American Indians are victims of violent crimes over 2.5 times more often than the national average. Trauma can lead to risk-taking behaviors, so researchers at the University of Washington and Yeshiva University surveyed American Indians about their experiences of trauma and their behaviors—particularly, risks that could lead to HIV infection.

What the researchers wanted to know: What is the connection between trauma and behavior that makes HIV infection more likely among American Indian women in New York City?

What they did: Anonymous questionnaires were mailed to everyone who belonged to an American Indian community center in New York City in 1998, for a study on HIV risk. The questionnaire had questions about attitudes toward condoms, knowledge about HIV, physical and sexual abuse, risky behaviors (such as IV drug use or unsafe sex), and substance abuse. Fifty-three percent of the 155 women who responded made less than $1,500 a month.

What they found: Over half of the respondents had been physically or sexually abused or assaulted at some time in their lives. Generally, that kind of trauma made it more likely that women would have unsafe sex or use intravenous drugs—both behaviors associated with HIV infection. Also, the women seemed to think their chance of getting infected with HIV was low, even if they were having risky sex. Over a third of the women agreed or strongly agreed with the statement "AIDS is another form of germ warfare on Indian peoples."

What this study means: The researchers say that people such as doctors and social workers should ask about sexual and physical trauma when working on HIV prevention.

Caveats: The sample wasn't recruited randomly, and only 30 percent of the questionnaires were returned. Also, the researchers didn't ask which came first—the risky behaviors or the trauma.

Find out more: The National Native American AIDS Prevention Center's mission is to stop the spread of HIV and related diseases among American Indians, Alaskan Natives, and Native Hawaiians: http://www.nnaapc.org

The New York City Department of Health and Mental Hygiene helped funded the research. http://www.nyc.gov/html/doh/home.html

Read the article: Simoni, J.M., Sehgal, S., and K.L. Walters. "Triangle of Risk: Urban American Indian Women's Sexual Trauma, Injection Drug Use, and HIV Sexual Risk Behaviors." AIDS and Behavior. March 2004, Vol. 8, No. 1, pp. 33-45.