Addressing Syphilis within American Indian and Alaska Native Communities: Using Culturally and Linguistically Appropriate Services for Healthier Outcomes

Syphilis is a serious but preventable sexually transmitted infection (STI) that can cause chronic health issues or even death if left untreated. A recent nationwide surge of syphilis cases, which represents the highest increase of reported syphilis infections since the 1950s, poses an urgent health concern among ethnic and racial populations, including American Indian and Alaska Native (AI/AN) communities. While many populations have been impacted, AI/AN communities had the largest increase in primary and secondary syphilis of all racial and ethnic groups between 2019 and 2023. According to recent data from the Centers for Disease Control and Prevention (CDC) published by the Indian Health Services:

• Rates of primary and secondary syphilis among AI/AN people increased from 21.1 cases per 100,000 people in 2019 to 58.2 cases per 100,000 people in 2023.
• Rates of congenital syphilis among AI/AN people continue to rise, increasing from approximately 200 cases per 100,000 people in 2019 to 680.8 cases per 100,000 people in 2023.
• In 2023, AI/AN people represented 0.7% of live births, but they accounted for 4.6% of all congenital syphilis cases.

The U.S. Department of Health and Human Services (HHS) Office of Minority Health (OMH) remains committed to addressing systemic health disparities that impact AI/AN populations. This includes exploring ways to enhance the cultural competency of public health providers to improve their engagement and outreach activities within AI/AN communities.

To help health care professionals and organizations implement CLAS in their approaches, OMH developed the National CLAS Standards in 2000. The standards are intended to help improve health care access, quality, and eliminate health care disparities.

For instance, one of the National CLAS Standards recommends partnering with community members to design, implement, and evaluate policies, practices, and services to ensure cultural and linguistic appropriateness. Another CLAS Standard encourages health providers and organizations to provide easy-to-understand print and multimedia materials and signage in the languages commonly used by the populations in the service area.

An example of this is the partnership OMH has with the CDC on the Hear Her® Campaign for AI/AN pregnant and postpartum people. The Hear Her Campaign amplifies the stories of women who have experienced complications during or after pregnancy and encourages partners, friends, family and healthcare providers to really listen when a person who is pregnant or postpartum shares concerns and help get them the care they need. The CDC, in collaboration with OMH, shares culturally appropriate resources for public use such as posters and conversation guides tailored for AI/AN communities in multiple languages with information on urgent maternal warning signs for pregnant and postpartum people.

The Hear Her Campaign is just one example of how CLAS can be used to help make prevention and treatment strategies more responsive to and respectful of the rich culture and traditions of AI/AN communities.