Creating a path forward: understanding the context of sexual health and sexually transmitted infections in American Indian/Alaska Native populations – a review
Jessica Leston A * , Hannah Wenger B , Brigg Reilley
A , Stephanie Craig Rushing A , Elizabeth Rink C , Hannah Warren D , Jean Howe E , Paul Bloomquist F , Tina Tah G , Itai Jeffries A , Jonathan Iralu H , Phoebe Thorpe I , Andria Apostolou G and Melanie M. Taylor J
+ Author Affiliations
- Author Affiliations
A Northwest Portland Area Indian Health Board, Portland, OR, USA.
B Massachusetts General Hospital, Boston, MA, USA.
C Montana State University, Bozeman, MT, USA.
D Alaska Native Tribal Health Consortium, Anchorage, AK, USA.
E Northern Navajo Medical Center, Indian Health Service, Shiprock, NM, USA.
F Indian Health Service Area Office, Phoenix, AZ, USA.
G Indian Health Service Headquarters, Rockville, MD, USA.
H Gallup Indian Medical Center, Indian Health Service, Gallup, NM, USA.
I U.S. Centers for Disease Control and Prevention, Division of STD Prevention, Atlanta, GA, USA.
J U.S. Centers for Disease Control and Prevention, Division of HIV Prevention, Atlanta, GA, USA.
Sexual Health - https://doi.org/10.1071/SH22040
Submitted: 4 March 2022 Accepted: 17 May 2022 Published online: 28 June 2022
© 2022 The Author(s) (or their employer(s)). Published by CSIRO Publishing. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)
Abstract
This review assessed sexual health and sexually transmitted infection (STI) burden among American Indian/Alaska Native (AI/AN) peoples within the context of current clinical and public health services. We conducted a review of published literature about sexual health and bacterial STIs among AI/AN populations in the United States using Medline (OVID), CINAHL (EbscoHost) and Scopus. Peer-reviewed journals published during 1 January 2005–2 December 2021 were included and supplemented by other publicly available literature. A total of 138 articles from reference lists met inclusion criteria, including 85 peer-review articles and 53 additional references. Results indicate a disproportionate burden of STIs is carried by AI/AN populations compared to non-Hispanic Whites. Risk for STIs in AI/AN people has origins in historical trauma and structural and social determinants of health. STI services are available for AI/AN populations, but many barriers to care exist. Community-based sexual health programming has been successful, but has thus far focused primarily on adolescents and young adults. A myriad of factors contributes to high rates of STIs among AI/AN populations. Longstanding disparities show a clear need to increase the availability of integrated, low-barrier STI prevention and treatment services. Implementation of multi-level (individual, physician, clinic, healthcare organisation, and/or community level), culturally relevant sexual health and STI interventions should be community-based and person-centred, acknowledge social determinants of health, and grounded in deep respect and understanding of AI/AN histories and cultures.
Keywords: American Indian/Alaska Native, chlamydia, congenital syphilis, disparity, gonorrhoea, sexual health, STI, STD, syphilis.
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