Tag Archives: aids

HIV VIRUS

The “Undetectability” Of It All, Part Two

     This past March, I penned “The Undetectability Of It All,” for Wyattevans.com.  The article stated that the AIDS United Public Policy Committee declared that it has “strongly affirmed the conclusive evidence proving that people living with HIV who have achieved a sustained, undetectable viral load cannot transmit HIV to sexual partners.  This evidence-based declaration reinforces AIDS United’s programmatic, policy and advocacy work to expand access to antiretroviral medications to all people living with HIV.”  AIDS United is the largest and longest-running national coalition of community-based HIV/AIDS organizations.

     And now, there’s additional evidence that supports the AIDS United declaration.  But before we examine those findings, let’s answer the question:  what does it truly mean to be undetectable?   

     Well, it doesn’t mean that the HIV-positive individual is cured.  However, it does mean that antiretroviral treatment is being effective, and that the amount of HIV in the blood is so low that even the best available tests don’t detect it.

     To have an undetectable viral load means that there are fewer than 20 copies of the virus in one milliliter of blood.  Typically, the tests of those who have just been diagnosed and not having undergone treatment show millions of copies in the exact same sample size.

     Now, let’s examine the new study that supports the AIDS United proclamation.  The findings demonstrate that there were no transmissions of the virus within mixed-HIV-status couples when the partner living with the virus was on antiretroviral (ARV) treatment and had a fully suppressed viral load.

     This study, entitled Opposites Attract, was comprised of gay/SGL (same gender loving) couples that had nearly 600 cumulative years of follow-up data and about 12,000 reported acts of condomless penetration.  These acts excluded any for which the HIV-neg partner was taking PrEP (pre-exposure prophylaxis).

     Based on the Opposites Attract data, the investigators were able to estimate that the annual risk of HIV transmission in which only one infected partner with an undetectable viral load is between zero and 1.56 percent.

UNDETECTABLE8

     According to Poz.com, Andrew Grulich, PhD, an HIV epidemiologist at the Kirby Institute at the University of New South Wales in Sydney, Australia, and chief investigator of the study, stated, “’We think this is a really exciting result and adds to a body of research that HIV is not passed on in the context of undetectable viral load, even with high rates of sexually transmitted infections’.”

     Opposites Attract did not restrict potential participants according to whether they used condoms or had undetectable viral loads.  By the end of last year, the study had enrolled 358 gay/SGL male couples in which one partner was poz (158 from Australia, 105 from Thailand, 96 from Brazil).

     So, just how was the study conducted?  “Researchers collected information about sexual behaviors from the HIV-negative partner at each study visit,” stated Poz.com.  “These partners received HIV testing along with sexually transmitted infection (STI) testing upon entering the study and at all subsequent study visits.  The HIV-positive partners received viral load and STI testing at each study visit.

     “The investigators defined an undetectable viral load as less than 200.  For all new HIV infections in the initially HIV-negative partners, generic testing was conducted to determine whether these men likely contracted the virus from their partner in the study.

     “A total of 343 couples made at least one follow-up visit, contributing 591 cumulative years of follow-up data.  (Each year of data on a couple counted as one year of follow-up.)  The men reported anal sex with any man beside their study partner at 57.4 percent of these visits.”

     The online publication continued.  “Upon their entry into the study, 79.9 percent of HIV-positive men were on ARVs and 77.9 percent had an undetectable viral load.  A total of 75.2 percent of the men on HIV treatment maintained a fully suppressed virus throughout their participation in the study.

      “Overall, 14.3 percent and 11.7 percent of the HIV-positive and -negative men, respectively, were diagnosed with an STI during the study.

     “A total of 73.8 percent of the couples reported engaging in condomless sex during the study.  These men provided 318 cumulative years of follow-up data on periods when they reported engaging in condomless intercourse within their study partnership, including a total of 16,889 reported such acts.”

     Grulich concluded the following about the Opposites Attract findings.  “’This is life-changing news for couples of differing HIV status’.” 

     However, the chief investigator of the study cautioned, “’But it is important that the HIV-positive partner is under regular medical care and does not miss any of their antiretroviral medication in order to ensure they maintain an undetectable viral load.  Our data add to previous studies that show that there has never been a recorded case of HIV transmission from an HIV-positive person to their HIV-negative sexual partner when the HIV-positive partner had an undetectable viral load’.”

