Tribally-Driven HIV/AIDS Health Services Partnerships: Evidence-Based Meets Culture-Centered Interventions

Abstract

This paper describes a successful HIV/AIDS prevention and treatment project that combined medical, support, and educational services, thereby improving care in a rural American Indian tribe in the southwestern United States. Using the methods of community-based participatory evaluation and motivational interviewing, the 5-year, multiparty collaborative project improved health care access and medical regimen adherence of people with HIV/AIDS and increased the risk- and protective-factor knowledge of tribal members at high risk for the disease. The success of the collaborative in achieving all these goals highlights the importance of tribal control, collaboration, and incorporation of tradition and culture in HIV/AIDS diagnostic, treatment, and prevention efforts.

KEYWORDS:

• alcohol abuse
• American Indian
• community-based participatory evaluation
• community-led partnerships
• drug abuse
• HIV care
• HIV screening
• HIV/AIDS
• mental illness
• Native American

The writing of this article was made possible in part by a grant from the U.S. Department of Health and Human Services, Health Resources and Services Administration's (HRSA) Special Projects of National Significance (SPNS), Grant 5H97HA00254-01-00, and by the Network for Multicultural Research on Health and Healthcare, Department of Family Medicine–UCLA David Geffen School of Medicine, funded by the Robert Wood Johnson Foundation. Points of view in this article are those of the authors and do not necessarily represent the official views of the HRSA, the University of New Mexico (UNM), the University of Washington, or the Na'Nizhoozhi Center Inc. (NCI, a substance abuse recovery center located in Gallup, New Mexico).

The institutional review boards of UNM's Health Science Center and the Navajo Nation¹ approved this study.

Finally, we thank Leo Egashira, who edited this article.

Notes

^a Reflects those incarcerated (n = 30).

^b Reflects men having sex with men (n = 30).

^c Reflects men having sex with men in the previous 12 months (n = 22).

^d Reflects times missing HIV medication doses in the previous 4 weeks (n = 34).

^a Percent reflects services received of those in need (received/need = %).

^b 1 = very satisfied; 2 = somewhat satisfied; 3 = somewhat dissatisfied; 4 = very dissatisfied.

*p < 0.05.

The Navajo Nation is defined as the tribal government representing enrolled Navajo people living on or in proximity to the federally designated Navajo Indian Reservation; the Navajo Nation can also refer to the Navajo people, as well as the lands that the Navajo people occupy.

“Frontier” is a National Institutes of Health definition of rural counties and subcounties using a weighted average of low population density (0 to 20 people per square mile), long distances from markets and services (30 to 90 + miles), and long travel times to markets and services (30 to 90 + minutes). Most of the Navajo Nation falls under this definition of “frontier.” When used in this specific context, it will be noted as “rural frontier” in this article. For details, see http://www.frontierus.org/documents/consensus.htm.

The CDC's epidemiological database does not parse out American Indians and Alaska Natives. While this paper focuses solely on American Indians, leaving out Alaska Native in the statistical data would be misleading.

The “Colonial Health Deficit” is inspired by the term “Slave Health Deficit” used in the report “Racism in Medicine and Health Parity for African Americans: ‘The Slave Health Deficit'” by the National Medical Association, 2002. For details, see http://www.nmanet.org/images/uploads/Racism%20in%20Medicine.pdf.