Skip to site content

IHS Awards Address HIV Syndemic in Indian Country

by Andrew Yu, MS, RN, ACRN, HIV/HCV/STI Clinical Coordinator, Division of Clinical and Community Services

On World AIDS Day, recognized on December 1, the Indian Health Service is bringing attention to the current human immunodeficiency virus (HIV), hepatitis C (HCV) and sexually transmitted infection syndemic affecting many parts of Indian Country. This day is an opportunity for people worldwide to unite in the fight against HIV, to show support for people living with HIV, and to commemorate those who have died from an HIV-related illness. In recognition of World AIDS Day, the IHS National HIV/HCV/STI program is sharing news and resources about its commitment to end the HIV epidemic in Indian Country on its website.

In 2022, the IHS announced the availability of $2.5 million in cooperative agreements to End the HIV and HCV Epidemics in Indian Country, known at IHS as the ETHIC Program. Seven tribal and urban Indian organizations received $1.2 million in funding to work towards eliminating HIV, HCV and STIs. Here are grantee highlights and accomplishments from the first year of funding, framed by the EHE pillars of Diagnose, Treat, Prevent and Respond:

Albuquerque Area Indian Health Board, Inc. – Albuquerque, New Mexico

ETHIC funding was utilized to serve 27 tribes in the Albuquerque area heavily impacted by HIV, HCV and STIs. Access to care, including HIV, HCV, STI testing and HIV pre-exposure prophylaxis (PrEP) has been limited, especially for those residing in rural areas. To address this, the health board distributed testing and safer sex supplies directly to tribal communities. ETHIC funds were also used to certify public health staff as HIV, HCV and STI counselors/testers and conduct referral services. AAIHB trained health care providers on HIV PrEP implementation while honoring spiritual and cultural values. Additionally, the health board developed regional strengths-based and trauma-informed social media marketing campaigns to raise community awareness of prevention and treatment strategies.

The Chickasaw Nation – Ada, Oklahoma

The Chickasaw Nation utilized ETHIC funding to hire a full-time registered nurse case manager and program coordinator. This position provides the ability to conduct follow-up and assess adherence to medications and medical appointments. ETHIC funding was also utilized to purchase thousands of HIV screening tests and phlebotomy supplies, resulting in significant increases in HIV screening. Reducing new HIV infections is critical as Oklahoma is identified as an EHE focus state with a substantial HIV burden in rural areas. In addition, the Chickasaw Nation developed standardized screening tools to implement opt-out HIV testing, created awareness campaigns to help promote sexual health education and HIV PrEP services, immediately linked people testing positive for HIV/HCV/STIs to care, and trained additional medical and clinical staff on HIV, HCV and STI issues.

First Nations Community HealthSource – Albuquerque, New Mexico

FNCH’s goal remains to reduce new HIV and HCV diagnosis rates by increasing prevention services, testing, and treatment available to American Indian and Alaska Native people in New Mexico. With ETHIC funding, they were able to hire HIV prevention specialists, conduct HIV and HCV testing with counseling services, provide prevention education, and rapidly link people to HIV, HCV and STI treatment and HIV PrEP services. FNCH plans on hiring additional HIV prevention specialists to expand its ability to conduct testing and counseling outside the walls of the clinic and directly in the community. First Nations also provides case management services to newly diagnosed people living with HIV to improve retention in care and reach sustained viral suppression.

Native American Rehabilitation Association of the Northwest – Portland, Oregon

The association expanded its access to HIV, HCV, and STI testing by purchasing rapid test and conducting testing across several clinical sites. The testing kits purchased using the ETHIC funds also provided an option for individuals to test themselves at home. Funding also increased the ability to provide linkage to treatment services for individuals that tested positive. NARA NW will continue to plan on hiring a STI registered nurse and project coordinator to conduct frequent educational training on HIV, HCV, and STI prevention, diagnosis, and treatment across all the association’s sites. In addition, they implemented the ability to provide HIV PrEP and developed videos with medical providers, the Two-Spirit community, and youth for prevention and advocacy messaging.

Rosebud Sioux Tribe – Rosebud, South Dakota

The Rosebud Sioux Tribe utilized ETHIC funding by hiring a project coordinator to work on improving outreach, screening events, data management, collaboration with neighboring tribal programs, and to work with the RST correctional facility and support HIV and HCV screening and care navigation. This position is vital as Todd County, South Dakota, the seat of the Rosebud Indian Reservation, has the highest HCV rate among non-urban counties in South Dakota and the fourth highest of all U.S. counties for liver-disease-related mortality. In addition, care navigation will result in a reduction of frequent delays and interruptions in treatment, leading to better medication adherence and the ability to achieve viral suppression rapidly.

Seattle Indian Health Board – Seattle, Washington

With ETHIC funding, SIHB responded to the HIV and HCV epidemics with the goal of reducing new HIV and HCV infections in Seattle-King County’s American Indian and Alaska Native communities. Reducing infections is critical as Seattle-King County is an EHE focus jurisdiction and the most populous county in Washington state. The county is home to approximately 7,000 individuals living with HIV. ETHIC has provided the ability to rapidly link care for American Indians and Alaska Natives diagnosed with HIV, HCV and STIs, including treatment initiation. In addition, SIHB was able to increase the number of individuals on HIV PrEP, and started providing HIV post-exposure prophylaxis on-site, which was a significant step to lowering barriers for individuals seeking this time-sensitive preventative treatment.

Southern Indian Health Council, Inc. – Alpine, California

The SIHC’s primary goal remains to expand its Roaming Outpatient Access Mobile Program, a mobile clinic providing outpatient medical, dental and behavioral health services to seven consortium tribal reservations in southern California. To increase access to care and to meet the needs of Native youth, funding will expand ROAM services by increasing hours of operation to include evenings and weekends, and provide resources at youth-oriented events. With ETHIC funds, SIHC was able to hire a full-time registered nurse to provide free rapid testing and counseling, engage directly with the community at local events to provide information on where to access HIV, HCV, STI testing and treatment, and provide free human papillomavirus 9-valent vaccines for HPV prevention.

Andrew Yu, MS, RN, ACRN, HIV/HCV/STI Clinical Coordinator, Division of Clinical and Community Services
Andrew Yu is the national HIV/HCV/STI clinical coordinator for the Indian Health Service Division of Clinical and Community Services. He obtained his Bachelor of Science in Nursing from Georgetown University and his Master of Science in Community and Public Health Nursing from Hunter College - CUNY. He is also certified as an HIV/AIDS care registered nurse and an active member of the Association of Nurses in HIV/AIDS Care.