title: Within the hidden epidemic: sexually transmitted diseases and HIV/AIDS among American Indians and Alaska Natives.
abstract: OBJECTIVE
  To review the epidemiology, research, and prevention programs for sexually transmitted diseases in American Indians and Alaska Natives (AI/ANs).
  
  
  METHODS
  We reviewed the current national and regional trends in sexually transmitted diseases (STDs) for AI/ANs from 1998-2004, peer-reviewed studies from January 1996, through May 2006, and reports, unpublished documents, and electronic resources addressing AI/AN STD prevention and control.
  
  
  RESULTS
  STD prevalence among AI/ANs remains high. For example, the case rate of C. trachomatis in the North Central Plains AI/AN populations is 6 times the overall US rate. Trends for C. trachomatis also show sustained increases. Little research exists on STDs for this population, and most is focused on HIV/AIDS. Fear of compromised confidentiality, cultural taboos, and complex financial and service relationships inhibit effective surveillance, prevention, and management.
  
  
  CONCLUSIONS
  Recommendations for STD control in this population include improved local surveillance and incorporation of existing frameworks of health and healing into prevention and intervention efforts. Research defining the parameters of cultural context and social epidemiology of STDs is necessary.
authors.affiliation: American Indian and Alaska Native Programs, University of Colorado at Denver and Health Sciences Center, Aurora, Colorado 80045, USA. carol.kaufman@uchsc.edu
authors.forename: Carol E
authors.initials: CE
authors.lastname: Kaufman
authors.forename: Laura
authors.initials: L
authors.lastname: Shelby
authors.forename: Debra J
authors.initials: DJ
authors.lastname: Mosure
authors.forename: Jeanne
authors.initials: J
authors.lastname: Marrazzo
authors.forename: David
authors.initials: D
authors.lastname: Wong
authors.forename: Lori
authors.initials: L
authors.lastname: de Ravello
authors.forename: Stephanie Craig
authors.initials: SC
authors.lastname: Rushing
authors.forename: Victoria
authors.initials: V
authors.lastname: Warren-Mears
authors.forename: Lisa
authors.initials: L
authors.lastname: Neel
authors.forename: Sara Jumping
authors.initials: SJ
authors.lastname: Eagle
authors.forename: Scott
authors.initials: S
authors.lastname: Tulloch
authors.forename: Francine
authors.initials: F
authors.lastname: Romero
authors.forename: Sarah
authors.initials: S
authors.lastname: Patrick
authors.forename: James E
authors.initials: JE
authors.lastname: Cheek
mesh_terms: D000413:Alaska / Q000453:epidemiology; D004196:Disease Outbreaks; D015658:HIV Infections / Q000453:epidemiology* / Q000208:ethnology / Q000821:virology; D006801:Humans; D007198:Indians, North American / Q000706:statistics & numerical data*; D004930:Inuit / Q000706:statistics & numerical data*; D011159:Population Surveillance / Q000379:methods; D015995:Prevalence; D012309:Risk-Taking; D012749:Sexually Transmitted Diseases / Q000453:epidemiology* / Q000208:ethnology / Q000382:microbiology / Q000821:virology; D012959:Socioeconomic Factors