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AN ANTHROPOLOGICAL STUDY OF THE ACQUIRED IMMUNEDEFICIENCY SYNDROME AMONG AMERICAN INDIAN POPULATIONS

CHARLES CAMBRIDGE, Ph.D.

ACKNOWLEDGEMENTS

A number of people and institutions have contributed significantly to the preparation and development of this dissertation. Encouragement and guidance for my research were provided by my generous dissertation committee: Drs. Deward E. Walker, Jr., Edward L. Rose, Gordon W. Hewes, Robert A. Hackenberg, and Leonard J. Pinto. During my research, fieldwork, and writing, my committee always supported my efforts in every way possible. This dissertation would not have been possible without their gracious support.

During my research and fieldwork, the Governors of the 50 States and Territories offered their kind assistance. State health officials responded with information, data, and interviews that assisted in the development of this dissertation. Their support was both kind and significant.

U.S. government officials from the Centers for Disease Control, the Indian Health Service and from other agencies have also supported my efforts with research materials and interviews. Their information has been critical in completing this dissertation.

My greatest support has come from Indian people who have wanted to express their opinions concerning AIDS. Their opinions have ranged from denial of AIDS as a problem to the fear that it will destroy us. In every situation, Indian people have wanted this research to be done. Each Indian person became an informant with important views to be expressed, and their assistance has been invaluable.

For the Indians who have been infected with AIDS, this document is important, because their lives and views are expressed in a unique way. This dissertation documents the need to explain their story to the general Indian and non-Indian public. Many of the Indians who have been infected were my personal friends. They wanted their story told with a warning about the future dangers of AIDS to Indian people.

Importantly, I wish to thank several groups for their financial support: the Navaho tribe, the Graduate School and Department of Anthropology of the University of Colorado at Boulder, and the U.S. West Foundation.

For organizing, writing and editorial assistance, several individuals must be thanked for the long task of bringing this dissertation into form. Drs. Deward Walker and Edward Rose spent long hours reviewing drafts and offering advice about form and content. Mss. Stephanie Pache, Red Dawn Foster, Roz Dorf, and Catherine Gilliland spent many long hours typing, editing, and copying many drafts of the dissertation. Their help was essential in making this document a reality.

Many friends and relatives have assisted in many different ways. Mr. David Axtell nursed my computer through four different mother boards and viruses. Messrs. Ken Garry, Mark Seahmer, and Luca Boscardin have assisted me in numerous ways in completing this dissertation. My mother, Mary, my Aunt Annabell, my cousin Sonya, my sister, Debbie, and her husband, Bill have lessened my ordeal in many ways. Other friends have been supportive and patient with me. I thank all my relatives and all my friends for their kindnesses. There are many whom I have failed to mention. I apologize and appreciate their encouragement and support.

DEDICATION

The idea for this dissertation originated in 1971 from the surprising and puzzling death of a friend. At the time, his death was a mystery and the circumstances of his early death led me to undertake this study.

INTRODUCTION

As has happened numerous times in the last 500 years, an old World disease has been introduced into American Indian populations and, like prior epidemics, threatens to eradicate whole tribes. This disease is known as the Acquired Immune Deficiency Syndrome [AIDS]. The full impact of this disease among American Indian people is not yet apparent, but it is now spreading rapidly as the virus becomes self-perpetuating in Indian communities. The introduction of the AIDS virus into different social groups of American Indians has been varied and has resulted in different cultural responses. Indians infected with the AIDS virus have been greeted with fear, avoidance and banning. In turn, AIDS infected Indians have turned to traditional healing in attempts to seek a cure not available from Western medical science.

This dissertation describes the expanding AIDS epidemic among American Indians, describes ten individual cases of AIDS infected individuals, and makes a number of predictions about the future course of this epidemic. A number of needed reforms are recommended in the existing programs of prevention, identification, and treatment of AIDS among American Indians. If these reforms are not made, the epidemic will continue to run its course, possibly ending in the eradication of large numbers of Indian people and their tribal cultures.

TABLE OF CONTENTS

Chapter One: THE ORIGIN AND DEVELOPMENT OF THIS DISSERTATION

Introduction

Sources of Information

Legal Issues and Confidentiality of Research

Tribal Cultural Factors Influencing this Research

Urban vs. Reservation AIDS Research

My Key Informant

Limitations of this Dissertation

Chapter Two:  A STATISTICAL OVERVIEW OF A GROWING EPIDEMIC

Introduction

Who Is An Indian

Statistical Graphs

Go To Statistical Graphs

Chapter Three:  TEN AIDS CASES

Henry Sawyer

The Trucker Girl

The Transvestite

The College Student

The Mainliner

The Entrepreneur

Fresh from the Reservation

A Medicine Man

The Activist

Our New Leader

Chapter Four:  CONCLUSION

BIBLIOGRAPHY

CHAPTER ONE

THE ORIGIN AND DEVELOPMENT OF THIS DISSERTATION

A. Introduction

This dissertation is an anthropological exploration of the Acquired Immune Deficiency Syndrome (AIDS) and its impacts on American Indian people. My first goal is to provide statistical and ethnographic information for use by scholars, American Indian tribes, organizations, and individuals who have been affected by AIDS. My hope is that this research will assist in meeting the health needs of Indian victims of AIDS on reservations as well as in urban areas. This dissertation will demonstrate my conclusion that AIDS is rapidly becoming a threat to the survival of tribal people. As early as 1984, it was already clear that American Indian tribes and people were facing this threat to their continued existence. By 1993, AIDS had created conditions in which some tribes will probably lose a large part of their membership. My purpose in this dissertation is to present a realistic view of this deadly reality that now surrounds Indian people.

By 1984 it was apparent to me that some smaller American Indian communities might disappear; that AIDS could become the Indian's twentieth century smallpox; that certain Indian religious practices might be dangerous including piercing of skin, flesh offerings, scarring, and tattooing; and that a common denominator of Indian AIDS cases was alcohol abuse.

In 1984 such ideas were not taken very seriously by either Indians or non-Indians. Today they are taken seriously by a growing number of non-Indian and Indian people who have come to fear this plague. It is clear that once again, an Old World disease is being introduced into the Indian populations of the Western Hemisphere with devastating results. This new disease, like smallpox, will probably decimate many Indian populations. By 1993 a leveling off in the number of AIDS cases in the general population of the United States had become apparent, but as will be shown, it has continued to increase rapidly among American Indians.    Go To Table Of Contents

B. Sources of Information

Anthropology is the study of people. This dissertation is a study of ten Indian people infected with the HIV virus. Listening to people's stories has provided the basis for much of this dissertation. I believe their stories will add significantly to our understanding of both tribal and urban patterns of AIDS infection among Indians. Fieldwork was conducted in both reservation and urban environments in order to gain an adequate understanding. I have been acquainted with the ten individuals described in Chapter three for most of the eight years I have expended in this research. Observation and interviews have been the major tools of my research.

As part of this research, I also have conducted a survey of the literature concerning AIDS and American Indians. When I began in 1984, research on AIDS and ethnic groups was very limited; research on AIDS and American Indians was nonexistent. Even now the Index Medicus has less than 30 citations for American Indians and AIDS, and a majority of these articles are concerned only with American Indians as part of different statistical databases. A few articles present American Indians as part of a general discussion of ethnic populations facing the threat of AIDS. One short paper deals with the AIDS threat to tribes. In addition to a continuing literature survey since 1984 I have continued to conduct interviews with members of many groups as possible that are involved with or have knowledge of AIDS among Indians. They include the following:

Observation and interviews have been the major tools in my research. Go To Table Of Contents

C.  Legal Issues and Confidentiality of Research

Enthusiastic tribal support greeted the first Indian AIDS education and prevention programs in the late 1980's, stemming not from a strong desire to deal with AIDS but probably from a desire for increased tribal revenue. Tribal revenue depends primarily on grants by outside agencies instead of on a tribal tax base. It was thought that AIDS programs would employ individuals who had been terminated from other tribal programs because of federal cutbacks in the 1980's. In an atmosphere of worsening recession and increasing federal deficits, AIDS programs became a source of income and employment for some tribes. More recently, however, AIDS workers in Indian programs have shown a greater commitment to preventing this epidemic. Yet others have greeted the news of increases in Indian AIDS cases with continuing fear, denial, and ignorance. They do not wish to be reminded of past epidemics, ghastly memories deeply ingrained in their tribal memory of bodies twisted by smallpox.

In 1988, as the number of American Indian AIDS cases began to increase and as AIDS education programs began to reach Indian people, fear of this highly infectious virus created homophobic paranoia on many reservations followed by efforts to ban all such persons. For example, attempts to enact tribal restrictions and penalties against those who had AIDS and who had been tested positive for the HIV virus.

Because of my research, I was even threatened with a lawsuit in which a tribal attorney for a northern Plains tribe demanded my field notes and information dealing with AIDS/HIV-positive tribal members. When I refused to release my field notes or the names of tribal persons with AIDS, the tribal attorney called the regional U.S. attorney's office.

The U.S. attorney was asked to apply federal pressure to force me to surrender my field notes and other materials. Tribal leaders told the U.S. attorney that I had done a video of a Mr. Christian, an AIDS victim described below, that contained information that could be used against Mr. Christian. While I had not filmed any videos of Mr. Christian, I did have intensive field notes from my interviews with him.

The U.S. attorney seemed unaware of AIDS issues in general and of the obligation for confidentiality between anthropologists and their informants. This issue was eventually laid to rest, but the reader should note the special relationship between American Indians and the U.S. Government that led to this conflict. Federally-recognized American Indian tribes possess political sovereignty and have enacted special laws that make this type of interference in research possible.

The need for confidentiality requires that the names of tribes and the tribal affiliations of individuals remain confidential in this dissertation. Without their cooperation I would not have been able to complete this dissertation. Interviews were conducted with many Indian and non-Indian IHS staff members who desire anonymity for many reasons. All my informants, including tribal leaders, wanted their privacy protected. The research and fieldwork for this dissertation were, therefore, performed with assurances that the privacy of individuals and groups would be protected. Because of this, I was given access to a wide range of individuals and information not otherwise accessible. My ten Indian AIDS case studies are not identified, and my ethnographic accounts of their lives have been generalized so as not to permit their identification by others. Their identities will remain secret.   Go To Table Of Contents

D. Tribal Cultural Factors Influencing this Research

Many tribal people attribute importance to nonhuman factors that are causes of disease. They often believe that animals, plants, and other entities see, feel, smell, and think in ways beyond the range of human awareness. These beliefs are important, but anthropology lacks a complete understanding of such factors describing them merely as magic, medicine, or religion. With the introduction of AIDS some traditional Indian religions' healers have to combat this new threat.

