Sexual Health Among Native Youth

Social, economic, and cultural barriers limit the ability of many American Native American teenagers to receive accurate and adequate information on preventing HIV and other sexually transmitted infections (STI). Young Native women, in particular, need culturally competent, affordable services which build on their assets. Additionally, there is a striking lack of research on cultural issues that influence the reproductive and sexual health of Native American teens, particularly females.


Underreporting of HIV is a persistent problem in Indian Country. One study in California found that 56% of Native American patients with HIV were racially misclassified. Nevertheless, the CDC estimates that the rate of AIDS diagnoses for American Indian adults and adolescents is 9.9 per 100,000 persons. This rate is higher than whites and Asians but lower than blacks and Hispanics. Women accounted for 29% of those diagnosed.

Many factors contribute to these disproportionate HIV rates. The majority of HIV positive Native American women (66%) contracted HIV through heterosexual intercourse, while a significant number (33%) were infected through injection drug use.


In early 2010, the most recent Indian Health Surveillance Report was released reflecting the rates of sexually transmitted infections among Native American populations. The report was a collaboration between the U.S. Department of Health and Human Services, Centers for Disease Control and Prevention and the Indian Health Service and is available on the CDC website.

Findings in the report suggest that although much has been done to reduce disparities among populations and communities of color, such as increasing access to STI care and expanding prevention education programs and other interventions, there continues to be significant challenges in preventing the spread of infection in this population.

Data from the IHS Report identifies unsurprisingly, that Chlamydia is the most commonly reported STI among all US residents including American Indian teens. In 2007, 17,871 Chlamydia diagnoses were reported among Native Americans, down from 19,267 cases in 2006. According to the data, the national rate of reported Chlamydia in 2007 was 732.9 cases per 100,000 population, a decrease of 7.2% from 2006 among Native Americans. However, when compared more broadly, this community is disproportionately affected by Chlamydia with a rate twice as high as the overall US rate. Notably, there have been increased efforts in Chlamydia screening throughout Indian Country that may reduce the number of reported cases.

The second most common sexually transmitted disease affecting Native American communities is gonorrhea. As mentioned in the report, in 2007 American Indian populations reported a decrease in gonorrhea cases of 2,657 down from 3,398 in 2006. This reflects a lower rate among this community than the US rate.

Overall, the Indian Health Surveillance Report confirms that public health efforts should be directed toward eradicating health disparities, increasing the availability of screening and delivering evidence-based programs and interventions to Native American communities with an emphasis on youth and women. The lower rates of STI incidence compared to the previous year indicate that progress is being made and many agencies [like Capacity Builders Inc.] have been actively working to improve sexual health outcomes.

However the relative dearth of comprehensive programs that are culturally relevant for American Indian populations continues to be a problem. In 2008, the National Coalition of STI Directors in partnership with the Centers for Disease Control and Prevention and the Indian Health Service National STI Program began development of a curriculum titled Native STAND: Students Together Against Negative Decisions. Native STAND incorporates the Transtheoretical Model (Stages of Change) and the Diffusion of Innovations Theory to train teen opinion leaders to be role models and peer educators who promote abstinence, risk reduction, and healthy decision making with their friends.

The curriculum is not specific to one tribe or geographic region and utilizes the cultural teachings from many American Indian tribes and communities. It is comprised of 29 sessions that average 90 minutes of delivery time each. The comprehensive curriculum covers topics such as: Respecting Differences, Healthy Relationships, Goals and Values, Decision-Making, and Birth Control Methods as well as sessions on Communication, Reproductive Health, HIV, and STI’s. The curriculum is currently being piloted in four Bureau of Indian Education (BIE) residential schools and has received significant interest from American Indian communities around the country.

What other assets can help protect young Native American teens from negative sexual outcomes?

Research shows that parental communication and involvement are very important in empowering teens to make healthy decisions about sex (that is, to delay first sex and to use condoms and birth control when having sex).

Self-efficacy (trust and confidence in one’s own decisions) is a powerful protective factor for both condom use and abstaining from sex.

Those who do well in school are also less likely to be sexually active, while for those who are sexually active, valuing academic achievement is still a protective factor against sexual risk behavior.

Positive Native identity and a sense of belonging to a Native community are strongly associated with good sexual health outcomes for Native American youth. Research shows that female adolescents from families who have lived on a reservation and spoke a tribal language have sex for the first time at an older age and are more likely to use condoms than those from families who do not; while urban-dwelling youth benefit from programs that emphasize a connection to Native culture.

Regardless, Native youth should be included in creating, designing, and implementing programs and policies around sexuality education. Many opportunities exist for involving Native youth and empowering them to teach their peers. Successful approaches have included:

Source: Advocates for Youth
Source: RH Reality Check