Designing culturally-appropriate HIV prevention services for native populations in Denver

In the U.S., Native Americans face profound health issues that are exacerbated by poverty and social breakdown. Diabetes and alcoholism are perhaps the most talked about, but while overall numbers for American Indians are comparatively small, they are also significantly affected by HIV. As with other communities of color, HIV cases among American Indians have increased since the mid-1980s, ranking third in rates of AIDS diagnoses, after African Americans and Hispanics. Yet despite increasing attention paid to health disparities in other racial/ethnic minority populations, Native American are often overlooked.

Denver, Colorado, is one of the original sites for relocation of Indian people from their home reservations, and is a hub for Native Americans. Denver's Indian population is estimated at 25,000 and is comprised of people who have lived in Denver for over 30 years, as well as those who are transient and move to and from their reservations on a regular basis, looking for employment and a better standard of living than reservations offer.

The Denver Indian Health and Family Services, DIHFS, is a full-service, primary care clinic that serves American Indians in a culturally appropriate and respectful manner. It is an urban clinic in a city where a variety of native people, including Lakota, Sioux, and Navajo, live. The majority of DIHFS clients are single-parent heads of household, and the average client income is $621 per month or $7,452 per year. Seventy-three percent of DIHFS patients do not have health insurance. JSI/Denver has been collaborating with DIHFS to develop a more comprehensive HIV-prevention program for American Indians living in the Denver area.

JSI began the process of building better HIV services by conducting a survey of DIHFS staff to determine issues and needs in HIV services. Results indicated that clinic staff had little understanding and awareness of HIV and other sexually transmitted diseases and their effects on the native community. To remedy this, JSI, with feedback from DIHFS staff, started HIV Integration and Client-Centered Counseling Trainings for employees, and worked with staff to develop a more culturally-responsive and sensitive tool. This adaptive risk assessment tool was introduced and evaluated by the native community in a series of five 'talking circles' or focus groups. JSI also worked with DIHFS to create an HIV-prevention protocol, which did not exist previously. JSI also developed a referral resource and corresponding training manual for providing culturally-sensitive services to American Indians who need HIV or substance use services. At the end of the project, a summary report of all interventions and findings were made available to other clinics who serve similar populations so that they could learn from and model DIHFS' established best practices.

"DIHFS is thrilled to work with JSI on developing a more comprehensive and culturally appropriate program," said Danica Brown, Prevention Specialist at DIHFS and key contact to its HIV project. And the staff at JSI/Colorado were honored to provide the service.