Preventing STDs Among Native American And Alaskan Native Populations

American Indian and Alaska Native communities represent smaller numbers but higher risks for STD infection than those found in other sub-groups in the U.S. population. Addressing these requires focused strategies.

April is National STD Awareness Month and sexual and reproductive health organizations throughout the country urge you to Get Yourself Tested.  Rewire has partnered with The National Coalition of STD Directors (NCSD) to produce a series of articles on the importance of STD prevention and treatment among populations throughout the United States.  Other articles in this series include one by Sandra Serna-Smith and Peter Leone.

April is National STD Awareness Month and with over 19 million new cases of sexually transmitted infections each year, some might say that we need more than a month to boost awareness about the consequences of sexually transmitted diseases (STDs) and the populations that are most deeply affected. Unfortunately, young people ages 14 to 19 and communities of color suffer crucial inequities related to sexual transmitted infections.

That is why increasing attention is being paid to issues of adolescent and racial andethnic inequities when it comes to sexual and reproductive health. The National Coalition of STD Directors (NCSD) has been at the forefront of addressing these issues and also has recently focused on interventions that promote sexual health among Native American populations.

In early 2010, the most recent Indian Health Surveillance Report was released reflecting the rates of sexually transmitted diseases (STDs) among American Indian and Alaska Native (AI/AN) populations. The report was a collaboration between the U.S. Department of Health and Human Services, Centers for Disease Control and Prevention and the Indian Health Service and is available on the CDC website.

Findings in the report suggest that although much has been done to reduce disparities among populations and communities of color, such as increasing access to care, expanding educational programs and other interventions, there continue to be significant challenges in preventing the spread of infection in this population. American Indian and Alaska Native communities are not alone in this dilemma; however AI/AN populations are pointedly smaller than many other populations of interest.

Data from the IHS Report identifies unsurprisingly, that Chlamydia is the most commonly reported STD among all U.S. residents including American Indian/Alaska Natives. In 2007, 17,871 Chlamydia diagnoses were reported among AI/AN, down from 19,267 cases in 2006. According to the data, the national AI/AN rate of reported Chlamydia in 2007 was 732.9 cases per 100,000 population, a decrease of 7.2 percent from 2006. However, when compared more broadly, this community is disproportionately affected by Chlamydia with a rate twice as high as the overall U.S. rate. Notably there have been increased efforts in Chlamydia screening throughout the country that may reduce the number of reported cases.

The second most common sexually transmitted disease affecting American Indian/Alaska Native communities is gonorrhea. As mentioned in the report, in 2007 AI/AN populations reported a decrease in gonorrhea cases of 2,657 down from 3,398 in 2006. This reflects a lower rate among AI/AN communities than the U.S. rate.

Overall, the Indian Health Surveillance Report confirms that public health efforts should be directed toward eradicating health disparities, increasing the availability of screening and delivering evidence-based programs and interventions to communities with an emphasis on youth and women. The lower rates of STD incidence compared to the previous year indicate that progress is being made and NCSD and our partners have been actively working to improve sexual health outcomes.

However the relative dearth of comprehensive programs that are culturally relevant for American Indian populations continues to be a problem. In 2008, the National Coalition of STD Directors in partnership with the Centers for Disease Control and Prevention and the Indian Health Service National STD Program began development of a curriculum titled Native STAND: Students Together Against Negative Decisions. Native STAND incorporates the Transtheoretical Model (Stages of Change) and the Diffusion of Innovations Theory to train teen opinion leaders to be role models and peer educators who promote abstinence, risk reduction and healthy decision making with their friends.

The curriculum is not specific to one tribe or geographic region and utilizes the cultural teachings from many American Indian tribes and communities. It is comprised of 29 sessions that average 90 minutes of delivery time each. The comprehensive curriculum covers topics such as- Respecting Differences, Healthy Relationships, Goals and Values, Decision-Making, Birth Control Methods as well as sessions on Communication, Reproductive Health, HIV and STDs. The curriculum is currently being piloted in four Bureau of Indian Education (BIE) residential schools and has received significant interest from American Indian communities around the country.

To learn more about the Native STAND curriculum and materials please contact Dana Cropper Williams at [email protected] and remember to Get Yourself Tested!