Native Populations and the Prevention of Syphilis

Part of a Special Series on Health Communications in Native American Populations

The reemergence of syphilis after the disease was believed to have been nearly eradicated by the late 1980’s has stymied and alarmed CDC officials. And, the disproportionate infection rate among Native American populations has galvanized Indian Health Services efforts toward implementing more comprehensive testing, prevention and educational programs to address this and increases in other sexually transmitted diseases.

In the Navajo nation reservation in Arizona, New Mexico and Utah, for example, the 2002 incidence of reported syphilis cases was seven times the national general population rate. In North Carolina, the infection rate among Native American populations was five times higher than the rate among white Americans. Additionally, there is uncertainty about rate disparities between non-reservation Native Americans and general populations due to errors in reporting racial classifications.

In June, 2003 the government-run Gallup Indian Medical Center initiated an STD awareness campaign in the Southwestern US to educate and inform Native Americans about the need for testing, safe sex and STD prevention measures. A multi-agency task force was formed to oversee the efforts, and full page ads placed in the Navajo Times featured Navajo President Joe Shirley, Jr. with a message to tribal members to ‘get tested and practice safe sex.’ Also, condom-filled safe-sex kits were distributed in and near the reservation.

Cultural Barriers, Language Stymie Educational Efforts

However, the public health agencies running the campaign encountered cultural obstacles, including reluctance of Navajo people to engage in discussions about sex, taboos regarding homosexuality, and translation difficulties due to a lack of Navajo words for sexually transmitted diseases.

“With an issue like this” Navajo President Shirley said, “cultural ramifications should not even be a factor, because you’re going to be putting lives at stake.” Accordingly, tribal members began seeking out elders and medicine men to develop ways to discuss the diseases and to teach health workers Navajo phrases that convey a description of syphilis symptoms.

Findings of a Public Health report issued in 1989 focusing on the disproportionate rate of infection among NA/AN populations remain true today: The report states that sexually transmitted diseases “are an important but little-publicized health problem affecting American Indians and Alaska Natives.” In addition to the morbidity and health expenditures directly due to these infections, there are numerous repercussive effects including cervical and penile cancer, ectopic pregnancy and related complications, infertility, and infected newborns.

Additional Resources:

"Sexually Transmitted Diseases & Native Americans; trends in reported gonorrhea and syphilis morbidity, 1984-88” Public Health Reports v-104(6) 566-572 Nov/Dec 1989 http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=1580156&blobtype=pdf
Public Health Report abstract http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1580156
“Navajos Confront Syphilis Outbreak With Rare Public Education Campaign,” June 18, 2003, CDC report http://www.thebody.com/content/whatis/art28531.html
Eliminating Syphilis Robeson County North Carolina CDC http://www.cdc.gov/stopsyphilis/factPDF/robeson.pdf
LA Times article, “Rates of Chlamydia, Syphilis on the rise in U.S., January 14, 2009 http://articles.latimes.com/2009/jan/14/science/sci-std14

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