NDSU Department of Child Development and Family Science
North Dakota Department of Human Services
October 1998
J. Douglas McDonald, Ph.D., University of North Dakota
Nova Griffith, University of North Dakota
Tami DeCoteau, University of North Dakota
Angela Azure, University of North Dakota
Dawn Bruce, University of North Dakota
Thomas L. Jackson, Ph.D., University of Arkansas
J. Douglas McDonald, Ph.D., University of North Dakota
Nova Griffith, University of North Dakota
Tami DeCoteau, University of North Dakota
Angela Azure, University of North Dakota
Dawn Bruce, University of North Dakota
Thomas L. Jackson, Ph.D., University of Arkansas
American Indians have suffered a sixfold increase in AIDS/HIV prevalence in the past six years. This rate exceeds that for the majority culture during the same period. Rural American Indian communities are at increased risk due to geographical and cultural isolation and lower access to adequate health care. Findings herein suggested that despite these community risk factors, information levels were quite similar in a Northern Plains reservation college student sample and a nonIndian, urban college student sample. Several specific differences in attitudes and beliefs, as well as culturally appropriate community intervention strategies are also discussed. Study limitations, as well as relationships between general Sexually Transmitted Disease (STD) related behaviors are also paralleled.
American Indian mental health researchers and clinicians have struggled for over a decade to blunt the potential wave of destruction that AIDS represents to American Indians communities. In spite of some heroic efforts1, especially at the grassroots levels (see Cantil, 1993), we have yet to develop a clear understanding of how the AIDS virus will impact these communities, and what steps may be taken toward effective prevention. This lack of information and understanding has not developed because of apathy or laziness. Quite to the contrary, many have courageously accepted the war pipe to battle this powerful, elusive enemy but their efforts have been hampered by several factors.
First, not enough Indian researchers, or crossculturally competent nonIndian researchers, exist (or are interested) in sufficient numbers (LaFramboise, 1988; McDonald, Morton & Stewart, 1993). Second, the Indian Health Service (IHS) and area Indian Health Boards are too understaffed and underfunded to be able to mount such a necessarily large and complex research and prevention campaign2 (Nelson, McCoy, Stetter, & Vanderwagen, 1992). Third, cultural differences often complicate American Indian mental health research efforts (LaFramboise & Plake, 1983, Norton & Manson, 1996), especially when sensitive behavioral information such as sexual preferences and practices are involved. Finally, the status of American Indian mental health research overall has only recently begun to approach its potential in terms of amount and sophistication (Manson, Walker, & Kivlahan, 1987, Norton & Manson, 1996).
Existing AIDS/HIV literature concerning American Indian communities (Estrada et al, 1990; Hall et al, 1990; Locust, 1988; Rowell, 1989) suggests the following points: (1) American Indian prevalence rates for sexuallytransmitted diseases (STDs) are higher than any other cultural group in America (CDC, 1985a, 1985b, 1989; Department of Defense, 1988); (2) more research is needed to address knowledge, attitudes, beliefs, and behaviors among Native peoples in order to better understand all aspects of the AIDS threats they will face; and, (3) increasing knowledge and or restructuring naive or intolerant attitudes concerning AIDS/HIV may have a significant effect in decreasing highrisk behaviors (Catania, Kegeles & Coates, 1988; Hepworth & Shernoff, 1989).
Some authors have suggested that community based information efforts can be one effective strategy toward transmitting information about AIDS prevention to culturally diverse communities (Evans, 1988; Jiminez, 1987). Most American Indian community education efforts are undertaken either by the IHS, or local triballycontrolled colleges. Sometimes other outside agencies such as the state, or even private AIDS awareness organizations visit reservation communities to provide information, and even present influential speakers infected with the HIV virus. While it is believed the recent communityinformation efforts on many reservations have been impressive, and have taken steps toward filling the huge information void, very few studies have empirically investigated their effectiveness. One major methodological challenge in designing an experimental community study is that smaller reservation communities are often both geographically isolated and culturally distinct from surrounding communities, thus making it difficult — and sometimes impossible — to select appropriate nonexperimental controls. These communities are also very suspicious of "outsiders" invading their reservation to study their behavior (McDonald, Morton, & Stewart, 1992). Interested readers can find an excellent discussion of general American Indian communitybased prevention strategies in Trimble (1982).
