1. Project Red Talon Northwest Portland Area Indian Health Board Sexually Transmitted Diseases: Information for Tribal Decision-Makers

2. For many of us, talking about sex is an uncomfortable topic. Because of this, we have remained silent. But our silence will not stop the devastating impact of STDs and HIV. Together, we must find the courage to stand up and have a voice to protect future generations.

3. A Product of the Northwest Portland Area Indian Health Board. STDs and HIV/AIDS: Impact on our Northwest Tribes 1.STDs: What are they? 2.Prevalence – The numbers… 3.Social Impact 4.Economic Impact 5.The Tribe’s Role in Prevention

4. A Product of the Northwest Portland Area Indian Health Board.

5. What are they? Sexually Transmitted Diseases (STDs) are caused by viruses or bacteria that enter the body through tiny cuts or tears. STDs can be passed via: 1.skin-to-skin contact 2.sexual fluids (blood, semen, infected discharge, vaginal fluids 3.oral, vaginal, or anal sex

6. A Product of the Northwest Portland Area Indian Health Board. PREVELENCE

7. A Product of the Northwest Portland Area Indian Health Board. Prevalence: Impact on our Northwest Tribes American Indians and Alaska Native are disproportionally affected by STDs and HIV/AIDS.

8. A Product of the Northwest Portland Area Indian Health Board. Chlamydia - Rates per 100,000 population by race/ethnicity, age group and sex: United States, 2000-2004 Year White, Non- Hispanic Black, Non- Hispanic HispanicAsian/PI American Indian/Alaska Native Total MaleFemale 2000105.9978.2384.7129.2590.2183986.1 2001118.71,083.90423.8138.3587.8185.6978.7 2002126.91,087.80423.4140.4644.8221.61,056.20 2003136.71,122.30428.2141.6672.2244.41,087.20 2004143.61,209.40436.1133.7705.8270.91,127.80 Nearly 5 times higher! DISPARITIES When comparing rates by ethnicity, American Indians have the second highest chlamydia rate in the United States.

9. A Product of the Northwest Portland Area Indian Health Board. Fact: 1 in 10 sexually active adolescents has chlamydia. Nearly 3/4 of all chlamydia cases occur among 15-24 year olds.

10. A Product of the Northwest Portland Area Indian Health Board. Gonorrhea - Rates per 100,000 population by race/ethnicity, age group and sex: United States, 2000-2004 Year White, Non- Hispanic Black, Non- Hispanic HispanicAsian/PI American Indian/Alaska Native 200027.8778.168.726.798.6 200129.476270.324.6102.6 200231713.769.221.4112.5 200332.6649.369.722.1102.5 200433.3629.671.321.4117.7 Almost 4 times higher! DISPARITIES In 2004, American Indians and Alaska Natives had the second-highest gonorrhea rate. From 2000-2004, gonorrhea rates increased 19.4% among AI/ANs.

11. A Product of the Northwest Portland Area Indian Health Board. Fact: Chlamydia and gonorrhea are most common among 15-29 year olds.

12. A Product of the Northwest Portland Area Indian Health Board. Primary and secondary syphilis - Rates per 100,000 population by race/ethnicity, age group and sex: United States, 2000-2004 White, Non- Hispanic Black, Non- Hispanic HispanicAsian/PI American Indian/Alaska Native Total MaleFemale 20000.5121.60.32.2 20010.710.720.53.84.23.4 20021.29.52.50.82.12.31.9 20031.57.72.912.84.21.5 20041.693.21.23.23.52.9 2 times as high! DISPARITIES From 2003-2004, syphilis rates increased 14.3% among AI/ANs. During this period, the number cases decreased among AI/AN men, but increased among AI/AN women.

13. A Product of the Northwest Portland Area Indian Health Board. Prevalence: Impact on our Northwest Tribes HIV/AIDS: AIDS has steadily increased in recent years, becoming the ninth leading killer of Native people between the ages of 15 – 44. Approximately 3,084 AI/ANs have been diagnosed with AIDS since the disease was first encountered in 1980.

14. A Product of the Northwest Portland Area Indian Health Board. Prevalence: Impact on our Northwest Tribes HIV/AIDS: When compared by ethnicity, AI/AN men and women both had the third highest HIV/AIDS rate in 2004.

15. A Product of the Northwest Portland Area Indian Health Board. Prevalence: Impact on our Northwest Tribes HIV/AIDS: Among AI/AN males, the HIV/AIDS case rate increased 2.4% from 2001 to 2004, the most significant increase observed among any reported racial/ethnic group. And among females, the rate increased 4.8%, an increase that was second only behind Asian/Pacific Islanders (A/PIs).

16. A Product of the Northwest Portland Area Indian Health Board. Prevalence: Impact on our Northwest Tribes HIV/AIDS: In 2004, HIV was diagnosed for an estimated 206 American Indians and Alaska Natives.

17. A Product of the Northwest Portland Area Indian Health Board. Prevalence: Impact on our Northwest Tribes These numbers may underestimate the true burden of disease: Misclassification of AI/ANs in state registries Not all Tribal clinics report cases Many infections produce no symptoms, and cases are not diagnosed

18. A Product of the Northwest Portland Area Indian Health Board. Social Impact

19. A Product of the Northwest Portland Area Indian Health Board. Social Impact: Impact on our Northwest Tribes Sexually Transmitted Diseases (STDs) produce a number of physical, mental, and social consequences. Sexually transmitted infections can cause pain, infertility, cancer, and death, impacting not only the individual’s well being, but the well being of the community as a whole.

