• In order for this plan to be successfully implemented, the collaboration of the following organizations will be necessary: Tribal Council and the Health Department of the Cheyenne River Sioux Indian Reservation, the National Native American AIDS Prevention Center (NNAAPC),

• Additionally one doctor and four nurse practitioners with experience in STDs, particularly HIV will be recruited.

• Initial assessment of the communities knowledg or STDs- Symptoms, transmission, treatment, etc.

• Screening of the population- exact number of STD cases in the community is unknown. Having specific data will allow finetuning of the plan and will enable appropriate treatment of these individuals.

• One of the biggest obstacles to effectively screening the population is the fear and misunderstanding individuals have of HIV Screening. For this reason, the STD screening will be managed by the doctor and four nurse practitioners that are being brought in so that patients will not personally know the staff providing the tests.

• Additionally,an identification number, rather than a name, can be used in association with the test. In this way, no one at the clinics will know the names of the individuals being tested or the names of individuals that test positive for HIV infection.

• Educating the educators: Staff of the Department of Health will need to be up-to-date as to how STDS are transmitted, what the symptoms of the various STDs are, the ways in which transmission can be limited, and ways to convey this information to the community.

• The nurse practitioners and doctor that have been brought in will need to learn about the aspects of American Indian culture that can make discussing STDs and promoting safer sex and STD testing difficult.

•  A workshop will be held that will educate staff. The doctor and nurses will lead the portion on statistics, symptoms, diagnosis, and treatment. The staff of the tribal health department will lead the portion of the workshop dealing will cultural differences and tribal customs.

• The team will also complete online HIV prevention tool kit designed by the NNAACP. The tool kit can be viewed here.

• The best way to educate the community is to talk with individuals on a regular basis and the team should use every opportunity to educate individuals about STDs, whether informally or formally.

• Workshops should be held at the local clinics for interested individuals.

• Advertisements outlining the availability of STD testing and that contain relevant information should be posted where appropriate.

• Individuals that have tested positive for non-HIV diseases be treated as soon as possible.

At the end of each year:

• A basic assessment will be conducted. This should include number of individuals screened for STDS, number of individuals that tested positive for one or more STDs, and number of individuals that were treated for an STD.

At the end of the program:

• A more thorough assessment should be made

• Final report will be produced.

• Report will include the information gathered at the end of each year as well as any meaningful changes that were observed.

• Outcomes that we are striving for should be evaluated, including:

•     Increased testing for STDs

•     Increased treatment of STDs

•     Decreased transmission of STDs including HIV

•     Overall increased knowledge of and use of preventative measures.

• Also, problems should be noted in this report and suggestions as to how to fix/improve on these issues should be provided.

• This report is important to determine what was accomplished by the project and as a tool for other tribes to utilize when developing their own similar projects.

• This plan can be applied to any tribe that has an existing healthcare system (of some sort) that could support the implementation of this plan. Based on the success of this pilot project, tribes could apply for grants from the CDC and the IHS under their HIV prevention programs. Larger tribes, such as the Cherokee and Navajo, who have sources of funding coming in from casinos, may not even need to apply for outside funding.

• It will be more challenging to implement this plan in smaller tribes that do not have an existing health care infrastructure. More money would be needed to sustain the project, as use of the Health Department as it occurs in this pilot, would not be an option. It may be necessary for tribes to get assistance in establishing their own government and healthcare systems before this particular plan could be implemented in their communities.

Perhaps the biggest need going into the future is more research as to the rates of infection in specific tribes. Although there is information on the infection rates of the overall American Indian and Alaska Native population, there is little information as to what the infection rates of specific tribes are and how different tribe-dependent factors may influence the rate of infection.

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