CDC H IV/A IDS Fact Sheet

HIV/AIDS among

American Indians

and Alaska Natives

1-800-CDC-INFO (232-4636)

In English, en Español

24 Hours/Day

cdcinfo@cdc.gov

http://www.cdc.gov/hiv 

April 2006

The numbers of HIV and AIDS diagnoses for 

American Indians and Alaska Natives represent 

less than 1% of the total number of HIV/AIDS 

cases reported to the HIV/AIDS Reporting System. 

However, when population size is taken into 

account, this population in 2004 was ranked 3rd in 

rates of AIDS diagnoses, after African Americans 

and Hispanics [1]. The rate of AIDS diagnoses 

for this group has been higher than that for whites 

since 1995.

Overall, surveillance data show that HIV/AIDS is 

a growing problem among American Indians and 

Alaska Natives.

STATISTICS

HIV/AIDS in 2004

The rate of HIV/AIDS diagnoses among 

American Indians and Alaska Natives increased 

from 9.5 per 100,000 population in 2001 to 11.1 

per 100,000 in 2004 [2].

In the 35 areas with long-term, confidential 

name-based HIV reporting,* HIV/AIDS was 

diagnosed for an estimated 208 American 

Indians and Alaska Natives (adults, adolescents, 

and children), representing 0.5% of the total 

number of HIV/AIDS diagnoses reported for that 

year [1].

In the 33 states with long-term, confidential 

name-based HIV reporting, women accounted 

for 29% of the HIV/AIDS diagnoses among 

American Indians and Alaska Natives during 

2001–2004 [2].

•

•

•

Race/ethnicity of persons (including 

children) with HIV/AIDS diagnosed during 

2004

Note. Based on data from 35 areas with long-term, 

confidential name-based HIV reporting.

Transmission categories for American 

Indian and Alaska Native adults and 

adolescents with HIV/AIDS diagnosed 

during 2001–2004

Note. Based on data from 33 states with long-term, 

confidential name-based HIV reporting.

Source. CDC. Trends in HIV/AIDS diagnoses—33 states, 

2001–2004. MMWR 2005;54:1149–1153. *See box before the References section for a list of the 35 

areas.
H IV/A IDS among Amer ican Ind ians and Alaska NAT IVES

AIDS in 2004

The estimated rate of AIDS diagnoses for 

American Indian and Alaska Native adults and 

adolescents was 9.9 per 100,000 persons, the 

3rd highest rate after those for African American 

adults and adolescents (72.1 per 100,000) 

and Hispanic adults and adolescents (25.0 

per 100,000). The estimated AIDS diagnosis 

rate was 7.1 per 100,000 for white adults and 

adolescents and 4.4 per 100,000 for Asian and 

Pacific Islander adults and adolescents [2].

An estimated 1,506 American Indian and Alaska 

Native adults and adolescents were living with 

AIDS [1]. 

AIDS was diagnosed for an estimated 193 

American Indians and Alaska Natives, 

representing approximately 0.5% of all AIDS 

diagnoses in 2004 [1]. 

An estimated 91 American Indians and Alaska 

Natives with AIDS died in 2004, representing 

approximately 0.6% of all deaths of persons with 

AIDS for that year [1]. 

•

•

•

•

From the beginning of the epidemic through 

2004, AIDS was diagnosed for an estimated 

3,084 American Indians and Alaska Natives [1].

From the beginning of the epidemic through 

2004, an estimated 1,578 American Indians and 

Alaska Natives with AIDS had died [1].

Of persons who had received a diagnosis of 

AIDS since 1996, American Indians and Alaska 

Natives had survived for a shorter time than 

had Asians and Pacific Islanders, whites, and 

Hispanics. After 9 years, 65% of American 

Indians and Alaska Natives were alive, compared 

with 64% of African Americans, 72% of 

Hispanics, 74% of whites, and 81% of Asians 

and Pacific Islanders [1].

From the beginning of the epidemic through 

2004, AIDS had been diagnosed for an estimated 

34 American Indian and Alaska Native children 

(younger than 13 years of age) [1]. 

•

•

•

•

Race/ethnicity of persons (including 

children) living with HIV/AIDS, 2004

Note. Based on data from 35 areas with long-term, 

confidential name-based reporting.

Note. Based on data from 33 states with long-term, 

confidential name-based HIV reporting.

Source. CDC. Trends in HIV/AIDS diagnoses—33 states, 

2001–2004. MMWR 2005;54:1149–1153.

