Providing refreshments also facilitates bonding. Asian and Pacific Islander participants will look

to a facilitator to provide direction and guidance. Rather than be assertive in talking, Asian and

Pacific Islander clients will more likely wait for a space to open up for them to speak and

consequently will rarely have the opportunity to do so when in a group with predominately non -

Asians and Pacific Islanders. Should this happen, the group leader needs to facilitate

opportunities for Asian and Pacific Islander clients to participate.

Native Americans

Native Americans and Alaskan Natives comprised 0.9 percent of the total U.S. population in

1999. From July 1998 through June 1999, they accounted for 0.4 percent of all adult and

adolescent HIV cases reported (these include only persons reported with HIV infection who have

not developed AIDS) and 0.6 percent of adult and adolescent AIDS cases. The largest percentage

of HIV and AIDS cases in women was from heterosexual contact (39 percent and 23 percent,

respectively). The largest percentage of HIV and AIDS cases in men was reported in men who

have sex with men (43 percent and 47 percent, respectively).

The CDC found that Native Americans have high rates of STDs and substance abuse, which in

turn raise their risk of HIV/AIDS. They also lack access to diagnosis and treatment. Gay men

and substance abusers run the highest risk of HIV/AIDS among Native Americans and Alaskan

Natives, just as they do among white Americans.

The combination of high rates of cofactors for HIV/AIDS, limited access to health care, lack of

information and education about HIV/AIDS issues, substantial numbers of Native Americans

who are already infected with HIV, and the flow of Native Americans between urban centers and

reservations all lead to an HIV/AIDS crisis for Native American communities.

Limited treatment services for HIV-infected substance abusers exist on and outside tribal lands.

In 1991, the American Indian Community House, which ministers to the health, social service,

and cultural needs of Native Americans in the New York City area, created the HIV/AIDS

Project, the first Native American program east of the Mississippi River to provide culturally

sensitive legal services, HIV/AIDS treatment information, emergency assistance, and prevention

education. The Friendship House Association of American Indians in San Francisco provides

another example of treatment (drop-in centers). This program provides comprehensive treatment

to Native Americans living with HIV/AIDS as well as treatment for substance dependency.

Services target the gay, lesbian, and bisexual communities. HIV/AIDS is presently underreported

for Native Americans and is based on the high incidence of sexually transmitted diseases (STDs)

in general, and thus substance abuse treatment centers will be faced with more and more HIV-

infected Native Americans.

Clients involved with thecriminal justice system

Many persons with substance abuse disorders receive treatment only after arrest and are offered

treatment as a diversionary service or receive treatment while they are in jail or prison. The racial

and class patterns characterizing arrest, adjudication, and sentencing in the United States skew

more white Americans (regardless of social class or income) to treatment trajectories and more

persons of color to jail or prison trajectories. Access to treatment within the criminal justice