Background: While the overall rate of new HIV diagnoses decreased in the U.S. from 2015 to 2019, the rate of HIV infections has increased among American Indians and Alaska Natives (AI/AN). HIV prevention strategies include condom use, timely diagnosis of HIV infection, and pre-exposure prophylaxis. Increased HIV knowledge has been associated with accessing HIV prevention strategies. This study aims to examine HIV/STI knowledge and its relationship to HIV testing and sexual behaviors among American Indians (AI) in Southern California.
Methods: A cross-sectional sample of 200 AI adults, aged 18 to 64, recruited from Southern California Tribes completed a self-administered questionnaire assessing sociodemographics, HIV/STI knowledge, HIV testing history, and sexual practices. HIV/STI knowledge was measured by a 17-item standardized instrument. Descriptive statistics and three logistic regression models were evaluated to examine the association between HIV/STI knowledge and each of the following outcomes: lifetime HIV testing, condom use, and more than one sexual partner.
Results: 69% of survey participants were women, the median age was 34 years (IQR: 27-42), and 32% were married or living with a partner. The median HIV/STI knowledge score was 6 (range: 0-17); on average 35% of the questions were correctly answered by participants. Over half of the participants (66%) reported receiving an HIV test during their lifetime. Among participants who were sexually active in the past year (n=166), 67% never used condoms and 22% reported more than one sexual partner in the past year. After adjusting for age, marital status, and gender, greater HIV/STI knowledge was significantly associated with an increased likelihood of lifetime HIV testing (OR: 1.14, 95% CI: 1.01 – 1.29) and decreased likelihood of never using condoms (OR: 0.84, 95% CI: 0.71 – 0.99). HIV/STI knowledge was not associated with reporting more than one sexual partner.
Conclusion: More than four decades into the HIV epidemic, and with many prevention strategies to eliminate new infections, certain populations are not effectively reached by HIV prevention efforts. Our study found greater HIV/STI knowledge increased lifetime HIV testing and decreased unsafe sexual practices suggesting that interventions to increase HIV/STI knowledge may decrease HIV/STI vulnerabilities within AI/AN communities.
