Specific to American Indian men identifying as gay, bisexual, two-spirit or who have same-sex experiences, this study assessed HIV-risk behaviours and barriers to testing, prevention and treatment efforts. A rapid assessment model was utilised as an indigenous-supporting research design. Rigour and thoroughness were achieved via multiple validation procedures. Central themes surrounding barriers to HIV prevention included social discrimination, low self-esteem and substance use. Findings suggest the underutilisation of condoms due to ineffective placement and limited availability in popular locations among gay, bisexual and two-spirit individuals.
Two-Spirit also two spirit or, occasionally, twospirited is a modern, pan-Indian , umbrella term used by some Indigenous North Americans to describe Native people in their communities who fulfill a traditional third-gender or other gender-variant ceremonial role in their cultures. Cameron writes, "The term two-spirit is thus an Aboriginal-specific term of resistance to colonization and non-transferable to other cultures. There are several underlying reasons for two spirited Aboriginals' desire to distance themselves from the mainstream queer community.
Current manifestations of colonization include an epidemic of violence toward AIAN women, who often are sexually and physically abused from early on in life. Such violence may erode AIAN women's sense of agency or mastery and contribute to their poor physical and mental health outcomes. In this study, sexual minority AIAN women were interviewed as part of an investigation addressing the health concerns of two-spirit persons.