Victimization, substance use, and HIV risk behaviors among gay/bisexual/two-spirit and heterosexual American Indian men in New York City

Objectives. Our primary aims were to identify differences on the basis of sexual orientation in victimization, substance use, and HIV risk behaviors and to examine associations among these variables in American Indian men. Our secondary aims included describing condom-use attitudes, beliefs about HIV/AIDS in the Indian community, HIV knowledge, HIV status, and preference for and access to HIV prevention services in this population. Methods. A survey was mailed to all members of an American Indian community organization in New York City. Results. The 20 men self-identifying as gay, two-spirit, or bisexual (hereafter, "two-spirit") were more likely to report being victimized and engaging in HIV risk behaviors than the 51 heterosexual respondents, although they reported comparable levels of recent substance use. Overall, victimization was associated with lifetime HIV risk behaviors (even after control for sexual orientation) but not with substance use or unsafe sex in the past 12 months. The percentage of HIV infection was surprisingly high (10% of two-spirit men and 6% of heterosexual men). Conclusions. Two-spirit men are a vulnerable population whose victimization must be understood within an appropriate historical and political context.