HIV/AIDS in the Two-Spirit Community: A Hidden Crisis

Harlan Pruden

Harlan Pruden

March 20th is National Native HIV/AIDS Awareness Day, a day to raise awareness of the terrible toll that HIV/AIDS continues to take on Native American populations. HIV/AIDS is a crisis that affects many American Indians and Alaska Natives, but particularly Two-Spirit individuals, who often experience stigma and discrimination in both Native and mainstream society.

What Does Two-Spirit Mean?

The term “Two-Spirit Exit Disclaimer” has several meanings within Native cultures and communities, but it is primarily a contemporary term that refers to those traditions in which some individuals have a blend of both male and female spirits. Two-Spirit is a concept of gender identity, not one of sexual orientation. Sexual orientation describes an individual’s choices in sexual relationships with others. Gender describes the expected roles an individual plays within a community’s social norms and structures. Many Two-Spirit organizations prefer to separate the Two-Spirit identity from the lesbian, gay, bisexual, transgender, and questioning (LGBTQ) identities of the mainstream/dominant culture, emphasizing the use of the term “Two-Spirit” to describe a person’s gender within their culture, rather than the more Western concept of sexual orientation.

Impact of HIV/AIDS

In the United States, HIV and AIDS are tracked according to certain categories recognized by the scientific/medical establishment. “Men who have sex with men” (MSM) is one of these categories; “Two-Spirit” is not. MSM (or what we would call male-bodied Two-Spirit individuals) bear the brunt of the HIV/AIDS crisis among Native American populations. According the Centers for Disease Control and Disease Prevention, MSM and MSM/IDU accounted for 62.3% of all new diagnoses of HIV infection among American Indians and Alaska Natives in 2011. MSM and MSM/IDU also accounted for 60.0% of American Indians and Alaska Natives living with AIDS in 2010.

Native Americans, including Two-Spirit people, call upon the public to consider the epidemic in relation to the size of the Native American population, lest comparisons to HIV/AIDS in other populations inappropriately dismiss the impact of the disease on Native communities.

During the Thursday, February 7, 2013 meeting of the Presidential Advisory Council on HIV/AIDS (PACHA), Dr. Karina Walters Exit Disclaimer of the University of Washington and I had the opportunity to brief the Council on the impact of HIV/AIDS on the Two-Spirit community. Learn more about the PACHA meeting on

The National Confederacy of Two-Spirit Organizations, a coalition of 17 Two-Spirit community-based organizations, looks forward to working with PACHA and HHS to better meet the needs of the Two-Spirit community.

Editor’s Note: For more information on HIV/AIDS surveillance among Native populations, see the CDC report, Improving HIV Surveillance Among American Indians and Alaska Natives in the United States (Jan. 2013).

For information on State Departments of Health response, see the National Alliance of State and Territorial AIDS Directors’ (NASTAD) ISSUE BRIEF: Native Gay Men & Two-Spirit People HIV/AIDS & Viral Hepatitis Programs and Services.


  1. Many thanks for the post – I had no idea of the plight of native Americans with regard to HIV.
    I am sorry to hear that once again it is a countries Indigenous peoples who are being hit hard by world issues.

  2. This is a very important article that must be shared. Our Two Spirit community carries the highest burden of infection yet has little to no funding with which to work. Natives in general, fall under the radar due to so many data problems. We must make our voices heard, as has Harlan Pruden!! Thank you for an excellent article!!

  3. Thanks so much to Harlan for his strong and consistent advoacy on this issue. NASTAD’s work has greatly benefitted from his participation on our Native American Networking Group, along with the participation of other Native American researchers and providers. The need of Native Gay men and Two Spirit people is critically important in our fight to end the epidemic in this country and to address the epidemic among Native Americans. Health departments can look to NASTAD’s document for ideas from their colleagues on this.

  4. Irene Vernon says:

    Important information that must be shared widely

  5. Scott Bramlett says:

    Great blog posting. The distinction between the usual LGBT identification and the Two-Spirit one is important to understand. Clearly, this is a deepening conversation both for the cultural/anthropological understanding of the greater gay communities (especially for those of us in those communities), and, obviously, for the healthcare community and Two-Spirited persons, who are, as Harlan writes, likely to be affected as part of the MSM cohort of Native persons.

