UNM researcher is advancing HIV Prevention and Health Equity for Native Americans

A University of New Mexico researcher and assistant professor is breaking barriers in the health community for fellow Native Americans.

Hailing from the Diné Nation, Crystal Lee has been researching health disparities in the Native American community, specializing in infectious diseases and associated preventative medicine practices.

“I specialized in HIV, Ebola, H1N1 (swine flu) and H1N3 (Influenza A), and with that training I translated a lot of those efforts into examining HIV prevention barriers and facilitators to Native American college students,” said Lee, who holds a master’s degree in Indigenous Peoples Law and a master’s and Ph.D. in Public Health.

“Our primary use of health care is through the Indian Health Service ... and the second is called Tribal 638.”

The Indian Health Service is federally funded and works similar to Veteran Affairs services. Tribal 638 is funded through the Indian Health Service but is not federally monitored. Instead, tribes self-govern the health care services.

Lee conducted a study to analyze which health services Native Americans preferred when needing HIV prevention and biomedical care and the distinction in services and effectiveness between tribal-operated clinics and Indian Health Service clinics.

“We compiled a total of 305 completed and validated surveys that stem from over 100 different tribal affiliations across the country, and they were both undergraduate and graduate students that reflected more than 100 different types of institutions that they are enrolled at, including public, private and tribal colleges and universities,” Lee said.

Students ranged from 18 to 57 years old. All surveys were returned within 10 days of being sent out. Each survey contained 37 pages, and each student was estimated to spend roughly one hour on it. Students were asked questions on health care access, cultural/social influences and more.

Results from the research showed that students who had a health clinic or health services had a better understanding of HIV and Pre-exposure prophylaxis (PrEP), a medicine that helps prevent HIV infection in high-risk people. Those students also had more access to preventative care items such as condoms or STD testing.

“The distinction in that is tribal colleges and universities do not typically have a robust health care system associated with their institution, so those that attended tribal colleges and universities were less likely to get tested for HIV or know about PrEP,” Lee said.

Lee said the rates of HIV infection have dramatically increased in the Native American population over recent years, primarily due to injection drug use.

“Typically, HIV has had a higher prevalence in the native LGBTQI+ community and Native American females had typically lower rates, but the spike has been associated with substance abuse, primarily injection drug use, and this was coming from some folks who are working with smaller Diné communities in the New Mexico area.”

Lee said HIV isn’t the only concern she has seen in the Indigenous community. After talking with the Navajo Nation Department of Behavioral Health, she was alerted to an outbreak of syphilis during fall 2023.

“Knowing the associated other sexually transmitted infections that have been on the rise is also important because they kind of go hand in hand to make our community members more vulnerable,” she said. “If they have other STIs as well, it makes them more susceptible to contract HIV.”

Lee has created a proposal for the National Institutes of Health focusing on HIV awareness and prevention using the results from her study.

“In general, we suffer from high rates of disparities, both infectious and chronic,” Lee said. “There are such a limited amount of Native American researchers in the U.S., especially that focus on infectious diseases. We need more Native American researchers out there who can conduct research in a culturally responsive capacity that benefits the community.”