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 AIDS.gov .
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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