The “Undetectability” Of It All

     For years, I’ve been reporting and writing about HIV/AIDS.  When I’ve asked individuals the question, “Would you be sexually intimate with someone who’s undetectable?,”  I’ve gotten some rather blunt and curt responses.   Here are three:

    “Uh-uh.”

    “But doesn’t pre-cum contain the virus?”

    “Nah…I’ll think I’ll pass!” 

    However, the 44-member AIDS United Public Policy Committee—the largest and longest-running national coalition of community-based HIV/AIDS organizations–strenuously begs to differ.  According to AIDS United, its Public Policy Committee very recently has “strongly affirmed the conclusive evidence proving that people living with HIV who have achieved a sustained, undetectable viral load cannot transmit HIV to sexual partners.  This evidence-based declaration reinforces AIDS United’s programmatic, policy and advocacy work to expand access to antiretroviral medications to all people living with HIV.”

     Before we go any further, let’s clearly and completely understand what it really means to be “undetectable.”   First, it doesn’t mean that the HIV-positive person is cured.  However, it does mean that antiretroviral treatment is being effective, and that the amount of HIV in the blood is so low that even the best available tests don’t detect it.

     To have an undetectable viral load means there are fewer than 20 copies of the virus in one milliliter of blood.  Typically, the tests of those who have just been diagnosed and not having undergone treatment show millions of copies in the exact same sample size.

     Therefore, on March 6, the AIDS United Public Policy Committee released the following statement:  “Substantial evidence strongly demonstrates that a person living with HIV who has a sustained, undetectable viral load cannot sexually transmit HIV to another person.  Continued analysis of large-scale clinical trials has shown zero cases of HIV sexual transmission.  This expands on prior data that the risk of HIV transmission from a person living with HIV who is on antiretroviral therapy and has achieved an undetectable viral load (viral suppression) in their blood for at least 6 months is negligible to non-existent.”

     AIDS United concurs with the stance of the Prevention Access Campaign (PAC), which is “People living with HIV on ART (antiretroviral therapy) with an undetectable viral load in their blood have a negligible risk of sexual transmission of HIV.”  PAC “is a multi-agency health equity initiative to end the dual epidemics of HIV and HIV-related stigma by expanding access to HIV prevention, and empowering people with and vulnerable to HIV with accurate and meaningful information.”

     The AIDS United Public Policy Committee added, “Too many people living with HIV are not getting the message of this benefit of treatment and sustained viral suppression from their clinical providers or the HIV education and advocacy community.  Understanding that maintaining viral suppression through successful antiretroviral therapy not only maintains health but also prevents transmission can encourage people living with HIV to initiate and adhere to treatment regimens and may help reduce HIV-related stigma.  We acknowledge, however, that social and structural barriers exist that prevent some people living with HIV from achieving viral suppression.”

     Sadly, antiquated U.S. HIV laws and policies simply do not reflect the up-to-date science regarding HIV transmission risks.  “Scientific evidence about the reality of transmission risk based in this data about viral suppression and transmission risk has already had an impact on HIV criminalization statutes and prosecutions in Europe,” according to AIDS United.

     The organization, therefore, makes two critical recommendations:

  • That providers and educators consistently share the message that new evidence demonstrates that a person living with HIV who has a sustained, undetectable viral load cannot sexually transmit HIV to another person.
  • That HIV criminal laws and policies in the United States be modernized to reflect the science related to viral suppression and HIV transmission risk.

    Jesse Milan, Jr., AIDS United president and CEO, termed the transmission evidence “a landmark development” that too few of us are hearing about.  “This development puts each one of us living with HIV at the forefront of stopping new infections,” stated Milan, Jr.  “It gives everyone strong, clear and direct language to stop the stigma and move all communities faster towards ending the epidemic.”

Jamal Hailey Stigma AIDS

Jamal Hailey:  Being a Frontline Soldier in the War on HIV is Personal, Part Two

     HIV expert JAMAL HAILEY has his own personal stake in the war on HIV he’s helping to wage: he’s had family die from the disease.

     In Part Two of my exclusive Huffington Post Queer Voices interview with Mr. Hailey, he discusses stigma, the intersection of HIV and IPV/A, HIV prevention and care from a radical social justice perspective, and the practice of counseling psychology.   It’s a rather substantive and telling conversation.