Likewise, an Indian AIDS individual interacts and flows through tribal and urban communities in ways that require an understanding of the individual's religious experiences. The ideal tribal person is generally traditional in belief and behavior, even though many tribal groups have undergone acculturation that has fragmented them into many sub-cultural groups. Within traditional tribal cultures, members are born into their positions that define their relationship to their tribal culture and mythology. From these positions, tribal members gain access to traditional healing and can understand their relationships with other tribal members. During moments of crisis, they call upon traditional medical systems for a cure, feeling secure and confident in the attention they will receive. In the case of AIDS, this has not always been true. Western medicine is viewed by some as an alternative, but since it has proven inadequate to prevent or cure AIDS, many return to traditional medicine in the hope of gaining cures.    Go To Table Of Contents

E. Urban vs. Reservation AIDS Research

Many tribal people visit urban areas. Most such visits are short-term journeys off the reservation. Likewise, a tribal person living in the city may return to the reservation for brief visits to satisfy traditional responsibilities. I was able to interview urban Indians not only in cities but also on reservations during such visits. Traditional individuals can be found in urban settings as well as on reservations. Alternatively, Indians may be enrolled in a tribe but have few connections to their tribal culture. Their home is not the reservation but the city where they are living. They do not have surviving tribal memories, nor do they have access to tribal society. When infected with AIDS they may seek the assistance of relatives on reservations but many of them lack relatives on their reservation; they must find others who are willing assist them. Nevertheless, many urban Indians with AIDS remain in the city for medical assistance at free clinics. Urban Indian AIDS victims are among the most isolated and helpless of all cases that I have encountered in my research.    Go To Table Of Contents

F. My Key Informant

Informants are the foundation of ethnography. An ideal informant exemplifies the culture of which he is a part. They provide the ethnographer with keys to the cultural jigsaw puzzle. A problem facing ethnographers, is whether the information provided by informants is correct. The most challenging step in ethnographic research, therefore, is selection of key informants. While I have interviewed many people, I still remain the key informant for much of the information contained in this dissertation.

Through my tribal identity and my journeys into different Indian communities, I have become my own key informant. While I come from a tribal world, I am also seeking an academic degree at the University of Colorado and am, therefore, part of the urban world. I am marginal and flow between the tribal and urban worlds, a member of both.

I was born on the Navaho reservation near Farmington, New Mexico. According to my Bureau of Indian Affairs' (BIA) enrollment papers, I'm a 4\4 Navaho Indian enrolled at the BIA Shiprock Agency. The blood quantum of 4\4 signifies that I am a full blood member of the tribe. I was born into the Bit'ahnii [Folded Arms] clan for the Ta'neeszahnii [Tangle] clan which defines my place in the Navaho social and mythological worlds. I am secure in both Navaho identity and in my urban Indian identity. My connections in both tribal and urban settings have allowed me to explore AIDS from several perspectives. I have attempted to avoid personal prejudice and bias during the course of this research. Because of my background, however, I am extremely sensitive to the concerns of Indian people and wish to avoid simplistic approaches and assumptions that prevent proper understanding of Indian people and their struggle with the AIDS epidemic.    Go To Table Of Contents

G. Limitations of this Dissertation

The totality of what I have seen and discovered about AIDS since 1984 is not contained in this document. My purpose in this dissertation is to personalize the often impersonal statistical image of American Indians and their struggle against the AIDS epidemic. This is not a reflection of all that is occurring in the reactions of Indian people to AIDS. While I could have investigated various AIDS hypotheses concerning the functions, social roles, social institutions, and cultural mechanisms involved in Indian responses to AIDS, I have followed a different course. I wish to characterize the problem using statistical data and then describe the experiences of ten Indians infected. While my concern centers on these ten Indian individuals infected with AIDS, I hope to provide improved understanding for all Indian AIDS victims. Describing the reality of AIDS for ten real Indian people and the problems they face is a challenging exercise. They are unlike any other Indians who have ever lived. They are among the first to be infected with a new disease, and they are dying or have died. Some of them were my friends, they knew of my research, and they wanted to help by sharing their lives in this way.    Go To Table Of Contents

CHAPTER TWO

A STATISTICAL OVERVIEW OF A GROWING EPIDEMIC

A.  Introduction

Although many people have been touched by the AIDS epidemic, few are aware of its progress or its accelerating impact on Indian people. In order to depict the growing impact of AIDS, I have prepared a series of graphs based on statistics provided by the Centers for Disease Control. They are presented in order to prepare the reader for the ten ethnographic accounts of individual AIDS cases presented in Chapter 3. By presenting both statistical and ethnographic information, I believe it is possible to convey a more accurate picture of this epidemic among Indian people than has been possible in prior studies. Together, the two types of information are mutually enhancing.

The following graphs are derived from data collected by the Centers for Disease Control (CDC). By simple grouping and manipulation of the data, the movement of the AIDS viruses through different American Indian populations can be illustrated. These graphs enable the reader to gain a sense of the magnitude of the epidemic which is not evident from the ten individual accounts I have chosen.    Go To Table Of Contents

B. Who Is An Indian

Who is an Indian, has become an important question in the study of Indian AIDS cases? Every decade the American Indian population is counted by the United States census, but this has never provided an accurate picture of this population. It is possible that the Centers for Disease Control's Indian AIDS population figures are inaccurate because some counted as Indians were probably not members of a tribe. They claimed to be Indian so they appeared in that category in the CDC's AIDS population census. It is clear that many Indians choose not to be so identified.

An IHS official stated, "There is a problem of who is an Indian, especially in Oklahoma and California. With the collapse of the oil industry in Oklahoma, the IHS saw an increase of non-Indians claiming to be Indians in order to get IHS service. These people have received medical care from us. In California, there are also large numbers of individuals claiming to be Indian in order to get IHS service. They have received services from us, but the system may collapse because of these spurious claims."

Many individuals are genetically Indian and may even be culturally Indian as well, but without legal records, they are denied tribal membership. Some are still accepted by their enrolled relatives. A nationally-known militant Indian leader was unable to find records proving his Indianess, because "The court house burned down along with all their records."

Likewise urban Indian children may not be enrolled in their tribes, because their parents may find it inconvenient and difficult to deal with the bureaucracy. In one case, an Indian woman had her children registered as members of the Negro race, because the hospital, under State law, only recognized White and Negro. When the girls began college, they attempted to change their racial classification, and it took nearly three years to accomplish this change in legal identity. The girls were finally enrolled after meeting the legal requirements of their tribe. Tribes now determine the rules for their own tribal membership.

For cultural and political reasons large numbers of tribal people have been legally excluded from tribal membership, but it is clear that large numbers claim to be Indian who may not be able to prove it. Thus, the statistics from federal agencies, such as the Centers for Disease Control, are far from ideal but are still the best we have.    Go To Table Of Contents

C.  Statistical Graphs

The graphs in this chapter are derived from information provided by the U.S. Centers for Disease Control. From them, it is clear that until 1988, the number of Indian AIDS cases was small, but in 1988, the number increased dramatically. This increase reflected the movement of the AIDS virus into more sectors of the American Indian population.

My field research shows that initially the HIV transmission was from non-Indian to Indian, but as the number of AIDS cases has increased, the AIDS virus has become more established in the American Indian population.   Indian to Indian HIV transmission will become more common.

The following graphs indicate that the Indian gay, male population was the first to be affected by the AIDS virus and where it has continued to increase to the present time. The vast majority of gay Indian male AIDS cases stem from sexual intercourse.

Currently, the American Indian gay, male population has the highest number of AIDS cases. Since 1988, their numbers have increased with a major increase between 1991 and 1993. As indicated by the graphs, the AIDS virus continues to increase sharply so that by 1993, there were 623 cases. If the maximum incubation period of eleven years for the AIDS virus is used as a measure, the new 1993 AIDS cases were initiated in 1982.

My comparative analysis of the geographical distribution of male AIDS cases contrasts the urban and reservation Indian populations. As the educational level of the urban Indian homosexual community increases, their AIDS numbers appear to be decreasing as a percentage of the total. The reservation Indian homosexual community has remained less concerned with the AIDS virus, and their AIDS numbers appear to be increasing more rapidly.

In 1989, the highest number of new Indian AIDS cases was in the 25-29 age cohort, followed by the 30-34 age cohort. Although the 30-34 group remains high in 1993, the AIDS virus is now beginning to increase in the 25-29, 35-39, and 40-44 age cohorts. This suggests that the AIDS virus is moving into both younger and older populations. Despite this, the AIDS population will become increasingly younger to reflect the general younger Indian population. The rate of AIDS virus infections should stabilize in the older population.

The graphs indicate that by 1993, there is an evident increase in the AIDS Indian female population. In the 1980's, the number of female cases was fairly constant, but beginning in 1989 the AIDS virus began to increase sharply among women, and is becoming quickly established in the Indian female population.

The vast majority of early Indian AIDS female cases occurred because of injection of drugs with dirty needles. In 1989, the highest number of Indian AIDS female cases was in the 30-34 age cohort followed by the 25-29 year old age cohort. These AIDS cases are primarily urban female IV drug users who live in disadvantaged areas where the supply of IV drugs is easy to obtain.

Heterosexual contact will be the leading cause of AIDS among Indian females. This increase will be parallel by similar increases in the Indian male population.

Cases stemming from IV drug use continue to be concentrated in the cities, because an IV drug infrastructure has not yet developed on most reservations.

In 1993, the highest number of Indian AIDS female cases was in the 30-34 age cohort, followed by the 25-29 age cohort. In most 1993 age cohorts, there are major increases from the 1989 AIDS figures. While the number of 30-34 cohort remains high, the AIDS virus shows a major increase in other cohorts, indicating the increasing movement of the AIDS virus into both younger and older female populations.

