# data[].attributes.body
I think each of the goals just need to be modified so that Native communities know that how they carry them out has to be modified to incorporate the uniqueness of the culture of their community

# data[].attributes.body
I believe all sections need Indigenous-specific data rather than the national data that's written here - or the national data could be supplementary to it. In our first committee meeting, Both the Native Advisory Committee and the IHS spoke to huge disparities in data when it came down to rates of HIV in tribal/rural communities, and it wasn't clear who was responsible for the inaccurate data. Reading through the strategic plan, I don't get a sense of urgency for Native communities that I should for rates of HIV.  I think this is a great section to include data related to substance/drug use in Indigenous communities as well and briefly highlight the epidemic here in order to showcase the heightened risk to Indigenous communities for HIV/STIs. Also, this is a great section to introduce, briefly, the problematic history of research and experimentation in Indigenous communities, and how it results still today in a lack of trust for outsiders, new medications, providers, etc. which leads (in part) to the resulting lack of data or accurate data reports mentioned previously. Because of this (and other reasons), many of the interventions outlined in other strategic plans or carried out in urban areas tend not to be as effective or applicable to Native communities. Then describe why our programming tend to be more 'promising practice' based.  I'd also like to emphasize how the Tribal Health System exists to protect Indigenous people, and highlight how strong of a partner that Tribal Health Systems truly are.  Idea: You could theme/name each of the goals listed here as a Native core value.

# data[].attributes.body
I think health systems are so varied that we have to help identify and connect Native people with access so we need to somehow say that. there may need to be linkages to appropriate care by partnering with external systems

# data[].attributes.body
I noticed here that there are some new practices listed as possibly helpful for HIV prevention that are still in need of research. Indigenous people have been the 'test group' for Western experimentation and research too often. While we should still access the fact that there is up and coming research, it should not be so emphasized from my perspective. Highlighting proven methods that work to prevent HIV - condoms, abstinence, education, possibly PEP/PrEP, is my recommendation. Again, highlight Indigenous expertise - Community rural providers are the strongest allies when it comes to community-based or individual interventions. We could take some time to highlight Indigenous rural health providers' place in HIV prevention and intervention.

# data[].attributes.body
This goal is huge. Sometimes people don't view our communities as have inequities in health because of "IHS" system and Tribal clinics. However, this goal is huge and will take some work to help educate our marginalized populations within our own communities and reach them.

# data[].attributes.body
This information is appropriate, but I see a lot of stigma towards Afro-Indigenous and Two-Spirit communities even today. Possibly explore the LGBTQ2S+ movement a little more, specifically Two-Spirit.

# data[].attributes.body
We have work to do on the state and federal level to get funding agencies recognize Tribal communities as being able to receive direct appropriations rather than pass thru as partners. There will be many stakeholders that will be necessary in order to achieve this goal. We have to think about how our systems work such as purchased and referred care, CDC cooperative agreements, etc.

# data[].attributes.body
Make a commitment to partner with the Tribal health system in order to streamline accurate data reports for HIV/STIs (the issue as mentioned under question 3 above). Tribes and tribal leaders are important partners and stakeholders when it comes to community healthcare - especially important in rural areas! Emphasize community and encourage Tribal partnerships.

# data[].attributes.body
In each section,

Challenges: prevention efforts are currently designed within a Western context.   Efforts should be made to ensure services, strategies, etc. are developed to ensure a culture is honored especially in areas with high prevalence of AI/AN, & NHAAPI.  And all cultures.

“culturally competent”

# data[].attributes.body
“culturally competent” is mentioned a few times, however, I feel that somewhere it should be expanded to acknowledge culture practices and practitioners in regards to healing the whole person.

# data[].attributes.body
Prevention efforts should be community led with full support from funders to implement and run programs with autonomy

# data[].attributes.body
Incorporating wording not only about cultural competent workforce, but that it includes cultural humility and recognition of historical trauma by workforce.

# data[].attributes.body
The goal should address eliminating barriers that can be met with bring treatment and prevention to the community. Meeting people in the places they feel safe and protected can reduce barriers and increase outcomes.

# data[].attributes.body
Release restrictions on communities not being able to access their own data around HIV and related comorbities. Communities can not create effective plans without accurate data.