JAMAL HAILEY

    For Part Two, click on the following link:   http://www.huffingtonpost.com/wyatt-obrian-evans/jamal-hailey-being-a-fron_1_b_9404788.html

Essex

Death Claims A Phenom Way Too Soon: A Tribute To Essex Hemphill

     This month, Essex Hemphill—the openly gay, African-American poet and author—would’ve turned 58.  Truly groundbreaking, Mr. Hemphill blazed the way for talents including James Earl Hardy, E. Lynn Harris…and myself. 

     I cannot allow the month of April to fade away before I pay homage to this gifted artist—who certainly was before his time.  Therefore, I’m reprinting my Huffington Post tribute, originally published in 2013. 

     Do you remember Mr. Essex Hemphill?  Well, I certainly do—particularly every April 16, the date of his birth.  He would’ve turned 56 this year.   

     Despite a relatively short literary career, Hemphill is arguably the most critically acclaimed and best-known contemporary openly gay African American poet and author.   He helped shatter the silence surrounding gay Black experiences, and empowered other gay Black men to find their voices.  AIDS snatched this ahead-of-his-time, literary genius away from us much too prematurely–denying us of all the rich gifts I’m sure he wanted to share.  

     Essex and I were good buddies.  But before I reminisce about the personal side of this remarkable talent, let me share what made the man such an undeniable force in shaping and popularizing modern LGBTQ literature as a whole.  

     Born in Chicago on April 16, 1957, Essex grew up in Washington, D.C.  He began writing poetry when he was 14.  “I started writing about and addressing my homosexuality because it wasn’t there in the black text,” he recalled.  “And I needed something to be there to validate that my experience was real for me.” 

     Essex earned a Bachelor of Arts degree in English at the University of the District of Columbia.  Believing that poetry should be heard, he regularly performed his work, often in collaboration with other D.C. African-American gay and lesbian artists.  In 1983, he, Wayson Jones and Larry Duckette teamed to create Cinque, a performance poetry group that combined cutting-edge political verse, vivid imagery about gay Black life, and tightly woven harmonies.   

     Quickly, the group amassed a loyal following.  And on one sweltering summer evening in 1985, I attended one of Essex’s performances, which was absolutely mesmerizing—and full of raw sexuality!    

     For me, that night became even hotter.  

     Cinque’s poetic style gained national attention in the next few years. Today, “poetry slams” are mainstream.  Essex introduced this art form in a profound way—developing and fashioning it.  He gave it crucial visibility. 

     In the 1980s, very few publishers were interested in the works of openly gay African-American writers.  Well, Essex didn’t wait for them to “come around.”  Instead, he self-published his first two collections of poetry, “Earth Life” (1985) and “Conditions” (1986).   His profile continued to rise after contributing to various anthologies and publications including the Advocate, Essence, Obsidian, and Gay Community News. 

     After his close friend Joseph Beam succumbed to AIDS in 1988, Essex moved to Philadelphia to complete Beam’s anthology, “Brother to Brother:  New Writings by Gay Black Men.”   Published in 1991, it won a Lambda Literary Award, garnering widespread literary acclaim. 

     The next year, a major publisher released Essex’s “Ceremonies: Prose and Poetry,” which won the American Library Association’s Gay and Lesbian Book Award in Literature.  “Ceremonies” provided powerful insights into the constructions of race, gender, and sexuality in America.  The topics it addressed included the sexual objectification of Black men in white gay culture.  

     The year 1993 was a virtual bonanza for Essex:  he received a Pew Charitable Trust Fellowship in the Arts, and the Emery S. Hetrick Award for community-based activism from the Hetrick-Martin Institute.  And, he became a visiting scholar at Santa Monica, California’s Getty Center for the History of Art and the Humanities. 

     After battling AIDS for several years, Essex passed away on November 4, 1995 in Philadelphia.  He was 38. 

     Now, what do I remember about him as a friend? 

     We met in April 1984, at the Potomac Electric Power Company, a major service provider in D.C.  Essex was a graphics designer while I was a writer within that utility’s corporate communications department. 

     Immediately, “Es” and I connected.  We had things in common: emotional accessibility.  A sense of free-spiritedness.  The preference for the Artist Known as Prince over Michael Jackson.  And most importantly,a hunger for writing.   We became fast friends. 

