Building a Tribal-Academic Partnership to Address PTSD, Substance Misuse, and HIV Among American Indian Women

OBJECTIVES

To describe our partnership and research infrastructure development strategies and discuss steps in developing a culturally grounded framework to obtain data and identify a trauma-informed evidence-based intervention.

METHOD

We present funding strategies that develop and maintain the partnership and tools that guided research development. We share how a community research committee was formed and the steps taken to clarify the health concern and develop a culturally tailored framework. We present results from our needs/assets assessment that led to the selection of a trauma-informed intervention. Finally, we describe the agreements and protocols developed.

RESULTS

We produced a strong sustainable research team that brought program and research funding to the community. We created a framework and matrix of program objectives grounded in community knowledge. We produced preliminary data and research and publication guidelines that have facilitated program and research funding to address community-driven concerns.

CONCLUSIONS

This study highlights the importance of bidirectional collaboration with American Indian communities, as well as the time and funding needed to maintain these relationships. A long-term approach is necessary to build a sustainable research infrastructure. Developing effective and efficient ways to build culturally based community research portfolios provides a critical step toward improving individual and community health outcomes.

Community-Based Assessment to Inform a Chlamydia Screening Program for Women in a Rural American Indian Community

BACKGROUND

Rates of chlamydial infection in American Indian/Alaska Native women in the United States are approximately 4-fold those in non-Hispanic white women. We conducted a community-based survey of self-identified American Indian/Alaska Native women 14 to 25 years of age on a reservation in the Northwestern United States to inform a chlamydia screening strategy.

METHODS

The anonymous survey assessed respondents' knowledge, perceptions, and preferences related to chlamydia screening, results receipt, and partner notification. We recruited women using respondent-driven sampling, school-based sampling, and direct recruitment through social media and fliers. Participants in schools completed the survey as a paper-based, self-administered survey. Other participants could complete the survey in person, by phone as an interviewer-administered survey, or online.

RESULTS

We recruited 162 participants, most in schools (n = 83; 51%) or by peer referral (n = 55; 34%). Only 1 woman completed the survey online. Thirty-one respondents (19%) reported a history of an unplanned first pregnancy, and 19 (12%) reported a history of a diagnosed sexually transmitted disease. Most women (n = 98; 63%) recognized the potential impact of Chlamydia trachomatis on fertility. The preferred site for chlamydia screening was the Indian Health Service Clinic (n = 114; 70%), but 79 women (41%) would accept a C. trachomatis test at a nonclinical testing site. Of the 56 women (35%) who would accept home testing, most preferred to get the test kit from a clinic.

CONCLUSIONS

Our results suggest that Indian Health Service efforts to increase chlamydia screening in the clinic and through outreach may be more successful than promotion of home testing in this population.

Post-traumatic stress disorder and HIV risk behaviors among rural American Indian/Alaska Native women

We assessed the relationship between post-traumatic stress disorder (PTSD), binge drinking, and HIV sexual risk behavior by examining number of unprotected sex acts and number of sexual partners in the past 6 months among 129 sexually active American Indian women. A total of 51 (39.5%) young women met PTSD criteria. Among women who met the PTSD criteria, binge drinking was associated with a 35% increased rate of unprotected sex (IRR 1.35, p < .05), and there was a stronger association between increased binge drinking and risk of more sexual partners (IRR 1.21, p < .001) than among women who did not meet PTSD criteria (IRR 1.08, p < .01) with a difference of 13% (p < .05). HIV intervention and prevention interventions in this population likely would benefit from the inclusion of efforts to reduce binge drinking and increase treatment of PTSD symptoms.