My principal hypothesis is that as AIDS increases, the population it affects will be increasingly younger and located in both urban and reservation areas. The rate of AIDS infections should stabilize in the old age cohorts in the near future. The principal means of transmission will be heterosexual activity. Unfortunately, as the virus spreads through the childbearing population, there will also be an increase in AIDS-infected children as mothers pass the virus to the unborn. Indian males and females receiving blood transfusions and transplants will remain a small percentage of the total.

While there are other possible conclusions to be drawn from these statistics, the one overriding conclusion from this statistical overview is that the AIDS epidemic is now reaching the "take off" stage among American Indians.

It is being transformed from a disease of primarily urban, gay and IV drug users into a general Indian disease affecting ever increasing numbers of both older and younger heterosexuals. It is now established in many tribal communities and is no longer being transmitted primarily from non-Indian to Indian but from Indian to Indian.     Go To Table Of Contents or Go To Statistical Graphs Diagrams.

CHAPTER THREE

TEN AIDS CASES

HENRY SAWYER

Henry Sawyer died unexpectedly. Henry was successful. He accomplished goals that many Indians have only attempted. He was educated and had good jobs. Through his sexual relations with non-Indian lovers, he was infected with the HIV virus, and in 1984, died in his mid-forties. Henry Sawyer was an Indian who had lived for several years in Denver, Colorado. He was not a full-blood Indian and was a tall, heavyset individual with a light complexion. He lacked Indian features and could easily pass as a White person. He was not raised on the reservation where he had tribal membership and looked upon himself as an urban Indian. He was comfortable with his professional life in the city.

Henry was a well-educated college graduate from the University of Colorado. During his academic career he rarely associated with other Indian students, and he did not actively seek assistance from the American Indian support programs located on campus. His educational goal in life was to become an administrator or manager. Later, as job advancement became crucial to his goals, he returned to school to complete his Master's degree. After receiving an MBA, Henry achieved a middle-class standard of living. He was employed in the private sector as a manager and became known for his professionalism and excellent work skills. He held several administrative positions with Denver companies, but he finally decided to switch to government service because of the greater stability and job security. Henry worked for several years with city and county governments in the Denver area.

When it became known that Henry was an Indian he was approached for possible employment by several local governmental and non-governmental agencies. His involvement with the local Indian community increased when he was appointed to sit on committees and boards concerned with ethnic or Indian issues. He was never totally comfortable with his increased public visibility and equally uncomfortable associating with Indian people who knew his personal and family history.

Save for his enrollment in his tribe Henry lacked a tribal cultural orientation. At times he would express loyalty to his tribe, but he did not own tribal lands or have other attachments to his reservation. On rare occasions, Henry would make reference to relatives on his reservation.

In reality Henry's Indian cultural orientation was limited to the urban pow wow and a few other urban Indian community events. He responded to his relatives' requests that he attend pow wows to support Indians events, but he was always as an observer and never a participant. He felt attendance at a pow wow was a small price to pay to maintain peace in his family and he would normally only attend for a short time. One of his relatives commented, "At least he showed up. He is always so busy." Henry rarely mentioned fellow tribal members other than those of his immediate family. His extended family was not important to him, and he did not participate in sweats or carry a pipe. He was raised in an assimilated family as a Christian and was not familiar with Indian religious life. He concluded that interaction with Indian people was bad for him.

Henry grew up in a home that had undergone extensive cultural assimilation. He knew he was an Indian and a tribal member, but he had acquired the belief that association with other Indians was somehow undesirable. This idea influenced Henry's social and sexual relationships which were mostly with non-Indians. He equated being White with being good. Associating with Whites and emulating Whites became very important for him. He believed that White culture could be transmitted through interaction with Whites. Henry's early view of himself as a professional limited his interaction and association with other Indian people. He felt ashamed and embarrassed in being associated with Indians. These fears helped shape his preference for gay activities with non-Indians.

Henry Sawyer achieved the high status sought by many Indians with professional ambitions. He defined himself as a success as his career advanced. He believed he had made it and pursued his roles in life with energy and enthusiasm. Nevertheless, a nagging feeling persisted that this was not enough. Eventually, he became more willing to work with local Indian groups. His associations and concerns with Indian people increased, and he became well liked. Because of his intelligence and experience, he often provided Indian organizations with information and advice that enhanced the effectiveness of their programs.

As his prominence as an Indian person increased, his private gay life became more difficult to disguise. He had effectively hidden his sexual orientation up to this time, choosing sex partners who were non-Indian and professional. He believed that these choices made him part of an urban intelligentsia. Henry had a great love for the theater and for ballet and would journey to distant cities to attend performances. He would frequently comment on the food and culture available in Denver. His apartment became a temple to his ambitious lifestyle, and his wine rack reflected his attempts to become a connoisseur. His magazines reflected his pursuit of culture and helped him create a refuge in his home for those seeking the good life. His entertainment center was an expensive technical marvel. The first releases of classical music and opera were occasions for musical events and gourmet feasts at his home. Cooking was a cultural event for him in his spotless kitchen that remained immaculate even when he was preparing a culinary feast.

Henry's home was a maze of artistic symbolism that complimented his personality. His furniture was a blend of the new and the antique, each piece contrasting in form and function. The majority of his pictures, posters, and paintings were abstract, reflecting his modern taste. The only Indian items evident in his apartment were a few pieces of beautiful beadwork.

Henry received a job offer to move to Washington, D.C. and he was excited about the prospect of moving to the nation's capital with its abundance of cultural activities. He died within a few years after his move, infected by a non-Indian gay lover while living in Washington, D.C. He was a very early Indian AIDS case in Denver, perhaps the first.     Go To Table Of Contents

COMMENTARY: HENRY SAWYER

Historically, assimilation has been a social goal for Indians promoted by Christian missionaries and governmental agents in their dealings with tribes. The Bureau of Indian Affairs (BIA) was the U.S. Government agency in charge of Indian relations. American Indians have believed rightly that the BIA's relocation program was a massive social experiment in assimilation. Relocation counselors would advise Indian clients in the vocational program not to associate with other Indians in the city. Government officials feared the program would fail if the Indians would get together and drink. Uncooperative Indians would therefore be forced to return to their reservations by the BIA. Through assimilation, it was thought that Indians would strive for the high social and economic levels demanded by the American social system.

Henry died because the Acquired Immune Deficiency Syndrome (AIDS) suppressed his body's immune system, significantly lowering his resistance to various infections and several forms of cancer. Henry's death was a direct result of unsuppressed infections, but at the time AIDS was a not major concern for most American Indians.

As the HIV virus moves through American Indian populations, heterosexual sex will certainly become the future primary means of AIDS transmission. The social practices that will most likely increase the transmission of AIDS among American Indian populations are alcohol-related loss of sexual inhibitions, recreational drug use, sexual intercourse, and perhaps certain religious practices.

Historically, American Indian people have found their tribal existence threatened in many tragic ways. Tribal cultures have been decimated by wars and epidemics as well as by forced urbanization of Indian people. Speaking about urban Indian youth who attempt to be traditional, one Indian woman elder of a southern Plains tribe, said, "They didn't even know how to chop wood. They couldn't build a fire. They don't know how to do anything." The BIA relocation program that began in the 1950's became the focus of the U.S. government's assimilation policy. The relocation program moved American Indians from their reservations to selected urban areas for vocational training. The BIA provided transportation, employment counseling, and financial support. Potential relocation participants had to be high-school graduates, effectively excluding many Indians and thus creating a division within the Indian population. Those with high school education left their reservations, and other less educated members stayed at home.

When an Indian was accepted into the relocation program, transportation was provided to a city where the vocational training was conducted. Workshops on various topics would be conducted for new arrivals to the city. Women were instructed in how to use gas stoves and how to be good housekeepers. Everyone received booklets on the correct way to use the telephone and ride on city buses. Such interaction was based on what the BIA assumed Indian people would have to know in order to survive in the city.

In more recent decades (especially since the 1960's), Indian people have been relocating to urban areas without BIA assistance, primarily in search of employment. One tribal leader stated that, "Because of federal cutbacks, people are leaving the reservation and going to the cities." Budget reductions continue to provide a steady flow of urban immigrants. The reductions in federal revenue and the lack of reservation jobs continue to force unemployed Indians to urban areas. Some younger Indians also move to the city because of the bright lights and excitement. Tribal leaders describe the situation as follows: "The kids are bored. They have nothing to do. The tribe doesn't have any activities for them." The most common view, expressed by members of many tribes, is that sex, drugs, and getting drunk are the most popular activities for bored Indian kids.

Urbanization continues to divorce Indians from their traditional lifestyle on reservations. It is unusual for Indians like Henry Sawyer, born and raised in cities, to have a connection to their reservations. They may have a verbal loyalty to a place they have never visited. More common is the urban Indian whose cultural loyalty is only to other Indians in the cities.

The urban Indian develops different social relationships than those found on reservations. Indians are culturally similar on reservations, while in cities, the urban Indian is culturally dissimilar. In an urban environment the Indian social groups are distinctive because of the diverse tribal affiliation of their members. Pan-Indianism helps unify such diverse populations. Intermarriage of individuals from differing tribes has also created children with no firm tribal identity. During a meeting in Washington, D.C., the chairman of a northern Plains tribe stated, "Tell the young people that they have to return to their reservation. Everyone is marrying outsiders." In another situation, an Indian woman elder of a northern Plains tribe said, "There is an Indian elder going with a White girl [because], she just wanted an Indian baby. Now, there is a custody battle going on." The Indian woman elder opposed White women who wanted Indian babies.   Go To Table Of Contents

THE TRUCKER GIRL

"She was beautiful." Helen Stuart was notorious as a party girl. She had fun in the bars of Los Angeles. When finally infected with the HIV virus, she returned to the reservation and continued her partying and sexual affairs. She was not concerned about infecting others. Eventually she died, but she infected many and she did not seem to care.

Helen Stuart was a full-blood and an enrolled tribal member of an Arizona tribe. She was raised on the reservation, but she moved to Los Angeles and lived there for several years. She eventually married but did not have children. During her years in the city, her contact with her family on the reservation was minimal.