Transmission categories for American 

Indian and Alaska Native adults and 

adolescents with HIV/AIDS diagnosed 

during 2001–2004 (cont.)
H IV/A IDS among Amer ican Ind ians and Alaska NAT IVES

RISK Factors AND BARRIERS 

TO PREVENTION

Race and ethnicity are not, by themselves, risk 

factors for HIV infection. However, American 

Indians and Alaska Natives are likely to face 

challenges associated with risk for HIV infection, 

including the following.

Sexual Risk Factors

High rates of chlamydial infection, gonorrhea, 

and syphilis suggest that the sexual behaviors 

that facilitate the spread of HIV are relatively 

common among American Indians and Alaska 

Natives. Further, the presence of a sexually 

transmitted disease can increase the chance of 

contracting or spreading HIV [3]. According 

to 2004 surveillance data by race/ethnicity, the 

2nd highest rates of gonorrhea and chlamydial 

infection were those for American Indians and 

Alaska Natives. The 2nd highest rates of syphilis 

were those for American Indians and Alaska 

Natives and for Hispanics [4, 5].

Substance Use

Persons who use illicit drugs, (casually or 

habitually) or who abuse alcohol are more likely 

to engage in high-risk behaviors, such as 

unprotected sex, when they are under the influence 

of drugs or alcohol [6]. Results of the 2004 

National Survey on Drug Use and Health indicate 

that the rate of current illicit drug use was higher 

among persons who reported 2 or more races 

(13.3%) and among American Indians and Alaska 

Natives (12.3%) than among persons of other races 

or ethnicities [7].

Cultural Diversity

The American Indian and Alaska Native 

population comprises 562 federally recognized 

tribes plus at least 50 state-recognized tribes 

[8]. Each tribe has its own culture, beliefs, and 

practices. Further, these tribes may be subdivided 

into language groups. Prevention programs that 

can be adapted to individual tribal beliefs are 

critically important. Current programs emphasize 

traditional teachings and the importance of the 

community.

Socioeconomic Issues

Socioeconomic factors coexist with epidemiologic 

risk factors for HIV infection in American 

Indian and Alaska Native communities. During 

2002–2004, approximately one quarter (24.3%) 

of American Indians and Alaska Natives―about 

twice the national average (12.4%)―were living in 

poverty [9]. Issues related to poverty (for example, 

lower levels of education and poorer access to 

health care) may directly or indirectly increase the 

risk for HIV infection [10]. The proportion of the 

American Indian and Alaska Native population 

with a high school diploma (66%) is less than the 

national average (75%) [11].

Life expectancy of this population is shorter than 

that of any other race/ethnicity; the rates of many 

diseases, including diabetes, tuberculosis, and 

alcoholism, are higher; and access to health care is 

poorer [12, 13].

Race/ethnicity of persons (including 

children) living with HIV/AIDS, 2004 (cont.)

Note. Based on data from 35 areas with long-term, 

confidential name-based reporting.
H IV/A IDS among Amer ican Ind ians and Alaska NAT IVES

These indicators demonstrate the vulnerability of 

American Indians and Alaska Natives to additional 

health stress, including HIV infection.

HIV Testing Issues

American Indians and Alaska Natives with AIDS 

are more likely to reside in a rural area at the time 

of AIDS diagnosis. American Indians and Alaska 

Natives who are at high risk for HIV infection and 

who live in rural areas may be less likely to be 

tested for HIV because of limited access to testing. 

At-risk American Indians and Alaska Natives 

may also be less likely to seek testing because 

of concerns about confidentiality in close-knit 

communities where someone who seeks testing 

is likely to encounter a friend, a relative, or an 

acquaintance at the local health care facility [14].

During 1997–2000, 50.5% of American Indians 

and Alaska Natives who responded to the 

Behavioral Risk Factor Surveillance System 

survey reported that they had never been tested 

for HIV. This percentage was higher in the 

southwestern United States, where 58.1% of the 

American Indians and Alaska Natives reported 

never having been tested [15].

Data Limitations

Current data regarding HIV and AIDS among 

American Indians and Alaska Natives have 

limitations.

Incomplete surveillance data. Not all 

states with large American Indian and Alaska 

Native populations have been conducting HIV 

surveillance. California only recently enacted 

laws requiring HIV surveillance; New York and 

Washington began HIV surveillance only during 

the past few years.

Racial misclassification and underreporting. 

