Since Oklahoma City and Tulsa are the two most populated areas in the state for HIV/AIDS incidence, access to services is easier. But in smaller communities, HIV/AIDS prevalence and anonymity are lower. The result is that disease prevention must be undertaken by local coalitions like PANI-HOPE in Pawnee, HEART Coalition in northeastern Oklahoma and Oklahoma Native Nations United Against AIDS in Anadarko.
Rural HIV/AIDS Indian coalitions were seeds planted in the most delicate of soils, organizers said. The homespun coalitions were often the only path in a culture where sex talk is not easily initiated and grandparents raising their grandchildren is common.
Despite their work, there is a gap. Not just a verbal gap about sex talk, but also in services. At present, there is no working arrangement with the state for HIV/AIDS services specifically for American Indians.
Chang Lee, director of the state Health Department's Division of Prevention and Intervention for STD services, said he knew of no American Indian-specific subcontractor for the federal funds administered by the department.
Lee explained Oklahoma receives federal funds from the CDC and contracts with various state nonprofits for HIV/AIDS disease management. He pointed out that any state funds set aside for medication in the budget go to county health departments for sexually transmitted diseases, of which HIV/AIDS is but one.
Sally Bouse-Pittser, manager of HIV Prevention and Training for the state Health Department, said the state funds STD medication costs to the tune of $200,000 a year. The money is not HIV/AIDS specific.
The job of HIV/AIDS services usually falls to local nonprofit organizations. One Oklahoma City nonprofit, Guiding Lights, contracts with the state for HIV/AIDS services. Their focus group is African-American women, the fastest growing minority group with HIV/AIDS, Lee said.
With an active grant writer, federal funds funnel into Oklahoma for HIV/AIDS Indian coalitions, but those funds are just as likely to ebb as they are to flow. While money was available, building coalitions was easy. Now the groups are working out how to keep HIV/AIDS awareness alive in their small towns. The irony is these rural communities are so small that the number of active cases often exceeds the number of stoplights.
That's small-town Indian America, coalition members said, meeting in hope of reaching that one teen who still has no clue how to prevent HIV/AIDS.