Risk Factors for HIV Disease Progression in a Rural Southwest American Indian Population

Objectives. Risk factors for human immunodeficiency virus (HIV) disease progression among American Indians (AIs) have been poorly characterized. We assessed the impact of socioeconomic factors and use of traditional healing on HIV disease progression in a rural AI community. Methods. From January 2004 through December 2006, we interviewed 36 HIV-positive AIs regarding their socioeconomic status, incarceration, and use of traditional healing. We also collected chart-abstracted adherence and substance-abuse data. Through bivariate analysis, we compared these factors with the CD4-cell counts and log HIV-1 viral loads (VLs). Using a simple regression model, we assessed interactions between the significant associations and the outcome. Results. Participant characteristics included being male (58.3%), being trans-gender (13.9%), having ever been incarcerated (63.9%), having a household income of <$1,000/month (41.7%), being unemployed (61.1%), being diagnosed with alcohol abuse (50.0%), and using traditional medicine (27.8%) in the last 12 months. Higher VLs were associated with recent incarceration (p<0.05), household income of <$1,000/month (p<0.05), and provider-assessed alcohol abuse (p<0.05). We found an interaction between incarceration and alcohol abuse, and alcohol abuse was the factor more strongly associated with higher VLs. A lower CD4 count was associated with recent incarceration (p<0.05) and use of traditional medicine (p<0.05). Conclusions. Alcohol abuse is an important contributor to HIV disease progression, and participants with lower CD4 counts were more likely to use traditional medicine. HIV care among this rural AI population should focus on addressing alcohol abuse and other socioeconomic risk factors and promote collaboration between Western medical and Navajo traditional practitioners.