Statistics from the National Native American AIDS Prevention Center (1996) recently recorded 1,439 cases of AIDSinfected American Indians. A general belief is that these numbers actually underrepresent the AIDS incidence rate in Indian Country, since many cases remain unreported and these figures do not account for HIVinfected patients not yet experiencing fullblown AIDS. Figure 1 demonstrates that although sophisticated epidemiological projections are important, the simple mathematical fact remains that this rate has increased sixfold in little more than six years. While the epidemiological validity of these rates may remain debatable, they still suggest a prevalence rate increase higher for Indian people than any other minority group, or the majority culture. The AIDS threat to Indian communities is so staggering in both size and complexity that many researchers and clinicians find it difficult to determine where to launch the most effective counterattack.
Figure 1. American Indian AIDS cases 1989-1996.
(Data from CDC and NNAAPC, 1996.)
The research herein focused on the knowledge, attitudes, and beliefs (KAB) of a sample of
Northern Plains American Indian college students concerning AIDS/HIV for several reasons.
First, many Indian college students either are or are soon will be community leaders. This
is especially true for tribal college students, for whom leaving their home communities to
pursue an education is unnecessary (Stein & Eagleeye, 1993). Investigating the
feelings and perceptions of these students so soon to be responsible for leading their
people was deemed crucial. The second reason Indian college students were selected is that
college students, regardless of culture, are considered a highrisk group (Brown, 1991;
Manning et al, 1989). AIDS has been described as a "disease of young people"
(Gottlieb et al, 1988, p. 67). Individuals between 20 and 39 comprise almost 70% of AIDS
victims nationwide (Selwyn, 1986) because this is the period of highest frequency of
sexual activity. Of the 94 known cases of Indian women infected with AIDS as of August,
1993, almost 30% had been infected by heterosexual contact (National Indian AIDS Media
Consortium [NIAMC], 1993).
Although AIDS research with nonIndian college students has often yielded conflicting results (Brown, 1993; Manning, 1989), it has demonstrated the need for further investigation into the relationship between attitudes and highrisk behaviors and behavior change. Since, according to the literature, so little is known about the AIDS/HIV KAB within these two groups, a majority culture sample was also included to help place the findings from the American Indian college students into a crosscultural context.
Two general hypotheses were proposed by the research team.
Hypothesis 1. The relationship of greatest conceptual significance to the research team suggested there would be no significant difference in AIDS/HIV general knowledge between the two groups. This null hypothesis would seem counterintuitive to many, and especially to those who postulate that American Indian communities in remote areas are not exposed to sufficient AIDS/HIV information. The researchers believed, however, that tribal college students would demonstrate AIDS/HIV knowledge comparable to their urban, majorityculture peers, thus supporting the view that tribal colleges and the Indian Health Service community interventions have been effective in processing and spreading this information. While it was understood that findings of "no significant difference" are often considered less intriguing scientifically, the serious nature of the information combined with the reality of the situation warranted this hypothetical conceptualization. Where AIDS and community KAB are concerned, "no significant difference" becomes important information.
Hypothesis 2. This hypothesis suggested that the two study groups would demonstrate significant differences in attitudes and beliefs about AIDS/HIV susceptibility and prevention, in spite of similarity in knowledge. It was believed this finding would directly reflect cultural and demographic differences in processing contemporary issues, especially those of a highly sensitive nature.
Fifty five American Indian students from a small, rural tribal college located in a Northern Plains reservation community and 104 predominantly white students from the University of Arkansas comprised the two groups studied in this project. The groups are discussed in greater detail below.