She became one of the earliest Indian female AIDS deaths in the United States. City life was a fun time for Helen. She was young and found the demands of traditional tribal life confining. She viewed the city as an escape, because her tribal family structure conflicted with Helen's unrestrained behavior.

Helen did not plan her journey to the city. It occurred on the spur of the moment when a friend was driving in that direction, and Helen joined him. Her motives were to meet other young people and to see relatives. She also sought employment, which was unavailable on her reservation.

As soon as she arrived in the city, she began to look for friends and relatives who could provide her a place to stay. Any gathering of Indian people at a bar or pow wow becomes a focal point and is an opportunity to meet someone who may have a place to stay. Her journey from one lover to another was part of a pattern followed by many young Indian women who move to the city.

Helen's immediate goals became partying and fun. She viewed employment as a way of gaining money for drinks at bars. Eventually, this life became impossible to escape. She became a party girl and a permanent part of the urban bar scene. She had many male friends who provided money for drinks in return for impersonal sexual encounters.

Helen finally formed a relationship that became a common-law marriage. She met her husband in an Indian bar in Los Angeles. He was a member of her tribe and from the same general region of her reservation. They were highly incompatible, lacking mutual respect and their marriage was full of conflict. Their marital relationship resembles those of many other urban Indian couples.

Helen and her boyfriend were attracted to each other physically and sexually. Constant fighting and abuse helped create a co-dependency. Without each other, they were lonely and desperate, they formed an abusive relationship that included many public fights and arguments. Mutual criticism and abusive comments increased with time, but their dependence upon each other persisted.

Eventually, a point was reached in their relationship where infidelity became frequent. It was a way of making their lives more exciting by increasing their sexual adventures. Her common-law relationship made Helen feel restricted and dampened her relationships with friends. Increasingly, when she would enter into the party spirit her husband would attempt to restrict her behavior.

Her short-term affairs became a means of reasserting her individual freedom. She was not deterred by tribal tradition, which seem absent among many urban Indians.

Helen came to believe that she was a free spirit, beyond anyone's power to control her. She was sexually involved with many lovers and became infected with the AIDS virus. As an early AIDS case Helen gained a great amount of notoriety. She was never certain how she became infected with the HIV virus and refused to disclose what she did know. Certain State health officials believed that her infection was caused by non-Indian heterosexual exposure, and tribal health officials theorized that her survival in the city was sexually based if not actually prostitution.

Helen's husband was tested and the results were negative. Some health officials believed his careless sexual encounters were the means of Helen's infection. Although her husband was Indian, her short sexual affairs were with non-Indians.

In Helen's situation, sexual relationships between Indians and non-Indians are typical and frequent. As an Indian with a degree in psychology said, "They (Indian women) have no respect for themselves. Their husbands may beat them up, but as long as they [the husbands] are White, then it is okay."

He observed that Indian men are usually insecure, and they also wish to gain access to the White world by marrying White women. Marrying a White woman has become a status symbol signifying that an Indian man has made it. Non-Indian mates tend to have more money and better resources than Indian mates, and in Helen's case this was an incentive to have affairs with non-Indians. They were able to spend large amounts of money at the bar and on other commodities.

Helen's life became centered on her non-Indian affairs and on the bar scene. After she was infected with AIDS, health officials reported that she continued her lifestyle, having little concern that her virus was beginning to kill her.

As her illness progressed there was little medical support for her in Los Angeles. Helen refused to believe she had the HIV virus and returned to her reservation. Once back on her reservation Helen was able to secure the free medical care that tribal members are entitled to receive.

Helen's medical history shows that she traveled from health clinic to health clinic, private and public, among facilities found both off and on her reservation. The initial diagnosis was that she had flu or a related respiratory problem. Various clinics prescribed drugs ranging from aspirins to antibiotics. After several weeks, a diagnosis confirmed that Helen was infected with the AIDS virus. A private clinic diagnosed her as HIV positive, and the government hospital was informed. This was one of the first Indian AIDS cases and she died after a lingering illness.

There is a view among certain Indian people that AIDS is good. One Indian Christian elder of a northern Plains tribe, stated, "AIDS is God's punishment." She believed strongly that God's wrath had created AIDS to destroy bad Indians and their way of life. This woman was convinced that AIDS Indians came from moral degeneration and that God was striking back against their immorality. She said that "Indians are going to have to behave. AIDS will destroy all bad people."    Go To Table Of Contents

COMMENTARY: THE TRUCKER GIRL

Health officials have theorized that Helen was diagnosed as HIV positive in the city and that she reacted in what has become a common pattern in which a person disbelieving a medical diagnosis of AIDS seeks other expert opinion. Medical authorities believe that she returned to her reservation seeking an alternative opinion. Her husband, who remained in the city after her departure eventually followed Helen to her family's home on the reservation.

When he arrived, he was told that he needed to go to the health clinic for testing, since his wife had tested positive for the HIV virus. Without understanding the ramifications of an AIDS diagnosis, he grudgingly went to the Indian Health Service (IHS) clinic for testing. Helen's family said that he had given her AIDS.

It is important to remember that there is a serious lack of knowledge of AIDS on reservations. It has been easy to associate AIDS with cancer. Since Indian people have been told that AIDS and cancer kill in the same ways, both diseases are assumed to be the same. As a result, Helen's husband was accused of giving her cancer. After he had tested negative for HIV, the family's criticism continued.

Living in his wife's family's household became unbearable, and he left, fearing that he would be beaten if he returned. Health officials became alarmed that Helen's husband had disappeared, because they wanted additional testing and information from him. Health officials still do not know where is or what he is doing. They fear that he will eventually test positive and infect others.

A reservation medical clinic reconfirmed Helen's diagnosis of AIDS. Except for the flu-like symptoms that lingered, she considered herself healthy. In the absence of counseling and advice on safe behavior Helen seemed unconcerned about her medical condition and quickly disappeared. What she did during her disappearances, caused major concern among health officials. Eventually, she reappeared on her reservation and stated that she had not had any sexual relationships. She told a disbelieving tribal health worker that she had been visiting friends.

Health officials believed that Helen was still sexually active while being aware that she had the AIDS virus. She returned to her reservation primarily for medical services and had little contact with her relatives or other traditional people. She began working at a nearby truck stop, and concerned health officials suspected her of continuing sexual activity.

Another HIV-infected Indian woman commented, "I will tell you. I don't have anything to lose. I may die tomorrow. I hope to last until Christmas. My life style has not changed." This woman, like Helen, also continued her sexual activity. Helen remained near her reservation and continued working as a waitress at a large truck stop nearby. During this time she denied having sexual relationships, but she continued to hitch rides from truckers on her days off to eastern and western cities.

Most Indian people do not believe there is prostitution among Indian people. In Indian prostitution, exploitation by pimps, police, and hotel employees, operates in urban areas. Nevertheless, Indian prostitutes are not usually part of an organized operation.

Certain reservation women and urban Indian females view sexual favors as a means to obtain better jobs, better places to stay, economic security, and as a means of survival. Casual sexual favors are viewed as a pleasant, part-time activity, but they are not viewed as prostitution by Indian women.

Indian people also find it difficult to imagine that there are young Indian men on urban streets prostituting themselves for money with men. As a young Indian informant stated, "I was lucky. My friend found me when I was fifteen. He takes care of me. We go to the Bahamas for vacations. I have been with my friend for three years."

If prostitution does become a means of survival, Indian women and men view non-Indians as their best clients. Non-Indians do not create as many problems and are not part of the Indian community. In this way, Indian male and female prostitutes can keep their occupations hidden, but Indian prostitutes, male and female, are found in all major urban areas in the United States.    Go To Table Of Contents

THE TRANSVESTITE

"Heck, I went to the reservation and got beat up." Michael Christian was feared by his tribe. He was their first AIDS victim and they tried to ban him from his reservation. He wanted only love and respect and wished to die on his reservation in peace but was forced to leave.

In 1987, Michael Christian was an early Indian male AIDS case. During his gay life, he defined himself as a transvestite with a very active love life. He was not a full-blood Indian and was not raised on his reservation. Even though he was an enrolled member of a Dakota tribe, he viewed himself as an urban individual. He had no loyalties to his tribe and was not culturally an Indian. He had few relationships or contacts with Indian people and had lost all ties with his traditional tribal culture except his official tribal membership. Michael did not complete high school, and his life became filled with minor criminal offenses.

Michael and Jim shared a common cell when they were in jail in Florida. Their initial sexual relationship eventually became a close, personal relationship. When Michael was released, he found an apartment and waited patiently for his boyfriend's release. Living together strengthened their bond, and they were married in a civil ceremony.

Michael said "I was dressed in white. I was happy." This was the high point of Michael's relationship with Jim, and they made marital vows to love each other and promised to be faithful to each other.

A short time after they were married, Michael and Jim agreed that Michael should undergo a sex change operation. Michael had several reasons for wanting a sex change, and after psychological therapy he decided to have the operation.

Michael's lover agreed that he would work and help pay for the operation. After the initial operation Michael was informed that his doctors refused to complete his surgical transformation, because he tested positive for the AIDS virus. Since Michael had been faithful to Jim, it meant that Jim had been unfaithful to Michael.

By this time, Michael's body had begun to take on a feminine appearance, but termination of the surgical procedures left his transformation incomplete. His pain increased after Jim's sudden death, and he decided to return to his reservation in deep depression.

Michael's experiences, upon returning to the reservation were disappointing. His appearance was so altered that he was quickly identified as an outsider by young men who were cruising the reservation roads and was beaten up and left on the side of the road. Interestingly, the tribal police officer who found Michael turned out to be his distant cousin. Although Michael's family had left the reservation long ago, he still had relatives who remained on the reservation and his cousin took him to the local Indian health clinic.

When a bloody and beaten Michael arrived at the health clinic, he informed the health officials that he had AIDS. By revealing this truth, Michael caused an immediate reaction in the health clinic. The rumors quickly spread to surrounding communities, and his case became a matter of considerable controversy on his reservation. This increased to a point where the tribe attempted to enact legal restrictions and penalties against Michael and other AIDS-infected individuals.    Go To Table Of Contents

COMMENTARY: THE TRANSVESTITE

Michael's experience with the lack of confidentiality at the IHS clinic illustrates a major problem. The official IHS policy has been to protect a patient's confidentiality, because AIDS individuals will not step forward for testing if their identity is not protected. This has been a major concern for everyone involved with AIDS issues.

