New York Times (05.19.2013)
The Indian Health Service (IHS) reported 47 new HIV cases on the Navajo reservation in 2012—a 20-percent increase from 2011. Since 1999, HIV incidence in the Navajo tribe has increased fivefold, according to Dr. Jonathan Iralu, the report’s author. Iralu partly attributed the recent rise in diagnoses to earlier detection of the virus among tribe members.
When AIDS emerged on the reservation in the late 1980s, patients tended to present late, and approximately one-third of patients died soon after diagnosis. Although improved treatment and awareness campaigns initially lowered incidence and mortality, cultural stigma remains a major barrier to HIV prevention. The Navajo rarely disclose HIV infection or discuss it publicly. IHS previously concluded that most new HIV cases originated among Navajo who traveled off the reservation to urban areas; Iralu now fears that transmission is taking place among tribe members on the reservation.
Executive Director of the Navajo AIDS Network (NAN) Melvin Harrison noted that most of NAN’s 65 patients have not disclosed their HIV status. Approximately 75 percent of NAN’s clients are gay Navajo men who do not make their relationships public. Men who have sex with men account for approximately half of the new HIV cases on the reservation. The intimate nature of the reservation also creates a barrier, as clients may know the staff at the clinic.
From 1998 to 2005, HIV incidence among the Navajo was close to the rate among whites and lower than among Hispanics and blacks. However, mortality has remained higher among HIV-infected Navajo, possibly because of co-morbidity with diabetes and drug and alcohol abuse. NAN, IHS, and Dr. Iralu’s clinic have increased prevention efforts, including distributing condoms, promoting awareness in social media, and providing public service messages in Navajo.