Group 1. Group 1 consisted of 55 (15 male, 40 female) American Indian tribal college students from a Northern Plains tribe. Recruitment of subjects into this group consisted of the following efforts. First, announcements describing the study were made in faculty meetings, student senate meeting, and psychology classes. Second, posters and flyers were posted on school bulletin boards and placed in student and faculty mailboxes describing the study. Both of these efforts clarified participant criteria, meeting time and place, and reimbursement for participation.
The participant criteria were quite simple; subjects were required to be an enrolled member of a federally or staterecognized tribe and enrolled in classes for that semester. No other requirements were imposed for inclusion into Group 1. It was understood that more traditional students might be offended by the offer of money for their participation, so students were given several reimbursement options. The choices offered included receiving payment ($5.00) or having a donation made in their (or their family's) name to the general scholarship fund at the tribal college. This arrangement seemed satisfactory, with approximately half of the sample choosing each of the two methods of payment. None of the participants in Group 1 dropped out of the study prematurely.
Group 2. Group 2 consisted of 104 (40 male, 64 female) urban, nonIndian students from the University of Arkansas (UA). Participants comprising this group were directly recruited from undergraduate UA psychology classes and received extra credit points for their participation. No participants from this group dropped out of the study prematurely.
Both of these groups were selected because they represented distinctly different value systems both crossculturally and geographically (urban versus rural). This was deemed important for testing Hypothesis 1. It was believed that the tribal college sample must therefore represent a very rural, culturally distinct community, and the majority culture sample must represent an urban, predominantly white community from a different part of the country to provide an interesting and informative group comparison.
Both study groups were administered a research packet containing a study introduction and informed consent form, and the Dull Knife Memorial College (DKMC)
AIDS/HIV Knowledge Attitudes and Beliefs Scale. The informed consent form introduced the study and the researchers and discussed the procedures to be followed in datagathering. It outlined participation reimbursement, the anonymous nature of the study, and provided referrals for further information or services.
The DKMC AIDS/HIV Knowledge, Attitudes and Beliefs Scale was developed by the authors in a previous study (McDonald, Jackson, McDonald, & Morton, 1992). The scale contains 37 items arranged in various formats ranging from Likertscaled to multiple choice. The DKMC scale requires a fourthgrade reading level and is typically completed in five minutes. Items assess AIDS/HIV knowledge sources and levels, as well as attitudes and opinions about the virus and those who are either infected or are at risk for various reasons. Items sampling knowledge and beliefs concerning prevention are also included. Most scale items were drawn from existing instruments from other studies and piloted in focus groups for readability and cultural sensitivity. The original 41item prototype was administered to 210 participants and factor and item analyzed. The finalized scale requires an appropriate reading level, is concise, and as culturally sensitive as possible.
The research team collected data from the University of Arkansas and the tribal college simultaneously. These efforts are discussed in further detail below.
Group 1 Data Collection. Prior to data collection, permission from the local tribal cultural committee (this reservation's equivalent of a Human Subjects Committee or IRB) was obtained. This preliminary step is of much more crucial importance than most researchers working with Indian subjects comprehend. Not only does this effort secure the proper authority for project to continue, it demonstrates proper respect to the community. If the tribe does not have an IRB of any kind, researchers should seek approval from the tribal health board or tribal council. If the reservation hosts a tribal college, administrators and faculty can often guide researchers to the proper authoritative body.
As mentioned above, the tribal college sample was recruited from psychology classes, wordofmouth, and bulletinboard announcements. Participants were run in groups of eight to 20 as they appeared. All were presented with standard instructions and the informed consent form and then administered the DKMC AIDS/HIV KAB Scale. Completed protocols were collected and stored, and students were reimbursed in the manner of their choosing. Although no records were kept of the reimbursement process, the researchers observed that older Indian students (e.g. over 40) tended to choose donation of their $5.00 back to the college more than younger students. (This "giving away" paralleled traditional Indian practices in the community and would form the basis for interesting further study.)