Even though the numbers of HIV and AIDS 

diagnoses among American Indians and Alaska 

Natives are relatively low, these numbers 

may be affected by racial misclassification. 

•

•

Studies in Alaska and Los Angeles have shown 

that the degree of misclassification differs 

geographically. In Alaska, 3% of American 

Indians and Alaska Natives with HIV/AIDS 

were misclassified as being of another race; 

in Los Angeles, 56% of American Indians 

and Alaska Natives with AIDS were racially 

misclassified [16, 17].

Prevention

Among all people in the United States, the annual 

number of new HIV infections declined from a 

peak of more than 150,000 during the mid-1980s 

and stabilized at approximately 40,000 after the 

late 1990s. Persons of minority races/ ethnicities 

are disproportionately affected by the HIV 

epidemic. To reduce further the incidence of HIV, 

CDC announced a new initiative, Advancing HIV 

Prevention (http://www.cdc.gov/hiv/topics/prev_

prog/AHP), in 2003. This initiative comprises 

4 strategies: making HIV testing a routine part 

of medical care, implementing new models 

for diagnosing HIV infections outside medical 

settings, preventing new infections by working 

with HIV-infected persons and their partners, and 

further decreasing perinatal HIV transmission.

CDC, through the Minority AIDS Initiative 

(http://www.cdc.gov/programs/hiv08.htm), also 

addresses the health disparities experienced in 

the communities of minority races/ethnicities 

at high risk for HIV. These funds are used to 

address high-priority HIV prevention needs 

in such communities. The following are some 

CDC-funded prevention programs that state and 

local health departments and community-based 

organizations provide for American Indians and 

Alaska Natives.

Helping tribes develop or expand HIV 

prevention services and improve services for 

persons infected with, or affected by, HIV/AIDS

Building and strengthening the capacity of tribal 

organizations and urban Indian health centers in 

Arizona, Nevada, and Utah to develop effective

•

•
H IV/A IDS among Amer ican Ind ians and Alaska NAT IVES

HIV prevention through intertribal networking 

and collaboration

Providing HIV prevention education in rural 

Alaska Native communities

Developing outreach models for HIV testing 

among American Indians and Alaska Natives and 

demonstrating the feasibility and best methods 

of integrating routine HIV testing programs 

(including rapid HIV testing) in Indian health 

centers in Arizona, Michigan, and Utah

•

•

Understanding HIV and AIDS Data

AIDS surveillance: Through a uniform system, CDC 

receives reports of AIDS cases from all US states and 

territories. Since the beginning of the epidemic, these 

data have been used to monitor trends because they 

are representative of all areas. The data are statistically 

adjusted for reporting delays and for the redistribution 

of cases initially reported without risk factors. As treatment has become more available, trends in new AIDS 

diagnoses no longer accurately represent trends in new 

HIV infections; these data now represent persons who 

are tested late in the course of HIV infection, who have 

limited access to care, or in whom treatment has failed.

HIV surveillance: Monitoring trends in the HIV 

epidemic today requires collecting information on HIV 

cases that have not progressed to AIDS. Areas with confidential name-based HIV infection reporting requirements use the same uniform system for data collection 

on HIV cases as for AIDS cases. A total of 35 areas—

the US Virgin Islands, Guam, and 33 states (Alabama, 

Alaska, Arizona, Arkansas, Colorado, Florida, Idaho, 

Indiana, Iowa, Kansas, Louisiana, Michigan, Minnesota, Mississippi, Missouri, Nebraska, Nevada, New 

Jersey, New York, New Mexico, North Carolina, North 

Dakota, Ohio, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, 

Wisconsin, and Wyoming)—have collected these data 

for at least 5 years, providing sufficient data to monitor HIV trends and to estimate risk behaviors for HIV 

infection. Recently, 9 additional areas have begun confidential name-based HIV surveillance, and data from 

these areas will be included in coming years.

HIV/AIDS: This term includes persons with a diagnosis of HIV infection (not AIDS), a diagnosis of HIV 

infection and a later diagnosis of AIDS, or concurrent 

diagnoses of HIV infection and AIDS.

REFERENCES

CDC. HIV/AIDS Surveillance Report, 2004. Vol. 16. 

Atlanta: US Department of Health and Human Services, 

CDC; 2005:1–46. Available at http://www.cdc.gov/

hiv/topics/surveillance/resources/reports/2004report. 

Accessed April 6, 2006.

CDC. Trends in HIV/AIDS diagnoses–33 states, 

2001–2004. MMWR 2005;54:1149–1153.

