HIV/AIDS, substance abuse, and hepatitis needs of American Indians: In their own words

Now, and for many decades, drug and alcohol use and abuse problems have plagued Native American communities; more recently, HIV/AIDS and hepatitis have appeared. A needs assessment was conducted in 2005 to determine the HIV/AIDS, substance abuse, and hepatitis prevention needs of Native Americans living in Baltimore, MD using a community based participatory approach to gain an in-depth understanding of local Native American health service needs. Community stakeholders and key informants embedded in the local Native American population were consulted at each stage of the research planning process. Two complementary methodologies (focus groups and surveys) produced a holistic assessment of the population's needs, risks, and strengths, and uncovered the social and cultural contexts in which health risk behaviors unfold. Six focus groups (n=39) and intercept health surveys (n=99) were conducted with male and female adults living in the Baltimore area who self-identified as American Indian. Participants ages ranged from 18-75, and over half were in their 40's. The use of multiple methods produced a more complete portrait of the substance abuse, HIV/AIDS, and hepatitis service needs of this urban Native American population. Using three raters, seven major themes were identified by consensus: 1) The scope of the problem; 2) Holistic conceptualizations of risk; 3) Pride, shame, and stigma; 4) Socioeconomic disadvantage; 5) Youth and reentry populations; 6) The city lifestyle and peer influences; and 7) Community disintegration. Findings from this study support the necessity for future HIV/AIDS, substance abuse, and hepatitis prevention programming for urban Indians.