By Lynne Greabell, Director of Member Services and Leadership Development, NASTAD
In conjunction with the seventh annual National Native HIV/AIDS Awareness Day, NASTAD published an issue brief, Native Gay Men and Two Spirit People and HIV/AIDS and Viral Hepatitis Programs and Services. The issue brief, developed by NASTAD’s Native American Networking Group (NANG) and Gay Men’s Health Equity Work Group (GMHEWG), provides specific recommendations for health departments to address HIV and viral hepatitis in Native American communities, consistent with the NASTAD and National Coalition for STD Directors’ joint policy statement “Getting to Zero: Scaling-Up Health Department Strategies for Gay Men/MSM.”
Native gay men and Two Spirit people (i.e., men who have sex with men [MSM] or what we would call male-bodied Two-Spirit individuals) face unique and specific challenges and opportunities related to their health and well-being such as stigma and discrimination due to their sexual orientation and gender status. Yet tribal traditions and connections through Two Spirit and lesbian, gay, bisexual, and transgender (LGBT) networking also can serve as protective factors (e.g., opportunities for cultural pride and education about prevention of disease acquisition) for Native gay men and Two Spirit people.
Impact of HIV and Viral Hepatitis on Among Native Gay Men and Two Spirit People
Native gay men and Two Spirit people are disproportionately impacted by HIV/AIDS and bear the brunt of the epidemic among Native Americans. Native American gay men/men who have sex with men (MSM, or male-bodied Two Spirit individuals) and Native MSM with a history of injection drug use (MSM-IDU) made up 58% and 15%, respectively, of all Native American people living with HIV through 2010. Native Americans are also disproportionately impacted by viral hepatitis, as they are approximately three times as likely to develop hepatitis C infection as Whites, and Native Americans over 40 years of age are 2.5 times as likely to have hepatitis B infection than Whites and Native American women are 2.6 times as likely to die from viral hepatitis than non-Hispanic Whites. Moreover, Native American people as a whole experience elevated rates of risk behaviors that contribute to HIV/AIDS and other STDs.
When examining the impact of the epidemic among Native American communities, the epidemic must be considered in relation to the size of the Native American population in a specific community, not solely as compared with the size of the epidemic in other racial/ethnic populations. Services to Native gay men and Two Spirit people must be tailored to their specific needs and the cultural affiliations with which they identify.
How Health Departments Are Addressing HIV/AIDS among Native Gay Men and Two Spirit People
As a result of NASTAD’s work with the NANG and the GMHEWG, NASTAD offers several recommendations to health departments for addressing the impact of HIV/AIDS among Native gay men and Two Spirit people:
- Let Data Drive Funding Decisions
- Include Native Gay Men and Two Spirit People in HIV/AIDS Planning Groups and Councils
- Support Native Gay and Two Spirit People’s Organizations and Communities
- Offer Culturally-Appropriate Services
- Break Down Bureaucratic Silos
- Build Public Health Capacity to Work Effectively with Native Gay Men and Two Spirit People and Connect with Tribal Leaders
- Implement Strategies In Social Networks
- Use New Tools to Effectively Communicate the Impact on Native Gay Men and Two Spirit People
In the Native Gay Men and Two Spirit People and HIV/AIDS and Viral Hepatitis Programs and Services issue brief, several health departments that have specifically partnered with Native gay men and Two Spirit people in their communities offer strategies they are using to address HIV and viral hepatitis, including conducting needs assessments specifically focused on Native gay men and Two Spirit people, ensuring the participation of Native gay men and Two Spirit people in planning groups, adapting effective interventions to make them culturally appropriate for Native gay men and Two Spirit people, and providing training for tribal leaders on Native gay men and Two Spirit people.
NASTAD was pleased to work with several Native gay men and Two Spirit people who participate in the NANG and contributed to the development of the issue brief. We must listen to and honor the voices of Native gay men and Two Spirit people as we do this work, and partner with them to develop programming to serve their communities.
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