American Indian gay, bisexual and two-spirit men: a rapid assessment of HIV/AIDS risk factors, barriers to prevention and culturally-sensitive intervention.
Epidemiological data indicate that HIV and AIDS are disproportionately affecting American Indians. Specific to American Indian men identifying as gay, bisexual, two-spirit or who have same-sex experiences, this study assessed HIV-risk behaviours and barriers to testing, prevention and treatment efforts. A rapid assessment model was utilised as an indigenous-supporting research design. Rigour and thoroughness were achieved via multiple validation procedures. Central themes surrounding barriers to HIV prevention included social discrimination, low self-esteem and substance use. Findings suggest the underutilisation of condoms due to ineffective placement and limited availability in popular locations among gay, bisexual and two-spirit individuals. Participants indicated that HIV testing is occurring less frequently and that testing was not available after hours or weekends. Barriers to treatment included a mistrust of the current healthcare system, a perceived lack of support from the Indian Health Service for AIDS care and a lack of transportation to healthcare appointments. Lastly, participants discussed and supported culturally-sensitive treatment services. This study calls attention to the value of an American Indian-specific HIV/AIDS service organisation, the presence of indigenous service providers in the community and culturally-sensitive healthcare providers.
Department of Veterans Affairs, Mental Illness Research, Education, and Clinical Centre, Portland, USA. derek.burks@va.gov
Derek J
DJ
Burks
Rockey
R
Robbins
Jayson P
JP
Durtschi
D000328:Adult; D001727:Bisexuality; D054521:Cultural Competency; D003625:Data Collection; D017144:Focus Groups; D015658:HIV Infections / Q000453:epidemiology / Q000208:ethnology / Q000209:etiology*; D006297:Health Services Accessibility; D018451:Homosexuality, Male; D006801:Humans; D007198:Indians, North American; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009825:Oklahoma / Q000453:epidemiology; D011322:Primary Prevention; D012307:Risk Factors