Since the introduction of Treaty Health Care in the late 1800s by the United States Government, healthcare for Native Americans has consistently lagged behind the rest of the US population. The 2003 US Commission on Civil Rights report detailed the unmet health needs of tribal people and noted that they “lagged 20 to 25 years behind the general population in health status”. [US Commission on Civil Rights 2003] Indian Health Services was established in 1921 under the Snyder Act which was started for "for the benefit, care and assistance . . . and for the relief of distress and the conservation of health . . . for Indians tribes throughout the United States." [Snyder Act, 1921]. The main goal of Indian Health Services was to not only provide healthcare to tribes, but to promote assimilation while preventing disease.
Since its start, Indian Health Services (IHS) has had a very tarnished reputation amongst Native Americans due to forced sterilization of women, drug experimentation and poor service. Distrust that Native People have for IHS has stemmed from centuries of colonization and decimation of millions through disease, the constant struggle for quality health care, broken treaties and the loss of tribal sovereignty. In a study conducted on Two-Spirit, Bisexual and Heterosexual men in New York City, thirty percent of the sample believed in a conspiracy theory regarding HIV and the federal government and their distrust thereof.
As with Tuberculosis, HIV transmission rates are higher in undeveloped countries and impoverished communities. TB was a major killer for many years amongst Native Americans until the 1950’s when the disease saw a decline. Compared to the general population of the United States today, TB mortality rates among Native Americans remain five times the national average. [Vernon & Jumper-Thurman 2005, pg. 248] Native Americans account for less than one percent of national reported cases of HIV they remain number three in transmission rates amongst minorities following Blacks and Hispanics. Since 1993, reported cases of HIV have risen from 322 reported cases amongst Native Americans in 1991 to 2875 in 2003. Although the trend shows a decline amongst White populations in the United States since the late 1990’s, minority population’s decrease of HIV is not evident.
There are many factors other than socio-economic status that account for transmission rates in Native American communities. Reservation communities for instance can be affected in part by the amount of homophobia present both in transmission rates and detection. One would ignore the threat and fear as well as education if HIV is thought to be a gay disease. This at times contributes to many Two-Spirits (Gay Native Americans) to migrate to and from city without knowing of HIV status for family gatherings and such. For people infected with HIV on reservations, there is a higher stigma against them at times due to their positive status. If HIV/AIDS is thought of as only a gay disease in Native Communities, then the results are devastating [Vernon 2005].
In a study conducted by the CDC and several other organizations, the city of Portland was observed for HIV-related risk behaviors with people identifying themselves as American Indian and Alaska Native (AI/AN). It is a known fact that the risk of HIV transmission doubles and sometimes is fivefold amongst people that contract other STDs. In 2003, Chlamydia rates were five times higher, Gonorrhea rate was three times higher and the primary and secondary syphilis rate was twice as high [Lapidus et al; 2006].
Screening for sexually transmitted diseases has its disparities on the reservations due to the fact that a greater degree of geographic isolation, poor access to healthcare, as well as certain stigma and unique social norms differing by tribe. Gonorrhea rates amongst Native Americans alone is almost as significant as the total US average and with an obvious correlation between HIV transmission rates and STDs nationally, this too is an alarming figure. The data collected concerning screening practices represents a sample taken from all twelve IHS area clinics. Youth comprise a substantial proportion of AI/AN contracting STDs which pose specific challenges to local prevention activities [Lapidus et al; 2006]. Due to tribal and federal laws, sufficient information required to screen youth is at many times contradictory to state and local laws.
These findings are reported by the CDC and IHS and have disparities in themselves. A lack of understanding of complex social networks that exist on reservations is often mistaken, as in the past, in a sexual context. Anthropologist and Ethnographers wrote extensive field notes on sexual practices of many Native Americans Tribes during their observations, many times attributing more imagination then actual observed social norms as in many of the Buffalo Calling ceremonies such as recorded by Paul Allen. History of the Expedition Under the Command of Lewis and Clark, 1814, in which he states that the Mandan braves would beg older distinguished men to sleep with their wives in order to ensure a good hunt. The last recorded event of this happening was by the Hidatsa people and George Will who was from the area and returned to do ethnographies after studying at Harvard. His actually accounts of this event as well as oral histories of the Hidatsa and Mandan people do not include any such complex sexual network. By this time, ethnographic methods had changed so as not to market sensationalism but actual knowledge as we know today under the Ethical Practices of the American Anthropological Association.
In order to better study and look at this modern day phenomenon, historical stereotypes as well as semantic frames of the noble savage need to be discarded and ideals put into place of dealing with an actual population in the United States no different from other ethnic populations. Much of the statistics used tend to relate alcohol and drug abuse to every ailment that affects Native Populations. But if one were to consider for instance where this data is being collected, they would realize that many Native People across Indian Country rarely use Indian Health Services due to the fact that they may live off the reservation or have health insurance from their jobs; distrust of services are also a major factor. So if this is the case, then why is it acceptable for IHS and other government agencies to use their statistics reported from Public Health facilities to broadly define what is going on in Indian Country?
In the future, other factors need to be considered such as sexuality and a different sampling rate other than HIV reported cases. If an agency is going to “study” a population, then it is feasible to conduct a study first that actually measures a realistic sample other than those of us that have no other option but to use Indian Health Services. It would be feasible to say that random survey regarding risk behavior from a sample of different age groups and professions would be a better predictor as to how HIV is spreading in Indian Country as well as other health ailments. We read the statistics, but are we really a part of the sample?
HIV will continue to be a problem amongst Native Americans until the disease itself is better related into a culture. With over five hundred federally recognized tribes, culturally relevant education is a necessity that will not only educate on prevention, but also on transmission and how easily one person can be exposed. Cultural views need to be incorporated into education and the clinical aspect needs to be removed to some extent. Not all Native Americans are at risk for bad behavior or other stereotypes that come with studies conducted by federal agencies. It is time that Native Americans take control of their own destiny and not rely on an institution that has repeatedly let down hopes and expectations to guide them into a better understanding of a disease that is very much a reality amongst us. We as Native Americans need to take the initiative and start looking at our statistics and numbers not from a stance of Treaty Health Care, the past has already shown us how well treaties have been accounted for, but from a stance as individual sovereign nations and governments.