Frequently Asked Questions (FAQs)
Q. What is the magnitude of HIV/AIDS
in the American Indian / Alaska Native population? (Please also refer to ‘Fact
According to CDC data, over the past 6 years, prevalence and incidence of HIV/AIDS in the AI/AN population has either continued to remain stable or has increased.
When population size is taken into account, AI/AN rank third in the US (among all ethnicities) in rates of HIV/AIDS cases.
The rates have been higher than that of whites since 1995 and have not decreased since the late 1990s.
Present in both urban and rural populations.
Surveys of sexually transmitted diseases (STD), sexual behavior and alcohol and drug abuse treatment programs as well as inherent health disparities have proven the vulnerability for HIV in virtually all AI/AN communities.
Q. How is the IHS funded for HIV/AIDS prevention and treatment?
The IHS does not have a separate line item budget for HIV/AIDS treatment and prevention services.
Activities largely encompassed within the health services provided locally.
Primary source of funding for medical services is the Hospitals and Health Clinics budget (H&C).
The H&C budget funds the salaries and expenses of most of the health care providers within a hospital or clinic, staff, pharmaceuticals, medical supplies, etc., for a myriad of health problems and diseases (including HIV/AIDS).
HIV activities may also be a component of other programs including Health Education, Public Health Nursing, HPDP, etc.
The Minority AIDS Initiative (see link on webpage) funds a select number of projects within the IHS dealing with training, epidemiology, technology and telemedicine. Proposals are submitted annually.
Q. What HIV/AIDS prevention and treatment services are
provided at IHS facilities?
Services are essentially decentralized and executed with funding assigned to all the hospitals and clinics via the H &C budget. The budget supports services to clients/patients that have HIV/AIDS, mainly through the provision of treatment and care. However, additional activities may also executed depending on local allocations and capacity, which include (but are not limited to) the following:
- Risk Assessment and Prevention Surveillance
- Provision of HIV/AIDS information and prevention education
- Counseling, testing, and partner notification
- Children and youth in HIV prevention
- Training of health care providers on HIV/AIDS topics/issues
- Provide HIV/AIDS surveillance data (reporting) to CDC through State health departments.
- Enhanced technological applications and reporting systems
- Interagency agreements (IAA) and Memorandums of Understanding (MOU) that can bring needed services and initiatives to our clients from agencies and organizations outside of the IHS.
- Monitoring and evaluation of initiatives
- Clinical consultation and technical assistance to healthcare providers
Q. Does IHS have clinical guidelines for treating HIV/AIDS?
Providers/clinicians follow nationally accepted guidelines (i.e. DHHS HIV/AIDS Guidelines) and best practices for screening, diagnosis, treatment and care. Treatment and care is also individualized to each circumstance with evidence based medicine and professional experience. Our performance measures and program level QA reports support this. Area guidelines may exist, but are implemented less often since it is challenging to keep up with the changes of standard recommendations within HIV/AIDS, which can change frequently.
Q. How do IHS facilities track and report their HIV/AIDS
IHS facilities are under the same requirement to report HIV/AIDS cases to the State Health Department as any other health care facility. Misclassification does exist, however the magnitude is unknown.
An automated reporting mechanism exists through the Clinical Reporting System (CRS). This is not a mandated GPRA measure at this time.
The RPMS HIV Management System (HMS) is another automated mechanism, however is new and not mandated at this time..
Non-automated data mining tools also exist for identifying patients with a diagnosis of HIV.
The current GPRA measure dealing with HIV/AIDS is prenatal screening.
Q. Are AI/AN routinely screened for HIV/AIDS?
Given the risks and current epidemiological data, another major nationwide initiative is HIV/AIDS screening. Although reporting of HIV/AIDS among AI/AN to state health departments is generally accurate, we do not use all of the opportunities we could to screen for HIV and a large portion of the population remains untested. Data collection on this particular issue is also challenging given sensitivities and confidentiality issues of testing. With new CDC Guidelines for HIV testing released in September 2006, it is imperative we make every attempt to enhance screening processes and awareness. As a major focus of the IHS HIV/AIDS Program, it is hoped that the number of population screened will increase in the near future.
