Although Indigenous Peoples account for just 3.8% of Canada’s total population, they represented 16% of positive HIV tests in the country, according to a 2013 report from the Public Health Agency of Canada. Over the 10-year period 2005 to 2014, the annual number of HIV diagnoses increased 19% among Native Americans/Alaska Natives overall and 63% among gay and bisexual men in these same populations.
Co-occurring factors responsible for this increased incidence include: biological factors, such as increased rates of sexually transmitted infections and pregnancy; social factors, such as homophobia and distrust in health systems; economic factors, such as poverty, which can inhibit access to good healthcare and health education; socioeconomic factors related to gender inequality and violence; and substance abuse, which often are not direct routes of HIV transmission but do influence risky behaviors such as unprotected sex. This case vignette features a 32-year-old Alaska Native man who has faced these manifest economic and sociocultural barriers within his Inupiat community in Northern Alaska and has a prior history of intravenous drug abuse. The case also outlines many HIV-prevention strategies and public health interventions that can help to reduce the HIV burden, morbidity, and mortality in Alaska Native populations.