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HIV/AIDS in the Two-Spirit Community: A Hidden Crisis

By Harlan Pruden

March 20, 2013

Harlan Pruden

Harlan Pruden

March 20th is National Native HIV/AIDS Awareness Day, a day to raise awareness of the terrible toll that HIV/AIDS continues to take on Native American populations. HIV/AIDS is a crisis that affects many American Indians and Alaska Natives, but particularly Two-Spirit individuals, who often experience stigma and discrimination in both Native and mainstream society.


What Does Two-Spirit Mean?

The term "Two-Spirit" has several meanings within Native cultures and communities, but it is primarily a contemporary term that refers to those traditions in which some individuals have a blend of both male and female spirits. Two-Spirit is a concept of gender identity, not one of sexual orientation. Sexual orientation describes an individual's choices in sexual relationships with others. Gender describes the expected roles an individual plays within a community's social norms and structures. Many Two-Spirit organizations prefer to separate the Two-Spirit identity from the lesbian, gay, bisexual, transgender, and questioning (LGBTQ) identities of the mainstream/dominant culture, emphasizing the use of the term "Two-Spirit" to describe a person's gender within their culture, rather than the more Western concept of sexual orientation.


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Impact of HIV/AIDS

In the United States, HIV and AIDS are tracked according to certain categories recognized by the scientific/medical establishment. "Men who have sex with men" (MSM) is one of these categories; "Two-Spirit" is not. MSM (or what we would call male-bodied Two-Spirit individuals) bear the brunt of the HIV/AIDS crisis among Native American populations. According the Centers for Disease Control and Disease Prevention, MSM and MSM/IDU accounted for 62.3% of all new diagnoses of HIV infection among American Indians and Alaska Natives in 2011. MSM and MSM/IDU also accounted for 60.0% of American Indians and Alaska Natives living with AIDS in 2010.

Native Americans, including Two-Spirit people, call upon the public to consider the epidemic in relation to the size of the Native American population, lest comparisons to HIV/AIDS in other populations inappropriately dismiss the impact of the disease on Native communities.

During the Thursday, February 7, 2013 meeting of the Presidential Advisory Council on HIV/AIDS (PACHA), Dr. Karina Walters of the University of Washington and I had the opportunity to brief the Council on the impact of HIV/AIDS on the Two-Spirit community. Learn more about the PACHA meeting on AIDS.gov.

The National Confederacy of Two-Spirit Organizations, a coalition of 17 Two-Spirit community-based organizations, looks forward to working with PACHA and HHS to better meet the needs of the Two-Spirit community.

Editor's Note: For more information on HIV/AIDS surveillance among Native populations, see the CDC report, Improving HIV Surveillance Among American Indians and Alaska Natives in the United States (Jan. 2013).

For information on State Departments of Health response, see the National Alliance of State and Territorial AIDS Directors' (NASTAD) ISSUE BRIEF: Native Gay Men & Two-Spirit People HIV/AIDS & Viral Hepatitis Programs and Services.




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