Fleming DT, Wasserheit JN. From epidemiological 

synergy to public health policy and practice: the 

contribution of other sexually transmitted diseases 

to sexual transmission of HIV infection. Sexually 

Transmitted Infections 1999;75:3–17.

CDC. Sexually Transmitted Disease Surveillance 2004. 

Atlanta: US Department of Health and Human Services, 

CDC; September 2005: Tables 11B, 21B, 34B. Also 

available at http://www.cdc.gov/std/stats/toc2004.htm. 

Accessed April 6, 2006.

McNaghten AD, Neal JJ, Li J, Fleming PL. 

Epidemiologic profile of HIV and AIDS among 

American Indians/Alaska Natives in the USA through 

2000. Ethnicity and Health 2005;10:55–71.

Leigh B, Stall R. Substance use and risky sexual 

behavior for exposure to HIV: issues in methodology, 

interpretation, and prevention. American Psychologist

1993;48:1035–1045.

Substance Abuse and Mental Health Services 

Administration. Results from the 2004 National Survey 

on Drug Use and Health. Available at http://oas.

samhsa.gov/nsduh/2k4nsduh/2k4results/2k4results.htm 

Accessed April 10, 2006. 

US Department of the Interior, Bureau of Indian Affairs. 

Indian entities recognized and eligible to receive 

services from the United States Bureau of Indian Affairs. 

Federal Register 2003(December 5);68(234):68179–

68184.

DeNavas-Walt C, Proctor BD, Lee CH. Income, Poverty, 

and Health Insurance Coverage in the United States: 

2004. Washington, DC: US Government Printing Office; 

August 2005. Current Population Reports P60-229. Also 

available at http://www.census.gov/prod/2005pubs/p60-

229.pdf . Accessed April 10, 2006.

Diaz T, Chu SY, Buehler JW, et al. Socioeconomic 

differences among people with AIDS: results from a 

multistate surveillance project. American Journal of 

Preventive Medicine 1994;10:217–222.

US Census Bureau. The American Indian, Eskimo, 

and Aleut population. 2001. Available at http://www.

census.gov/population/www/pop-profile/amerind.html. 

Accessed April 6, 2006.

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.


H IV/A IDS among Amer ican Ind ians and Alaska NAT IVES

For more information . . . 

CDC HIV/AIDS

http://www.cdc.gov/hiv

CDC HIV/AIDS resources

CDC-INFO

1-800-232-4636

Information about personal risk and where to 

get an HIV test

CDC National HIV Testing Resources

http://www.hivtest.org

Location of HIV testing sites

CDC National Prevention Information 

Network (NPIN)

1-800-458-5231

http://www.cdcnpin.org

CDC resources, technical assistance, and 

publications

AIDSinfo

1-800-448-0440

http://www.aidsinfo.nih.gov

Resources on HIV/AIDS treatment and 

clinical trials

Korenbrot CC, Ehlers S, Crouch JA. Disparities in 

hospitalizations of rural American Indians. Medical Care 

2003;41:626–636.

Zuckerman S, Haley J, Roubideaux Y, Lillie-Blanton M. 

Health service access, use, and insurance coverage 

among American Indians/Alaska Natives and whites: 

what role does the Indian Health Service play? American 

Journal of Public Health 2004;94:53–59.

Bertolli J, McNaghten AD, Campsmith M, et al. 

Surveillance systems monitoring HIV/AIDS and HIV 

risk behaviors among American Indians and Alaska 

Natives. AIDS Education and Prevention 2004;16:218–

237. 

CDC. Surveillance for health behaviors of American 

Indians and Alaska Natives: findings from the 

12.

13.

14.

15.

Behavioral Risk Factor Surveillance System 1997–2000. 

MMWR 2003;52(No. SS-07):1–13.

State of Alaska Health and Social Services, Section 

of Epidemiology. Accuracy of race/ethnicity data for 

HIV/AIDS cases among Alaska Natives. State of Alaska 

Epidemiology Bulletin 2003;No. 11(May 13). Available 

at http://www.epi.hss.state.ak.us/bulletins/docs/b2003_

11.htm. Accessed April 6, 2006.

Hu YW, Yu Harlan M, Frye DM. Racial misclassification 

among American Indians/Alaska Natives who were 

reported with AIDS in Los Angeles County, 1981–2002. 

National HIV Prevention Conference; August 2003; 

Atlanta. Abstract W0-B0703.

16.

17.