Sherry L. Hamby
Even in the 21 st century, victim blaming is alive and well in Indian country. Just last year, an Indian Health Service (IHS) physician published a paper in which she recommended that victims be lumped into categories such as “unintentional game players” and “intentional game players.” She recommended these harsh labels “to shed light on the experience of domestic violence in many American Indian communities” (MacEachen, 2003, p. 126) . Even more amazingly, MacEachen (2003) suggested that women with a history of child sexual abuse often “provoke rape and battery in order to satisfy [their] needs …” (p. 127). The stubborn persistence of these attitudes, and for that matter the implicit acceptance of such attitudes as indicated by their acceptance in a government-sponsored peer-reviewed journal, are just some of the many barriers American Indian and Alaska Native women face when seeking help for victimization.
Other barriers also confront American Indian women who must decide how (and whether) to seek help after a sexual victimization. Centuries of oppression by the United States government have left many lasting problems (Duran, Duran, Woodis, & Woodis, 1998; Duran, Guillory, & Tingley, 1993) . Sexual victimization itself is a part of the terrible history of oppression, violence, and maltreatment that American Indians have experienced at the hands of the United States government and its citizens (Smith, 1999) . Today, the majority culture is still often prejudiced and uninformed about tribal cultures. Because of U.S. actions, many reservations are in remote areas, and most American Indian communities are fairly small. These realities create additional problems, such as obtaining access to culturally congruent resources.
Looked at from another way, it is also important to realize that tribal membership offers resources that may help some American Indian women who have been sexually victimized. Many American Indian women have access to both Western and native healers (Kim & Kwok, 1998) . Many American Indians also have culturally specific spiritual practices that can help with their healing (Senturia, Sullivan, Cixke, & Shiu-Thorton, 2000) . Tribal members are entitled to some financial benefits, including free health care, and sometimes housing or education subsidies (Indian Health Service, 2002) . This paper summarizes the barriers facing and resources available to American Indian victims of sexual victimization, with a focus on systemic barriers found in the organizations and communities most likely to serve native women.
Many barriers face not only American Indian women who have been sexually victimized, but also agencies and organizations seeking to improve services to American Indian women. A review of the most challenging barriers follows.
Victim Blaming and Prejudice . MacEachen (2003) reported that many women did not disclose violence in her clinic, even when staff members knew of the violence from social services or law enforcement. She identified this as a problem with the patients, but given MacEachen’s tendency to blame victims, it seems likely that staff attitudes deterred disclosure as well.
In a qualitative study of patient perceptions of health care providers on one reservation, some patients reported negative experiences with providers, stating they showed superior attitudes, used confusing terminology, and avoided the reservation outside of working hours (Fifer, 1996) . In a study of shelter employees, White staff often reported stereotypic and even racist attitudes towards persons of color (Donnelly, Cook, & Wilson, 1999) . Many White shelter staff assumed other ethnic groups would “take care of their own” (Donnelly et al., 1999, p. 724) even though there were not other services nearby. Shelter staff also reported occasional problems with White residents showing prejudice towards victims from other ethnic groups.
Conflict of Values . Rape crisis advocates, prevention specialists, health care providers, and law enforcement personnel all typically make recommendations based on the values of the majority U.S. culture. These can include encouraging rape victims to have physical exams, get tested for sexually transmitted diseases and receive medication to prevent pregnancy, encouraging women who are sexually assaulted by partners to divorce or terminate the relationship, and encouraging women to legally prosecute perpetrators. Further, at a most basic level, most advocates and providers will expect victims to disclose the details of their victimization, often many times in the course of seeking help from different agencies.
Many American Indians hold values that do not mesh well with these recommendations. Some American Indian women may have difficulties disclosing intimate details about victimization (Hamby & Koss, 2003) , especially given that many American Indian cultures value privacy regarding sexuality and family problems. Some cultures may value responses from victims that are discouraged or controversial among mainstream violence advocates. For example, physical resistance to assault is respected among some women of the Passamaquoddy nation (A. Bardi, psychologist, personal communication, November, 2003).
This clash in values can present problems for American Indian victim advocates as well. For example, American Indians are often taught to respect their elders because “they have walked the path where you are now” (S. Locklear, victim advocate and Lumbee tribal member, personal communication, November, 2003). As such, American Indian advocates may feel uncomfortable giving advice to elder victims, and it may be especially difficult for them to see elders being victimized either sexually or physically. Further, American Indian advocates and victims alike may feel uncomfortable with use of a criminal justice system that can be racist (Hamby, 2000) .
Language Barriers . Language influences the way we perceive sexuality and victimization. As Tafoya (2000) noted, “English is a mélange (French), a conglomeration (Latin) of xenologic (Greek) words superimposed on a foundation of Anglo-Saxon” (p. 61). Victim advocates and prevention specialists tend to use Latin-based words, like “intercourse.” The one-word Anglo-Saxon equivalent for “intercourse” may be more familiar to some, but is not considered polite.
