In 2017, the Centers for Disease Control and Prevention (CDC) reported a 70% increase in HIV diagnoses among American Indians and Alaska Natives over the prior six years.
This week, data presented at the 2019 National HIV Prevention Conference (NHPC) offered new insight on that sobering statistic.
The data, presented in a poster by CDC epidemiologist Amy R. Baugher, M.P.H., found that American Indians and Alaska Natives living with HIV are more likely to experience homelessness, incarceration, and depression than other Americans living with HIV. They're also more likely to report HIV medication side effects and less likely to have access to HIV support services.
But Baugher's research also revealed a surprisingly hopeful statistic: Despite their socio-demographic challenges, indigenous Americans living with HIV are just as likely to adhere to antiretroviral treatment.
"The real takeaway," said Baugher, "is that American Indians and Alaskan Natives -- despite having some sub-optimal social determinants and behavioral factors -- still have HIV clinical outcomes that are on par with other groups."
"That's something that needs to be looked at more," said Baugher. Her research relied on data analysis from the CDC's Medical Monitoring Project, a national surveillance system that collects behavior data from U.S. adults in HIV care.
In general, indigenous Americans are woefully underrepresented in HIV research. For example, although CDC Director Robert Redfield, M.D., highlighted American Indians and Alaska Natives as an overlooked group during NHPC's opening plenary session, the conference itself included very little research focusing on HIV among this population.
Among the approximately 800 abstracts featured at NHPC, Baugher's poster was one of only two focusing specifically on American Indians and Alaska Natives. The dearth of research, Baugher explained, is likely because of the relatively small number of HIV cases among Native Americans compared to other groups.
Though striking, the 70% increase in HIV diagnoses reported in 2017 stems from a relatively small number of new diagnoses in American Indians and Alaska Natives, from 143 in 2011 to 243 reported in 2016. For comparison, 17,269 African Americans were diagnosed with HIV in 2016.
Despite their small numbers, American Indians and Alaska Natives ranked fourth highest in HIV diagnosis rates among all racial and ethnic groups. Yet the small population size means researchers like Baugher have to wait until they have several years of accumulated results in order to perform a robust analysis.
In Baugher's case, she collected HIV diagnosis data from 2011 to 2014 for a total population of 666 people. She collected for a broader definition of American Indian or Alaska Native, meaning that her study included people who were multi-ethnic. In the past, other researchers have maintained a narrower definition of indigenous ethnicity, but Baugher says there is good reason to include a broader definition for reported ethnicity.
"Because so many people are multiracial, I didn't want to make the decision on their behalf about whether they are experiencing something or not," she said. Overall, the study included 18,975 HIV-positive individuals, of whom 3.6% identified as American Indian or Alaska Native.
Compared to the average of other groups, indigenous Americans were more likely to report depression and binge drinking in the past two weeks or 30 days, respectively. But they were also more likely to have a high school degree, and about as likely to achieve viral suppression.
Though Baugher's research brought more clarity to the specific challenges facing American Indians and Alaska Natives living with HIV, it's still not clear exactly what could be driving the recent uptick in new diagnoses.
"I can't say for sure why that's happening," said Baugher, but this is "an important group to continue looking at."
Sony Salzman is a freelance journalist reporting on health care and medicine, who has won awards in both narrative writing and radio journalism. Follow Salzman on Twitter: @sonysalz.