Every year since 1988, the first of December has been internationally
observed as World AIDS Day. The theme for 2005 is “Stop AIDS. Keep the
Promise,” the United Nation’s appeal to world governments and policy-makers
to stem the infection of HIV and increase the quality of life for those
living with AIDS.

Around the world 40 million people have HIV/AIDS, 60 percent of whom live
in sub-Saharan Africa.

In his January 2003 State of the Union address, President Bush challenged
Congress to increase U.S. support to address the global HIV/AIDS epidemic.
In May 2003, Congress passed, and the president signed into law, the
“United States Leadership Against HIV/AIDS Act of 2003,” which approved a
five-year, $15 billion global initiative to combat the HIV/AIDS epidemic.

In this country, American Indians and Alaska Natives living with HIV/AIDS
often lack access to modern treatment and care in a growing public health
crisis that resembles the epidemic in developing countries. The actual
number of American Indians and Alaska Natives with HIV/AIDS is unknown
because of racial misclassification, poor surveillance and reporting, and
poor coordination between federal, state, tribal and local public health
agencies.

In his State of the Union address this past February, Bush recognized that
a gross disparity exists in this country in who gets HIV/AIDS services, but
he did not specifically call on Congress to renew the Ryan White
Comprehensive AIDS Resource Emergency Act to focus federal efforts on
American Indians and Alaska Natives as affected populations with the
highest rates of new cases.

In 2003, the Centers for Disease Control and Prevention estimated that
Natives had the third-highest rate of AIDS diagnosis, despite having the
smallest population. The CDC further estimated that the AIDS infection rate
among American Indians was 40 percent higher than among white Americans.
The number of HIV/AIDS cases within Native communities could increase
exponentially due to risk factors for contracting HIV that are prevalent
among American Indian and Alaska Natives: high rates of hepatitis C
infection and transmission, high rates of alcoholism, high rates of other
sexually transmitted diseases and increasing use of methamphetamines.

Signed into law in 1990, the CARE Act is the federal program designed to
improve the quality and availability of care for persons with HIV/AIDS and
their families. Administered by the Health Resources and Services
Administration within the Department of Health and Human Services, and
named to honor the young hemophiliac who became infected with HIV through a
contaminated blood transfusion, the CARE Act is intended to help people
with HIV/AIDS who don’t have private health insurance, don’t qualify for
Medicaid and are unable to afford the cost of their care.

In July 2003, the U.S. Commission on Civil Rights found that only 28
percent of American Indians and Alaska Natives have private health care
insurance through an employer and that 55 percent rely on the IHS for all
of their health care needs.

Although the CARE Act is the federal government’s largest program for
individuals living with HIV/AIDS, funding medical care, antiretroviral
treatments, and counseling and testing for more than 500,000 individuals,
the CARE Act excludes the IHS from any direct HIV/AIDS treatment funding.
Furthermore, the IHS has no line item within its annual budget for HIV/AIDS
treatment for American Indians and Alaska Natives.

The result of IHS’ lack of participation in the federal effort to
coordinate HIV programs to enhance continuity of care services is that AIDS
survival rates are lower for Native peoples than for any other ethnic group
except blacks. American Indians and Alaska Natives are diagnosed later in
the course of HIV infection. Furthermore, the care they receive, if any, is
less effective than for any other group.

While HRSA’s policy is that American Indians and Alaska Natives are
entitled to claim HIV/AIDS treatment from any CARE Act provider, individual
American Indians and Alaska Natives seeking HIV/AIDS treatment are
routinely told to go seek such treatment from the IHS. The CARE Act offers
no mechanism of accountability for, or sanction against, noncompliant CARE
Act grantees that violate this policy when they refuse to provide health
care treatment and support services to Native people with HIV/AIDS.

The National Native American AIDS Prevention Center has convened a group of
grassroots tribal HIV/AIDS advocates and health care professionals to
promulgate recommendations that are being forwarded to the House and Senate
health committees as they consider the CARE Act’s reauthorization.

Among the recommendations that the NNAAPC has forwarded are provisions for
a comprehensive, coordinated system of care for American Indian and Alaska
Native people, the elimination of existing obstacles to funding that bar
tribal providers from access to CARE Act funds, culturally competent
treatment and care, and mandatory tribal representation on all federal
HIV/AIDS prevention and treatment advisory committees.

HIV is a family issue, impacting Native women and children at greater rates
than ever before. As World AIDS Day 2005 ends, and its “Keep the Promise”
theme becomes a memory, the NNAAPC needs your support to effectively
challenge the Bush administration to keep its promise to American Indians
and Alaska Natives living with HIV/AIDS. We must keep focus on the Third
World conditions here in the United States — here in Indian country —
where American citizens have the unfortunate distinction of being the
neediest citizens whose needs are served last.

We respectfully demand that American Indian and Alaska Native governments
and elected tribal policy-makers work with the NNAAPC to assure that the
CARE Act be reauthorized to provide for dedicated funding so that
IHS-operated facilities, tribally operated self-government contract
facilities and urban Indian health programs designated by the IHS can join
the world fight against this global epidemic.

Yvonne M. Davis, who holds a Master of Public Health degree, is board
president of the National Native American AIDS Prevention Center.