As Tafoya pointed out, not all languages have the potential to shift between polite and vulgar terms for sexual experiences (2000) . For example, in one Apache community, outsiders are commonly told that there are no curse words in Apache. This is true in the sense that Tafoya described–there are not separate words for intercourse that sound vulgar no matter how they are used. On the other hand, there is no “polite” equivalent in Apache either, which relies on context and tone much more than English. Especially in cross-cultural communication, it can be hard to directly communicate information about sexuality in ways that are not offensive.
Other languages also differ from modern English in the extensiveness of their terms for victimization (DePuy, Hamby, & Monnier, 2002) . The U.S. social movements against rape and intimate violence have influenced American English. English-speakers have many terms for sexual victimization, including “rape,” “sexual assault,” “date rape,” “sexual abuse,” “incest,” and “molestation.” There are also numerous terms for physically and psychologically abusive behavior. For purposes of both intervention and prevention, it can be hard to identify comparable words in other languages. Even English speakers who are not immersed in addressing these social problems may not appreciate the subtle distinctions between these terms.
On the other hand, by no means do these differences imply that American Indian languages are lacking in specificity or subtlety (Manson, 2000) . There is considerable variability across languages, Indian and non-Indian alike, in the phenomenology and terms for emotion. For example, among the San Carlos Apache, the English word “somehow” is often used to convey a negative mood or irritability, perhaps without immediate apparent cause. The usage does not closely correspond to any majority culture usage of the same word. To provide effective services, one must learn the specific terms used in the community one serves.
Economic and Geographic Barriers . Many American Indian communities suffer from high rates of unemployment and poverty, due in most cases to a forced conversion to a cash economy from hunting, gathering, and farming economies (Bohn, 1989; Chester, Robin, Koss, Lopez, & Goldman, 1994; DeBruyn, Wilkins, & Artichoker, 1990) . Further, because tribes were pushed off more desirable lands, many reservations are in rural or geographically remote areas. As with most rural areas, public transportation is typically not available and a significant barrier to accessing care (Duran et al., 2000) . There may be fewer programs available and these programs often have high staff vacancy rates because it can be difficult to attract qualified individuals to remote areas (Indian Health Service, 2002) . Another consequence of poverty and isolation is lack of telephones in a high percentage of American Indian households. A recent study of American Indian communities in Arizona, Oklahoma, North Dakota, and South Dakota found only 43% to 72% of households had telephones in these communities (Stoddardt et al., 2000) .
Community Size Affects Confidentiality, Stigma, and Perception of Choices . This is a well-known issue on many reservations. Many tribal communities are a fraction of their size before colonization. As in many small communities, people know each other and are often interrelated by blood or marriage. Close-knit communities can offer enhanced support and other advantages, but the reduced privacy can be a problem for stigmatized issues such as sexual victimization. In one study, lack of confidentiality was cited as a major reason for not seeking help for another sensitive issue, drug and alcohol treatment (Duran et al., 2000) . Stigma is a concern of many American Indian victims (S. Locklear, victim advocate and Lumbee tribal member, personal communication, October, 2003). Although most advocates attempt to maintain confidentiality, even the perception of limited confidentiality can prevent women from seeking help.
Another important and often less recognized consequence of small community size is the very issue of tribal survival itself. Although more than four million people identified themselves as American Indian or Alaska Native on the 2000 U.S. Census, only 11 tribal groups had more than 50,000 members (Ogunwole, 2002) . Many tribal communities literally face the possibility of extinction. Victims may be unwilling to prosecute male tribal members because that will take another person out of the community. They may also hesitate to terminate a relationship with a male tribal member because options for intra-racial remarriage are more limited for American Indians than they are for other U.S. ethnic groups (Hamby, 2000) .
Fear of Law Enforcement and the Community Justice System. Some problems with the criminal justice system are common to many victims, especially victims from other U.S. minority groups. These include: fear of stigma following public charges, fear of being accused of a crime themselves, and hesitation to accuse a fellow tribal member and make him confront a racist legal system in addition to his crime. The complicated relationships among tribal, state, and Federal laws create unique issues, however. For example, if the perpetrator is non-Indian and the assault was committed on reservation land, jurisdictional problems may arise because reservation authorities cannot prosecute a non-Indian and off-reservation authorities are often reluctant to get involved in all but the most severe reservation crimes (Snyder-Joy, 1995) . Multiple legal jurisdictions complicate many offenses, including sexual assault and rape, that occur on reservation lands and can hamper the legal process even beyond what is usually seen in other jurisdictions (Millian, 2000) .
Lack of Funding . Considerable data document the longstanding lack of services available to American Indians (for a review, see Manson, 2000) . Recent changes from Public Law 93-638, which authorizes transfer of IHS functions from federal to tribal administration, are designed to improve local input and control over health services. Although the long-term effects of these changes are likely to be positive, in the short-term they are leading to dramatic shifts and increased variability in service provision and downsizing of technical assistance, quality control, and long-range planning at the federal level (Manson, 2000) .