      Confident in who and what he was, Es was totally unabashed about and firmly rooted in his sexuality.  The “brotha” had swagger!  His affecting smile, and mischievous glint that danced in his eye could win you “ovah” in no time flat. 

     Although Es was a sensitive, caring soul, he took no crap!  As well, he doggedly pushed back against any obstacles, turning his dreams into realities. 

     Unfortunately, Es and I lost contact after he moved to Philly. Although his struggle with AIDS was contracted, debilitating and agonizing, I was told that his spirit remained vibrant and strong. 

     Es, you’re sorely missed.  Without you, would there have been an E. Lynn Harris?  A James Earl Hardy?  

     Or for that matter–a Wyatt O’Brian Evans?

HIV/AIDS

Breaking:  HIV Is Killing Fewer Blacks

     HIV is losing a critical bout in the long and grueling boxing match called AIDS.  And this victory for persons of color certainly is a cause for celebration. 

     According to Michael Smith, writer for the health media outlet MedPage Today, the Centers for Disease Control (CDC) has reported that that the mortality rates of blacks in the U.S. fell substantially between 2009 and 2012.  During that time, the number of deaths fel1 by 18 percent. 

     However, the number of deaths remained higher among HIV-infected blacks  than among HIV-positive individuals of other racial and ethnic groups–although the gaps seem to be narrowing. 

     Consistent features of the U.S. HIV/AIDS epidemic have been ethnic and racial disparities:  each year, blacks have been making up almost half of all new diagnoses despite being only 14 percent of the population.  And cases have been soaring amongst some subgroups, including black MSM (men who have sex with men). 

    According to Smith, the CDC stated that this new data illustrate that decreases in mortality between 2009 and 2012 were seen in all groups but were “greater and more consistent among blacks than among other races/ethnicities.” 

     The CDC calculated two rates—the rate per 1,000 individuals living with HIV and the rate per 100,000 population.  In 2012, the CDC reported, “an estimated 8,165 deaths occurred among black persons living with HIV, which was 48% of the total mortality among people with HIV.  That was 1.5 times the 5,426 deaths among whites and 3.2 times the 2,586 deaths among Hispanics or Latinos. 

     “But overall, the number represented an 18% decline in the number of deaths among blacks from 2008 through 2012. 

     “The death rate per 1,000 blacks living with diagnosed HIV fell from 28.4 in 2008 to 20.5 in 2012—a 28% decline—but the rate remained 13% higher than for  whites and 47% higher than Hispanics or Latinos, the agency said. 

     “The 28% decline among blacks was greater than the 22% drop seen among all people living with HIV.” 

     Though this is encouraging and heartening news, we cannot afford “to rest on our laurels,” so to speak.  And let me put it another way:  before you “get horizontal to ‘Git Busy’,” strap on your favorite “latex raincoat!”

Gay couple dressed in suit and hat. caption talks about the importance of aids testing

HIV Infection Soaring Among Brooklyn MSMs

      There’s both good and bad news coming out of HIV stats from New York’s Department of Health and Mental Hygiene (DOHMH).

     First, the good news:  in the past 10 years, HIV infection rates have been cut in half.

     Now, the bad news.  More than half of new HIV infections occurred among MSMs (men who have sex with men)—specifically those under 30.

     Susan Scutti, writer for Medical Daily, quoted C. Virginia Fields, president and CEO of the National Black Leadership Commission on AIDS, who stated that  “’Complacency among the young that HIV/AIDS is just a matter of taking one pill a day’ can make them less likely to practice safe sex.”

     Scutti continued, “Close to 112,000 people were living with HIV/AIDS in New York City as of June 2011, but the true number, doctors with DOHMH believe, is possibly 20 percent higher since many people do not get tested and do not know their status.

     “New infections also disproportionately affect the black and Hispanic communities, which accounted for nearly 80 percent of the newly diagnosed cases.  The majority live in central Brooklyn neighborhoods—Bedford-Stuyvesant, Crown Heights, Williamsburg, Bushwick and East Flatbush—areas that are already home to the city’s largest group of those living with the disease.

     “Although infection among young MSMs is rising, they are not alone in contracting the disease.  Many MSMs do not identify as gay, preferring to hide their sexual preferences for other men, and some doctors believe they are infecting their black female partners, who made up 79 percent of all new HIV cases among Brooklyn women in 2011.” 

