Indians and Alaska Natives (Al/AN) is small (less than 2 ... the United States report AIDS cases with- out personal ... (White, Black, Hispanic, Asian/Pacific Is-.
AIDS Surveillance among American Indians and Alaska Natives Russ Metler, RN, MSPH, George A. Conway, MD, MPH, and Jeanette Stehr-Green, MD
Infodudion
Results
Although the population of American Indians and Alaska Natives (Al/AN) is small (less than 2 million), it includes highly diverse cultures and geography. Compared with the total US population, AJ/AN are younger, less educated, less likely to be employed, and poorer.1 These factors, combined with high rates of sexually transmitted diseases2-5 and drug use among AI/AN,6,7 may favor the spread of the human immunodeficiency virus (HIV).8 We compared selected demographic and risk characteristics among AT/AN with the acquired immunodeficiency syndrome (AIDS) and persons with AIDS of other raciaVethnic groups reported to the Centers for Disease Control (CDC) through 1990.
Al/AN had 237 AIDS cases reported through 1990, the lowest cumulative total of any race/ethnicity. The rate of reported AIDS cases per 100 000 population for 1990 was low for AlAN (4.0) relative to Blacks (42.5), Hispanics (31.9), and Whites (11.8). The rate for AlAN was similar to that for A/PI (3.8). Comparisons based on cases diagnosed in 1989 and 1990, with adjustments made for reporting delay, showed AVAN with the greatest relative increase (23.1%), compared with Hispanics (13.3%), Blacks (12.0%), Whites (2.5%) and A/PI (-8.8%).13 The exposure category distribution of AlAN AIDS cases differed from other groups, with a smaller proportion of cases attributed to homosexual/bisexual contact (53%) than Whites (76%) but a higher proportion than for Blacks (35%) or Hispanics (39%) (Table 1). The proportion of cases attnbuted to intravenous drug use among women and heterosexual men in AlAN (16%) was greater than for Whites (8%), but less than for Blacks (38%) and Hispanics (39%). AlAN had the lowest male-to-female ratio ofAIDS cases due to intravenous drug use. Of 37 Al/AN women with AIDS, 17 were intravenous drug users and 5 were heterosexual contacts of intravenous drug users. Overall, 79 (33%) of the AVAN AIDS cases had risk factors associated with intravenous drug use. Nearly half the AVAN with AIDS were first diagnosed at either a federal or nonfederal government facility (Table 2). However, only 9% of all cases were initially diagnosed at an Indian Health Service (IHS) facility. In four states (Alaska, Arizona, New Mexico, and Oklahoma) with a high percentage of AlAN served by IHS (data provided by the Division of
Methds State and local health departments in the United States report AIDS cases without personal identifiers to CDC. Among the variables collected are risk factors for HIV infection, setting where first AIDS diagnosis was made, and race/ethnicity (White, Black, Hispanic, Asian/Pacific Islander [A/PT], and Al/AN). Race/ethnicity is generally determined from available medical records. AIDS cases reported to CDC as of December 31, 1990, were compared by race/ethnicity. Population data for rate calculations were based on 1990 census estimates.9 For Al/AN cases, the hospital of AIDS diagnosis was compared for type of organization in theAmencanHospitalAssociation Guide to the Health Care Field 10 Nonhospital facilities were coded consistent with the American Hospital Association's classification scheme. All civilian applicants for US military service are tested for HIV infection.11,12 From data provided by the Office of the Assistant Secretary of Defense (Health Affairs), HIV results for military recruit applicants examined from October 1985 through December 1990 were analyzed by race/ethnicity. Of the 2 946 895 applicants screened, 20 036 (0.7%) were AlAN.
The authors are with the Division of HIV/ AIDS, Center for Infectious Diseases, Centers for Disease Control, Atlanta, Ga. Requests for reprints should be sent to Russ Metler, RN, MSPH, Division of HIV/ AIDS, E47, CID, CDC, Atlanta, GA 30333. This paper was submitted to the journal December 11, 1990, and accepted with revisions July 9, 1991.
American Journal of Public Health 1469
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