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BACKGROUND: Human immunodeficiency virus (HIV), sexually transmitted diseases (STD) and tuberculosis (TB) disproportionately affect some populations, including American Indians/Alaska Natives (AI/AN). Due to their smaller proportion of most state populations, AI/AN burden of disease is often not closely examined. This report estimates the burden of HIV, STD, and TB for American Indians/Alaska Natives as compared to all other race/ethnic groups in the Phoenix and Tucson Indian Health Service (IHS) Areas.
METHODS: Direct age standardization and rate ratios in SAS v. 9.3 (Cary, NC) using the 2000 US Census population and state population data were from the yearly estimates for each year of analysis was used to investigate burden of disease for AI/AN. The Phoenix and Tucson IHS Service Areas include all of Utah, Nevada, and all of Arizona except Navajo Nation. Data from the Arizona, Nevada, and Utah HIV, STD, and TB surveillance systems from years 2007-2012 were used in the analysis. Where possible, Navajo Nation Service Area cases were excluded. Cases were classified as AI/AN if AI/AN was reported in either the race/ethnicity fields. Emergent HIV and newly detected HIV were analyzed for Arizona. Only newly detected HIV was analyzed for Nevada and Utah. TB, chlamydia, gonorrhea, and non-congenitial syphilis (NCS) rates were calculated for all three states. Incidence rate ratios (IRR) and detection rate ratios (DRR) were calculated to estimate burden of disease for AI/AN.
RESULTS: The 2012 Arizona chlamydia age adjusted IRR for AI/AN compared to non-AI/AN was 2.1, gonorrhea IRR 1.7, NCS IRR was 1.7, newly detected HIV IRR was 1.4, emergent HIV IRR was 1.8, and TB IRR was 1.8. Similar ratios were seen in 2007-2011. The 2012 Nevada chlamydia IRR was 0.9 and gonorrhea IRR was 0.6. The IRR for 2007-2011 were comparable. The 2007-2012 NCS IRR was 0.2, newly detected HIV was 0.3, and TB IRR was 1.0. The chlamydia IRR in Utah for 2012 was 1.2 and gonorrhea IRR was 1.3. 2007-2011 showed similar IRR. The Utah NCS IRR for 2007-2012 was 1.7, newly detected HIV IRR was 0.9 and TB IRR was 1.9. In Utah and Nevada, the years were collapsed into a single rate due to the small number of cases to protect confidentiality.
CONCLUSIONS: Chlamydia, gonorrhea, and TB age-adjusted rates are higher in AI/AN compared to non-AI/AN in all three states. HIV and NCS AI/AN rates are higher in Arizona, but not Utah and Nevada.