Billings+Area+Indian+Health+Service

 **Billings Area Indian Health Service** ** Background and Information ** The Indian Health Service (HIS) was established in 1955 under the U.S. Department of Human and Health Services in order to take over the responsibility for Native American health services from The Bureau of Indian Affairs. The IHS provides health services to the natives of Alaska and the member of 562 recognized Native American Tribes. It services 1.9 million Native Americans and Alaskan natives, and 600,000 Native Americans from urban areas. The annual budget in 2010 was $4.05 billion and is expected to increase due to an increase in the amount of people that are serviced by the IHS. This is also a 13% increase from the previous fiscal year’s budget. (IHS, 2010)  Billings Area Indian Health Service is located in the states of Montana and Wyoming which are home to seven different tribal reservations (illustration on the map to the left). Billings Area IHS services more than 70,000 American Indians and Alaskan Natives in its six regional health centers, two self-governance service units, and five urban programs. Their mission is; “ In partnership with American Indians and Alaska Natives,  t  o raise their Physical, Mental, Social, Environmental and Spiritual Health to the highest level.” “The goal of the Billings Area is to eliminate health disparities between American Indian/Alaskan Natives and the general population.” (IHS, 2010)

** History and Strife ** After the establishment of the IHS in 1955, a powerful eugenic movement was spreading throughout the United States. The movement was aimed at preventing the spread of groups believed by some in government to be poor and/or mentally defective. The government was funding a lot of programs which would help increase the number of abortions on Indian Reservations and help sterilize Native American women. There is no accurate account of how many women were sterilized between the years 1960-1978, but some data was collected during the period and shows a disturbing picture. One study done on the Navajo Tribe Reservation shows a 130 per cent increase in the number of abortions between 1972 and 1978 (Temkin-Greener, 1981). When looking at the sterilization occurrences, the numbers rose from 15.1 per cent in 1972 to 30.7 per cent in 1978, more than doubling in a 6 year time frame (Temkin-Greener, 1981). Since most Native American would attend IHS hospitals, most of these procedures were funded through the government and performed at IHS facilities. Some cases went to the extremes; when two fifteen-year-old Native American girls went to get their tonsils removed, their ovaries were removed as well. The consent forms, if given to women, were often not in their language or could not be correctly interpreted by them leaving them to the mercy of the doctor. (Johansen, 1998) Change did not start to occur until voices were raised. WARN (Women of All Red Nations) formed a group that believed that, “truth and communication are among our most valuable tools in the liberation of our lands, people, and four-legged and winged creations.” These women started to talk about immoral sterilization of their women which lead to many investigations of the cases. Although the issue never made it to court, several lawsuits were filed in the process and settlements were paid out. By the beginning of the 1980’s legislation was implemented which required social workers to appreciate the way Natives raise and care for their children. Native American birth numbers significantly increased from 27,542 in 1975 to 45,871 by 1988, but the issue still remains at large for the poor women and women of color because they should be allowed to make their own reproductive decisions. Ultimately, through effective communication cases of forced sterilization were suppressed and legislation was passed to prevent future occurrences. (Torpy, 1998) In 1977, the American Indian Journal posted that, “changing administration of Indian Health... will never solve these problems until Congress...defines the legal scope of the Indian Health program and then determines the appropriation on the basis of this definition (American Indian Journal, 1977),” but in the end this will also be determined by the combined effort and cooperation of the Indian people. One lesson that can be learned is that the development of strong leadership, a unified body, and efficient communication is what allowed the IHS to make the transition from a corrupt government project to effective social service.

** HIV/AIDS ** In regards to new infection rates of HIV, American Indians are ranked third in the nation when compared with all the ethnicities and races in the US. By 2008, estimates show that more than 3500 cases of HIV/AIDS among American Indians in the US, with a diagnosis rate of 12.8 per cent per 100,000 people. HIV is a transmissible disease and tends to affect a younger population. This increases the risk factor for American Indians because they have a greater proportion of young adults in comparison to other social groups. The IHS has prevalent efforts to help reduce the spread of HIV/AIDS, however, accessible resources and drugs within the Indian health system that assist with the treatment of HIV/AIDS are oftentimes limited and unavailable. Therefore, the IHS focuses on an increase in individual testing, educational and informative messages, and an overall provision in support of social changes. (IHS, 2010)

Due to continued efforts by the IHS, since 2005 there has been an increase in prenatal screening rates from 54 percent to 78 percent. However, over the last 7 years, HIV rates among American Indians have tripled. Several, major risk factors contribute to the HIV/AIDS rates among American Indians, including: “high rates of sexually transmitted diseases (STDs), alcohol and substance abuse, depression, domestic violence, and low socioeconomic status.” However, social factor also play a very big role. Due to cultural influence and traditions, discussion on sexual relations and HIV/AIDS is very limited. Consequently, American Indians youth are only half as likely to use contraceptives, compared to other social groups, increasing their risk of contracting HIV. Overall, there exists a social stigma in relation to the disease that largely contributes to this serious epidemic. (IHS, 2010)

** Conclusion: **  Since the establishment of the IHS in 1955, many controversial issues have been dealt with by this department. From the forced sterilizations, to helping the Native American practice safe sex, the IHS has had a significant impact on the sex lives of the Native American community. It is evident that throughout the IHS history, efficient communication has been crucial in resolving problems: forced sterilizations were stopped because Native American women, in unity, decided to speak out against them; HIV rates have been increasing amongst Native Americans but if efficient communication is established between the doctors and the patients and education programs are implemented, this phenomenon can also be suppressed. Thus, the main goal for the IHS is to find an approach that will allow for effective cross-cultural communication which can lead to greater understanding of HIV/AIDS amongst tribal members and a decrease in their spread.  ** __References: __ **

<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">American Indian Journal ofthe Institute for the Development of Indian Law. Feb., 1977;

<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">Indian Health Service.(2010). HIS Fact Sheets: U.S. Department of Health and Human Services <span style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">Publication <span style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">. Retrieved from <span style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">[] <span style="font-family: "Times New Roman","serif"; font-size: 12.0pt;"> <span style="font-family: "Times New Roman","serif"; font-size: 12.0pt;"> <span style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">Johansen, Bruce E. 1998. "Reprise/Forced Sterilizations." //<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">Native Americas // <span style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">15 (Winter): 4, 44– <span style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">47. <span style="font-family: "Times New Roman","serif"; font-size: 12.0pt;"> <span style="font-family: "Times New Roman","serif"; font-size: 12.0pt;"> <span style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">Temkin-Greener, Helen. "Surgical Fertility Regulation Among Women on the Navajo Indian    <span style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">Reservation." American Journal of Public Health, Apr. 1981; <span style="font-family: "Times New Roman","serif"; font-size: 12.0pt;"> <span style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">Torpy, Sally J. 1998. "Endangered Species: Native American Women's Struggle for Their    <span style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">Reproductive Rights and Racial Identity: 1970's—1990's." Masters thesis, University of     <span style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">Nebraska. <span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;"> <span style="color: black; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 200%;">