  6. Thanks Harlan for bringing much needed attention to the impact of HIV / AIDS on our two spirit community. Here in Montana, Native two spirit men as well as gay, bisexual and MSM, continue to bear the brunt of new HIV infections in our state. Unfortunately, with recent funding cuts and more expected in the coming months and next year, the future of HIV prevention in Indian country is extremely precarious. In fact, HIV prevention services have for the most part been greatly reduced on the reservations. Thanks to the Montana Two Spirit Society and several grants, we’ve been able to continue HIV testing services in Browning and surrounding reservations. We’re hoping to expand to Fort Peck reservation this year, where many two spirit men continue to be at risk as a result of the oil boom in eastern Montana and North Dakota. Due to the stigma still associated with HIV on many reservations, the barriers to HIV testing and prevention are a challenge. But thanks to new opportunities involving social media, we’re hoping to bring much more needed awareness to the two spirit community and reservations. In addition, the work of the Two Spirit Confederacy, of which we are one of the 17 two spirit societies, continues to give voice on a national and regional level to not only our challenges, but as importantly our strengths and cultures, which sustain and nurture us as a two spirit community. Thanks again for a wonderful blog and I look forward to more awareness about our two spirit community!

  7. DON LITTLE says:

    So thankful for all the hard and dedicated work you are doing to put the “wake-up” call about the “silent crisis in our Two Spirit Community.”

  8. Phoenix Benner says:

    Thank you for a very insightful discussion about the HIV/AIDS pandemic within the Two Spirit community. Let us hope that it brings about change.

  9. Tommy Chesbro says:

    I have worked with the Two-Spirit community for over 20 years and have seen how stigma and prejudice has fueled the HIV/AIDS epidemic. Until Two-Spirit people are abel to take their rightful place in the circle Native Americans will continue to experience health disparitites related to HIV/AIDS. As a Two-Spirit person who has been living with HIV for 27 years I have seen first hand how stigma has lead to poor health outcomes. I have also seen how positive supportive relationships with family, community and health care providers has lead to long health lives. Wa do to all who have been involved in bringing this issue to the forefront.

  10. Fascinating and sad to think of the disconnect in addressing this crisis and pushing for change in the community, especially in this technologically advanced day and age.

  11. Arizona State Senator & PACHA member Jack Jackson Jr., (Navajo) says:

    As the sole Native American member on the Presidential Advisory Council on HIV/AIDS, I am especially proud of the representatives of the National Confederacy of Two-Sprit Organizations for their eye-opening presentation about the disproportionate impact HIV/AIDS is having on the Two-Spirit community at the February 2013 PACHA meeting. They also drew attention to the unfortunate circumstance of the lack of funds that are being directed to the organizations that are working with this at risk community. An integral part of the National HIV/AIDS Strategy is the need for resources that must follow the HIV/AIDS data. Mr. Pruden and Dr. Walters exposed the harsh reality the male-bodied Two-Spirit community is bearing the brunt of this disease in Native communities which was confirmed with the recently released data from the CDC’s 2011 Surveillance Report. The time is now for the resources to begin to flow to these organizations and this community. Anything less is unconscionable.

    • Thank you Senator Jack Jackson Jr.! Am so grateful that you are on the Presidential Advisory Council on HIV/AIDS, providing leadership, vision and voice to issues impacting our Native two spirit communities. Would love to have you as a guest for our annual Montana Two Spirit Gathering in July! Thanks again!

  12. Thanks Harlan for such a great post that just begins to touch a vital topic that has been routinely ignored or swept up in the LGBT “bundle. My team was fortunate enough to have an hour workshop with Harlan last week and now everyone is clamoring for more!

    • Harlan Pruden says:

      Carrie Davis is the Directory of Community Services at the LGBT Community Center in NYC, and I did a presentation for her staff on Tues. Mar. 21. For more info. email

      Two-Spirit People: Then and Now – Sex, Gender and Sexuality in Historical & Contemporary Native America

      The Indigenous peoples of North America have many cultural traditions that have often been misrepresented or suppressed through the colonization process. Many of these are significantly different perspectives about sex, gender and sexuality than those imported from Western Europe. In the 21st century, one tradition that was nearly lost is what is referred to as Two-Spirit (lesbian, gay, bisexual or transgender Native peoples).

      This presentation will examine these traditions from a pre-contact and to a present day context. Finally, a detail report on the findings of country’s first-ever two-spirit needs assessment, and its recommendations on how to best fill the gaps and work with this high marginalized sub-population will be also presented.