Group 2 Data Collection. Data were collected from the University of Arkansas (UA) in much the same manner in terms of procedures. Following IRB approval, the second author solicited a sample of participants from UA psychology classes. The participants were surveyed after classes, and assigned extra credit at that time. Protocols were then compiled and responses coded. The coded sheets were then sent to the first author for data analyses.
Data Analyses. Data from Groups 1 and 2 were analyzed with the SYSTAT 5.0 statistical software system for MacIntosh. Demographic variables analysis provided descriptive statistics for comparing group characteristics. Independent ttests were also calculated for comparison of mean group responses on individual items. Both analyses were performed to assess the accuracy of the study hypotheses. Several interesting similarities and differences in group responses were noted and are presented in the following sections.
As seen in Table 1, students comprising Group 1 were older than Group 2 students (M = 31, sd = 7.2 to M = 19.2, sd = 3.2 respectively). Slightly more women were represented in Group 1 (78%) than in Group 2 (61.1%). The desired urban versus rural distinction was clearly obtained, with 100% of Group 1 students indicating being from communities of less than 25,000 while 90.1% of Group 2 students hailed from communities of over 25,000. A chisquared analysis was deemed unnecessary to demonstrate the significance of this difference.
A chisquared analysis was run, however, on the item assessing AIDS/HIV information sources. The results — X2 (4, N=59) = 24.4, p<.001 — suggested the two groups obtained AIDS/HIV information from significantly different sources.
Table 1. Descriptive Demographics for Groups 1 and 2.
Characteristic M SD %
----------------------------------
Age
Group 1 31.0 7.2
Group 2 19.2 3.2
----------------------------------
Gender
Group 1
Female 78
Male 22
Group 2
Female 61
Male 39
----------------------------------
Background (Urban v. Rural)
Group 1
< 25,000 100
Group 2
> 25,000 90
< 25,000 10
----------------------------------
Sources of AIDS/HIV information
Group 1
Public Health Workers 35.5
College Workshops 27.5
Doctors 15.3
Television 15.1
Radio 8.6
Group 2
Television 32.0
Radio 25.9
Doctors 16.1
College Workshops 14.8
Public Health Workers 11.2
----------------------------------
Notes. (1) Group 1 n=55, Group 2 n=104
Independent t-tests were run on all scale items with the exception of the demographic items. Selected t-test results are listed in Table 2 below. As seen in Figure 2, response choices ranged - in Likert-scaled format -from Definitely True (1) to Definitely False (4). As anticipated, no significant differences emerged on items assessing general knowledge, but six attitudinallyoriented items did produce significant differences.
Table 2. Selected Independent tTests Results.
Means
------------------------
Item T Group 1 Group 2
----------------------------------------------------------------------
1. "AIDS is a White Mans' disease." 4.0*** 3.7 3.2
2. "People who get AIDS must deserve it" 2.8** 3.4 3.7
3-6. "What are ____________ chances of getting AIDS?"
People who abuse alcohol' 7.9*** 1.9 3.1
Black peoples' 2.9** 1.9 2.4
People who live in big cities' 2.7* 2.8 3.2
White peoples' 2.3* 1.9 2.3
----------------------------------------------------------------------
Note.
(1) Items 1 and 2 responses range from "Definitely True" to
Definitely False", 36 range from "Very High" to "Very Low"
(2) Degrees of Freedom for all tests = 157
(3) *p<.05, **p<.01, ***p<.001
The most significant variance between the two groups was observed for an
attitudinally-oriented item asking to what extent "drinkers" were susceptible to
acquiring AIDS. Group 1 believed consumers of alcohol were more likely to acquire AIDS
than did group 2 t(157) = 7.9, p<.001. Examination of the mean scores for this item
(Group 1 M = 1.9, Group 2 = 3.1) suggested an interesting relative lack of concern among
Group 2 respondents for the established correlation between the disinhibiting effects of
alcohol abuse and AIDS infection (see Leigh and Stall, 1993).
