Rise in HIV cases 'alarming,' IHS says

By Carolyn Calvin
Navajo Times

WINDOW ROCK, March 18, 2011

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The Navajo Area Indian Health Service on Monday reported an "alarming" increase in new HIV cases diagnosed each year.

"The number of new HIV cases diagnosed at Navajo Area Indian Health Service and tribal service units has increased dramatically since 2000," said Dr. Jonathan Iralu, an infectious disease consultant for the agency.

"In 2000, approximately 15 cases were diagnosed per year at Navajo area facilities," Iralu said in a press release. "In 2009, there were 40 new cases and in 2010, there were 35 new HIV cases. These figures are very alarming."

Melvin Harrison, executive director of the nonprofit Navajo AIDS Network, agreed with Iralu.

"From 1987 to 2009, there were 315 cases treated in Navajo Area IHS facilities - 255 males and 50 females," Harrison said.

Of those 315 cases, 41 percent are HIV-positive, 34 percent have AIDS and 25 percent have died.

"One of the biggest risk factors are men who have sex with men," Harrison said.

Another risk factor is substance abuse, he said. "People lose inhibitions when they are drinking and drugging and don't take any precautions."

Harrison said 10 years ago, most HIV cases were contracted away from the reservation. Since 2003, however, many of the cases are "Navajo infecting Navajo," he said. "It's a scary thought."

"People have to realize that HIV does exist on the Navajo Nation," Harrison said.

He is especially concerned with the increasing number of women being diagnosed with HIV.

If left untreated, HIV develops into AIDS, which is fatal unless treated with expensive medications, so health authorities are once again stepping up preventive efforts.

The Navajo Aids Network will host a couple of events to mark National Native HIV/AIDS Awareness Day on March 20.

On Friday, Harrison will give a lecture at Diné College in Tsaile, Ariz. On Saturday in Chinle, rapid-results HIV tests will be offered at a booth at the powwow to honor former President Joe Shirley Jr.

In addition, local IHS officials are instituting new screening and HIV awareness efforts, and expanding clinical services for HIV patients.

IHS information officer Jenny Notah said voluntary HIV testing is now available to everyone aged 13 to 64 who gets seen at an IHS-operated clinic or hospital.

At Gallup Indian Medical Center, HIV testing, first adopted in the inpatient wards, has now expanded to the obstetrics clinic, primary care clinics and the urgent care clinic.

"Patients admitted to the hospital are routinely offered a voluntary HIV test upon admission," Notah said. "Patients presenting to the obstetrics clinic for prenatal care are given the same opportunity for testing."

According to Notah, screening and prevention activities also are occurring outside IHS. Fort Defiance Indian Hospital, a former IHS facility now operated by a nonprofit corporation, worked with the Navajo AIDS Network to set up testing and HIV education. A 15-second public service advertisement encouraging people get tested is being shown at theatres in Gallup.

"The NAIHS has greatly expanded care at IHS facilities through funding by the Minority AIDS Initiative," Notah said. "HIV primary care is available at all IHS service units on the Navajo Nation and specialty care is available at GIMC. An HIV nurse specialist was hired at GIMC to improve HIV care and coordinate care of people who are HIV positive."

"Home visits are an important component of the program," Notah said. "IHS staff team up with the Navajo AIDS Network case managers, who are well-versed in the Navajo language and culture and serve as a bridge between the patient and the hospital."

As a result of this program, the agency has seen an improvement in the response to HIV drug therapy with 77 percent of enrolled patients showing excellent control of the virus in their blood, up from 50 percent in past years.

An automatic prescription refill program has been created and patients are notified monthly that their medications are ready for pickup. This, together with patient education by pharmacists, increases the number of people who take their medicine as directed instead of haphazardly.

"Plans are in place to begin phone calls and home visits to patients that have difficulty reaching the clinic," Notah said.

Other plans include a cholesterol-lowering component to the HIV program since HIV medicines and the HIV virus itself may elevate cholesterol levels, increasing the risk of stroke and heart disease. In addition, the pharmacy team is developing a program to treat people with HIV who also are infected with the hepatitis C virus.

GIMC has added a second HIV/AIDS specialist to its HIV clinic, ensuring that a physician is available five days a week. A nutritionist also was added to assist patients trying to amend their lifestyle through weight loss, cholesterol control, and healthy eating.

The addition of a health technician to allow for intensive home therapy and education for high-risk persons with HIV/AIDS is in the works.

"It is hope that these improvements in outreach and care will result in increased awareness of HIV on and near the Navajo Nation and improved quality of life for HIV patients as well as a reduction in the spread of HIV," said Iralu.

As always, prevention is the key, and no one is exempt from concern, he said.

"All individuals should learn about the increased risk of HIV in our region," Iralu said. "We hope that with increased awareness of the risk for HIV, the people will protect themselves and the ones they love in a number of ways: abstaining from sex, maintaining sexual relations with one person only and using condoms even when other forms of birth control are in use. Condoms work well when used every time."

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