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The major aim of this chapter is to stimulate scholarship in the area of place and health, specifically examining how American Indian and Alaska Natives’ (AIAN) health outcomes can be understood in light of historical trauma losses and disruptions tied to place or land. Although classic social determinants of health, such as poor socioeconomic status, substandard housing, and poor access to appropriate health care all contribute to poor health among AIAN, these factors do not sufficiently explain the high rates of poor health. As a result, indigenous scholars have turned their attention to examining how historical and societal determinants of health, particularly the role of historically traumatic events related to land-based events (e.g., forced relocation and land loss), land-based environmental microaggressions (discrimination distress related to land-based destruction), and disproportionate exposures to high rates of contemporary trauma are health hazards for the present and descendant AIAN generations. After reviewing the literature on indigenous place and health, this chapter shares empirical findings related to land and place loss on physical and mental health outcomes among a national sample of 447 gay, lesbian, bisexual, or transgender AIAN. Findings indicate that after controlling for contemporary lifetime trauma, historical trauma related to land loss, dis-placement, and neglect had a significant effect on physical and mental health.

This reprinted article originally appeared in Cultural Diversity and Ethnic Minority Psychology, 2009, Vol. 15, (No. 3), 275–284. (The following abstract of the original article appeared in record 2009-10166-008). American Indian and Alaska Native (AIAN) women have endured a history of colonial oppression in the United States. Current manifestations of colonization include an epidemic of violence toward AIAN women, who often are sexually and physically abused from early on in life. Such violence may erode AIAN women's sense of agency or mastery and contribute to their poor physical and mental health outcomes. AIAN women who identify as lesbian, bisexual, or “two-spirit” appear to experience disproportionate levels of violence and may be particularly vulnerable to disparities in health outcomes. In this study, 152 sexual minority AIAN women were interviewed as part of an investigation addressing the health concerns of two-spirit persons. Participants reported disturbingly high prevalence of both sexual (85%) and physical (78%) assault, both of which were associated with worse overall mental and physical health. These relationships generally were mediated by a diminished sense of control or mastery. The need to indigenize the concept of mastery is discussed, as is the urgency of interventions to work toward decreasing levels of abuse and increasing mastery among sexual minority AIAN women. (PsycINFO Database Record (c) 2010 APA, all rights reserved)

American Indian and Alaska Native (AIAN) scholars in the fields of mental health and HIV face formidable barriers to scientific success. These include justifiable mistrust of historically oppressive educational systems, educational disparities, role burdens within academe, the devaluation and marginalization of their research interests, and outright discrimination. Research partners can work to dismantle these barriers by embracing indigenous worldviews, engaging in collaborative research partnerships, building research capacity within universities and tribal communities, changing reward systems, and developing mentoring programs. At the individual level, aspiring AIAN scholars must build coalitions, reject internalized colonial messages, and utilize indigenous ethical frames. The creation of a cadre of AIAN researchers is crucial to improving the health of AIAN peoples.

Public and scientific discourse on health disparities often fails to consider American Indians and Alaska Natives (AIAN or ‘‘Natives’’), especially those who are gay, lesbian, bisexual, and transgender (hereafter referred to as ‘‘twospirit’’). Two-spirit Native men who are living on the streets or in unstable housing are even further marginalized. The invisibility of Native men’s health, in general, and two-spirit men’s health, in particular, stems from their existence as a people in a colonial nation state that has endured a succession of traumatic assaults on their land, homes, bodies, minds, and spirits. AsWarren (1993, cited in Smitha, 1998: 17) noted, ‘‘Dysfunctional systems are often maintained through systematic denial, a failure or inability to see the reality of a situation. This denial need not be conscious, intentional, or malicious; it only needs to be pervasive to be effective.’’ The little research that exists on the health of Native men suggests that they share a disproportionate burden in terms of morbidity and mortality. Specifically, Native men aged 15–19 years are more likely to die by suicide, homicide, motor vehicle accidents, firearm-related incidents, and drowning than any other racial/ethnic group in the United States (U.S.; U.S. Indian Health Service [IHS], 1997). In fact, nearly one-fourth ofNativemen die by 34 years of age, and nearly one-half die by the age of 54 (United States Indian Health Service [IHS], 2001).

