Telling the Stories: Health Issues Affecting the State of in North Dakota

1. 2012 HIV/STD/TB/Hepatitis Symposium Telling the Stories: Health Issues Affecting the State of in North Dakota Robert Foley National Native American AIDS Prevention Center April 12, 2012

2. Who is NNAAPC • National, Native-specific agency • Founded in 1987 • Headquartered in Denver, CO • Address the impact of HIV/AIDS on American Indians, Alaska Natives, and Native Hawaiians through culturally appropriate advocacy, research, education, and policy development in support of healthy Indigenous people

3. NNAAPC Services • Research • Evidence based practices • Capacity Building • Training • Resource brokering • Awareness • Social marketing • Materials development • Advocacy

4. Objectives • By the end of the presentation, participants will be able to… • Explain the current state of HIV among people in North Dakota • Explain the state of other health-related issues in North Dakota • Describe at least three underlying risk and protective factors • Explain the process of behavior change • Explain current health federal initiatives

5. We have the Power! Knowledge can provides power, and with that comes the empowerment to act accordingly One person’s knowledge can change individual behavior, but a community’s knowledge can change the course of us all

6. Preventable and Treatable Health Issues Facing People Today Substance Use & Abuse Liver Disease Unintended Pregnancy ALLERGIES Diabetes Weight Control HIV STIs Tobacco Mental Health

7. Recent Survey of AI/AN Community Members • Drug and alcohol abuse • Heart disease • Diabetes • Cancer • Intentional injuries • Unintentional injuries

8. North Dakota Leading Causes of Death, 2009 Alzheimer’s 7% Cancer 21% Heart Disease 24.3%

9. North Dakota Leading Causes of Death, 2009 • Heart Disease • Cancer • Alzheimer’s Disease • Lung/Pulmonary Disease • Accidents • Stroke • Diabetes • Other Cardiovascular Disease • Influenza/Pneumonia • Kidney Disease 24.3% 21% 7% 6% 6% 5.4% 4% 2.1% 2% 2%

10. STIs

11. Reported Cases of ChlamydiaNorth Dakota, 2006-2010

12. Chlamydia Rates by Race/EthnicityNorth Dakota, 2010

13. Reported Cases of Gonorrhea North Dakota, 2006-2010

14. Gonorrhea Rates by Race/EthnicityNorth Dakota, 2010

15. GC and CT Summary, North Dakota • High 60% female, low 30% male • Vast majority in youth ages 20-24 • African American and American Indian representing the highest rates • Represents a disproportionate impact

16. CT Rates in Aberdeen Area IHS

17. GC Rates in Aberdeen Area IHS

18. HIV & AIDS

19. Race/Ethnicity of HIV/AIDS Cases Diagnosed in ND 2005 - 2009 Race/Ethnicity of Current HIV/AIDS North Dakota, 2011 (n=248)

20. Race/Ethnicity of HIV/AIDS Cases Diagnosed in ND 2005 - 2009 Risk Category for Current HIV/AIDS North Dakota, 2011 (n=248)

21. Matching up Against the National Trends • Total new HIV infections in 2010 = 48,298

22. Matching up Against the National Trends • Total new HIV infections in North Dakota in 2010 = 11 (10 males, 1 female)

23. New HIV/AIDS CasesNorth Dakota, 2011

24. HIV/AIDS Among AI/AN • Native Hawaiians/Other Pacific Islanders (NHOPI) and American Indians/Alaska Natives (AI/AN) have the 3rd and 4th highest rate of new HIV infections, respectively. • Between 2005 and 2009, the percent of new HIV infections rose for AI/AN by 7% • Highest climb among racial/ethnic groups • Of persons who were diagnosed with HIV, AI/ANs had the shortest overall survival rate, with 88% living longer than 3 years.

25. Hepatitis

26. * Includes acute and “past or present” infections Reported Hepatitis C Cases* by YearNorth Dakota, 2006-2010

27. *Based on reported positive lab result North Dakota Hepatitis C Cases* by Age Group2010 N=486

28. *Based on reported positive lab result ^Race reported for 29% of cases North Dakota Hepatitis C Cases* by Race2010 N=486^

29. *Based on reported positive lab result Reported Hepatitis B Cases* by YearNorth Dakota, 2006-2010

30. *Based on reported positive lab result North Dakota Hepatitis B Cases* by Age Group2010 N=54

31. North Dakota Hepatitis B and C Cases by Gender, 2010 HBV • HCV

32. Tuberculosis

33. US and North Dakota Tuberculosis Rates, 2007 – 2011

34. TB Cases by Race/EthnicityNorth Dakota, 2007 – 2011

35. Tuberculosis by Age, North Dakota, 2007 – 2011

36. Origin of TB Cases in North Dakota, 2007 – 2011

37. Sexual Behaviors

38. Behaviors among 9th to 12th Graders

39. Number of ND Teen Births by Race/Ethnicity, 2008 In 2008, in North Dakota, there were 1,976 American Indian Females (almost 12%)

40. Diabetes

41. Diabetes • Diabetes is the 6thleading cause of death in North Dakota • In 2007, 6% of adults in North Dakota reported being diagnosed with non-pregnancy related diabetes

42. Who is Getting Diabetes in ND? American Indians • Experience death from diabetes at more than five times the rate of Caucasians • Nearly twice as likely to get diabetes as Caucasians North Dakotans 65 and Older • Diabetes prevalence rate of 18 percent, • More than twice the rate of those ages 45 through 64 Youth • Dramatic rise in children suffering from Type 2 diabetes • Linked to the rise in children being overweight

44. Diabetes by Race,in North Dakota

45. Substance Use

46. Substance Use & Abuse • North Dakota ranks #1 in the nation for the rate of binge drinking among 18-25 year olds • 3 out of 4 high school students believe people who binge drink once or twice each week do not put themselves at great risk • 1 out of 5 (20%) ND high school students start using marijuana between ages 13 &16 • 3% used meth • 11% used inhalants • 13% OTC drugs to get high • Decrease in past 30 day alcohol use among Native Americans • Binge drinking still ranks the highest

47. 9th-12th graders in North Dakota

48. 9th-12th graders in North Dakota

49. Community Perception of Adult Drinking

50. Other Health Issues