My research shows that the lack of confidentiality forces tribal people from the reservation to urban centers to seek HIV blood testing and related medical services. Most Indian people seeking HIV testing now travel off their reservation in order to gain confidentiality in testing. They undertake long journeys to a place where they are unknown, because they fear being named publicly if tested in their own IHS clinics.

This lack of confidentiality is well-known to IHS officials and IHS medical personnel who appear unable to solve the problem. As one IHS doctor stated, "Confidentiality at this clinic is a joke. It is impossible to keep things confidential on the reservation. The reason a person comes to us will be known on the other side of town the moment he leaves the clinic."

AIDS also provides an opportunity to condemn and criticize people who are not well liked. Spreading spiteful, inaccurate rumors has become common. Gossip will be spread that someone has AIDS even if it is not true. Under these conditions, the Indian clinics, both private and public, cannot provide assurances for confidentiality for any medical diagnosis. "I have a friend who works at the hospital who tells me things. I have another friend, a nurse. She tells me what my cousin has been doing."

The U.S. attorney became involved after he was called by the tribe's attorney. "They [the tribe] are concerned about Mr. Christian. I have been requested by the tribe to issue a legal order restricting Mr. Christian's sexual activity.

Mr. Christian has engaged in heterosexual activity on the reservation, and three women have been identified who refuse to take the test for AIDS." Because of the fear of AIDS, there was a reexamination of the old Bureau of Indian Affairs regulations concerning Indian sexual conduct on reservations.

The tribe requested the U.S. attorney to use these regulations as a weapon against HIV infected individuals. They hoped that they would serve as a model for regulations they would adopt into their own law-and order code. These regulations include the following provisions and are drawn from the United States Code of Federal Regulations:

A. 11.59: Adultery. Any Indian who shall have sexual intercourse with another person, either of such persons being married to a third person, shall be deemed guilty of adultery and upon conviction thereof shall be sentenced to labor for a period not to exceed 30 days.

B. 11.60C: Fornication. Any Indian who shall have sexual intercourse with another person, neither of such persons being married, shall be deemed guilty of fornication and upon conviction thereof shall be sentenced to labor for a period of not to exceed 25 days.

C. 11.61: Illicit cohabitation. Any Indian who shall live or cohabit with another as man and wife not then and there being married shall be deemed guilty of illicit cohabitation and upon conviction thereof shall be sentenced to labor for a period not to exceed 30 days.

D. 11.62: Prostitution. Any Indian who shall practice prostitution or who shall knowingly keep, maintain, rent or lease, any house, room, tent, or other place for the purpose of prostitution shall be deemed guilty of an offense and upon conviction thereof shall be sentenced to labor for a period not to exceed 6 months.

E. 11.63: Giving venereal disease to another. Any Indian who shall infect another person with a venereal disease shall be deemed guilty of an offense, and upon conviction thereof shall be sentenced to labor for a period not to exceed 3 months. The Court of Indian Offenses shall have authority to order and compel the medical examination and treatment of any person charged with violation of this section or found to be afflicted with any communicable disease of this nature.

The tribe hoped that the U.S. government could enforce these or similar regulations against AIDS-infected individuals on their reservation. It was also suggested that the tribe make the names of tribal AIDS carriers public. The tribe continued to insist that tribal AIDS carriers should be banned from the reservation. A neighboring tribe suggested that tribal AIDS carriers should be disenrolled from their tribe.

This controversy raised issues concerning the power of tribal governments and the civil rights of tribal members. It has led to a series of ethical and legal debates. Can an enrolled tribal person be disenrolled or banned from his tribe for having acquired AIDS? Such banning of a tribal member would obviously eliminate their civil rights, but tribal elders continue to argue for this solution.

Recent federal decisions have begun to protect Indian AIDS victims. As legal protection grows for non-Indian AIDS individuals, many tribal officials have moved their reservations in an opposite direction. It is clear that banning tribal members, or restricting the rights of AIDS individuals, would serve to drive AIDS individuals underground. Tribal anti-AIDS laws only make Indian people even more reluctant to seek much-needed medical attention. There are Indian people eager to force tribal members to leave their reservations for many reasons and AIDS has become an excuse.

Banning a tribal member with AIDS has been considered seriously by various other Northern Plains tribes. For example, the chairman of a Dakota tribe said that their tribal council had met with a tribal member who had AIDS and "banished him from the reservation." When they became aware of his condition, they had called him in, informed him that he was a threat to their tribe and ordered him to leave.     Go To Table Of Contents

THE COLLEGE STUDENT

James Gay worn a black hat. The hat was the traditional style found on his reservation. James left the reservation to go to school. He viewed education as the ladder to success and prominence. After graduation, he was becoming successful, but he was constantly ill. His illness was AIDS and he is dying.

James Gay was born and raised on a reservation in the State of Washington. He is a full-blood Indian and an enrolled member of his tribe. He considers himself to be a traditional Indian and often visits the reservation. James is highly intelligent and well-educated. His life in the city is strictly middle class, interspersed with journeys to the reservation for religious reasons.

James Gay's tribal cultural orientation is focused upon the activities that occur on his reservation in the State of Washington. His family's tribal lands, and their horses and cattle are important cultural focuses. He constantly refers to his relatives and friends on the reservation, and he maintains a traditional lifestyle. His Indian cultural orientation does not include the urban pow wow nor various other urban Indian community events. When he does attend these events, it is to visit friends or relatives.

He is a traditional dancer, but only participates in pow wows on his reservation. Most of his family lives on the reservation and have not moved to the city. They are comfortable with their lifestyle on the reservation, and their land and livestock provide for their needs. James' loyalty is to his reservation home even though he lives in the city most of the time.

Traditional people like James believe that the home is not the city where they reside but the reservation. When a traditional Indian questions another Indian about going home, he is referring to the reservation. If the respondent to this question appears puzzled, the questioners know that he is speaking to an urban Indian who views the city and not the reservation as his home.

James left his reservation and moved to Seattle to attend the University of Washington. He had a difficult time as a college student but persevered and received his Bachelor's degree. Even with a degree from the university, James was not able to find employment on the reservation and he decided to remain in Seattle.

While in college, James formed liaisons with non-Indian gays and experimented with a gay lifestyle. He was open about being gay when he was in the city, but silent when on the reservation. His tribal society accepted homosexuality, but he did not want to be so identified.

In the city James could participate in a more open gay lifestyle. He had many lovers and frequented the bath house scene and gay bars. James' infection with the HIV virus in 1987 was not the result of these impersonal sexual encounters. Instead, James became infected by a long-term lover, in what he had assumed was a monogamous relationship. James believed that a long-term and monogamous relationship was the ideal arrangement in a time when everyone feared AIDS. However, James's non-Indian lover had a sexual affair and became infected.

After a long period of denial, James now accepts the fact of his illness. His current lover has avoided infection with the HIV virus and he is protective of James, providing him support and encouragement. James is constantly concerned about his T-cell count. He is fortunate that his T-cell count has remained high and he remains healthy and hopeful about the future.    Go To Table Of Contents

COMMENTARY: THE COLLEGE STUDENT

A major issue concerning James Gay is obtaining adequate medical attention and other services for his AIDS condition. His reservation is small and local health services are inadequate. He is forced, therefore, to remain in the city to obtain medical care.

The U.S. government exercises legal authority over all aspects of federally provided Indian health services. The U.S. government has discretionary powers to determine what health services will be provided under the Indian Health Care Improvement Act of 1976. Congress has recognized its obligation to provide existing Indian health services with adequate resources. The Indian Health Service (IHS) of the U.S. Public Health Service (PHS) has the responsibility in implementing the wishes of Congress in this matter.

The 1986 Office of Technology Assessment report on Indian health care stated that:

"Services, including social and health services, were provided to Indian tribes from the very beginning of the United States as an independent nation. Congress routinely appropriated funds for these purposes, though there was no specific statutory authority to do so until 1921. In that year, the Snyder Act (25 U.S.C. 13) was passed to avoid a procedural objection to continuing to fund Indian service programs without an authorizing statute. The Snyder Act remains the basis for most of the Indian health services provided by the Federal Government. The pertinent language in regard to health care was simply 'such moneys as Congress may from time to time appropriate, for benefit, care, and assistance of the Indians throughout the United States...for the relief of distress and conservation of health...and for the employment of...physicians' (25 U.S.C. 13)."

The report continues, stating that

"While Congress has consistently provided funds for Indian service programs, the courts so far have ruled that these benefits are voluntarily provided by Congress and not mandated under the Federal Government's trust responsibility for Indian tribes. Appropriated funds are public moneys and not treaty or tribal funds belonging really to the Indians. The trust responsibility for Indians does not in itself constitute a legal entitlement to Federal benefits. In the absence of a treaty, statute, executive order, or agreement that provides for such benefits, the trust responsibility cannot be the basis for a claim against the Federal Government (Ibid.).

Existing health services and social services programs are inadequate in their AIDS programs. An individual must be diagnosed early on with AIDS in order to receive immediate medical attention and counseling. Many IHS clinics appear unable to provide HIV individuals with much assistance because of budget restraints and lack of trained personnel.

Fragmented and underfunded, Indian AIDS programs are of little help to James Gay or other in this crisis. Unfortunately, the head of the Indian Health Service from Washington stated on a Dakota reservation that, "AIDS does not pose a danger to Indian people." He said it had a "low priority for the IHS." He stated that they were more concerned with heart disease and diabetes and that these diseases pose a greater threat than AIDS.

Indian informants argue that IHS has systematically concealed facts concerning AIDS issues and budgets. As an Indian community health representative stated, "They [IHS] don't tell us anything. They don't tell us what they are doing. Can you get me their budgets? Their secrecy is hard to penetrate." In his mind, information and facts are hidden in the bureaucracy of IHS of to many people.

The official IHS evasion has become a part of the AIDS crisis. They believe that IHS does not respond to medical situations through planned efforts, but only in desperate and panic reactions. The Indian Health Service is viewed as isolated and insulated from tribal opinion or control. Tribal individuals and tribes have little or no influence over federally provided health services. IHS has a biased view of medical care that often ignores traditional tribal medicine. Tribal informants believe that the federal government's failure to provide adequate support for Indian health requires immediate reform.