Significant response disparity was also observed for an item claiming AIDS to be a "White Mans' Disease. While both Group 1's and 2's mean scores reflected general disbelief in this statement (3.1 and 3.7, respectively), Group 1 students disagreed with the statement significantly less than did Group 2, t(157) = 4.0, p<001. Another intriguing observation suggested Group 1 felt "Black Peoples'" and "White Peoples'" chances of becoming infected were significantly higher than their own (t(157) = 2.9, p<.01 and t(157)=2.3, p<.02, respectively).
The two groups also differed in their risk beliefs about people "Living in Big Cities." Although both generally felt urban-dwellers were only moderately at-risk (Group 1 M = 2.8, Group 2 M = 3.2) Group 1 (predominantly reservation-dwellers) believed them at significantly greater risk (t(157) = 2.9, p<.01).
Finally, an interesting difference was also observed for an item asking respondents to rate whether individuals afflicted with AIDS "must deserve it." While both groups again generally felt this statement to be false (Group 1 M = 3.4, Group 2 M = 3.7) they still differed significantly with Group 1 being less convinced that this statement was false then Group 2 (t(157) = 2.9, p<.01). Although the difference was significant and interesting, we believe it should not be over interpreted, especially in light of the strong overall disagreement that both groups shared.
The nature of the AIDS/HIV threat to American Indian communities is both large and complex. It is also upon us. Although desperately needed, research investigating epidemiology, community prevention and treatment effectiveness, and crosscultural appropriateness remains sparse and scattered. This study addressed a small but important area within that information void. American Indian college student enrollment is increasing, especially in tribal colleges. Many of these young people will graduate and return to assist their communities. Gaining insight into the amount and nature of AIDS/HIV knowledge and attitudes held by these future community leaders, especially in comparison to their majority culture peers, was considered vitally important.
The most significant suggestion from the data gathered in this study lies in the similarity of knowledge levels and attitudes between the two very distinct groups studied. As hypothesized, the Northern Plains, American Indian, rural, tribal college students did not differ to any great extent from their Southern, predominantly white, urban, state college peers in terms of AIDS/HIV knowledge despite receiving their information from different sources. Perhaps geographically and culturally isolated American Indian communities are in fact responding positively to community health awareness interventions by IHS, local Indian Health Boards (including community health representatives [CHRs]), tribal colleges, reservation community action groups, and the general media. Several (but few) items addressing AIDS attitudes and beliefs did, however, produce interesting differences.
While it was encouraging that the tribal college students (Group 1) generally did not believe AIDS to merely be a "White Mans' Disease," some did. In fact enough participants agreed to make the difference statistically (but not practically) significant. As mentioned earlier, the number of AIDSafflicted American Indians has more than quintupled in a few short years. It has become increasingly obvious that no cultural group or community, urban or rural, is immune to the AIDS threat.
The majority culture college students in this study appeared less realistic about the hazardous correlation between alcohol abuse and AIDS acquisition. Perhaps the higher rates of drug and alcohol abuse and sexuallytransmitted diseases (STDs) typical of many reservations causes tribal college students to be more cognizant of the dangers of alcoholinduced behavioral disinhibition.
We believe these results supported the two general hypotheses of the study. First, no significant group differences were observed for knowledgebased items. This similarity in AIDS/HIV knowledge supported Hypothesis 1. Second, several items addressing attitudinal AIDS issues did produce significant differences that could be interpreted as information processed from varying cultural perspectives. This finding supported Hypothesis 2.
The results indicating differential attitudinal responses also suggest that AIDS/HIV community education/behavior change effort developed for majority-culture communities may not be appropriate for rural American Indian communities. It is note-worthy to mention that each American Indian and Alaska Native community represents challenges that, although similar, are also distinct in culturally significant ways. Interventions must therefore be adapted and refined to address the cultural, economic, and other demographic needs of the particular communities involved.
