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CDC Report Highlights Need to Invigorate Services for Native Americans Living with HIV
January 29, 2013 - Denver - In 2011, Gardner, et.al. released research findings regarding the state
of HIV care and treatment in America, and the gaps that exist in working with those people living
with HIV to benefit from modern biomedical and treatment options. Out of all of the individuals
with HIV in the U.S. , only 80% are aware of their status, 62% have been linked to care, 41% stay in
care, 36% get antiretroviral therapy, and only 28% are able to achieve an undetectable viral load
through medication adherence.i The disturbing results have been widely disseminated and are now
commonly referred to as the "treatment cascade". The treatment cascade coupled with research
demonstrating that viral suppression through medication adherence is one of the most effective
HIV prevention strategies available and has changed the face of HIV and AIDS prevention in the
America. The current focus is shifting to the importance of biomedical interventions and ensuring
that people living with HIV or newly diagnosed are linked to stable systems of care and disease
maintenance.
The Centers for Disease Control and Prevention (CDC) released a supplemental surveillance report
in January, 2013 titled Monitoring Selected National HIV Prevention and Care Objectives by Using HIV
Surveillance Data-United States and 6 U.S. Dependent Areas-2010. This report details important
statistics on linkage to care, retention in care and viral suppression - all of which are leading health
indicators for people living with HIV and are now indicators of successful prevention and treatment
efforts. Data were collected from 14 U.S. jurisdictions (Delaware, District of Columbia, Illinois,
Indiana, Iowa, Minnesota, Missouri, Nebraska, New York, North Dakota, California [San
Francisco], South Carolina, West Virginia, and Wyoming). This sample, while not encompassing all
areas within the U.S., is geographically diverse and includes some very large American Indian, Alaska
Native, and Native Hawaiian populations.
"The CDC should be applauded for releasing these data during this time of shifting prevention
priorities," said Robert Foley, President/CEO of the National Native American AIDS Prevention
Center. "However, the disparity continues to grow and this report should serve as a call to action for
all parties working for the health and wellness of American Indian, Alaska Native, and Native
Hawaiian people. HIV and AIDS in America cannot be eradicated and there is no hope of 'reaching
zero' if these trends are left unaddressed."
According to the report, American Indians and Alaska Natives are not accessing or receiving the
care and attention that they require to in order to maintain their health after an HIV diagnoses.
Only 75% of American Indian/Alaska Native (AI/AN) individuals (13 years or older) that
tested positive for HIV during 2010 were linked to medical care (indicated by the reception
of a CD4 count and viral load testing) within 3 months after their diagnosis. This is the
lowest percentage of linkage when compared to other races/ethnicities. This means that only 25% of those diagnosed in these states have not been linked to care within 3
months.ii
Only 33% of American Indian/Alaska Native (AI/AN) and 44% of Native Hawaiian
individuals (13 years or older) that were diagnosed with HIV in 2008 had achieved viral
suppression by the end of 2009 (indicated by a viral load of less than 200 viral copies per
milliliter). These are the 3rd and 4th lowest rates when compared to other races/ethnicities.iii
This is an alarming trend. When these statistics are viewed beside the statistics that were released by
the CDC in 2012 that stated new HIV infections among AI/AN people increased by 8.7% from
2007 to 2010, it is becoming apparent that changes need to be made and action must be taken in
order to meet the needs of Native Americans newly diagnosed and living with HIV.
"Knowing what we know now about how to conduct effective HIV prevention and care, it is
shocking to see how few Native people are accessing the care that they need. Hopefully, this report
can serve as a call to action," asserted D'Shane Barnett (Mandan/Arikara), Chairman of the National
Native American AIDS Prevention Center. "Governmental organizations and federal decisionmakers
must pay attention to these trends and realign funding and resources to Native communities
in order to ensure that Tribes and Native healthcare systems have the capacity to create and sustain
linkage to care programs, that HIV medications are readily available, and that adherence programs
and treatment regimens are culturally responsive."
"Native communities need to examine their internal systems in order to ensure that they have
processes and staff in place to work with people who are newly diagnosed to assist them with
navigating a potentially confusing systems of care," stated Mr. Foley. "And there needs to be
persistent efforts to combat community-based stigma caused by fear, misinformation, and
discrimination. These continue to serve as barriers to people who know they need to access care,
but are fearful of the social ramifications of doing so. This report is a new signpost laying out the
path that we have to follow."
The CDC report can be viewed on the CDC website here
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About NNAAPC
The National Native American AIDS Prevention Center (NNAAPC), located in Denver, CO, is a non-profit organization
founded in 1987 to address the impact of HIV/AIDS on American Indians, Alaska Natives, and Native Hawaiians
through culturally appropriate advocacy, research, education, and policy development in support of healthy Indigenous people.
NNAAPC provides capacity building assistance to tribal and urban health organizations and communities, community-based
organizations serving Native people, and agencies that administer federal HIV/AIDS policy. Over the last 25 years,
NNAAPC has conducted work in community mobilization, training and technical assistance in HIV/AIDS prevention,
intervention and case management, communications and media development, outreach and recruitment, developing technologies with HIV applications, and forging a policy agenda that ensures the inclusion of Native people. NNAAPC is the only national
HIV/AIDS-specific Native organization in the United States.
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i
Gardner, E.M., McLees M.P., Steiner, J.F., Del Rio C., & Burman, W.J. The spectrum of engagement in HIV care and its relevance
to test-and-treat strategies for prevention of HIV infection. Clinical Infectious Diseases. 2011; 52: 793-800.
ii
Centers for Disease Control and Prevention. Monitoring selected national HIV prevention and care objectives by using HIV
surveillance data-United States and 6 U.S. dependent areas-2010. HIV Surveillance Supplemental Report 2013; 18 (No. 2, part
B). http://www.cdc.gov/hiv/topics/surveillance/resources/reports/#supplemental. Published January 2013. Accessed January 23,
2013.
iii
CDC, 2013
Source:
National Native American AIDS Prevention Center (NNAAPC)
"Reproduced with permission - National Native American AIDS Prevention Center (NNAAPC)"
National Native American AIDS Prevention Center (NNAAPC)
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