The study also indicates that HIV rates among American Indian women may be much higher than suggested by HIV/AIDS surveillance data collected by the federal government. Specifically, 3 percent of the women in the study reported being HIV-positive, while 1 percent refused to answer questions about HIV and 7 percent said they did not know their HIV status. According to latest available data from the Centers for Disease Control, only 388 American Indian women in the United States, or .0002 percent, are living with HIV/AIDS.
Overall, 52 percent of 155 women surveyed reported being abused physically or sexually, or both. In addition, 91 percent of the women, all living in New York or New Jersey, had engaged in at least one lifetime risky sexual behavior and 7 percent said they had injected illegal drugs, according to the paper which appears in the current issue of the journal AIDS & Behavior.
"This is particularly distressing as it indicates that almost all participants could have been exposed to HIV infection at some point in their lives, seemingly belying the majority's reports of being at no or low risk for HIV," write University of Washington professors Jane Simoni and Karina Walters, the study's lead authors.
"Of even greater concern, however, is that 58 percent had participated in at least one lifetime high-risk sexual behavior such as sex with a stranger or an HIV-positive individual, and, therefore, may have been even more likely to be exposed to HIV."
The study was part of a comprehensive assessment of HIV risk behaviors, including intravenous drug use, and prevention needs among American Indians living in metropolitan New York funded by the New York City Department of Health. The data on the American Indian men are currently being analyzed.
"American Indian women are the group at highest risk for assault in our society and this accelerates their risk for adverse health consequences," said Simoni, a UW associate professor of psychology. She noted that the rate for assault against these women is 30 percent higher than it is for black males, the group with the second-highest assault victimization rate.
Walters, an associate professor of social work and an enrolled member of the Choctaw Nation, said trauma has a pernicious effect on the family and has the potential to devastate the entire Indian community because there is considerable circular migration between urban areas, where 60 percent of American Indians now live, and reservations. Eleven percent of the women in the study had lived on a reservation or their tribal lands in the previous year, she said. New York City now has the largest urban Indian population in the country, jumping ahead of Tulsa, Okla., and Los Angeles in the past decade.
"We need to see that any future HIV intervention and prevention messages and programs directed at Indians include assessments of physical and sexual trauma, as well as drug use and sexual risk taking," said Walters.
Historical traumas experienced by Indians also have left many individuals suspicious of medical institutions and the intentions of health-care providers, she added. Of the women surveyed, 36 percent agreed or strongly agreed that AIDS is another form of germ warfare against Indians. This means any community-based HIV program will have to assume high levels distrust.
"Despite the high rates of traumas and other negative findings, there are a number of healthy behaviors going on in Indian communities. Condom use is high and so is awareness of HIV," Walters said.
"We need to focus on the strengths of the Indian community and are interested in knowing what protects people against risk factors. We want to know who does well and why, and the role that such factors as a person's strength of Indian identity, traditional healing practices and community involvement has in prevention."
Shalini Sehgal, now a staff psychologist at VA New York Harbor Healthcare System, is a co-author of the study.