Future research in this area should therefore focus on the specific cultural and sociological dynamics, as well as human services resources, which may be accounting for these subtle yet important differences. A more direct assessment of the effects of cultural orientation on AIDS/HIV attitudes and knowledge levels would also be important to pursue.
In summary, although we believe these findings are suggestive of progress, they must be tempered with several cautionary notes. First, this was not an experimental study that, for example, utilized a control community and pre- and post-testing. While findings from studies with such designs typically demonstrate more reliable internal and external validity, they are also extremely difficult to implement in smaller reservation communities for a variety of reasons discussed above. Finally, the prevalence rates for most STDs are still very high in our Indian communities. The same highrisk behaviors that develop and maintain other STDs also contribute to the spread of AIDS. So, while it is believed these results are generally encouraging, they by no means justify complacency. The fight against the AIDS/HIV threat in American Indian communities must not only continue but intensify. It is hoped that findings such as those from this study will contribute to larger and more complex efforts that are so desperately needed to slow the spread of this deadly disease in Indian Country.
Anastassi, A. (1988). Psychological testing (6e). Macmillan Publishing Co. New York
Baum, A., & Nesselhof, S. E. (1988). Psychological research and the prevention, etiology, and treatment of AIDS. American Psychologist, 43, 900906.
Brown, W. J. (1991). An AIDS prevention campaign. American Behavioral cientist, 34, 666678.
Cantil, J. (1993). HIV prevention in rural Alaska. Seasons, Spring/Summer, 26.
Catania, J., Kegeles, S., & Coates, T. (1988). Towards an understanding of risk behavior: The AIDS riskreduction model (ARRM). Manuscript submitted for publication.
Centers for Disease Control. (1989). [Indian vs other racial/ethnic groups HIV transmission categories]. Unpublished raw data.
Centers for Disease Control (1994). HIV/AIDS surveillance report. U.S. Dept of Health and Human Services report, midyear edition, 6(1).
Department of Defense (DOD) (1988). [Military HIV/AIDS seroprevalence rates by ethnicity]. Unpublished raw data.
Estrada, A.L., Erickson, J.L., Fernandez, M.E., & Stevens, S. (1989). AIDS risk behaviors among Native American IVDU's: A preliminary report. Paper presented at the meeting of the NIDA/NIMH Technical Review, Albuquerque, NM.
Evans, P. (1988). Minorities and AIDS: Special Issue: AIDS. Health Education Research Theory and Practice, 3, 113115.
Gottlieb, N.H., Vacalis, T.D., Palmer, D.R., Conlon, R.T. (1988). AIDSrelated knowledge, attitudes, and behaviors and intentions among Texas college students. Health Education Research Theory and Practice, 3, 6773.
Hall, R.L., Wilder, D., Bodenroeder, P., & Hess, M. (1990). Assessment of AIDS knowledge, attitudes, behaviors, and risk levels of Norwestern American Indians. American Journal of Public Health, 80, 875877.
Hepworth, J. & Shernoff, M. (1989). Strategies for AIDS education and prevention. Marriage and Family Review, 13, 3980.
Indian Health Service (1989a). National Indian rodeo AIDS knowledge, attitudes and behaviors study. (Available from IHS).
Indian Health Service (1989b). New mexico Indian AIDS/HIV knowledge, attitudes and behaviors study. (Available from IHS).
Jiminez, R. (1987). Educating minorities about AIDS. Family and Community Health, 10, 7073.
Kelly, J.A., Murphy, D.A., Sikkema, K.J., & Kalichman, S.C. (1993). Psychological interventions to prevent HIV infection are urgently needed: New priorities for behavioral research in the second decade of AIDS. American Psychologist, 48, 10231034.
LaFramboise, T. D. (1988). American Indian mental health policy. American Psychologist, 43, 388397
LaFramboise, T.D., & Plake, B.S., (1984). A model for the systematic review of mental health research: American Indian family, a case in point. White Cloud Journal, 3, 4452.
