AIDS Action Weekly Update Special Edition
Report From the HIV Prevention Leadership Summit
Atlanta, Georgia, June 16-19, 2004
June 25, 2004
Advancing Prevention for All Populations
Tradition, Culture and the State of HIV Among Native American and Alaska Native Communities
Like The Eagle, Native people have cultural and traditional ways that render them unique. These unique cultural characteristics influence the way they perceive and respond to the world. This influence can even affect their attitudes and behaviors in health care and disease prevention, including HIV prevention. This was a recurring topic of discussion during a number of Native-specific HPLS sessions.
The different sessions touched on cultural, historical and socio-economic co-factors that affect HIV prevalence. Topics varied from needle exchange to parity, inclusion and representation in community planning groups. During these sessions, Native community members from South Dakota to California and from Phoenix to Alaska shared their hopes, frustrations, challenges and questions related to HIV prevention efforts in their communities. And they readily posed questions. For example, how does a health department allocate health care funds to an area where the population density seems insignificant; How does a government agency adapt effective interventions that are effective and appropriate for different Native populations; and when will equal access to health care reach Native people? Answers, however, were not as readily available.
Several participants discussed the myriad barriers that the Native community faces in accessing HIV prevention and care services. Stigma associated with HIV affects the attitudes toward the disease within a community and has negative impact on disclosure.
Cultural taboos also exist in Native communities against discussions about sex related behaviors. A CPG member from Anchorage, Alaska explained the challenges in "stepping up" to talk about sexual issues related to HIV and agreeing to represent her community in a CPG. "I never would mention the word 'sex'; I do not even believe it's me when I am talking about it. But I had to do it. And explain to my people that I am here to help, even though it is hard for me, too. I want to help the state to see my community's situation."
Another subject of discussion during a roundtable session was how the definitions for fundamental health care concepts vary from person to person, even when they are using the same language. As one participant revealed, "Even within the same community, we use the same words but mean different things." The concept of epidemiology was cited as one communications challenge; apparently there is no word for epidemiology in Native American languages. "So the question is how does one even translate and explain it?" a participant asked fellow attendees.
The concept of cultural competency has yet to be applied appropriately to Native people's perspective and experience. As one participant put forward, "The health-agency administrators want to be culturally competent and put it on paper, saying the interventions should be culturally relevant; however they do not take it one step forward and practice it." A CBO representative from Anchorage added, "We spend more time explaining that we are different to state, to government and others than the time spent doing our real work."
The notion of "difference" becomes an issue for collaboration not only between tribal and state governments, but also between different tribal governments. Disagreement between tribal governments is an obstacle in working together and achieving efficiency for effective HIV prevention in Native communities.
There were a number of recommended strategies made by participants of the roundtable that addressed the challenges surrounding HIV prevention among Native communities, such as providing technical assistance for Native Health Departments and community based organizations; encouraging Native CPG participation through a curriculum on CPG procedures, policies, skills building and public speaking sessions; and creating linkages between tribal governments and state governments.
Throughout the summit's workshops and roundtables, there seemed to be one common message all Native people wanted the administration officials to hear: they should quit rendering Native people "invisible." Some Native community members, on the other hand, had a more positive outlook; one roundtable participant strongly believed in relying on the Native perspective to help each other and their communities in dealing with HIV. "We'll find solutions if we start wearing our native hats," she said. Michael Bird with National Native American AIDS Prevention Center (NNAAPC) concluded, "We need to be able to articulate what we see, and feel. We need to be brave and support each other, encourage each other. We need to share information to help each other and build relationships to benefit our communities."
This article was provided by AIDS Action Council. It is a part of the publication AIDS Action Weekly Update.