Creating a path forward: understanding the context of sexual health and sexually transmitted infections in American Indian/Alaska Native populations – a review

Abstract

This review assessed sexual health and sexually transmitted infection (STI) burden among American Indian/Alaska Native (AI/AN) peoples within the context of current clinical and public health services. We conducted a review of published literature about sexual health and bacterial STIs among AI/AN populations in the United States using Medline (OVID), CINAHL (EbscoHost) and Scopus. Peer-reviewed journals published during 1 January 2005-2 December 2021 were included and supplemented by other publicly available literature. A total of 138 articles from reference lists met inclusion criteria, including 85 peer-review articles and 53 additional references. Results indicate a disproportionate burden of STIs is carried by AI/AN populations compared to non-Hispanic Whites. Risk for STIs in AI/AN people has origins in historical trauma and structural and social determinants of health. STI services are available for AI/AN populations, but many barriers to care exist. Community-based sexual health programming has been successful, but has thus far focused primarily on adolescents and young adults. A myriad of factors contributes to high rates of STIs among AI/AN populations. Longstanding disparities show a clear need to increase the availability of integrated, low-barrier STI prevention and treatment services. Implementation of multi-level (individual, physician, clinic, healthcare organisation, and/or community level), culturally relevant sexual health and STI interventions should be community-based and person-centred, acknowledge social determinants of health, and grounded in deep respect and understanding of AI/AN histories and cultures.

Fig. 1.

Literature search flow diagram. 1. Search terms: “American Indian OR Native American OR Alaska Native AND STI OR STD OR sexual health OR syphilis OR gonorrhea OR chlamydia OR trichomoniasis.” Search performed by U.S. Centers for Disease Control (CDC) Library December 2, 2021. 2. Duplicates were identified using the Endnote automated “find duplicates” function with preference set to match on title, author and year, and removed. 3. Total excluded articles based on eligibility criteria not being met = 466.

Fig. 2.

Rates of reported (a) chlamydia, (b) gonorrhoea, (c) syphilis, and (d) congenital syphilis by race/Hispanic ethnicity, United States, 2015–19.

Fig. 3.

A framework for understanding the context and contributors to sexual health and the prevention of sexually transmitted infections in AI/AN communities. SDoH, social determinants of health; ACEs, adverse childhood experiences.