In comparison to other racial/ethnic groups, American Indians and Alaska Natives (AIANs or “Natives”) suffer from glaring disparities in health-related resources and outcomes. Specifically, morbidity due to violence and substance use is higher and overall mortality is greater [IHS]. AIANs who identify as gay, lesbian, bisexual, or transgender (GLBT) or with the modern roughly equivalent Native term “two-spirit” (hereafter collectively referred to as “twospirits”) face additional stressors associated with negotiating their dual oppressed statuses. They often confront heterosexism from Natives and racism from GLBTs. Not surprisingly, two-spirits are thought to be at even greater risk for adverse health outcomes than other Natives (Walters, 1997; Walters et al., 2001). Preliminary empirical evidence supports the notion that two-spirits experience disproportionately greater anti-gay as well as anti-Native violence, including sexual and physical assault during childhood and adulthood (Walters et al., 2001; Simoni et al., 2004a) and historical trauma (Balsam et al., 2004)-experiences that are typically linked to adverse health and psychosocial functioning. Despite the considerable heterogeneity both within and across the more than 562 federally recognized tribes in the United States, the universal experience of colonization has created a shared history for two-spirit people, shaping distinctive conditions of health risk and resilience.

Objective. We surveyed American Indian/Alaska Native (AIAN) women in New York City to determine the prevalence of 3 types of interpersonal violence among urban AIAN women and the behavioral health and mental health factors associated with this violence. Methods. Using a survey, we questioned 112 adult AIAN women in New York City about their experiences with interpersonal violence, mental health, HIV risk behaviors, and help-seeking. The sampling plan utilized a multiple-wave approach with modified respondent-driven sampling, chain referral, and target sampling. Results. Among respondents, over 65% had experienced some form of interpersonal violence, of which 28% reported childhood physical abuse, 48% reported rape, 40% reported a history of domestic violence, and 40% reported multiple victimization experiences. Overwhelmingly, women experienced high levels of emotional trauma related to these events. A history of interpersonal violence was associated with depression, dysphoria, help-seeking behaviors, and an increase in high–HIV risk sexual behaviors. Conclusions. AIAN women experience high rates of interpersonal violence and trauma that are associated with a host of health problems and have important implications for health and mental health professionals.

In a community-based sample of urban American Indian and Alaska Native adults, 25 lesbian, gay, bisexual, and two-spirit participants were compared with 154 heterosexual participants with respect to sociodemographic characteristics, Native, cultural participation, trauma, physical and mental health, and substance use. Compared with their heterosexual counterparts, two-spirit participants reported higher rates of childhood physical abuse and more historical trauma in their families, higher levels of psychological symptoms, and more mental health service utilization. Two-spirit participants reported differences in patterns of alcohol use and were more likely to have used illicit drugs other than marijuana. Discussion and recommendations for health promotion interventions and future research are presented in consideration of an "indigenist" health model and the multiple minority status of two-spirit people.

Many tribal and urban American Indians and Alaska Native communities have initiated HIV/AIDS prevention and treatment services. The richness, depth, and scope of these efforts, however, are not well known and have not been sufficiently documented in the academic literature. In this article we assess the strengths and weakness of the published literature using the constructs of the socioecological framework. We discuss the need to apply an “indigenist” etiology paradigm to HIV/AIDS risk and protection. Finally, we define and discuss the varied postcolonial approaches to HIV/AIDS prevention, treatment, and healing. In response to the HIV/AIDS epidemic, American Indian and Alaskan Native (AIAN) tribes and urban communities have initiated prevention and treatment measures and services. Like community-based programs in all U.S. communities of color, the richness, scope and depth of these efforts are not well represented in the published academic literature. In this paper we use a multilevel social ecological framework to review the scant HIV/AIDS etiologic and interventions research conducted among AIAN populations. We then describe gaps in the literature and suggest a research and intervention agenda applicable to all levels of the social ecological model. Because there are so few published studies available to give context and depth to this study, we have taken the approach of describing examples of postcolonial approaches to intervention and suggesting how the postcolonial approach may be useful in future research.

