• Salish Kootenai College Integrative Community

Empowerment (ICE) grant

• College of the Muscogee Nation’s Guarding the

Future grant

• Minority AIDS Initiative Targeted Capacity

Expansion: Integrated Behavioral Health/Primary

Care Network (MAI-TCE Program)

For more information, please visit http://www.samhsa.

gov/hiv-aids-viral-hepatitis/samhsas-efforts.

8. Treatment Improvement Protocol (TIP) Series, No. 53. Center for Substance Abuse Treatment. Rockville (MD): Substance Abuse and Mental Health 

Services Administration (US); 2011.

9. Freedman K, Nathanson J. Interferon-based hepatitis C treatment in patients with preexisting severe mental illness and substance use disorders.

Expert Review of Anti-infective Therapy. 2009;7(3):363–376.