American Indian AIDS individuals continue to confront many discriminatory barriers as they seek adequate treatment and counseling from the IHS medical system. They become quickly alienated from the IHS. Some doctors and medical support personnel simply refuse to treat an Indian AIDS patient, and there are no legal means to deal with this failure.

Unfortunately, IHS's small budget sets severe limits upon the services available. Clearly, AIDS expenditures have not reached adequate levels for Indian AIDS health care. IHS budgets for AIDS have remained static since 1987, and AIDS medical programs are expensive. IHS's medical services to meet the AIDS crisis cannot be accomplished without large increases in funding levels. IHS area administrators will determine if and when this happens. This agenda usually reflects the personal biases of health administrators and does not address the massive failure of governmental and tribal agencies to deal with AIDS. They remain unresponsive to victims such as James Gay.

IHS does have its defenders, and it is all too easy to condemn the Indian Health Service. Medical/financial crises are normal in the IHS. An AIDS worker spoke in support of IHS, "They had good intent in the Health Service." This is a reflection of some IHS employees who are dedicated to improving Indian health.

An Arizona Indian woman who worked with AIDS patients at an IHS clinic believed in the importance of AIDS education, but she had little support from her superiors. She paid travel expenses for AIDS educators out of her own pocket, and through her personal commitment, high school students on her reservation learned about AIDS.

Likewise, IHS doctors cannot test an Indian patient for the HIV virus without their permission and are, therefore, in personally dangerous situations at certain times. One doctor complained that he might become infected when he performs surgery. Without testing, he does not know if the person has AIDS. He is not currently allowed to test a person before surgery and he stated that "just a nick, a small cut, and I could have AIDS. I have a HIV test done every six months."  This has created a deep psychological fear of Indian patients.    Go To Table Of Contents

THE MAINLINER

Minnie Salt was a drug addict. Her life was typical of an urban dweller who became involved with drugs. She injected drugs into her body. She was sharing needles. She used a dirty needle and became infected with the HIV virus. She was a member of a northern tribe located in Wisconsin.

She was not a full-blood, nor did she have any direct cultural ties to her tribe. She was raised in Minneapolis and her background did not include exposure to her tribal traditions. Her family moved to the city before her birth. Employment opportunities and other urban advantages accustomed her to the ease of city living and the family decided to remain in Minneapolis where they became firmly established.

Minnie Salt was typical of successful urban Indians. She said that "My parents wanted me to get ahead. They wanted me to be educated." Minnie went to public school, graduated from high school and attended the University of Minnesota. After graduation she became employed in a local hospital.

By any definition she was successful. She had achieved her educational and employment goals. She was a college graduate, and had obtained a good job. Nevertheless, after achieving these goals, she began to have emotional problems. As Minnie's depression increased, she began to take medication and became dependent on her medication as a source of strength. Eventually she turned to street drugs and injected them into her body, with cocaine the drug of choice and later, heroin. Minnie depended upon drugs to bring meaning into her life. Increasingly, she acted without regard for her personal safety and exchanged needles with other addicts.

While avoiding the world of prostitution, theft, and alcoholism, Minnie supported her habit through her employment. She worked in a hospital, but the streets of the city became her home. She became very skilled in obtaining drugs from drug dealers. She patronized a shooting gallery where she would insert her arm into a hole in the wall where drugs were injected into it. This drug operation takes on the appearance of an assembly line and it protects the drug dealers against robbery.

When she learned of her AIDS infection Minnie accepted the fact that the sharing of needles with strangers was the cause and it was not casual sex with strangers. After her initial shock she decided to give up the use of drugs. She, like many others, also turned to American Indian spirituality.

Minnie was an urban Indian who had no experience with a traditional environment but as she sickened she became more involved in tribal culture and religion. She actively participated in taking sweat ceremonies located in the city. As her medical condition worsened, she began taking herbs. The herbs have helped, but Minnie's medical condition remains very precarious. She tires easily and constantly must rest. She believes firmly that Indian spirituality and herbs have helped in her successful struggle to survive.    Go To Table Of Contents

COMMENTARY: THE MAINLINER

For many, it is difficult to believe that Indian people engage in hard-core drug use. Minnie is a typical urban Indian who has become addicted to drugs. Drug addiction has been a major source of HIV infection for the female Indian population in the United States and is located mostly in the cities.

There is little sympathy for drug users among Indian peoples. Their infection with AIDS brings responses that these people are law breakers and addicts. They are powerless and AIDS education and programs are not readily available to them. Their situation is very precarious, Indian addicts isolate themselves in tiny social groups in order to protect their illegal activity and privacy. Most Indian drug addicts are at serious risk for AIDS infection.

"You drink beer to get fucked up. You don't drink it because it tastes good." These statements were made by an Indian drinking in a bar in Phoenix.

The issue of alcohol and Indians is well known and has been explored extensively. With the introduction of the HIV virus, Indian alcoholism becomes more dangerous. In particular, the danger is enhanced with young Indians who are frequently alcoholic.

An Arizona tribal health official making comments about young Indians states, "They are getting in with the wrong crowd. The only thing that they do is drink. They only want to borrow the car to go to town to get some beer."

A Wyoming tribal official states, "She retreats to her closet to drink a beer in darkness. She is only thirteen." In another statement, she states, "To quiet a crying baby, beer will be given to it in a baby bottle."

A high level IHS official states, "There are drinking areas [drinking camps] on the reservation near here. You will usually have a couple of hundred Indians out there, drinking every weekend. If AIDS got into that population we would have a disaster."

Another IHS official expressed this same concerned about this source of AIDS infection when he talked about sexually transmitted diseases (STD's) and the high rate of alcoholism. He states, "Twenty to thirty percent of the young Indian girls have Chlamydia in some areas of the reservation. STD's is a concern." His belief is that alcohol plays a major role in the high STD's rates on the reservations.

In Atlanta, a confidential source in the Centers for Disease Control has stated, "There is a problem of the Indians in Upper State New York, in that they do not want to report STD rates. We really don't know what is going on." The keeping of a STD's secret, because of tribal sovereignty undermines our knowledge of these diseases and their movement within Indian populations. It prevents effective medical planning and program development among the tribes.

Official tribal response has often been that tribes and Indians do not have a drug problem. The threat of obtaining AIDS through infected needles is not of any concern. One tribal official stated, "Indian people do not take drugs. Only Whites and Blacks do." As we have often seen there are numerous Indians, who are recreational and hard-drug users, some of whom are using AIDS-infected needles.

In urban areas, drug dealers are not necessarily Indian, but they are well known and quite accessible. An Indian from Los Angeles who knows the drug scene states, "Everyone [Indians] is spread out, and they will shoot in their own place. They shoot up at home or use the shooting galleries. Shooting galleries are scattered in the city [Los Angeles] in abandoned buildings and in homes. They are all over the place. People get to the shooting galleries by car and buses. They use their money only to get high."

Drugs are not isolated within the urban Indian population, but also can be found on the reservations. On reservations, a common view is that one can purchase drugs from established Indian drug dealers who are, according to one Indian woman, "easy to find. You can find them everywhere. Wacky tobaccky, grass, and weed are Indian terms for marijuana. On one reservation the local drug dealers are called peddlers. They go to Denver to buy drugs, but people on the reservation use mostly grass."

Reservation Indians are unlikely to have an addiction to urban drugs such as heroin, crack, or cocaine. "I don't know of any people using needles on the reservation." An IHS official stated, however, that "individuals use contaminated intravenous drug needles" and believed there were IV drug users on reservations. Nevertheless, alternative drugs are found. Inhalants are glue, gasoline, Lysol and spray paint.

A former BIA policeman described "ditch weed" as a variety of marijuana that is harvested near ditches or rivers on some reservations. He states, "The police stop this Indian who was taking 28 pounds of ditch weed to Los Angeles to sell." It is known that certain communities on reservations are known to have drugs for sale.    Go To Table Of Contents

THE ENTREPRENEUR

Tom Change was a friend to many. He was honest and bright with a playful smile. He had a personal concern for others and was quick to offer help. He created businesses and became successful. He hid his homosexuality, but it did not matter to his friends. He was not a full-blood Indian, but was an enrolled member of his tribe. He spent a few years on a Wyoming reservation in his childhood.

He was of medium height, light in complexion and followed traditional Indian religion, regarding the Indian community as his extended family. He was an urban Indian and functioned well within the city. Like others, he decided to remain in the urban areas because of its economic opportunities.

Tom was highly-educated with a degree from the University of Colorado but struggled with financial problems. He sacrificed time and resources to help both friends and strangers. Tom constantly strove for success and was the ideal example of an Indian who never gave up. Eventually, he achieved middle class status and supported himself in various successful enterprises, but he continued to feel a need for human interaction with Indian people in the community. Even when busy with school and business, he was able to participate in Indian events and activities.

Tom avoided local, urban Indian politics believing that many individuals involved in Indian politics were self-seeking and not interested in the improvement of life for urban Indians. He avoided local Indian organizations and established personal rapport with all those he assisted.

Tom Change was diagnosed in Denver with the AIDS virus. Although he had sexual relationships with Indian women, he remained gay. During his years in the military, Tom had practiced bisexuality to hide his gay orientation. Fearing discovery, he associated with non-Indian gays and kept his gay activities strictly private. He believed that public knowledge of his gay lifestyle would serious damage his community image.

Eventually, a gay lover infected Tom with the AIDS virus and he went through a long period of denial. Many could not believe such a caring supportive individual could have contacted AIDS. At the time of death Tom was in his mid-forties.     Go To Table Of Contents

COMMENTARY: THE ENTREPRENEUR

Currently, there is a debate whether tribal religious practices need to make adjustments in order to deal with AIDS. There has been a natural clash between individuals supporting pure traditional religious integrity, while others have advised strict adherence to contemporary Western medicine.

Some whites generally believe that Indians have lost their culture. An IHS White health worker stated, "They are losing their culture." An Indian health board member stated: "The young kids don't listen to us anymore." Another White health worker said, "The young [Indians] growing up in town, are losing their language." He expressed the opinion that this condition is also happening to the youth who are part of reservation populations.