# data[].attributes.body
Addressing mental health

# data[].attributes.headline
Relate each goal to a practice of sustenance in our communities. In the narrative of each goal, different regions could offer cultural stories of how their communities thrive and survive through the different seasons. Perhaps each goal could be a season. In prevention, or in the winter, we begin to harvest seeds (prevention), in the spring we plant the seeds (improving outcomes), in the fall we harvest our crops (reduce disparities and achieve coordinated effort). Or other stories like salmon harvesting, berry harvesting, etc. 

# data[].attributes.subject
Relate each goal to a practice of sustenance in our communities. In the narrative of each goal, different regions could offer cultural stories of how their communities thrive and survive through the different seasons. Perhaps each goal could be a season. In prevention, or in the winter, we begin to harvest seeds (prevention), in the spring we plant the seeds (improving outcomes), in the fall we harvest our crops (reduce disparities and achieve coordinated effort). Or other stories like salmon harvesting, berry harvesting, etc. 

# data[].attributes.headline
Thoughts:  When was the last time a survey or focus group was conducted to visit with clients about their feelings about preventing new diagnosis?  Can we reach out and collect this information?  Additionally, is PrEP even available at our IHS facilities?  How knowledgeable are our tribal physicians in offering PrEP?  

# data[].attributes.subject
Thoughts:  When was the last time a survey or focus group was conducted to visit with clients about their feelings about preventing new diagnosis?  Can we reach out and collect this information?  Additionally, is PrEP even available at our IHS facilities?  How knowledgeable are our tribal physicians in offering PrEP?  

# data[].attributes.headline
opportunity to expand on strengthening protective factors?

# data[].attributes.subject
opportunity to expand on strengthening protective factors?

# data[].attributes.headline
Discuss what prevention means. And what is needed for prevention. 

# data[].attributes.subject
Discuss what prevention means. And what is needed for prevention. 

# data[].attributes.headline
Access . . .where and how?  Do we have options on how to access care?  Telemedicine, face to face, social platforms, etc.

# data[].attributes.subject
Access . . .where and how?  Do we have options on how to access care?  Telemedicine, face to face, social platforms, etc.

# data[].attributes.headline
I like some of the ideas brought forward in the plan, would like to add to and make them Native specific. What are examples of these going on in Native communities.

# data[].attributes.subject
I like some of the ideas brought forward in the plan, would like to add to and make them Native specific. What are examples of these going on in Native communities.

# data[].attributes.headline
Cultural competent/responsive workforce is limited.  How can we work to improve this situation?  Maybe somethings are in place, but we are clueless to those opportunities.

# data[].attributes.subject
Cultural competent/responsive workforce is limited.  How can we work to improve this situation?  Maybe somethings are in place, but we are clueless to those opportunities.

# data[].attributes.body
Mindfulness that mental illness, drug addiction, domestic abuse, etc. should also be addressed, as well as, providing sexual/reproductive health services as part of well-being/positive health outcomes.

# data[].attributes.body
I feel that Indigenous and rural populations experience different disparities and health inequities that more urban or other populations do not experience as much. Under this goal, this might be a good place to expand on what these disparities are and why they exist (a need for a better flow between reporting HIV status)

# data[].attributes.body
Attention to and promotion of personal identity and intergenerational strength.

# data[].attributes.body
Utilizing allies to promote indigenous inclusion and strengthen our political voice.

Provide comprehensive list of health care providers across the U.S., whether within IHS or tribal health services and or non-profit groups, that can/will aid those in need. List must be easily accessible to everyone.

# data[].attributes.body
I like that IHS/Tribal Health system is constantly being brought up. It is how healthcare is accessed by a good majority of Native people's. It's where I obtain around 90% of my healthcare, So keeping in mind how Native people access their healthcare is important.

# data[].attributes.headline
How are we doing this right now?   I'm not sure I understand current approach therefore, unsure how to make it stronger and more effective.

# data[].attributes.subject
How are we doing this right now?   I'm not sure I understand current approach therefore, unsure how to make it stronger and more effective.

