SPNS Initiative: American Indian/Alaska Native, 2003–2007


The Special Projects of National Significance (SPNS) American Indian/Alaska Native (AI/AN) Initiative was designed to integrate substance abuse and mental health services with HIV primary health care for American Indian and Alaska Native communities. The target population for the initiative included American Indian and Alaska Natives who were HIV-positive or at risk for HIV infection with co-morbidities of substance abuse (including alcohol), sexually transmitted infections and/or mental illness. Six demonstration projects and the National American Indian/Alaska Native HIV/AIDS Technical Assistance Center comprised this five-year initiative. Since AI/AN agencies operate under a Federal policy that promotes self-determination for American Indian and Alaska Native peoples, the Technical Assistance Center respected the intent of the AI/AN projects to develop culturally appropriate solutions to community, tribal, and village issues, encouraging solutions to come from the local level. The Center provided technical assistance to the six HIV care demonstration projects for their local evaluation efforts, to assess local evaluation capabilities, and to disseminate the findings of the initiative.

During the first year of the initiative, time was spent refining the local evaluation and proposed interventions. This included formalizing a logic model and client flow chart delineating how HIV counseling and testing, appropriate access to HIV care, and HIV prevention could be integrated and provided to an AI/AN population already receiving services for HIV and/or related co-morbidities of STI's, substance abuse, and mental health issues. The logic model and client flow chart served as the basis for developing IRB protocols and the designing of models based on the distinct cultural values and beliefs of each grant recipients' target population. Ongoing technical assistance was provided to grantees as they entered the implementation phase and began data collection and evaluation activities. While each project had specific goals and strategies, the overarching theme of the initiative was to integrate an array of services for HIV-positive or at risk American Indian and Alaska Natives, particularly those with co-morbidities as described above, to ultimately improve health of those targeted and prevent the continued spread of HIV within their communities.

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