HIV-Related Disparities in American Indian, Alaska Native Patients

Offering screening and referrals for mental health and peer support services can improve HIV outcomes in American Indian and Alaska Native patients.

Understanding the experiences and needs of American Indians and Alaska Natives (AI/ANs) with HIV can help health care providers improve outcomes in this patient population, according to the CDC’s Morbidity and Mortality Weekly Report.

In 2016, the CDC estimated that American Indians and Alaska Natives (AI/ANs) had the fourth highest HIV diagnosis rate among all racial/ethnic groups. For the report, CDC officials analyzed data from the Medical Monitoring Project, a surveillance system that collected information from 2011 to 2015 among AI/AN adults receiving HIV medical care.

According to the study, diagnoses of HIV infection among AI/AN patients increased by 70% from 2011 to 2016, signaling a need to address and improve care in this population. The data indicated that, among adults receiving HIV care from 2011 to 2016, AI/ANs had high poverty levels (51%), depression (27%), HIV stigma (78%), and suboptimal sustained HIV viral suppression (64%), based on self-reporting.

Furthermore, 12% of AI/AN patients experienced homelessness in the past 12 months and 6% had been incarcerated in the past 12 months. Compared with other racial/ethnic groups, the authors noted a higher rate of poverty among AI/AN patients.

The study also showed that internalized HIV-related stigma was reported by 78% of patients, while 37% experienced health care discrimination since receiving a diagnosis.

Among AI/AN patients in HIV care, 27% reported symptoms consistent with major/other depression in the past 2 weeks, 12% were dissatisfied with their social support, 20% reported binge drinking, 32% used non-injection drugs and 5% used injection drugs in the past 12 months, and 46% currently smoked cigarettes.

“Receiving culturally appropriate mental health and peer group support services could reduce symptoms of depression and increase social support,” the authors wrote.

They also noted that some patients in the analysis needed, but did not receive, these services.

Additionally, 86% of AI/AN patients on antiretroviral therapy were adherent, 64% had achieved sustained viral suppression, and 76% had achieved viral suppression as of their most recent viral load test in the past 12 months.

“Because of historical factors affecting AI/AIN populations, AI/AN patients receiving HIV care face unique circumstances that might interfere with their ability to achieve sustained viral suppression, including a high prevalence of poverty, depression, stigma, and substance use,” the authors wrote in the study.

They concluded that HIV providers and clinics should offer screening for mental health and peer support services to improve the health outcomes in this population and reduce HIV-related disparities.

Reference

Baugher AR, Beer L, Bradley HM, et al. Behavioral and clinical characteristics of American Indian/Alaska Native adults in HIV care — Medical Monitoring Project, United States, 2011-2015. Morbidity and Mortality Weekly Report. https://www.cdc.gov/mmwr/volumes/67/wr/mm675152a1.htm?s_cid=mm675152a1_w