MEXICO CITY – Indigenous communities in the Americas are largely being left out of efforts to achieve UNAIDS’ global HIV elimination targets of 90 percent of people knowing their HIV status by 2020, 90 percent of people diagnosed with HIV accessing lifesaving antiretroviral therapy, and 90 percent of people on treatment achieving viral suppression, indigenous leaders said here. Rather than being included in 90-90-90, indigenous communities in the Americas are a part of the 10-10-10 – the people being left out of efforts to accelerate global HIV responses, Trevor Stratton of the Canadian Aboriginal AIDS Network said.
HIV infections risks, barriers to treatment and services and marginalization are amplified for indigenous peoples who are also transgender or nonbinary, leaders said.
Facing barriers that include structural and sexual violence, racism, poverty, linguistic barriers and issues around migration these populations remain both more vulnerable to HIV infection, less likely to access services and also less likely to have services tailored to their unique needs by HIV programs, Amaranta Gomez of the Mexican Coalition LGBTTI+ said. Gomez identifies as Muxe – a third gender identity historically rooted in pre-Hispanic Latin American indigenous populations.
“Indigenous communities remain one of the most marginalized people in the word,” Roberto Orellana of Portland State University said. “Extreme poverty, low educational attainment, histories of trauma, domestic violence, lack of access to health care – these are all issues indigenous communities face daily which are risk factors for HIV,” he said.
In Canada, indigenous peoples account for less than five percent of the Canadian population yet account for 11 percent of new HIV infections in 2016 and 10 percent of all Canadians living with HIV, Orellana said. In the U.S., new HIV diagnoses among indigenous populations increased by 46 percent and by 81 percent among gay and bisexual indigenous men in 2017, he said.
Indigenous individuals diagnosed with HIV progress to AIDS much more quickly than individuals from other ethnic groups, Orellana added, suggesting not only delays in diagnosis but poorer health outcomes once diagnosed.
In a study examining the relationship between trauma, stress and health behaviors among Two Spirit individuals – members of indigenous communities in North America that embody two genders – Orellana found Two Spirit individuals who experienced discrimination because of their identity were 53 percent more likely to engage in sexual behaviors that increased their HIV risk, like having unprotected anal sex. However, when members of the community participated in Two Spirit cultural events, that risk went away, Orellana said, indicating that social acceptance acted as a protection against HIV.
“90-90-90 isn’t going to happen in indigenous groups unless social and structural factors that increase vulnerability to HIV are addressed,” he said.
Indigenous communities are also disproportionately affected by tuberculosis and TB-HIV coinfection, Wendy Wobeser of Queen’s University in Canada, said. While globally, there has been a 42 percent reduction in deaths from TB among people infected with HIV, that number has increased by seven percent in Latin America, Wobeser said.
Strengthening access to rapid TB diagnosis is a top priority for accelerating efforts against TB-HIV coinfection, she said, estimating that over 10,000 cases of TB-HIV in the region are going undetected.
Indigenous communities – often situated in rural areas – lack access to health centers and information, Gomez said, which increases their vulnerability to HIV and other sexually transmitted infections. “There are villages where many people don’t even know what HIV is,” she said. “How can we reach 90-90-90 if they don’t know?”
“We need to indigenize our responses,” Stratton said, “and work with people how and where they are rather than trying to change them to make them good enough to access services,” he said.