Transcript Assessing and improving the quality of cancer surveillance

STDs & HIV
in Indian Country
Lori de Ravello, MPH
CDC assignee to the Indian Health Service
June 14, 2007
Cases of HIV/AIDS among persons aged >=13, by
year of diagnosis and race/ethnicity, 2001–2005
Chlamydia rates (per 100,000)
by race/ethnicity & sex, 2005
Women
Men
2000
0
0
1000
63.6
White
1000
237
Black
717.8
201.4
79.3
305.9
163.5
1729
Hispanic
API
733.2
222.3
AI/AN
Total
2000
1177.7
497.9
Gonorrhea rates (per 100,000)
by race/ethnicity & sex, 2005
Men
750
600
450
Women
300
150
0
0
27.7
White
150
300
67.5
26.6
Hispanic
API
92.2
AI/AN
112
Total
600
42.5
Black
666
450
590.4
82.7
25.3
170
119.5
750
Primary & Secondary Syphilis rates (per
100,000) by race/ethnicity & sex, 2005
Men
20
16
12
Women
8
4
3.3
0
0
White
4
0.3
Black
15.7
5.5
Hispanic
2.3
3.3
5.1
API
AI/AN
Total
8
4.4
0.9
0.2
1.6
0.9
12
16
20
Vulnerabilities of AI/AN to HIV
Economic and health disparities
STDs
Social norms/stigma
Mobile population
Risky sexual behavior in youth
Suicide/depression
Alcohol/drug use
Percent males living with HIV/AIDS at
the end of 2005 by transmission category
80
70
Percent
60
White NH
Black NH
Hispanic
API
AI/AN
50
40
30
20
10
0
MSM
IDU
MSM+IDU
Hetero
Other
Percent females living with HIV/AIDS at
the end of 2005 by transmission category
90
80
70
White NH
Black NH
Hispanic
API
AI/AN
Percent
60
50
40
30
20
10
0
IDU
Hetero
Other
Challenges to Addressing
HIV/AIDS in Indian Country
 High rates of STDs
 Substance abuse
 Socioeconomic
issues
 Cultural diversity
between tribes
 Competing priorities
 Lack of HIV screening
 Access to health care
 Dearth of specialists
 Training challenges
 Jurisdictional issues
 Confidentiality issues
 Stigma
 Denial, complacency,
misconceptions
 Lack of surveillance
data
Promising Practices
and Projects
Minority AIDS Initiative Funding for
IHS HIV/AIDS Program
Raise awareness
Increase HIV screening, knowing one’s
HIV status
Provide capacity building opportunities
for health care providers
Integrate behavioral health
Improve quality of care
Improve surveillance
Capacity Building Assistance from CDC
National Native American
AIDS Prevention Center
Advancing HIV/AIDS
Prevention in Native
Communities
Inter-Tribal Council of AZ
Project
Red
Talon
What can you do?