Innovative Approaches to HIV Prevention Among Native American Youth

The theme of this year's National Native American HIV/AIDS Awareness Day (NNAHAD) on March 20 was "Unity in CommUNITY: Stand Strong for HIV Prevention." Panelists in a webinar sponsored by What Works in Youth HIV ahead of NNAHAD showcased a few HIV prevention initiatives that target Native American/Alaska Native (NAAN) youth.

HIV prevalence in NAAN communities is undercounted, Pamela Jumper Thurman, Ph.D., of the Cherokee Nation and Colorado State University noted. Native Americans are often misrepresented in statistics. Access to medical care, including HIV testing, is limited on many Native American reservations (rez), which means fewer people are diagnosed with HIV. Higher rates of sexually transmitted diseases, alcohol and substance use, teen pregnancy and poverty compared with the white population put NAAN at higher risk for HIV. Yet, tribal leadership may not acknowledge this problem and therefore not act on it.

This is where innovative prevention campaigns, such as the Rez Condom Tour, can help, explained Keioshiah Peter, B.A., of the Diné people (Navajo) in New Mexico. The tour developed materials based on the tribe's philosophy. Tour organizers emphasize respect for tribal elders. They distribute condoms and printed materials at flea markets, fairs, parades and similar events. Most of the response to these activities has been positive, with only a few hateful comments. The tour's message is not limited to HIV prevention but addresses all aspects healthy sexuality and relationships. This includes starting a conversation about sexual identity and expression as a first step to combat homophobia in the community. Other tribes may adapt the material to their own unique culture and philosophy with help from the tour organizers.

LGBT characters are a prominent storyline in an HIV prevention video aimed at young Native Americans in the Pacific Northwest, Stephanie Craig Rushing, Ph.D., M.P.H., of the Northwest Portland Area Indian Health Board said. The video, Native Voices, comes with a facilitator's guide and different lesson plans, depending on available time and resources. It is part of a website for educators and teachers that includes culturally appropriate sexual health curricula for different age groups. Other groups and educators can upload their own curricula to this website. There is a companion multimedia website, We R Native, for teenagers and young adults that provides information on mental, physical and sexual health.

Another video program was created for Alaskan Native high schoolers in rural communities, Cornelia Jessen, M.A., of the Alaska Native Tribal Health Consortium reported. The script for Safe in the Village was developed in collaboration with tribal entities and young people. It emphasizes respect for teenagers' decisions to delay sexual activity or decline alcohol and drugs, and it discusses interpersonal violence and the need for talking to a trusted adult. The video's impact has been evaluated by surveys in communities that did not participate in the making of the film. The program also includes a social media campaign and a version of the movie as mini episodes.

To tackle seroconversions among NAAN youth, the stigma surrounding conversations about sex or sexuality that persists in many Native communities must be addressed, panelists agreed. This is particularly important for LGBT youth in those communities. The approaches detailed above are attempts to break through that stigma.