Leigh, B.C., Stall, R. (1993). Substance use and risky sexual behavior for exposure to HIV. American Psychologist, 48, 10351045.
Locust, C. (1988). A survey of American Indian knowledge, attitudes, and beliefs about AIDS: A final report. Unpublished manuscript, University of Arizona, Native American Research and Training Center, Tucson.
Manning, D., Balson, P., Barenberg, N., & Moore, T. (1989). Susceptability to AIDS: What college students do and don't believe. Journal of American College Health, 38, 6773.
Manson, S., Walker, R.D., & Kivlahan, D.R., (1987). Psychiatric assessment and treatment of American Indians and Alaska Natives. Hospital and Community Psychiatry, 38, 165173.
McDonald, J.D., Morton, R., & Stewart, C. (1993). Clinical issues of concern with American Indian patients. Innovations in Clinical Practice, 12, 437454.
McDonald, J.D., & Morton (1991). The development of the DKMC AIDS/HIV knowledge, attitudes and beliefs scale. Paper presented at the meeting of the Association of American Indian Psychologists and Psychiatrists, Madison, WI.
Mays, V.M., & Cochran, S.D., (1988). Issues in the perception of AIDS risk and risk reduction activities by Black and Hispanic/Latina women. American Psychologist, 43, 949957.
National Commission on AIDS (NCOA) (1993). Behavioral and social sciences and the HIV/AIDS epidemic. Washington, DC: NCOA.
National Native American AIDS Prevention Center. (1989) Minnesota Indian AIDS/HIV knowledge, attitudes and beliefs study. Available from NNAAPC).
National Native American AIDS Prevention Center, (1996). Native American AIDS Cases. Seasons, Autumn, 14.
Nelson, S., McCoy, G., Stetter, & Vanderwagen, (1992). An overview of mental health services for American Indians and Alaska Natives in the 1990s. Hospital and Community Psychiatry, 43, 257261.
Norton, I., & Manson, S. (1996). Reserach in American Indian and Alaska Native communities: Navigating the cultural universe of values and process. Journal of Consulting and Clinical Psychology, 64, 856860.
Peterson, J.L., & Marin, G. (1988). Issues in the prevention of AIDS among Black and Hispanic men. American Psychologist, 43, 871877.
Rowell, R.M. (1989). AIDS and Native Americans: New battle with an old enemy. Seasons: The National Native American AIDS Prevention Center Quarterly, 1,
Rowell, R.M. (1990). Alcohol and AIDS. Seasons: The National Native American AIDS Prevention Center Quarterly, 2, 56.
Selwyn, P.A. (1986). AIDS: What is now known. Hospital Practice, May, 71.
Siegel, L. (1986). AIDS: Relationship to alcohol and other drugs. Journal of Substance Abuse Treatment, 3, 271274.
Stein, W., & Eagleeye, D. (1993). Learned leadership: Preparing the next generation of tribal administrators. Tribal College: The Journal of American Indian Higher Education, Autumn, 3336.
Thomas, S.B., Gilliam, A.G., & Iwrey, C.G. (1989). Knowledge about AIDS and reported risk behaviors among Black college students. Journal of American College Health, 38, 6166.
Trimble, J. (1982). American Indian mental health and the role of training for prevention. In S. Manson (Ed.) New directions in prevention among American Indian and Alaska Native communities. Oregon Health Sciences University: Portland, OR.
The authors would like to acknowledge the assistance of the National Native American AIDS Prevention Center and the American Indian/Alaska Native/Hawaiian Native Community AIDS Network (see Footnote 1) for sharing their data, expertise, and hearts in support of this project.
The authors are also thankful to the elders of the Turtle Mountain Chippewa, Oglala Lakota and Northern Cheyenne tribes for their guidance and support in this project. Mr. Ron Morton was also instrumental in providing necessary guidance for the completion of this project.
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The North Dakota Journal of Human Services, October 1998