Q. When services are unavailable through IHS, what other sources of
care are available for AI/AN people with HIV/AIDS?
HIV care outside of the IHS would depend on the resources available to the patient, and the skills and competencies of the health care organizations and providers in the region.
Resources: Medicaid and Medicare (M/M) likely are the main payers of health care (as they are in any population). Private Insurance (PI) is also available to some. The VA is also a likely source of care. Over 50% of our patients have one of these resources. For those without M/M or PI, then Ryan White eligibility criteria may apply. The newly authorized Ryan White Treatment Modernization Act of 2006. An AI/AN person does not require and is not required to inform IHS of their seeking care (See more detailed info below).
Locations: HIV care is an emerging specialty though the practitioners are often generalists with a specific interest in the disease. Locations range from hospital based to free standing community clinic settings. County public health agencies are frequent testing and counseling sites as with most STDs.
AI/AN are eligible for the Ryan White CARE Act, including AIDS Drugs Assistance Program (ADAP). The AI/AN are seen as any other applicant at a state ADAP facility and eligibility is also the same.
These guidelines have been in existence for a few years now and have helped to ease the burden of an AI/AN seeking care/prescription drugs for his/her HIV/AIDS infection.
Q. Can you provide more details about the Ryan White Care
The Ryan White CARE Act (RWCA) was reauthorized (12/19/2006) as the “Ryan White HIV/AIDS Treatment Modernization Act of 2006 (RWMA)”. The language establishes opportunity for more seamless access to HIV/AIDS care and treatment. It is a privilege to note that this revised language is due in large part to the hard work, diligence, and passion of community members and organizations that came from within our AI/AN communities. The following RWMA provisions affect the IHS and AI/AN population:
AI/AN individuals are/were always eligible for RWCA services if requirements were met – same requirements as non AI/AN.
IHS federally operated Health Facilities will now be eligible to apply for services (as a direct grantee) under Title III and IV through the RWMA (in addition to previously authorized Urban Programs and 638 Tribal Facilities under RWCA).
IHS facilities are exempt from the “Payer of Last Resort” restriction for Titles I, II and III. Although RWCA grantees are the payer of last resort, this amendment exempts I/T/U facilities from reimbursement, regardless of referral.
The new legislature supports access for all AI/AN under RWMA regardless of I/T/U utilization/affiliation or geographic location. (Previously, HRSA Policy 00-01 stated that AI/AN could not be turned away from RWCA services, now, the RWMA codifies (that IHS is exempt from the Payer of Last Resort restriction) this language into law.
Planning council representation should include members from federally recognized Indian tribes as represented in the population.
Language surrounding AIDS Education and Training Centers (AETCs) now specifically names “Native Americans” as person(s) to be trained.
The Goal is to ensure that comprehensive, culturally acceptable personal and public health services are available and accessible to all American Indian and Alaska Native people.
Q. What type(s) of facilities and
providers make up the “IHS”?
The IHS is made up of three types of facilities: IHS-direct facilities (I), Tribally run facilities (T) and Urban health centers (U), thus ‘I/T/U’ will be utilized hereafter. Within each type of facility, there are differences in how programs are funded, organized and managed.
Federal system - 33 hospitals, 52 health centers, 38 health stations, 2 school health centers, 4 residential treatment centers, 34 urban Indian health projects (direct care, CHS).
Tribal system - 15 hospitals, 220 health centers, 116 health stations, 8 residential treatment centers, 9 school health centers, 180 Alaska village clinics (contract, compact).
Indian Health Service clinical staff (roughly)- 2,615 nurses, 896 physicians, 512 pharmacists, 387 engineers, 305 dentists, 171 sanitarians, 75 physician assistants, and other allied health professionals - nutritionists, health administrators, and medical records administrators.
Q. What are the estimates of the number of people who use IHS services (user population)?
IHS has the ability to collect data on user population from both IHS and Tribal facilities. Urban user population is reported to us from separate mechanisms, but is obtained as best possible. The tribal input (by roughly 68% of the tribes) accounts for roughly 85% of the tribal user population. The total reported for 2005 from all I/T/U facilities was roughly 1.5 million people.