# data[].attributes.body
Starts with how we were taught as indigenous youth – we weren’t taught about HIV, STIs, sex in general – need to have education, schools that don’t rely on abstinence only rules, start with young before we get to elders. We can teach our youth so that they’re aware of their bodies and autonomy.

# data[].attributes.body
Make testing a normalized thing – we can avert new cases of HIV. One thing that curb new infections – is people who currently have HIV to know their status – so they reduce viral loads, so that they’re undetectable. Treatment as Prevention.

# data[].attributes.body
Education goes a long way; importance of being trusted adult. Youth 13-17 don’t need parental consent

# data[].attributes.body
Making sure awareness re: PrEP is something that individuals are aware of so they can protect themselves. How is PrEP promoted within different communities across the US (e.g. urban versus rural, reservation based). There is never any representation of Indigenous people in PrEP ads. People won’t realize that it’s for them. Representation is important so that people know that it is relevant to them.

# data[].attributes.body
A lot of education materials are geared toward the general public, rather than Indigenous populations. E.G. two spirit is not often used in LGBTQI2S+ materials. Importance of not conflating two-spirit with trans. Two-spirit needs to be represented in a very intentional way.

# data[].attributes.body
Need to first have to specific around where we’re preventing new infections – needs to be included in the overarching goal.

# data[].attributes.body
If you look at 1.1 -- increase awareness of HIV – in any public service announcement, need to make it Cherokee specific. Their campaign looks very different from campaigns around them. Need to make the language centric to the specific Indigenous community that PSA is going to. Each culture is specific. Need to capture the essence that this is broad strokes but need to realize that it can be customized in granular ways to local realities.

# data[].attributes.body
One program – the we are native program – it's more regional – the program aims to cater to youth and talk about different topics related to sexual health, STIs, domestic violence, birth control – snag bags can be requested by Native youth. Will have WE are native gear, along with condoms, dental dams, etc.

# data[].attributes.body
There are a lot of great programs out there that do sexual health promotion. There’s a program called get tested AZ – they use home tests (oral swabs) -- need to let people know that there are options for testing that don’t involve needles. Making it fun for everybody. Fun to talk about. Make it funny and humorous. Make it art filled.

# data[].attributes.body
We almost have to start from scratch – has been so long that we have seen an HIV campaign in native communities. Providers don’t even talk about it. Is it part of standardized care panel? Speculating that there is a large group of school population that doesn’t even know what HIV is. People don’t see themselves in campaigns and it is not discussed much.

# data[].attributes.body
Even within the Syringe program, we are not necessarily talking about it as much as we could.

# data[].attributes.body
Need to use the language that people know without shaming them. All kinds of different ways to explain different diseases concepts. Don’t censor anything.

# data[].attributes.body
When we talk about HIV education – need to have courageous conversations that testing needs to occur among younger youth because of sexual trauma that occurs – also need to stop perpetration

# data[].attributes.body
Opportunities for care to meet the individual where they are

# data[].attributes.body
Creating connection between individual and clinician (community health worker as strategy)

# data[].attributes.body
Expanding services to unsheltered folks that do not have access to health resources, knowledge

# data[].attributes.body
Supporting peer navigation - can be for substance use, HIV care

# data[].attributes.body
Focus on indigenous standpoint on community and connectedness

# data[].attributes.body
Implement trauma-informed and resilience-oriented care

# data[].attributes.body
Goal is specific, actionable

# data[].attributes.body
Care capacity – supporting non-traditional HIV care providers (PCP – use strategies that work, support PCPs and others in seeing value in providing this care)

# data[].attributes.body
Incorporate traditional medicines into practices; traditional ways of knowing/wisdom/culture/ceremonies

# data[].attributes.body
Referral networks to support patients- access may exist but need care network – drawing on communities and networks for support - include case management for other health outcomes/needs - may not be specific to HIV treatment – need solid care networks

# data[].attributes.body
Systems of care to support both providers and patients to address patient and provider needs

# data[].attributes.body
Funding for housing for people with HIV exists– why can’t housing support everyone instead of being tied to a diagnosis – if HIV dollars can be spent on housing why just for HIV positive people, especially if HIV is treated for HIV positive people – Ryan White funding – couldn't people live somewhere else? - Housing first, to prevent HIV and support treatment; housing decisions/and decisions about basic needs for health and life should be autonomous – HIV positive specific housing is stigmatizing – people should live where they want to live so they can thrive – more flexible funding