20. A Product of the Northwest Portland Area Indian Health Board. Fact: 1 of every 4 sexually active teens will get an STD this year, and Native youth may be at even higher risk.

21. A Product of the Northwest Portland Area Indian Health Board. Social Impact: Impact on our Northwest Tribes Studies indicate that the presence of an STD infection can make an individual 3 to 5 times more likely to acquire HIV, if exposed.

22. A Product of the Northwest Portland Area Indian Health Board. Fact: Two U.S. teens are infected with HIV every hour of every day.

23. A Product of the Northwest Portland Area Indian Health Board. Social Impact: Impact on our Northwest Tribes Women are biologically more susceptible to the transmission of STDs and HIV than men — and adolescent girls are more susceptible than adult women. At all ages, women are more likely than men to contract genital herpes, chlamydia or gonorrhea.

24. A Product of the Northwest Portland Area Indian Health Board. Social Impact: Impact on our Northwest Tribes Elevated STD rates among American Indians and Alaska Natives put us and our youth at heightened risk for HIV transmission. Rural geography, low rates of condom use, and risky sexual norms could further contribute to an epidemic of HIV among our NW Tribes.

25. A Product of the Northwest Portland Area Indian Health Board. Economic Impact

26. A Product of the Northwest Portland Area Indian Health Board. Economic Impact: Impact on our Northwest Tribes In addition to the physical and social consequences of sexually transmitted diseases, STDs impose a substantial economic burden on our NW Tribes.

27. A Product of the Northwest Portland Area Indian Health Board. Economic Impact: Impact on our Northwest Tribes Average direct medical expenses associated with treating each STD and the sequelae that result from untreated or inadequately treated STDs (in 2000): Chlamydia: $20 for men and $244 for women. Gonorrhea: $53 for men and $266 for women. Syphilis: $444 for men and women. Human Papilloma Virus: $1,228 for women & $27 for men. Genital Herpes: $417 for women and $511 for men, including suppressive therapy for some patients.

28. A Product of the Northwest Portland Area Indian Health Board. Economic Impact: Impact on our Northwest Tribes Average direct medical expenses associated with treating each STD and the sequelae that result from untreated or inadequately treated STDs (in 2000) : HIV/AIDS: lifetime cost = $199,800 for men and women. Trichomonas vaginalis: $18 for men and women. Hepatitis B: $779 for men and women.

29. A Product of the Northwest Portland Area Indian Health Board. Tribe’s Role in Prevention

30. A Product of the Northwest Portland Area Indian Health Board. Tribe’s Role in Prevention There are many benefits to investing in STD and HIV Prevention. By keeping people from becoming infected, STD/HIV Prevention Programs not only save lives, but also reduce the number of people needing expensive medical treatments.

31. A Product of the Northwest Portland Area Indian Health Board. Tribe’s Role in Prevention Effective Strategies: 1.Provide clinic-based screening and testing services. 2.Increase Community Awareness. 3.Support community and school- based interventions.

32. A Product of the Northwest Portland Area Indian Health Board. What we are doing: Coalition objectives: 1. Improve STD testing, screening, and treatment among NW tribal clinics. 2. Strengthen the capacity of tribal health advocates to provide STD prevention services to the NW tribes. 3. Increase community awareness about Sexually Transmitted Diseases. Tribal Activities….

33. A Product of the Northwest Portland Area Indian Health Board. W hat You Can Do... Learn more about STDs/HIV and their impact on your Tribe. Adopt a Resolution supporting your tribe’s participation in the Red Talon STD/HIV Coalition and use of the Red Talon Tribal Action Plan. Work with local schools and educators to strengthen school-based curricula preventing STDs and teen pregnancy.

34. A Product of the Northwest Portland Area Indian Health Board. W hat You Can Do... Work with the Tribal Clinic to improve clinic- based policies. Encourage community awareness by participating in community observances, and by implementing the Red Talon STD/HIV Media Campaign. Protect yourself against STDs and HIV infection. Know the risks associated with sex and drug use.

35. A Product of the Northwest Portland Area Indian Health Board. W hat You Can Do... Get tested - and encourage others to do the same. It’s important to know your STD and HIV status to protect yourself and others. Blood, urine, and saliva test are available for different STDs. Most infections can be treated or cured! Educate others about STD and HIV/AIDS -- They listen and learn from you. Volunteer with your tribe’s STD/HIV Prevention Program.

36. A Product of the Northwest Portland Area Indian Health Board. W hat You Can Do... Get medical care and support if you’re living with HIV. Effective treatments exist. Help someone living with HIV/AIDS by being a friend. Help end the stigma associated with HIV/AIDS.

37. A Product of the Northwest Portland Area Indian Health Board. Social Impact: Impact on our Northwest Tribes Elevated STD rates among American Indians and Alaska Natives put us and our youth at heightened risk for HIV transmission. Rural geography, low rates of condom use, and risky sexual norms could further contribute to an epidemic of HIV among our NW Tribes. As decision-makers, you play a significant role in the health and welfare of your Tribe. Your opinions are heard and respected. Your actions are observed and influence others. Your policies and decisions will shape the lives of future generations. With this power, comes responsibility...

38. A Product of the Northwest Portland Area Indian Health Board. Social Impact: Impact on our Northwest Tribes Elevated STD rates among American Indians and Alaska Natives put us and our youth at heightened risk for HIV transmission. Rural geography, low rates of condom use, and risky sexual norms could further contribute to an epidemic of HIV among our NW Tribes. Know the Facts: Educate, Motivate, and Mobilize against Sexually Transmitted Diseases & HIV/AIDS!

39. A Product of the Northwest Portland Area Indian Health Board. Questions?