This commentary presents an “indigenist” model of Native women's health, a stress-coping paradigm that situates Native women's health within the larger context of their status as a colonized people. The model is grounded in empirical evidence that traumas such as the “soul wound” of historical and contemporary discrimination among Native women influence health and mental health outcomes. The preliminary model also incorporates cultural resilience, including as moderators identity, enculturation, spiritual coping, and traditional healing practices. Current epidemiological data on Native women's general health and mental health are reconsidered within the framework of this model.

We propose that heterosexuals' attitudes toward their own heterosexual identity evolve in a manner similar to the development of racial identity attitudes among Whites-another dominant group with privileged social status. A more developed heterosexual identity, we hypothesized, would be associated with diminished levels of negative attitudes toward non-heterosexuals. To test our hypotheses, we administered to 154 heterosexual students Herek's (1988) Attitudes Toward Gays and Lesbians scale measuring heterosexist (i.e., anti-gay) attitudes and a version of Helms and Carter's (1990) White Racial Identity Attitude Scale (WRIAS) modified to assess heterosexual identity attitudes. Hierarchical regression analyses controlling demographic indicators partially confirmed the hypothesized associations between evolving identity stages and less heterosexist attitudes. The role of recognizing one's social privilege is proposed (though not empirically examined) as a potential mediator between developing a dominant group identity and decreasing prejudicial attitudes towards non-privileged groups. Finally, implications and recommendations for future research and addressing heterosexism are presented.

Background As part of a systemic effort of assimilation between the late 19 th and mid-20 th centuries, thousands of American Indian/Alaska Native (AIAN) children were placed in residential Indian boarding schools. To understand the impact of forced attendance in Indian boarding schools on HIV risk, we explored sexual risk behaviours, STI diagnosis, and substance misuse among AIAN two-spirit (gay, lesbian, bisexual, and transgender) adults who had attended Indian boarding school as children compared to those with no history of boarding school. Methods The current investigation was part of a comprehensive multi-site, cross-sectional national health survey of 447 AIAN two-spirit people from seven metropolitan areas in the U.S. To minimise selection bias, multiple sampling strategies were used including targeted, partial network, and respondent-driven sampling (RDS) techniques. Results Eighty-two (22.9%) respondents had a history of Indian boarding school attendance. Compared to others, respondents who attended boarding school were more likely to have a diagnosis of alcohol abuse or dependence (58.5% vs. 44.9%, p p p p p p p Conclusion Findings from this study provide some of the first data on boarding school experience and HIV risk among an urban two-spirit AIAN community sample and underscore the need for increased HIV/STI prevention efforts in AIAN communities. In addition, advanced statistical models are needed that identify mediational pathways to health outcomes and risk behaviours.

A preliminary survey of HIV risk and service preferences among American Indians residing in the New York metropolitan area included 68 women and 32 men (M age=35.8 years). Overall, the sample was knowledgeable about the mechanisms of HIV transmission, and 58 percent reported having taken an HIV test. However, of the 63 percent who reported sexual activity in the last six months, 73 percent reported engaging in vaginal or anal sex without a condom with at least 1 partner, and 52 percent used condoms none of the time during vaginal and anal sex. Almost half (43 percent) reported alcohol or other drug (AOD) use for non-ceremonial purposes in the last six months. Alarmingly, 44 percent reported lifetime trauma, including domestic violence (20 percent) and physical (29 percent) or sexual (26 percent) assault by a family member or stranger. Bivariate and multivariate analyses indicated trauma and drug use were factors that may place respondents at risk for sexual transmission of HIV. Trauma variables were better predictors of HIV risk behaviors than social cognitive variables providing preliminary support for the use of a postcolonial framework in American Indian HIV studies.