Understanding the Impact of HIV/AIDS in Native American Communities

According to the CDC, Native Americans make up 1.3% of the U.S. population and approximately 1% of all new reported HIV infections.

Centuries of discrimination, forced removals to remote lands, limited access to jobs, and broken treaties about providing adequate funding and healthcare have all resulted in inadequate healthcare infrastructure on reservations and high levels of poverty among many Native American nations. These factors have created a higher burden of disease and disability among Native Americans. At the same time, Native American communities often have tremendous social capital and resilience, and as a nurse, you can help to leverage those resources.

With challenges accessing healthcare, an increase in cases, and the stigma of HIV/AIDS within the Native American community, nurses can help break the barriers to effective care. To do this, nurses must understand the special challenges the Native American community faces related to HIV/AIDS and deliver culturally competent care to address this crisis.

This page describes what nurses need to know about the impact of HIV/AIDS in Native American communities and how to administer proper care.

Native Americans often face barriers to adequate healthcare, such as limited access to healthcare and education. Of the percentage of Native Americans with HIV, 20% may not be aware of their condition, making them more likely to transmit HIV to others.

Daniel J. Calac, M.D., points out the logistical barriers that many experience. “Native American communities need access to healthcare laboratories and healthcare providers for examinations. Transportation to facilities is an ongoing concern in communities when making appointments for care.”

Inadequate health education is another barrier, since many schools in and near reservations are inadequately staffed, access to libraries and the internet is limited, both on reservations and for lower-income communities elsewhere, and healthcare organizations are also understaffed and less able to provide healthcare education during patient visits.

Stigma is also a tremendous barrier to diagnosis and treatment. However, equipped with information, nurses can partner with the Native American community to address this stigma.

The stigma surrounding HIV/AIDS is psychologically devastating to Native Americans. Bill Hall, a Tlingit from Southeast Alaska who serves on the community advisory board for Fred Hutch, claims that stigma is “the biggest obstacle to effectively battling this disease.” Hall knows of fellow Alaska Natives so concerned with this stigma that they avoided seeking help from a doctor or taking the antiretroviral medications that could have saved their lives.

Dr. Calac adds, “Native American communities tend to be small, and there is a familiarity due to proximity and the close social connections across territories and even states. Since Native Americans tend to gather with other Native Americans at cultural events, there are usually the same faces and families attending these events.”

In a small and close-knit community, stigma can be even more devastating. But without active efforts to fight stigma, the crisis continues.

Nurses and other healthcare professionals can address stigma, encourage testing, support patients during diagnosis and treatment, and therefore reduce both the incidence and impact of HIV/AIDS in Native American communities.

As trusted healthcare professionals, nurses can provide education on HIV/AIDS transmission, testing, and HIV/AIDS treatments. To build this relationship, nurses must earn the trust and respect of these patients by treating them with empathy.

Nurses can encourage those diagnosed with HIV/AIDS to follow through with treatment and help them find support groups, mental health professionals who can provide culturally competent care, and other resources that address stigma.

Nurses can also help prevent HIV/AIDS in Native American communities by providing non-judgmental and culturally appropriate sex and substance abuse education to reduce the incidence of unprotected sex and needle sharing.

According to the CDC, Native Americans are more likely than other ethnic groups to use drugs and alcohol at a young age and use them more frequently and in greater quantities. Nurses can provide nonjudgmental advice on abstaining, quitting, or reducing these harmful substances. They can also partner with organizations to advocate for wider access to education surrounding substance abuse and its connection to HIV/AIDS.

Nursing assistants caring for a resident with HIV/AIDS should take the same precautions that they do against any other blood-borne pathogen. They should use gloves when encountering blood, either directly or in feces or vomit. Nurses should also take all possible precautions to avoid exposing a resident to other infections by washing their hands regularly and thoroughly, getting vaccinations and boosters, and using a mask when appropriate.

If HIV progresses to AIDS, it increases a patient’s vulnerability to other infections, so nurses must treat these patients with the same precautions they take with other immunocompromised patients, maintaining hygiene and keeping vaccinations and boosters up-to-date. HIV patients, like others with serious chronic conditions, may need additional support for mental and emotional wellbeing.

Patients with HIV receive antiretroviral treatments that reduce the number of viruses in their blood. If treated early, most patients with HIV can lead a normal life, which is why HIV diagnosis and treatment are of critical need for Native Americans. They are also far less likely to transmit HIV to others.

HIV patients are at risk of developing AIDS. This compromises their immune systems, making them more vulnerable to illness. Some of the most common infections among those with HIV are pneumonia, certain types of cancers, hepatitis, shingles, and fungal infections like thrush.

Many government offices and healthcare associations provide support and resources for nurses and other healthcare providers who are engaged in preventing and treating HIV/AIDS. There are also resources specifically for HIV prevention and treatment among Native Americans.

The federal government and other organizations provide authoritative resources for Native Americans on HIV prevention, testing, and treatment.