|Statement of Anthony S. Fauci, M.D.
Director, National Institute of Allergy and Infectious Diseases
National Institutes of Health on
National Native HIV/AIDS Awareness Day
March 20, 2009
HIV/AIDS has left no segment of American society untouched. On the third annual
National Native HIV/AIDS Awareness Day, we highlight the impact of this scourge
on American Indians, Alaska Natives and Native Hawaiians, and we intensify
our commitment to fight the HIV/AIDS epidemic in these multifaceted communities.
Lack of access to basic health care services, stigma associated with homosexuality
and HIV/AIDS, barriers to effective mental health care, and high rates of substance
abuse, sexually transmitted infections and poverty all increase the risk of
HIV/AIDS in native communities and create obstacles to HIV prevention and treatment.
Consequently, as a proportion of their population, more American Indians and
Alaska Natives became infected with HIV than whites in 2006. American Indians
and Alaska Natives acquired new HIV infections at a rate of 14.6 cases per
100,000 people, while whites became newly infected at a rate of 11.5 cases
per 100,000. Moreover, American Indian and
Alaska Native women became infected with HIV at more than three times the rate
of white women in 2006.
In addition, American Indians, Alaska Natives and Native Hawaiians who are diagnosed
with AIDS die sooner after their diagnosis than members of any other ethnic
or racial group, suggesting that they are diagnosed late in the course of infection,
after the point when antiretroviral drugs would have the most benefit. This
is unacceptable. We as a nation must take bold action to promote the prompt
diagnosis and treatment of all people with HIV, including members of native
communities in the United States.
American Indians, Alaska Natives and Native Hawaiians most often acquire HIV
through unprotected sex with an HIV-infected male partner, and a significant
proportion of these HIV-infected men do not know they have the virus. An estimated
26 percent of HIV-infected American Indians and Alaska Natives are unaware
of their infection — more than the proportion
of HIV-infected Americans overall who are undiagnosed (21 percent). This means
that many American Indians and Alaska Natives with HIV are not receiving proper
counseling and care, placing them at risk for becoming extremely ill and for
spreading the virus further. The National Institute of Allergy and Infectious
Diseases (NIAID), part of the National Institutes of Health, strongly endorses
testing for HIV during routine medical care for adolescents, adults and pregnant
women, as the Centers for Disease Control and Prevention and the American College
of Physicians recommend.
The stigma often associated with HIV/AIDS and homosexuality may discourage many
American Indians, Alaska Natives and Native Hawaiians from getting tested for
HIV and seeking counseling and treatment. NIAID applauds those who are fighting
this stigma in native communities. Limited access to health care services may
also obstruct the way to HIV testing for American Indians, Alaska Natives and
Native Hawaiians. As our nation works to broaden access to health care, it
is my hope that more native communities will gain access to testing and treatment
facilities for HIV as well as other sexually transmitted infections that increase
the risk of acquiring and spreading HIV and are highly prevalent among native
Substance abuse tears at the seams of American Indian and Alaska Native communities
and contributes significantly to the HIV epidemic among them. In 2007, 32 percent
of all American Indian and Alaska Native women living with HIV/AIDS had become
infected through illicit injection drug use — a greater proportion of people
than in any other minority gender group. In addition, the combination of injection
drug use and male-to-male sexual contact accounted for a higher percentage
of male HIV/AIDS cases among American Indians and Alaska Natives than among
any other racial or ethnic group. Injection drug use can lead to HIV infection
directly when contaminated syringes or other paraphernalia are shared; many
kinds of substance abuse also contribute to sexual HIV transmission by impairing
judgment, leading to risky behavior. I encourage native communities to integrate
HIV prevention messages into culturally appropriate substance abuse treatment
programs and to support needle exchange programs, which will help reduce the
spread of HIV among injection drug users.
Native Americans, Alaska Natives and Native Hawaiians are making commendable
efforts to raise awareness about HIV/AIDS in their communities and to increase
the proportion of people who get tested for HIV. Culturally attuned HIV/AIDS
prevention and treatment programs can limit the spread of this devastating
disease among native peoples. We at NIAID stand side by side with native communities
in our mission to sponsor and conduct biomedical research to prolong and improve
the quality of life of people living with HIV and to end the HIV/AIDS epidemic.
Each year, the NIH Office of AIDS Research produces a Trans-NIH Plan for HIV-Related
Research that identifies strategic priorities for all areas of HIV/AIDS research
(http://www.oar.nih.gov/). The plan is developed in collaboration with experts
from the NIH institutes and centers, other government agencies, non-governmental
organizations and HIV/AIDS community representatives. The Fiscal Year 2010
Trans-NIH Plan for HIV-Related Research contains a chapter specifically devoted
to research addressing HIV/AIDS in special populations, including American
Indians, Alaska Natives and Native Hawaiians (http://www.oar.nih.gov/strategicplan/fy2010/index.asp).
For more information about National Native HIV/AIDS Awareness Day, visit http://www.hhs.gov/aidsawarenessdays/days/native/index.html.
The Indian Health Service, an agency of the U.S. Department of Health and Human
Services, maintains an HIV/AIDS program specifically tailored to the needs
of Native Americans and Alaska Natives. For information about this program,
go to http://www.ihs.gov/MedicalPrograms/HIVAIDS/index.cfm. For more information
about HIV/AIDS, visit www.aids.gov.
Dr. Fauci is director of the National Institute of Allergy and Infectious Diseases
at the National Institutes of Health in Bethesda, Maryland.
Media inquiries can be directed to the NIAID Office of Communications at 301-402-1663,
NIAID conducts and supports research — at NIH, throughout the United
States, and worldwide — to study the causes of infectious and immune-mediated
diseases, and to develop better means of preventing, diagnosing and treating
these illnesses. News releases, fact sheets and other NIAID-related materials
are available on the NIAID Web site at http://www.niaid.nih.gov.
The National Institutes of Health (NIH) — The Nation's
Medical Research Agency — includes 27 Institutes and
Centers and is a component of the U.S. Department of Health and
Human Services. It is the primary federal agency for conducting
and supporting basic, clinical and translational medical research,
and it investigates the causes, treatments, and cures for both
common and rare diseases. For more information about NIH and
its programs, visit www.nih.gov.
1. Hall et al. 2008. Estimation of HIV incidence in the United States. JAMA 300(5):525.
2. Centers for Disease Control and Prevention (CDC). 2009. HIV/AIDS
Surveillance Report, 2007. Vol. 19. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, p. 14.
3. Ibid., p. 29.
4. Campsmith et al., 2009. Undiagnosed HIV prevalence in the United States
at the end of 2006. Poster presentation 1036, 16th Conference on Retroviruses
and Opportunistic Infections (CROI), Montreal.
5. CDC. 2008. HIV prevalence estimates — United States, 2006. MMWR 57(39):1075.
6. CDC. 2009, p. 22.
8. See, for example,