NNAAPC'S 1999-2000 PUBLIC POLICY PRIORITIES
(with thanks to the Ford Foundation and Hoffmann-LaRoche for their support of our efforts)

The Board of Directors of NNAAPC have adopted the following four policy priorities for 1999 and 2000.  These priorities were identified by the National Policy Advisory Council at NNAAPC and were presented for public review and discussion at the 2nd national Native American HIV/AIDS conference, "Sharing the Vision II" in Minneapolis, Minnesota, in September, 1998.  For more information, please contact Ron Rowell, Executive Director, at (510) 444-2051 x 305, or by e-mail at RRowell@aol.com.

Improved Disease Surveillance in Native America

Disease surveillance is one of the fundamentals of public health.  It is how we are able to discover and track the appearance of infectious diseases.  It helps us to target our resources in the best way to prevent further spread of such diseases. 

There have long been documented problems with the mis-reporting of race and ethnicity for our population.  This has also been documented in AIDS case reporting by CDC studies.  Unfortunately, AIDS case reporting is no longer very useful because new drugs to treat people with HIV infection are slowing the progression to AIDS in many people.  There are now 31 states who do HIV case reporting.  It will still take some time before there is HIV reporting from all states.

In the meantime, the reorganization of the Indian Health Service and the increase in tribal compacting has complicated disease surveillance in the Indian Health Service/Tribal/Urban Clinic program.  Based upon a recent survey of IHS service units and tribal health departments nationally by NNAAPC, the Inter-Tribal Council of AZ, and the NW Portland Area Indian Health Board, the majority of the 94 tribes responding stated that they report infectious diseases neither to state and local health departments, nor to CDC and IHS.  An even higher number of IHS service units reported that they do not collect nor do tribes report infectious diseases to them.

NNAAPC is working to get the attention of responsible federal agencies, Congress, and Native American communities to the danger such a situation poses to the health of our population.

Insuring Availability of and Access to AIDS Drugs for Native Americans Living with HIV/AIDS

The cost of providing highly active anti-retroviral therapy (HAART) for individuals living with HIV is approximately $12,000-$13,000 per year, just for the drugs.   Such a cost is out of the reach of most Native Americans with HIV/AIDS and it represents a very serious burden on tribal and urban health budgets.  Congress recognized the burden of cost on states and passed the AIDS Drug Assistance Program (ADAP) to assist state health departments with underwriting the cost of the drugs, especially for those people dependent upon Medicaid and Medicare.  Congress did not consider the burden of cost on the Indian health care system. 

NNAAPC is working to change this and to insure the funds are available to purchase these drugs for people dependent upon IHS, tribal health systems, or urban Indian clinics.  We believe Congress should add the Indian health care system into the ADAP program and ask the GAO for a study of the extent of need for this program in Native America.

Insuring Native American Coverage in the Reauthorization of the Ryan White Care Act

Under the current Ryan White Care Act, the needs of Native America are covered only through a section of the Act called "Special Projects of National Significance," or SPNS.  This section of the Act is designed to evaluate demonstration projects, not to serve ongoing needs, as in Titles I (for especially impacted cities) and Title II (a formula grant for states).  Since 1990, SPNS has been the primary source of funds for Native American-specific care programs.

NNAAPC is working to insure that in any reauthorization of the Act, the federal trust responsibility is upheld through insuring that the ongoing needs of Native Americans with HIV/AIDS are provided for.

Education of Tribal Officials Concerning the Cost of Treating HIV/AIDS

Given the potential impact of HIV/AIDS on tribal health budgets, NNAAPC believes it is critical to provide reliable information to elected tribal leaders who must make decisions about how to expend limited health resources.   With the generous support of corporate donors, NNAAPC will be developing specialized mailings for elected tribal leaders in the near future.