      Gain knowledge of Native and Two-Spirit sub populations and current data on the two-spirit community,

      Increase familiarity of issues and challenges confronting Native and Two-Spirit individuals,

      Learn about culturally competent approaches in providing services and working with Native and Two-Spirit individuals and communities, and

      Gain access to more resources for additional learning and referrals.

  13. Tony Aaron Fuller says:

    This is a great way for people to learn more about the Two Spirit Community!! As the HIV epidemic continues to effect all populations, an increase of prevention efforts specifically tailored to the cultural needs of the Two Spirit community is crucial in filling gaps and building relationships to promote HIV prevention, education, and advocacy!!! If you are a Native person, ask yourself what kind of work happens in your community that promotes and advocates better understanding of what “two-spirit” means among your people. Getting that information out to the community is the first step in supporting HIV prevention efforts among the Two Spirit community!!

  14. Thank you Harlan for speaking up for the Two Spirit community and raising awareness. As a gay man and an American I want to support all of my brothers and sisters in Native populations to get what they need.

  15. An important conversation for some of our most marginalized citizens. Many two-spirit youth are caught between multiple life worlds. A Native American community that does not accept their two-spirit identity. An LGBTQ community which discriminates against them for being Native American. A post-colonial society which discriminates against both an LGBTQ and Native American identity. Our two-spirit youth are particularly vulnerable as everywhere they turn they cannot find a community that will support them fully and completely for all facets of their identity. As a result of this rejection, these youth often turn to self-harming behaviours to cope with a hostile and discriminatory world around them finding no safe refuge to simply be themselves.

  16. Rita Rivas says:

    Harlan what fabulous information you have provided in this piece….you rock my friend!!! Keep up the fantastic work you do!

  17. Ron Rowell says:

    Yakoke, Harlan, for your good and wise words!

  18. Cara Thunder says:

    Thank you to the Director of the NorthEast TwoSpirit Society, Harlan Pruden, for raising national awareness on the issue of HIV/AIDS on the indigenous people living in this country. His informed comments point to the need for increased understanding of how tribal communities view health and gender attitudes differently than the western world. These significant differences cause a disconnect between prevention and treatment of HIV/AIDS in the two spirit communities. I wholeheartedly believe that with more cultural understanding and targeting funding towards a culturally appropriate solution, that we will finally be able to address this crisis in Indian Country.

  19. We are pleased to have Harlan Pruden join our Institute’s Honorary Committee, which supports the importance of research, teaching, and community service work on sexual and gender minority issues and concerns. Continuing research, building inclusive supports, and advocating for sexual and gender minority and two-spirit youth is critical for the health and future of our communities. Harlan’s longstanding leadership is making a significant difference in policy and grassroots change. We are thrilled to have his support, wisdom, and courage of convictions as part of our advisory team. Together we can be the change we seek in the world. Together we can ensure that research reaches and positively impacts our marginalized communities. Together we can lead the way to a brighter future.

  20. this is interesting thanks Harlan for sharing this… Just had one question is their evidence that societies other than Native North Americans has similar two spirit and community , if yes did they also perform similar roles and similar social status… I know for sure there is some evidence of that in old Indian societies but do not have authentic sources to quote here.. can you help me with any sources and research done on two spirit folks in other societies.

  21. At least in the USA, there are healthcare facilities for people suffering from Aids. In third world countries, the awareness about diseases like Aids is very low and people are ostracized from society. More awareness is required but people need to be more educated about Aids and HIV

  22. Many gay circuit parties that raise money for HIV actually create more cases then funds can support. Thus further burdening society with careless lifestyles.

  23. Maistoo'a waastaan - Crow flag (Rodney Little Mustache) says:

    Harlen – I am Blackfoot from the Piikani Nation in, Brocket Alberta. I have been poz for the past 21+ years. I have worked in the HIV/AIDS for 15 years, both in governance and administrative, volunteer and paid. There were so many issues I had to deal with on a personal level. i have also stepped forward to help get our (2-Spirit) issues, mainly STIGMA & DISCRIMINATION addressed. I have recently applied for University, I thought the last time I put a school book down – it would be my last, I WAS WRONG! I want to do more and I am more ALIVE. I thank you so much for your hard work. may Creator be with you everyday.

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