They Tell Us “We Don't Belong in the World and We Shouldn't Take up a Place”: HIV Discourse within Two-Spirit Communities

BACKGROUND & PURPOSE

HIV/AIDS is simultaneously a physiological and psychosocial phenomenon. American Indian and Alaska Native (AIAN) are less than 2% of the U.S. population, and account for approximately 1% of all new HIV infections. However, these rates obscure the enduring fourth world status of AIAN people, characterized by little empirical research, historical trauma, and concomitant and disproportionate socio-health disparities. Compounding this are more unequal disparities for Two-Spirit (TS) AIAN people. 76% of those AIAN infected are men, and three-quarters occurred via male-to-male sexual contact (MSM), which is 18 times more than Whites. Parallel to this, TS people face an increased number of public health problems associated with the sexual risk taking, including intersectional discrimination and stigma, sexual victimization, substance use, and adversely affected mental health.

METHODS

This project sought to center attention on TS persons themselves, instead of reducing TS identity to one demographic in the predictive calculus of HIV transmission. Through their lived experience, an understanding of HIV was sought, especially for those who have always lived under the specter of HIV, that is, young people. To that end, a Discourse Analysis was conducted on a theoretical sample of 6 in-depth qualitative interviews of self-identified male TS leaders, who represent a “second wave” within the HIV epidemic. The data is from the first multi-site study of TS AIANs across the United States.

RESULTS

The analysis illuminated four discursive themes for how “HIV” manifests within these narratives. First, HIV is a “shadow presence”, largely silent and silenced yet felt and implied nonetheless, working to distance communities along ethnic lines and intersectionally compound stigma. Second, HIV functions as a professionalized identity that aligns those in the AIDS service world with a larger (non-Native) LGBT community. Third, HIV becomes hierarchized as a health sub-/priority; whereas alcohol is a tie that binds ethnic and gendered and sexualized identities, HIV works to bifurcate identities. Fourth and finally, HIV functions as a discursive mechanism to connect with and re-/claim community and culture, but moreover to belong.

CONCLUSIONS

This paper is important to social work for a number of reasons. This study compliments social epidemiological efforts by illustrating what noted determinants and disparities mean in-context, how TS people negotiate them, and how HIV operates in everyday life. These findings also reinforce existing recommendations for interventions specifically with AIAN communities, including relying on data-driven knowledge, increasing culturally responsive services, and comprehending the differential impacts of HIV (and co-occurring health disparities) within AIAN and TS communities. Ultimately, this study brings to bear the importance of The National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care (the National CLAS Standards), which advance equity, reduce disparities, and improve quality. Quite critically, this work speaks to need for “rhetorical sovereignty”, or that language is a necessary component of the social and health justice of AIAN people.