Gonorrhea Control in Region X Seattle, July 20, 2009 Jessica Leston, MPH ANTHC STD Program Clinical and Research Services

Overview  Alaska Overview  Alaska Tribal Health System  ANTHC STI/HIV Program  Overview of GC in the AN population of AK  ANTHC Programs

Alaska is Big

Alaska Native Peoples and Languages

Alaska Tribal Health System

Current Tribal Health Entities  12 “unaffiliated” tribes provide community-based health programs  Regional health organizations are non-profit, authorized by tribal government resolutions, with Native boards of directors  Some are small, representing 6-7 tribes, serving about 2,000 beneficiaries  Others are larger, representing as many as 50 tribes, serving about 25,000 beneficiaries; six of these manage regional hospitals

Chignik Lake Clinic

Alaska Tribal Health System Levels of Care…  Village-based services: Community Health Aide/Practitioner working in a village clinic  Sub-regional services (some regions): Mid-level practitioner serving several villages  Regional services: Referral hospital or physician health center  Statewide services: Alaska Native Medical Center and Alaska Native Tribal Health Consortium  Contract Health Services: for private sector referrals

Alaska Native Tribal Health Consortium  The Alaska Native Tribal Health Consortium (ANTHC) was formed in late 1997 to manage statewide Native health programs based in Anchorage, including the Alaska Native Medical Center  ANTHC is the largest tribal self-governance entity in the United States with 1,700 employees

STI/HIV Services through ANTHC  Early Intervention Services  Medical care and management  Prevention with Positives  HIV/STD Prevention Center  Outreach and education (Community PROMISE, Mpowerment)  Prevention Media Development and Distribution  Social Marketing/Youth Intervention  Research  Advocacy and Policy  International Partnership Building

Gonorrhea Rates 2008  Overall, GC rates decreased 1% in AK in 2008  Rates of GC increased by 53% in Alaska Native and American Indian males and increased 19% in Alaska Native and American Indian females.  The highest GC infection rates were among Alaska Native and American Indian people at 229 cases per 100,000 males and 347 cases per 100,000 females.

Unpublished IHS Surveillance Report 2007

ANTHC STI Projects  Focus Group and Interview Project  Media/Technology  Marketing  Self-collected specimen project  International Collaborations

Alaska Native Focus Group and In-Depth Interview Project  Alaska Native adolescents (n=105) from five rural communities in Alaska, ages 15-24, participated in 21 focus groups.  In-depth interviews with 35+ community members

Alaska Native Focus Group and In-Depth Interview Project  Assessed themes related to knowledge and beliefs about STD, HIV/AIDS, and unplanned pregnancy, as well as perceptions of how adolescents prefer to learn about sexual health issues.

Results  STD/HIV and unplanned pregnancy messages are viewed within a framework of disease prevention and health protection activities  Sexual health messages should be delivered via the internet and school  Young adults want to hear messages promoting STD/HIV testing and condom use  Easier access to condoms is needed

Results  There is a basic understanding of sexual health, but adolescents have a lot of unanswered questions pertaining to STD/HIV  Alcohol and drug use affect sexual behavior and risk taking  Issues of confidentiality and embarrassment affect healthcare seeking behaviors for sexual health issues

Next Steps  Use the information gathered in the focus group and interview project to create an intervention:  Alaska Native Youth Social Marketing Campaign  Education/Health Promotion  Alaska Native Youth Website  STD Screening/Treatment

Education and Health Promotion

Self-Collected Specimen Project

Quayana Jessica Leston STD Program Manager, ANTHC Clinical and Research Services