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HIV/AIDS in the Two-Spirit Community: A Hidden Crisis

March 20, 2013 | By Harlan Pruden, Director, NorthEast Two­Spirit Society

March 20th is National Native HIV/AIDS Awareness Day, a day to raise awareness of the terrible toll that HIV/AIDS continues to take on Native American populations. HIV/AIDS is a crisis that affects many American Indians and Alaska Natives, but particularly Two-Spirit individuals, who often experience stigma and discrimination in both Native and mainstream society.

What Does Two-Spirit Mean?

The term " Two-Spirit " has several meanings within Native cultures and communities, but it is primarily a contemporary term that refers to those traditions in which some individuals have a blend of both male and female spirits. Two-Spirit is a concept of gender identity, not one of sexual orientation. Sexual orientation describes an individual's choices in sexual relationships with others. Gender describes the expected roles an individual plays within a community's social norms and structures. Many Two-Spirit organizations prefer to separate the Two-Spirit identity from the lesbian, gay, bisexual, transgender, and questioning (LGBTQ) identities of the mainstream/dominant culture, emphasizing the use of the term "Two-Spirit" to describe a person's gender within their culture, rather than the more Western concept of sexual orientation.

Impact of HIV/AIDS

In the United States, HIV and AIDS are tracked according to certain categories recognized by the scientific/medical establishment. "Men who have sex with men" (MSM) is one of these categories; "Two-Spirit" is not. MSM (or what we would call male-bodied Two-Spirit individuals) bear the brunt of the HIV/AIDS crisis among Native American populations. According the Centers for Disease Control and Disease Prevention , MSM and MSM/IDU accounted for 62.3% of all new diagnoses of HIV infection among American Indians and Alaska Natives in 2011. MSM and MSM/IDU also accounted for 60.0% of American Indians and Alaska Natives living with AIDS in 2010.

Native Americans, including Two-Spirit people, call upon the public to consider the epidemic in relation to the size of the Native American population, lest comparisons to HIV/AIDS in other populations inappropriately dismiss the impact of the disease on Native communities.

During the Thursday, February 7, 2013 meeting of the Presidential Advisory Council on HIV/AIDS (PACHA) , Dr. Karina Walters of the University of Washington and I had the opportunity to brief the Council on the impact of HIV/AIDS on the Two-Spirit community. Learn more about the PACHA meeting on .

The National Confederacy of Two-Spirit Organizations, a coalition of 17 Two-Spirit community-based organizations, looks forward to working with PACHA and HHS to better meet the needs of the Two-Spirit community.


Editor's Note: For more information on HIV/AIDS surveillance among Native populations, see the CDC report, Improving HIV Surveillance Among American Indians and Alaska Natives in the United States (Jan. 2013) .

For information on State Departments of Health response, see the National Alliance of State and Territorial AIDS Directors' (NASTAD)  ISSUE BRIEF: Native Gay Men & Two-Spirit People HIV/AIDS & Viral Hepatitis Programs and Services.

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