Special Projects of National Significance and the Alaska Tribal Health System: an overview of the development of a best practice model for HIV/AIDS care and treatment in Alaska

This article presents a discussion about the increased risk of the spread of HIV among Alaska Natives resulting from high-risk co-occurring conditions and social and cultural customs that create barriers to HIV/AIDS prevention education. Additionally, an overview of the unique structure of the Alaska Tribal Health System and how the Health Resources Service Administration's (HRSA) American Indian Alaska Native Special Projects of National Significance Initiatives (AI/AN SPNS) have been a critical component in creating the foundation for the development of a best practice model for HIV/AIDS care and treatment in Alaska is provided. This article is not a comparative analysis of the Indian Health Care System. Rather, it provides a discussion about tribal federalism, the Alaska Tribal Health System (ATHS), and the influence the AI/AN SPNS initiatives have had on the development of HIV/AIDS care and treatment in Alaska. In order to explain how the AI/AN SPNS initiatives have influenced the development of HIV/AIDS care and treatment in Alaska, it is also necessary to understand the evolution of the ATHS and how this system is unique compared to other tribal, private, and public health care systems throughout the United States.