As stated by an IHS Indian doctor, "Don't go to a medicine man. You will only waste your money. They don't do anyone any good." An IHS Indian nurse stated, "I hate going to the reservation. We have to be careful. We have to take our own water. I'm scared that the kids will get sick out there if they drink the water. The water has all kinds of bugs in it."

In a tribal society, illness becomes a stimulus for curing rituals that combat the sickness. Tribal people believe that when illness has entered the human body it becomes a part of the individual's being and religious rituals are needed to restore the harmony lost during illness. In traditional Indian cultures the AIDS virus cannot be treated in isolation.

Traditional medicine treats AIDS holistically and includes cultural and religious involvement of the individual, family, community and tribe as a whole.

In Southwest tribal society, one is born into one's religion. This is defined by the clans one is born to. A tribal person has a special connection to tribal mythology and religion. It is through an individual's clans that one's supernatural relatives are determined.

When a person falls ill the medicine person will seek assistance from both a person's human relatives and his supernatural relatives. The nature of the ritual depends upon the sacred position and connections of the individual. This is necessary for a curing ceremony to function effectively and be successful. Without supernatural relatives, the individual has little hope of achieving harmony and a cure for his illness.

Tom Change stated, "They [non-Indians] aren't related to anyone. They do not have relatives in the spirit world."

Indian people fully realize life is filled with hardships, inequities and uncertainties. Life as a dangerous reality is ingrained in tribal philosophies. In a traditional setting, however, the tribal individual can cope with the uncertainties in life. In this setting, the strength of tribal individuals depends primarily on their connections with relatives and other members of the tribe. When an illness occurs, it becomes a family and community issue. This participation must occur if the person is to be cured. The traditional religious philosophies of most tribes include the following ideas:

These principles function in order to achieve oneness and wholeness. If this is absent, the survival of the tribe is endangered. Indian women cannot deny maleness. Indian men cannot deny femaleness. Achieving a wholeness through correct behavior, sharing and cooperation, allows the achievement of harmony and balance which is essential to healing.

Ceremonialists must sing the correct songs, perform the correct ritual steps and all other details must be placed in harmony. Their goal is to restore the harmony of the individual. With this restoration of harmony, it is believed that illness is removed and health will return to the individual.

Within the tribal cultural definitions, AIDS is not viewed as a single biological phenomenon as it is in Western medicine. Traditional conceptions hold that AIDS has both a supernatural and physical basis.

Because of the seriousness of AIDS, concern has been raised about AIDS transmission through traditional religious practices. During the Sun Dance, there is a traditional practice of piercing the dancer's skin. A potential for AIDS infection occurs when a common piercing tool is used for all Sun Dancers with tainted blood being passed from one dancer to another.

An additional AIDS danger is the use of the same cutting tool to secure the skin offerings by members of the community at the end of a Sun Dance. During the Sun Dance, people of all ages have small pieces of skin cut from the body which serves as a religious offering.

An Indian medicine man stated, "The Great Spirit will protect us," clear denial of the danger of AIDS. The medicine man was expressing the belief that common Indian people sometimes place their fate in the hands of the spirits.

However, other medicine people have expressed concern over the transmission of AIDS. Beyond adjusting the Sun Dance ritual to meet the biological reality of AIDS, some medicine men have also expressed concern about other ceremonial AIDS transmissions.

Saliva exchange through the use of the same pipe during pipe ceremonies or drinking from the same pail during peyote ceremonies, have become a major concern. Medical researchers are in disagreement about the potential danger of saliva exchange as a means of transmitting AIDS. Medicine people view the dangerous universe in a realistic fashion and express concern accordingly. One peyote road chief stated, "I don't want to be the first to give someone AIDS in my ceremony." Subsequently, he began using individual cups during the peyote ceremony to prevent saliva exchange.

Nevertheless, some traditionalists have responded to the possibility of AIDS transmission through these practices with disbelief and denial. Reminding tribal people of smallpox and its devastation sometimes overcame such denial. A vast majority of medicine men have adjusted their religious ways to the AIDS threat.

One medicine man recruited a nurse from the IHS to assist in piercing Sun Dancers. Another obtained sealed scalpels from IHS for use by Sun Dancers. Another medicine man requested that each Sun Dancer bring their own piercing tool for personal use. An Indian woman elder stated, "Medicine man Fools Crow used new razors for each sun dancer. They even had a nurse there. There was no flesh offering last time [last year]."  Before his death, Fools Crow accept the danger of AIDS and used any means to protect his dancers.

A chairman of a northern tribe stated, "People are using safe methods for piercing for Sun Dance. Some dancers are a little embarrassed when they place their little personal medical packet of rubber gloves and scalpel for piercing to the medicine man." Because of his position as tribal chairman, he must pierce in a traditional manner by using wood as piercing tools and did not fear of getting AIDS.     Go To Table Of Contents

FRESH FROM THE RESERVATION

Sarah Ivanhoe was a traditional Indian woman. She was trusting, innocent, and honest. Sarah went to the city to find work. She avoided drinking and the party scene, but she fell in love and contracted AIDS. In 1989, Sarah was a full-blood member of an Arizona tribe. Her early life was typical for someone growing up on the reservation and she was raised within the traditional manner of her tribe.

The traditional norms found on the reservation demanded that everyone cooperate for the survival of their family. Traditionalism was the cultural glue that kept her family intact. Sarah had culturally-defined chores that included care of the livestock that her family depended upon for survival, chopping wood, hauling water and helping with other domestic chores. When she went with the family to town for supplies and entertainment, it was an adventure for her. Because of her traditional upbringing she had a strong work ethic and was deeply involved in her tribal religious life.

Sarah attended a day school in her local community and was an average student. Nevertheless, her high school graduation was a proud moment for she was one of the few individuals in her family to graduate from high school. Sarah did not aspire to become a college student or pursue a professional career, but she improved her life by constantly acquiring new skills.

A few years after graduation, she decided to move to the city but not for a good time or to party. She moved to the city and stayed with her married cousin. Shortly after arriving, Sarah was forced to move because of turmoil in her cousin's home. She moved in with some "younger girls who always partied."

Sarah had several experiences in the city. She met members of other tribes and saw how they lived but formed a low opinion of the Indian transients who appeared frequently in the city. Such transients were homeless and had few means of support other than welfare. "It is easier to get welfare here than back home. To get money on the reservation, you have to be related to somebody before they help you."

Sarah felt that such Indians shouldn't have to beg and that they should find themselves a job even washing dishes or sweeping floors. Many transients had a circuit of churches and assistance agencies they employed to obtain money for survival. Some transients would come to Sarah's office for money for coffee, and Sarah would grudgingly give them money with lectures to get jobs. Arguing became a game for Sarah and the transients in which the transients would get the lecture and finally money for coffee.

Sarah had many doubts about the members of other tribes. She was particularly concerned about intertribal marriages between city Indians. Sarah was raised with the belief that marriage should only occur with fellow tribal members. She saw Indian children being born with different tribes in their makeup and was concerned about the tribal culture the kids would be raised in. She stated, "These kids don't know who they are. Some of them don't know who their fathers are." With these children, one tribal culture does not become dominant. Instead, a form of Pan-Indian culture becomes the child's culture.

Sarah was initially curious about urban pow wows. The pow wow is not a traditional part of her tribal culture. She was amused at first but then regarded it as boring. "They sound like they are singing the same song over and over," she said. After a short time, she stopped going to them.

Traditional Indians transplanted to the city may lead very lonely lives, because there are few opportunities for them to interact with other Indians in the city. This was true for Sarah who had moved to Denver to work and had only a limited understanding of urban life. Despite relocation to the city and a job in the city, Sarah still viewed her home as the family's area on the reservation where she spent her youth and where most of her relatives lived.

Sarah's contact with her family was minimal. The family did not have a telephone on the reservation and the mail was slow. Her family contact lessened even more when her cousin went back home to the reservation. Sporadic letters home and travel to the reservation were all that kept her in touch with her family. Sarah's life in the city became more solitary and lonely. She had a few friends and her work became her life. Initially, she had little skills, but over time she became an excellent secretary and clerk.

As her skills increased, she gained confidence and was able to secure increasingly better jobs. With each new job, she increased her salary and responsibilities and her employers viewed her as a dedicated and capable employee. Sarah's last position was with a consulting agency with branch offices across the United States. The staff was small and the head of the agency was constantly away from the office. Sarah thought that he had a drinking problem that kept him away from the office.

In his absence, Sarah became an administrative assistant and for all practical purposes, the person in charge. She dealt efficiently with irate field staff scattered across the country who constantly wanted paychecks, information and other assistance. On several occasions she effectively established order out of chaos, increasing confidence in the agency.

Sarah did not own a car or live a middle class lifestyle. She lived in a small apartment and rode the bus for transportation. A bus driver's daily greeting became a simple form of friendship. She kept to herself and had few social activities. Eventually, she met a White person by chance who was the third person she dated in the city. "He was nice," so they started dating.

He usually included his male friends on dates, so they were never alone. At the time she did not think it strange, as long as she was part of the group. After dating and "hanging out with him," they began living together and were later married. Afterwards, she discovered that her husband was bisexual. He would leave her to spend time with his male lovers.

Sarah stated, "At least I know where he is, if he doesn't come home." Because of her traditional culture, she defended her husband, despite the pain his personal choices caused her. She finally discovered that her husband was also an IV drug user.

It was through her husband's gay and IV activities that Sarah became infected with the HIV virus and later died.    Go To Table Of Contents

COMMENTARY: FRESH FROM THE RESERVATION

Sarah was hopeful but in a traditional way. Her hope did not depend upon a widely-held notion that American science and technology would provide a cure for her strange illness. Non-Indian AIDS victims often hope that advancing technologies will save them from the AIDS virus but such medical services are either very limited or nonexistent for Indians.

This medical and social reality dashes the hopes of Indian AIDS people, and Sarah found herself in this situation where she was alone in dealing with her illness. It was difficult for her to separate her emotions from her intellect when faced with difficult personal choices. She confronted the reality of her AIDS infection alone and was left to her own resources. She isolated herself and she did not return to the reservation before she died.

At the time, general knowledge of AIDS among Indian people was not available. Few doctors were frank in their counseling that AIDS would wither the physical body, and deteriorate the mental souls of the dying.

