American Indian/Alaska Native Epidemiological Profile Jennifer Kawatu, RN, MPH November 9,

Background National Objective of IPP Infrastructure: Epidemiological Profile of American Indian/Native Alaskans 4.5 X Sources: For men and women, 15 and older, in US and outlying areas. US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for HIV, STD and TB Prevention (NCHSTP), Division of STD/HIV Prevention, Sexually Transmitted Disease Morbidity for selected STDs by age, race/ethnicity and gender , CDC WONDER On-line Database, June Accessed at on Oct 5, :35:43 PM National Chlamydia rates for men and women 2009 American Indian / Alaska Native White White

American Indians/Alaska Natives in Region I AI/AN make up less than 1% of population in Region I ( ~ 0.3%) 560 Federally recognized tribes Many others with state or no official recognition American Indians from all over the country live in Region I Source: Census, 2010.

Green=Densest AI/AN populations in rural areas Region I AI/AN Population Density Source: U.S. Census

Socioeconomics AI/AN more likely than Whites to: Live in poverty Have lower median family incomes Have fewer years of education Be Younger

History AI/AN population, has a distinct history with the federal government Snyder Act of 1921 led to development of Indian Health Service (IHS) – IHS serves almost 2 million members of the 564 federally recognized AI/AN tribes. IHS Direct Care Tribally Managed Services Tribal Services Urban Indian Health Programs

AI/AN Health Care Management Systems by State StateFunding SourcesFacilities CTFederal and tribal Federally funded Indian Health Service primary care facility; tribal insurances; tribal contract care services; tribally managed MA Federal (may also be some tribal funding) Federally funded Indian Health Service primary care facility; tribal contract care services; tribally managed ME Federal, state, and private Federally funded Indian Health Service primary care facilities that are tribally managed; tribal contract care services NH State and private funding Non-profit education and prevention programs RIFederal Federally funded Indian Health Service primary care facility; tribal contract care services; tribally managed VTNA

Cultural Contracted with Medical Anthropologist with extensive experience working with native population in Northeast to conduct KII Between Feb-May, 2011 conducted 7 interviews with residents of all six states Purpose of interviews to identify: – Barriers to care – Perceptions and beliefs about STI/Family planning care – Opportunities to partner with IPP

Cross Regional Messages from KIIs Transportation challenges for rural and youth populations Fears of breached confidentiality may affect utilization choices Concerns of perceived illness connected to stigma, socio-cultural prejudice, and racism may incline individuals to not identify as Natives among non-Natives. Concerns about identity may alter the use of non-Native STD services. Both of these situations can and do skew associated statistics.

Cross Regional Messages from KIIs Appropriate messaging must be culturally relevant and competent. – Messengers gender and tribal specific – Consider Message technology, methods of dissemination, and literacy levels. – More rural, older and northern populations tend to emphasize personal oral transmission of knowledge and information. Southern, as opposed to urban, communities may have greater access to education through smart phones and internet technologies.

AI/AN Served By Region I IPP ( ) Estimated Number of Female AI/AN Average number reached per year84 Estimated % of AI/AN Female Population Reached2%

Chlamydia Positivity among AI/AN Age Breakdown by State Percent Positive (Number) Total Tested 24/25 and Younger** 5.5 (23)421 25/26 and Older 3.3 (4)121 Total 5.0 (27)542 Percent Positive for Chlamydia among AI/AN* IPP Females Region I *Includes AI/AN only or AI/AN along with another race

Region I Chlamydia Positivity Rates in Women 24/25 and Younger by Race ( )

Conclusions AI/AN populations in Region I are small and very diverse group AI/AN make up less than 1% of population in general, and less than 1% of population tested for Chlamydia Reaching 2% of AI/AN in the under 24/25 age group – room to expand

Conclusions Cont. If funds and personnel available improve outreach to AI/AN: Have additional conversations with tribal health contacts to elicit culturally specific message content. Collaborate with tribal health leaders to disseminate messages using locally specific approaches. E.g. Project Red Talon in Oregon Timelines should consider time to build relationships with AI/AN organizations

Conclusions Cont. Non-Native facilities should actively train staff about perceived discrimination and its impact on Native clients. Media messages should address both genders and a variety of ages. Multi- generational audiences might encourage other participants to actively engage in education. Messages should “normalize” and de- stigmatize prevention and screening services and education.