     And according to Dr. Kevin Fenton, director of the National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention at the Centers for Disease Control and Prevention, Black women are “bearing a disproportionate burden of disease compared with their white or Hispanic counterparts.” 

     Fortunately however, there are avenues of hope.  For nearly 25 years, an infrastructure of health care services specifically targeting HIV/AIDS have been in place within Brooklyn:  HEAT/FACES, a network of HIV/AIDS clinics; and the Brooklyn AIDS Task Force, which serves minority communities in particular.

 

Sir Elton John

Sir Elton John Continues to Step Up to the Plate, Batting Home Runs

     While conducting my usual round of research, I uncovered a rather timely article by Darryl Hannah for Inside Philanthropy entitled, “With HIV Infections Rising among Gay Men, This Funder Aims to Sound the Alarm.”  Hannah stated, “Here in the U.S., AIDS can feel like yesterday’s news, and many funders long ago moved on to other issues, including many LGBT funders who’ve been focused on rights issues.”

     The writer continued, “In fact, though, the rate of new HIV infections remains very high, and is rising.  But you’d never know that judging by the complacency of the media or, unfortunately, of many gay men.  Which is why the Elton John AIDS Foundation’s (EJAF) latest grant making includes funding to raise awareness of the persistent threat of HIV.”

     According to the Kaiser Family Foundation, the following dire and gloomy realities are concrete, undeniable evidence that we continue to need EJAF support, clout…and dollars more than ever:

  • In 2010, over 15,000 individuals died of AIDS.
  • Although gay/SGL (same gender loving) men make up just two percent of the U.S. population, they account for 55 percent of all AIDS deaths.
  • This two percent comprise the majority, 56 percent, of people living with HIV.
  • Gay/SGL men account for 66 percent of new HIV infections.
  • 12 to 13 percent of gay/SGL and bisexual men in the U.S. are HIV-positive—including one in five in many major American cities.
  • When you examine HIV/AIDS infections among African-American gay/SGL and bisexual men, the numbers are nearly doubled.

     Hannah wrote, “In short, AIDS is hardly a plague of the past in the gay community.  But it’s seen as such, and the Kaiser study found that few gay men said they discuss HIV with friends and sexual partners and 30 percent had never been tested for HIV.  Only a third knew that HIV infections are rising.  A majority said they were ‘not concerned’ about HIV.

     “It’s frightening findings like these that has the Elton John AIDS Foundation, one of the nation’s largest funders fighting HIV/AIDS, sounding the alarm more loudly and looking for ways to challenge rising complacency about AIDS in the LGBT community.”

     Recently, EJAF formed a partnership with the Human Rights Campaign.  The Foundation awarded this national LGBT organization a $300,000 grant to increase awareness of HIV prevention, treatment, and care among LGBT persons—with a specific focus on young gay/SGL and bisexual men, and transgender women.  The Foundation also hopes to increase awareness and access to care for low-income individuals.

     Additionally, EJAF has just announced $1.5 million in grants, which includes funding to combat stigma confronting those who are poz.

     According to Hannah, “Sir Elton John himself remains as dedicated to this issue as ever.  And deeply worried, too, about issues that he wants more widely shared.  In a recent op-ed for the New York Times, he wrote:

     “’…as engaged as the gay community and civil rights activists have been in the fight for marriage equality, we have lost ground on the fight that so intensely galvanized the gay community to begin with:  HIV and AIDS…we are failing to maintain the kind of basic awareness and education that is needed to save lives’.”    

Drinking and HIV

Kickin’ One Back May Be One Too Many

      Some time ago, I wrote a Huffington Post Gay Voices column entitled, “Kickin’ One Back May Be One Too Many.”  The piece deals with such an important and timely issue, that I’ve decided to re-introduce it. 

     So, here it is:  in a group of U.S. men who have sex with men (MSM), heavy drinking plus having more than one unprotected receptive anal intercourse partner in the past two years doubled the risk of acquiring the HIV virus.  And check this out: heavy drinking alone raised the risk of HIV infection by a whopping 60 percent. 

     The impact of heavy drinking on HIV infection –with or without unprotected receptive anal intercourse—is not well understood.  Therefore, to address these issues, Multicenter AIDS Cohort Study (MACS) investigators studied 3,725 HIV-negative men enrolled in the cohort from 1984-2008.  

