On National Native HIV/AIDS Awareness Day, the National Institute of Allergy and Infectious Diseases (NIAID), part of NIH, joins American Indians, Alaska Natives and Native Hawaiians in remembering those who have succumbed to HIV/AIDS. We at NIAID reaffirm our commitment on this occasion to the goal of controlling and ultimately ending this devastating pandemic.

An estimated 3,500 American Indians and Alaska Natives have been diagnosed with AIDS;^[1] more than 1,790 already have died.^[2] Tragically, the proportion of American Indians and Alaska Natives who survive after an AIDS diagnosis is smaller than that of any other U.S. racial or ethnic group.^[3] Compared with white people in the United States, American Indians and Alaska Natives suffer a higher rate of HIV infection: 14.6 cases versus 11.5 cases per 100,000 in 2006, the most recent year for which nationwide HIV incidence data are available.^[4] Native Hawaiians and other Pacific Islanders represented 13 percent of all Hawaiians with AIDS at the end of 2008,^[5] although they composed only 9.1 percent of the Hawaiian population.^[6]

Stigmatization of homosexuality in native communities poses a formidable challenge to HIV/AIDS prevention and treatment efforts, as it likely discourages many men from getting an HIV test and, if needed, seeking counseling and treatment. Male-to-male sexual contact, with and without concomitant injection drug use, accounted for more than three quarters of the AIDS cases among male American Indians and Alaska Natives in 2007.^[7] Delaying HIV testing and treatment places infected individuals at greater risk for becoming extremely ill and spreading the virus further. Fostering the social acceptance of all people in native communities, including men who have sex with men, likely would help curb the spread of HIV.

High rates of alcohol and substance abuse in native communities also boost the risk of HIV transmission by increasing the chances that individuals will engage in additional risky behaviors, such as unprotected sex or needle-sharing. In 2007, 32 percent of female American Indians and Alaska Natives living with HIV/AIDS in 34 states had become infected through injection drug use, a greater percentage than any other minority gender group.^[8] Incorporating culturally sensitive HIV/AIDS prevention messages into intervention programs for drug and alcohol addiction and other health issues confronting native communities would augment the benefits of these programs.

Nearly 40 percent of American Indians and Alaska Natives in 34 states who received a new diagnosis of HIV infection in 2006 were diagnosed with AIDS less than a year later, indicating that they learned of their HIV infection after the virus had substantially damaged their immune systems.^[9] We as a nation must remove barriers to health care and routine HIV testing in native communities — and indeed, in all American communities — to improve the chances that individuals are diagnosed early in the course of HIV infection, when antiretroviral drugs can do the most good and opportunities for HIV prevention are greatest. Improved access to health care also would facilitate testing and treatment for other sexually transmitted infections, which place a burden on native communities and increase the risk of acquiring and spreading HIV.^[10]

I applaud the many individuals and organizations who are working in native communities to promote HIV testing, prevention and linkage to care; to foster tolerance of homosexuality; and to reduce alcohol and substance abuse. We at NIAID stand with American Indians, Alaska Natives and Native Hawaiians in the ongoing battle against the HIV/AIDS pandemic.

Dr. Fauci is director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health in Bethesda, Maryland.

Each year, the NIH Office of AIDS Research (http://www.oar.nih.gov/) produces a Trans-NIH Plan for HIV-Related Research that identifies strategic priorities for all areas of HIV/AIDS research. The plan is developed in collaboration with experts from the NIH institutes and centers, other government agencies, non-governmental organizations and HIV/AIDS community representatives. The Fiscal Year 2011 Trans-NIH Plan for HIV-Related Research contains a chapter specifically devoted to research addressing HIV/AIDS in special populations, including racial and ethnic minorities (http://www.oar.nih.gov/strategicplan/fy2011/index.asp).

For more information about HIV/AIDS, please visit www.aids.gov and NIAID’s HIV/AIDS portal (http://www3.niaid.nih.gov/topics/HIVAIDS/). To volunteer for an HIV/AIDS clinical trial, go tohttp://www.clinicaltrials.gov/ct2/results?term=HIV&recr=Open.

NIAID conducts and supports research — at NIH, throughout the United States, and worldwide — to study the causes of infectious and immune-mediated diseases, and to develop better means of preventing, diagnosing and treating these illnesses. News releases, fact sheets and other NIAID-related materials are available on the NIAID Web site athttp://www.niaid.nih.gov.

The National Institutes of Health (NIH) — The Nation's Medical Research Agency — includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

1. Centers for Disease Control and Prevention (CDC). 2009. HIV/AIDS Surveillance Report, 2007. Vol. 19, Table 4.http://www.cdc.gov/hiv/topics/surveillance/resources/reports/2007report/default.htm.

2. Ibid., Table 8.

3. Ibid., Figure 4.

4. Ibid., Table 3.

5. Hawaii State Department of Health. 2009. HIV/AIDS Surveillance Semi-Annual Report, p. 2.http://hawaii.gov/health/healthy-lifestyles/std-aids/aboutus/prg-aids/aids_rep/2h2008.pdf.

6. U.S. Census Bureau. 2010. State & County QuickFacts: Hawaii. http://quickfacts.census.gov/qfd/states/15000.html.

7. CDC, Table 13.

8. Ibid., Table 10.

9. Ibid., Table 2.

10. CDC. 2009. Sexually Transmitted Disease Surveillance, 2008, pp. 65–69. http://www.cdc.gov/std/stats08/main.htm.