Doctors did not advise the Indian patient that rational mentality would slowly slip away. Health officials did not discuss the patient's symptoms and diagnoses, and the AIDS Indians were not told that their medical needs would dramatically increase before they died.

Indians who are infected with AIDS feel trapped by frustration, attempting to deal with forces beyond their control. Indian AIDS patients still are not given an endless discussion of symptoms and diagnoses by health officials. Patients and their families do not receive counseling, because in the health agencies there is an "out of sight, out of mind" attitude. Indians like Sarah are alone.    Go To Table Of Contents

A MEDICINE MAN

Bradley Gene was a medicine man. He became a religious leader of his tribe as a young man and was responsible for healing his people. He was responsible for the religious traditions of his tribe and when he died of AIDS in 1991, part of his tribal religion died.

Bradley was born and raised on a New Mexico reservation. He was a traditional, full-blood Indian and an enrolled member of his tribe. Bradley's personal path led him to become a medicine man and a highly respected religious leader of his tribe. His lifestyle was strictly tribal and traditional. He was tall and thin with an intense personality. Enhanced by his stoic manner before strangers, and his fierce loyalty to his friends, he was the prototypical Indian. During his life, his physical appearance never changed. Bradley was quite familiar with his tribal language, traditions and religion.

One of the few times Bradley left his reservation was to attend college in 1972 when he attended the University of Colorado for one semester. He had difficulty in adjusting to the demands of college life. During this time, he was not quite sure what direction his college career should take.

He was unable to decide upon a major. Most of his classes were in the social sciences, and he discovered and admired the theory of marginality. The theory provided an explanation to the confusion he felt being in American society. However, he dropped out of school because he could not adjust to being a student.

While in college, easy access to alcohol became a problem. Bradley, wearing distinctive western boots, garments and hat, would patiently wait for the liquor store to open. Inside, he would purchase his usual two cans of beer. Bradley would walk around until he finished drinking the beer and return to the store and purchase two more cans of beer. This became a pattern for Bradley. Later in life, straight whisky became the preferred drink.

Bradley grew up on his family farm and loved their land. His family raised cattle as a part of a tribal program and most of their family time was spent herding, feeding, and caring for the herd. Everyone participated in the annual tribal roundup. Bradley and his family also maintained a string of horses which he would ride into the high mountains for spiritual purposes.

When money was available during his difficult semester at college, he would visit a ranch near the university and rent a horse. He loved horseback riding, which allowed him to reminisce about his reservation. His traditional orientation became evident when an urban Indian girl put on his cowboy hat. He became enraged, and explained she was showing disrespect. After a long discussion she came to understand the traditional meaning of what she had done and apologized to him.

Bradley was raised in a traditional manner which included an integrated role in the tribal religion. He was an excellent sacred singer in his tribe but never participated in the singing of Pan-Indian songs by students from other tribes. Those songs "were theirs and not mine."

After he left college in 1972, he became a full-time medicine man and was in constant demand by tribal members for blessings and as a singer for religious events. As his religious powers grew, he became more dedicated to his duties, responding wholeheartedly to the needs of others.

He had been involved with tribal politics when he was young, but as his religious duties grew, he discontinued his political activities. He remained at home. Bradley's personal path was long and difficult. His religious education was from well-respected teachers and focused upon the healing of tribal members. He followed the rule that a medicine person must remain in the area where his family originated. He remained there while he practiced as a medicine man and throughout his life, he remained traditional and always helped tribal members with their religious concerns. His attempted marriage failed because of the heavy demands upon his time as a medicine man.     Go To Table Of Contents

COMMENTARY: THE MEDICINE MAN

Bradley, who died in 1991, was an early Indian male AIDS case. He was diagnosed as having the AIDS virus while living on his reservation. He was infected because of his active gay lifestyle after marriage, which he took care to participate in only off the reservation.

He led a gay life that was within tribal traditions and he was not feared or criticized by others. Over the course of time, he had mostly Indian gay lovers but, when visiting the city, he would have short-term sexual contact with non-Indians.

He continued to act as a medicine man throughout his time of sickness until he died. During this time, he would become upset with people coming up to him claiming to be Indian. He stated, "Real Indians don't do that." An example of this phenomenon described by Bradley is as follows. A young White woman after a heated discussion at the end of a lecture, stated, "But, I know what you are talking about. I'm also an Indian. I was an Indian in my past life. I was an Indian princess." During her present life, she was a White woman.

Because of her past life, she believed that she could claim to be an Indian in this life and be included in Indian events, ceremonies, and healing. Tribal membership is metaphysical for such people who report themselves to be Indian. (The White-male version of this story was told by a White man who stated, "I was once a king of a tribe.") This young White woman had many past lives. She had been "a slave under an Egyptian Pharaoh."

Such metaphysical Indians have increased and have probably inflated the U.S. census of American Indians. Bradley reported some who had even attempted to become Indian religious leaders and healers.

The numerous rights of Indian people are envied by others who claim to be Indian. As a medicine man and spiritual leader, Bradley was frequently approached by Chicanos. Historically, it was considered disgraceful if a Chicano family was thought to have Indian blood in their ancestry.

A young Chicana approached Bradley claiming to be an Aztec Indian. During the course of several long conversations, she admitted claiming this glorious, mythological past without any evidence. She later approached her family to inquire about their Indian past, and her parents and grandparents responded with disapproval, fearing that she would bring dishonor to the family.

Her family eventually acknowledged their Indian past stemming from a Navaho slave woman kept previously by the family for domestic chores. This woman had children with one of the male members of the family.

One Chicano group has even developed its own Indian medicine society, with healing ceremonies and rituals that are primarily Sioux in design. A member of this group argued that the Aztecs developed the Sun Dance religion, and it, therefore, belonged to them.

Bradley's response was, "Those damn Mexicans. The only thing they did to us was to shoot us." His concerns are shared by the tribes of the Southwest, who are only familiar only with the killing, enslaving, and suppression of tribal people by the Spanish and by the Mexicans.   Go To Table Of Contents

THE ACTIVIST

Lenora is sophisticated and at ease in the urban world. She fell in love, but her boyfriend cheated on her and she acquired AIDS. She is still alive and is an educator and political activist.

Lenora is a member of an Oklahoma tribe and is not a full-blood. Her family is aware of their tribal background, and her upbringing was rural. Since her AIDS infection, Lenora has become an outspoken advocate of Indian AIDS issues and she works constantly against the spread of the HIV virus in American Indian communities.

AIDS education has become Lenora's life's commitment after facing the realization of her own impending AIDS death. She is active in educational efforts to inform Indian people about AIDS and, as part of this process, is becoming more aware of the history of Indian people and their political struggle for survival. As she increases her knowledge, she believes that AIDS education must be considered in the larger political context of American Indians history.

As the HIV virus grew in her body, she started reading publications concerned with the history and problems of Indian people in the United States. She believes that, "Everyone should read Bury My Heart At Wounded Knee. This book should be read by every Indian in the country." She believes that Indian people need to be aware of the atrocities committed against them. With this awareness, Lenora hopes that Indian people will unify to advocate the rights of Indians AIDS victims.

With a taxing lecture schedule, Lenora is constantly traveling to present AIDS facts at Indian meetings. Her audiences are young and old and they express shock and curiosity about her AIDS infection. Her lecture fees support her AIDS education efforts. She now views her remaining life's work as bringing AIDS awareness to Indian people.

She has made a serious effort to combat her HIV infection and her personal struggle has become a model for others. Although only in her twenties, she is committed to a celibate lifestyle, stating that "I am not having sex any longer," not wishing to infect anyone.

Lenora was infected through heterosexual activity with her non-Indian love in whom she was very trusting. Lenora still loves her ex-boyfriend and does not hold him responsible for her infection. (He infected another woman who was unaware of his infection and he eventually married her.) This has created credibility problems for her as she attempts to educate others about the dangers of AIDS. The Indian audiences believe that Lenora caught AIDS, because she was fooling around with a non-Indian. "She wasn't even going out with an Indian."

Nevertheless, anyone who meets Lenora is impressed that she still glows with anticipation for life and is firm in her commitment to protect Indian people from AIDS.   Go To Table Of Contents

COMMENTARY: THE ACTIVIST

"You cannot serve mutton stew, because it will stain our floor. It is greasy and will get on the floors." This comment was made by White administrators who would not allow mutton stew to be served at a Navaho AIDS education lunch. AIDS grant monies are beginning to flow into the reservations and some urban Indian health care centers now have AIDS education projects.

Early AIDS education relied on established educational methodologies with such programs designed for the young and for the general Indian population. AIDS poster contests were initiated, and video films have been made. Pamphlets have been distributed and classes of Indian students have served as captive audiences for the latest medical information on AIDS.

However, many Indians continue to deny that AIDS is of any importance. These educational programs have not been very successful, because they are not culturally appropriate. Even today AIDS is viewed as unimportant by many Indian people. A tribal AIDS official stated, "We really aren't worried about AIDS, but with the AIDS money, we now have people working."

It is essential that AIDS education programs for urban Indians be constructed differently than those for reservation Indians. As we have seen, the urban Indian population is culturally different from reservation populations. Within the urban setting, Indians have greater opportunities to participate in a wide range of social activities that are far different from those found on the reservation.

Current AIDS education programs have not been adjusted to take these differences into account, and will probably not slow the spread of the disease. "The whole person has to be involved when talking about health care." This comment from a Navaho informant is important in pointing to the need for holistic approaches to reservation AIDS that are consistent with tribal tradition and religion.

Currently, AIDS education emphasizes abstinence with scare tactics. Other means of controlling AIDS, such as use of condoms, are not being emphasized enough. A few training sessions have attempted to demonstrate how to use a condom. Bananas and cucumbers are used to symbolize the penis, but questions remain concerning whether condoms are being used consistently and correctly. Lenora has spent a great deal of effort in such public education.

Another problem is that Indian AIDS education programs are designed primarily for heterosexuals. The Indian gay community must be involved if such AIDS programs are to be effective. A few Indian gays have established their own educational programs.

According to one Indian gay informant, "safe zones" have been designated by Indian gays, which serve as "places to talk." This informal Indian support system has "worked since 1984." The Indian gay populatio