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HIV Prevention in Native American Communities

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HIV Prevention in Native American Communities HIV Pre ve n't i on in Native American C omm unities OFFICE OF MIHORSTY HEALTH Resource Center . Ca'i Toll-free , 1^0044-1-6472 Compiled by Andrea Green Rush Design by Brian Blanchard Design, San Francisco for the National Native American AIDS Prevention Center 35 I 5 Grand Avenue, Suite I 00 Oakland CA 946 I 0 Supported by grant number H62/CCH 903 122 from the Center for Disease Control (CDC). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the CDC. NNAAPC 1992 mnj-piib&i I I I V Prevention in Native A. m er i ca n C o m m unities OFFICE OF MINORITY HEALTH Resource Center Cal! Toll-Free 1-800444-6472 A Manual for Native American Health and Human Service Providers PK'face 0 nee long ago, two boys went hunting with bows and arrows. They hunted a long time but didn’t find a squirrel or deer to kill and eat so they shot a black bird. They made a fire with sticks and cooked the bird so that they could eat. When the bird was cooked, the two boys sat down on the ground to eat. Before they could eat, a woman came to them. “I’m very hungry,” she said. The boys offered their food to the woman and she ate it with relish. The boys were still hungry, but now they had nothing to eat. They didn’t tell the woman how hungry they were. The woman thanked the boys and said, “Because you know how to share, I’m going to give you a surprise.” She told the boys to go home and to come back tomorrow. So the boys went home and returned the next day to the place where they had given the woman their cooked bird. There was something growing that looked like a tree. The skinny tree had yellow things growing on it. They had no idea what it was. They took down one of the yellow things and smelled it. It smelled good and tasted good. “Let’s take this home and ask somebody what it is,” the boys said. Mother didn’t know what it was. Father didn’t know what it was. No one in the whole village knew what it was, but they all liked the way it tasted. So the boys called it corn, and to this day that’s what it is called. Because the boys cared enough to feed a stranger even when it meant sacrifice for them, the people have survived for generations and generations. If we apply the lesson of this story to the HIV epidemic, we will ensure the survival of future generations. Introduction increasing numbers of cases of HIV disease in Native and the National Native American AIDS Prevention American communities, which indicates a need for more Center developed Acquired Immune Deficiency Syndrome: information on treatment and care. the Basics: a Manual for Native American Health and Human This manual was developed as a response to the Service Workers. The manual provided information and changes taking place with respect to HIV and AIDS in the focused on developing skills to enable health and human Native American community. It is intended to bring the services workers to address AIDS in their communities. information on HIV up to date and to address the current In the three years since the development of AIDS: the needs of health and human service workers in Native Basics there has been a great deal of change. There is American communities. While it provides an overview of increasing emphasis on HIV as a spectrum disease, rather issues related to HIV, the primary focus is on educational than on the artificial distinctions of ARC and AIDS. There interventions and training. It is also different from its is greater emphasis on treatment and on monitoring predecessor because it includes contributions by health indicators of immune system health. educators, HIV program coordinators, and HIV service There has also been a great deal of change in the Native providers. American community with respect to HIV. More Section I provides an overview ofHIV as a spectrum communities are addressing HIV with prevention and disease. It includes a summary of what is known about HIV education campaigns. There are community-based task disease (written by Earl Pike, a Minnesota-based HIV forces in several communities. Unfortunately there are also educator); an overview of HIV antibody testing; and a summary of current treatment strategies (provided by drug users (by Andrea Green Rush, Ron Rowell of Project Inform, a leader in HIV treatment information). NNAAPC and Darlene Titus, CHR Coordinator of Section 2 addresses the relationship between HIV Hoopa Health, Inc.); women (by Charon Asetoyer of the and high-risk behaviors such as alcohol and dmg use. It Native American Women’s Health Education Resource includes a chapter on other sexually transmitted diseases. It Center