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HIV/AIDS Among American Indians and Alaska Natives

April 15, 2015

Fast Facts
  • HIV affects AI/AN in ways that are not always obvious because of their small population sizes.
  • Of all races/ethnicities, AI/AN had the highest percentages of diagnosed HIV infections due to injection drug use.
  • AI/AN face HIV prevention challenges, including poverty, high rates of STIs, and stigma.

HIV/AIDS Among American Indians and Alaska Natives

HIV is a public health issue among the approximately 5.2 million American Indians and Alaska Natives (AI/AN), who represent about 1.7%1 of the U.S. population. Compared with other racial/ethnic groups, AI/AN ranked fifth in estimated rates of HIV infection diagnoses in 2013, with lower rates than in blacks/African Americans, Hispanics/Latinos,2 Native Hawaiians/Other Pacific Islanders, and people reporting multiple races, but higher rates than in Asians and whites.

The Numbers

Overall, the effect of HIV infection on AI/AN is proportional to their U.S. population size. However, within the overall statistics of new HIV infections and diagnoses, certain measures are disproportionate in this population group relative to other races/ethnicities.

New HIV Infections3

HIV and AIDS Diagnoses4 and Deaths

Estimated Diagnoses of HIV Infection Among Adult and Adolescent American Indians/Alaska Natives by Transmission Category and Sex, 2011 -- United States

Estimated Diagnoses of HIV Infection Among Adult and Adolescent American Indians/Alaska Natives by Transmission Category and Sex, 2011 -- United States

†Male-to-male sexual contact. ‡Injection drug use §Male-to-male sexual contact and injection drug use.

The terms male-to-male sexual contact (MSM) and male-to-male sexual contact and injection drug use (MSM/IDU) are used in CDC surveillance systems. They indicate the behaviors that transmit HIV infection, not how individuals self-identify in terms of their sexuality.

Why Are American Indians and Alaska Natives Affected by HIV?

Race and ethnicity alone are not risk factors for HIV infection. However, AI/AN may face challenges associated with risk for HIV.

What CDC Is Doing

The Centers for Disease Control and Prevention (CDC) and its partners are pursuing a High-Impact Prevention approach to advance the goals of the National HIV/AIDS Strategy (NHAS),maximize the effectiveness of current HIV prevention methods, and improve surveillance among AI/AN. Activities include:

In addition, the Office for State, Tribal, Local, and Territorial Support (OSTLTS) serves as the primary link between CDC, the Agency for Toxic Substance and Disease Registry, and tribal governments. OSTLTS' tribal support activities are focused on fulfilling CDC's supportive role in ensuring that AI/AN communities receive public health services that keep them safe and healthy.


  1. U.S. Census Bureau. Facts for Features, American Indian and Alaska Native Heritage Month, 2014. Accessed March 3, 2015.
  2. CDC. Diagnoses of HIV infection and AIDS in the United States and dependent areas, 2013. HIV Surveillance Report 2014;25. Accessed March 3, 2015.
  3. CDC. Estimated HIV incidence among adults and adolescents in the United States, 2007-2010. HIV Surveillance Supplemental Report 2012;17(4). Accessed March 11, 2014.
  4. CDC. Monitoring Selected National HIV Prevention and Care Objectives by Using HIV Surveillance Data -- United States and 6 Dependent Areas -- 2012. Accessed March 3, 2015.
  5. CDC. Sexually Transmitted Disease Surveillance 2013. Atlanta: U.S. Department of Health and Human Services; 2014. Accessed March 3, 2015.
  6. Burks DJ, Robbins R, Durtschi JP. American Indian gay, bisexual and two-spirit men: a rapid assessment of HIV/AIDS risk factors, barriers to prevention and culturally-sensitive intervention. Cult Health Sex 2011;13(3):283-98. PubMed abstract.
  7. Indian entities recognized and eligible to receive services from the Bureau of Indian Affairs. Fed Regist 2012;77(155):47868. Accessed March 3, 2015.
  8. James C, Schwartz K, Berndt J. A profile of American Indians and Alaska Natives and their health coverage. Menlo Park, CA: Henry J. Kaiser Family Foundation; 2009. Accessed March 14, 2014.
  9. Walters KL, Simoni JM, Evans-Campbell T. Substance use among American Indians and Alaska Natives: incorporating culture in an "Indigenist" stress-coping paradigm. Public Health Rep 2002;117(1):s104-17. Accessed March 3, 2015.
  10. Bertolli J, Lee LM, Sullivan PS, AI/AN Race/Ethnicity Data Validation Workgroup. Racial misidentification of American Indians/Alaska natives in the HIV/AIDS reporting systems of five states and one urban health jurisdiction, U.S., 1984-2000. Public Health Rep 2007;122(3):382-94.
  11. Oetting ER, Beauvais F. Epidemiology and correlates of alcohol use among Indian adolescents living on reservations. In: Alcohol Use Among U.S. Ethnic Minorities, NIAAA research monograph No. 18. Rockville, MD: U.S. Public Health Service; 1989:239-67.
  12. CDC. High-Impact HIV Prevention: CDC's Approach to Reducing HIV Infections in the United States. Accessed February 28, 2013.
  13. CDC. Report: Improving HIV Surveillance Among American Indians and Alaska Natives in the United States. January 2013. Accessed March 3, 2015.

Additional Resources

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

CDC HIV Website

CDC Act Against AIDS Campaign


  1. Census population estimates for AI/AN include those reporting Hispanic ethnicity or one or more races.
  2. Hispanics/Latinos can be of any race.
  3. New HIV infections refer to HIV incidence, or the number of people who are newly infected with HIV, whether or not they are aware of their infection.
  4. HIV and AIDS diagnoses refer to the number of people diagnosed with HIV infection (regardless of stage of disease) and the number of people diagnosed with AIDS, respectively, during a given time period. The terms do not indicate when they were infected.

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