# data[].attributes.body
Ability to really tailor programming so that we can incorporate Indigenous principles, etc.  - how could this apply across communities

# data[].attributes.body
How can we better reflect the community

# data[].attributes.body
Finding ways to address SDOH as it relates to Indigenous communities – address syndemic issues (SUD, BH, need for harm reduction)

Health in All policies approach – clinic walls and in community (as a way to address SDOE)

# data[].attributes.body
Address continued stigma of HIV – how do we continue to elevate HIV as a health priority in the same way that conversations re to OUD, SUD, etc. HIV still seen as a behavioral issue

How do we train service providers to adjust views of HIV (general providers) - integration considerations; how to address provider stigma; train up providers to “de-silo" prevention, care, and treatment

Normalizing conversations, training providers around HIV/destigmatizing conversations

Implement general campaigns to normalize discussions re HIV in Indigenous communities and to educate and engage Indigenous communities – big and “out there” significant –consider as an objective under Goal 3

# data[].attributes.body
Ideas to consider to expand upon Goal 3:

Indigenous designed programming and services

Increase in Indigenous providers and healthcare workers

Incorporation of Indigenous healing practices

Set aside funding for Indigenous communities to address HIV – as a way to acknowledge need for dedicated attention

Indigenous healing practices as a form of prevention/early intervention – giving context to the general idea of general sexual health and wellness (specific to Indigenous health systems)

# data[].attributes.body
National Native HIV Network’s goal is to work on Goal 4. Investing in the Network, so we can continue to build partnerships and coordinated efforts across Indigenous communities.

# data[].attributes.body
Regional reps from nine regions that represent American Indian, Native Hawaiian, Alaska Native communities. Hawaii Health and Harm Reduction Center (Kunane), Kumakahi Health and Wellness (Kiva), ANTHC (Hannah and Jennifer Arnold), Seattle Indian Health Board and Montana Two-Spirit Society, San Diego Indian Health Center, Arizona Department of Health, Southern Plains Chairmen’s Tribal Health Board, Rural AIDS Action Network (RAAN), Indigenous People’s Task Force, American Indian Community Health and United South and Eastern Tribes, Albuquerque Indian Health Board. Receive funding through IHS.

# data[].attributes.body
Coordinated efforts around National Native HIV Awareness Days and other awareness days. Working towards capacity building in Tribal communities and leadership development for people working in Tribal communities. Webinars, Circle of Harmony conference, planning of institutes and work with NMAC, U.S. Conference on HIV/AIDS.

# data[].attributes.body
How do we do meaningful community engagement to help improve HIV/AIDS prevention and services?

# data[].attributes.body
Think about different partnerships that I’ve worked with in my role. A lot of the partnerships that I’ve been on have revolved around substance misuse, need for more harm reduction education, how harm reduction is related to HIV, STIs. Substance misuse prevention program at ANTHC. HIV/STI program and substance misuse prevention with the State of Alaska. ANTHC early intervention program—partner with clinical services.

# data[].attributes.body
Having access to data that the State of Alaska and EIS have to inform programming. Without that data, I’m working without the information I need. Tough to access data because there are HIPAA concerns. State of Alaska had a cyber attack recently…difficulty in accessing data. Need a streamlined way to access.

# data[].attributes.body
Also working with the Alaska Harm Reduction Network on issues related to substance misuse and HIV prevention.

# data[].attributes.body
Our tribes could have a coordinated national effort, but still have to work in the states we’re in.

# data[].attributes.body
Policy advocacy or national, coordinated effort. Some education and capacity building on how to effectively collaborate with states. Not every Tribal community has great relationships with the states they’re in.

# data[].attributes.body
Advocating in each of the state’s Community Planning Groups. American Indians and Alaska Natives have their own group with the broader Community Planning Group.

# data[].attributes.body
I believe either goal 3, or in all goals, we should keep the intension of grounding in Indigenous Trauma Care. This idea that we acknowledge the traumas every one deals with every day (historical and present) in order to live and thrive, and that there is a way to address this and work with each other in an indigenous and trauma informed context.