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Risk Factors

Race and ethnicity are not, by themselves, risk factors for HIV infection. However, American Indian/Alaska Natives (AI/AN) may face additional challenges associated with risk for HIV infection, including the following.

Sexual Risk Factors
The presence of a sexually transmitted disease can increase the chance of contracting or spreading HIV. High rates of Chlamydia trachomatis infection, gonorrhea, and syphilis among AI/AN suggest that the sexual behaviors that facilitate the spread of HIV are relatively common among AI/AN. According to 2005 surveillance data by race/ethnicity, the 2nd highest rates of gonorrhea and Chlamydia trachomatis infection were those for AI/AN. The 3rd highest rate of syphilis was that for AI/AN.

Substance Use
People who casually or habitually use illicit drugs or who abuse alcohol are more likely to engage in risky behaviors such as unprotected sex when under the influence of drugs or alcohol. Results of the 2019 National Survey on Drug Use and Health [PDF - 3.2 MB] Exit Disclaimer: You Are Leaving  indicate that 10.2% of AI/AN people aged 18 or older had a substance use disorder.

Cultural Diversity
To be effective, HIV/AIDS prevention interventions must be tailored to specific audiences. The American Indian and Alaska Native population makes up 564 federally recognized tribes plus at least 50 state-recognized tribes. Because each tribe has its own culture, beliefs, and practices and these tribes may be subdivided into language groups, it can be challenging to create programs for each group. Therefore, prevention programs that can be adapted to individual tribal cultures and beliefs are critically important. Current programs emphasize traditional teachings and the importance of the community.

Socioeconomic Issues
Issues related to poverty (for example, lower levels of education and poorer access to health care) may directly or indirectly increase the risk for HIV infection. Socioeconomic factors, such as poverty, coexist with epidemiologic risk factors for HIV infection in American Indian and Alaska Native communities. During 2002–2004, approximately one quarter (24.3%) of AI/AN - about twice the national average (12.4%) - were living in poverty. The proportion of the American Indian and Alaska Native population with a high school diploma (66%) in 1990 was less than the national average (75%).

Life expectancy for AI/AN is shorter than that for persons of other races/ethnicities in the United States; the rates of many diseases, including diabetes, tuberculosis, and alcoholism, are higher; and access to health care is poorer. These indicators demonstrate the vulnerability of AI/AN to additional health stress, including HIV infection.