     MACS is the first and largest study specifically created to examine the natural history of AIDS.  Now in its third decade, this study involves nearly 7,000 MSM nationwide.  MACS is ongoing at four institutions:  UCLA, Northwestern University in Chicago, the University of Pittsburgh, and Johns Hopkins University in Baltimore.  With 2,000 participants, the UCLA site is the largest.  And amazingly, after more than 25 years, the cumulative dropout rate is less than 15 percent.  This reflects the participants’ high level of commitment and interest. 

     These men self-reported their drinking habits and the number of unprotected receptive anal intercourse partners.  They reported drinking a median of eight drinks weekly, and 30 percent reported having multiple unprotected receptive anal intercourse partners in the past two years.  During 35, 870 person-years of follow-up, 529 men became infected with HIV. 

     Statistical analysis determined that heavy drinking—in excess of 14 drinks weekly—raised the risk of HIV infection 61 percent.  Among men with zero or one unprotected receptive anal intercourse partner in the past two years, heavy drinking did not significantly affect risk of HIV acquisition.  However, among men with two or more partners, heavy drinking doubled the risk of infection. 

     According to the researchers, their findings “suggest that alcohol interventions to reduce heavy drinking among men who have sex with men should be integrated into existing HIV prevention activities.” 

     This study resonates so strongly with me because my ex-partner Alonzo, whom I wrote about in a Huffington Post Gay Voices column entitled “It’s (Just) The Way That I Love You,” was, on occasion, a heavy drinker.  And nearing the end of our monogamous relationship, his drinking became even more excessive.  Alonzo suffered from chronic depression, which certainly contributed to overindulging. 

     After we parted, Alonzo’s drinking worsened.  It’s my understanding that that excess caused him to engage in unsafe sex.  Subsequently, he contracted HIV, which developed into full-blown AIDS. 

     And with breakneck speed, the disease ravaged this robust, muscular man.  And sadly, as a result of AIDS-related complication, Alonzo passed away in 1996. 

     In the coming months, I’ll be exploring and writing about LGBTQ depression, particularly in African-American men.

American Indians With HIV/AIDS

The Quiet Invader within Native Americans

     A rather disturbing report just hit my desk that really gave me pause.  Therefore, I decided to make it a Wyattevans.com exclusive. 

     According to Neal Broverman’s article, “Are the Odds Stacked Against Native Americans with HIV,” recently published at Hivplusmag.com, “The most recent studies of HIV among Native Americans living on the Navajo reservation in New Mexico found alarming numbers, with infections up 20 percent from 2011 to 2012.”

That article went on to state, “The results, reported in the New York Times, included another disturbing but little-discussed statistic:  Native Americans with HIV and AIDS have lower survival rates than any other racial group.  This affects me deeply because my maternal grandmother was Native American.

Statistics from 1998 to 2005 demonstrate that HIV rates among Native Americans “were slightly higher than but comparable to those of Caucasians, but lower than those of African-Americans and Latinos.  The problem is that testing, treatment, and care are not reaching Native Americans the same way they’re reaching other Americans.”

According to Lisa Neel–a program analyst at the HIV Program for the Indian Health Service, the federal government health program for American Indians and Alaska Natives–there are an assortment of reasons why.  “Poverty, which limits access to doctors and can put health concerns on the back burner for those struggling to feed themselves, is an all too common problem for Native Americans.”

Neel also says, “That compared with other racial and ethnic groups, American Indians and Alaska Natives have higher poverty rates, have completed fewer years of education, are younger, are less likely to be employed, and have lower rates of health insurance coverage.”

Often, this results into individuals not getting tested; as a result, scores being oblivious that they are in fact HIV-positive.  Stats show that at the end of 2009, 18 percent of all Americans infected with HIV weren’t aware of their status, while 25 percent of Native Americans and Alaska Natives living with HIV did not know they had the disease.  And of course, this means that some of those infected in these groups not getting needed treatment until their HIV advances to the point that they experience symptoms.

Neel is concerned that “cultural stigma faced by some gay and bisexual Native American men could also be discouraging testing and treatment,” and cites the higher rates of alcohol and drug use among all American Indians and Alaska Natives.

She concludes, “’Although alcohol and substance abuse does not cause HIV infection, it is an associated risk factor because of its ability to reduce inhibitions and impair judgment.  Compared with other racial/ethnic groups, AI/AN tend to use alcohol and drugs at a younger age, use them more often, and in higher quantities, and experience more negative consequences from them’.”