and Lori Beaulieu and Andrea Green Rush, both also includes a detailed risk assessment questionnaire. of NNAAPC); and youth (by Carol Marquez of the Section 3 deals specifically with training and other American Indian Health Care Association and Rene educational activities. It includes proposed guidelines for Whiterabbit of the Indian Health Board of Minneapolis). HIV education (by Earl Pike), and a chapter on how to Section 5 provides practical information and planning integrate Native American traditions and values into training guidelines for developing HIV interventions. This section activities (by Sharon Day, Executive Director of the deals with the planning process that is common to all HIV Minnesota American Indian AIDS Task Force). prevention interventions, from developing a brochure to Section 4 addresses the special concerns of four conducting a workshop. target populations within the Native American community: men who have sex with men (by Les Hanson of the American Indian AIDS Institute of San Francisco); injection Contents Section 1. HIV: The Spectrum Disease 1. Critical Facts about HIV-I and AIDS by Earl C Pike 1 2. HIV Antibody Testing: An Overview by Lori Beaulieu and Andrea Green Rush 7 3. Treatment Strategies by Project Inform 13 Section II. HIV and High-Risk Behaviors by Ron Rowell and Andrea Green Rush 4. Sexual Behavior abd HIV 25 5. HIV and Drug Use 27 6. Sexually Transmitted Disease and HIV 29 7. Risk Behavior Questionnaire 33 Section III. HIV Prevention Education and Training 8. Values Clarification & Self-Assessment by Ron Rowell and Andrea Green Rush 41 9. An Overview of Psychosocial Issues Related to HIV by Ron Rowell 43 10. Some General Guidelines for HIV Education by Earl C. Pike 47 II. Incorporating Native Traditions and Culture into Training Activities by Sharon M. Day 57 Section IV. Target Populations 12. HIV and Native Americans: An Overview by Charon Asetoyer 63 13. Indian Men Who Have Sex with Men by Les Hanson 65 14. Injection Drug Users (IDUs) by Darlene Titus, Andrea Green Rush, and Ron Rowell 73 15. Women and HIV by Charon Asetoyer, Lori Beaulieu, and Andrea Green Rush 77 16. HIV Prevention Education with Native American Youth by Carol Marquez and Rene Whiterabbit 83 Section V. Planning HIV Prevention Interventions by Andrea Green Rush 89 Appendices 1. Revision of the CDC Surveillance Definition for AIDS 103 2. 1992 Revised Classification System for HIV Infection 113 3. Recommendations for Prevention of HIV Transmission in Health Care Settings 125 4. About the Contributors 137 5. Resources 139 I HIV: THE SPECTRUM DISEASE I Critical Facts about 1 11 Vi arid AIDS* by Earl C. Pike A. INTRODUCTION AIDS-related illnesses. Some of those theories are purely There has been sufficient misinformation and attendant speculative, some rest on firmer logical premises. But the confusion about HIV-1* 1 and AIDS that it makes sense to truth is that we are not now able to answer the question preface these guidelines with a simple, straightforward “How did this get started, where did it come from?” We do summary of the facts. Many individuals tend to think that know however, what it is, and a great deal about how it “all the facts aren’t in yet,” or that “what the experts say works. keeps changing,” or that “even the scientists seem to In 1981 doctors on the East and West Coasts of the disagree with each other.” In reality we know a great deal United States began reporting cases of highly unusual and are learning more all the time. The essential information infection and disease among otherwise healthy young men. isn ’/changing, and public health officials do agree about the Two particular features of those reported cases gave a small long-term reliability of that information. In other words, group of doctors cause for concern. First, they were seeing there is a solid body of data on which to base policy, kinds of infections or diseases rarely seen among that age program, and clinical decisions and actions related to HIV. group or population before. Second, the severity of those diseases or infections was sometimes astonishing. In fact B. THE NATURE AND ACTION OF HIV patients were sometimes dying before the physician even Theories abound as to the origins of the Human had a chance to engage in comprehensive study or diagnosis. Immunodeficiency Virus (HIV), the virus known to cause Compounding the confusion was the fact that those Acquired Immunodeficiency Syndrome (AIDS) and early cases were nearly all among gay men and intravenous * “Critical Facts About HIV-1 and AIDS” by Earl C. Pike is excerpted from Human Immunodeficiency Virus (HIV-1) Guidelinesfor Chemical Dependency Treatment and Care Programs in Minnesota, 1989.
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