Alyson Shirley is a former Miss Navajo Nation who is a rising star in Indigenous health. She recently earned a master’s degree in global health from Arizona State University’s School of Human Evolution and Social Change. Today she works as an HIV Program Specialist for CAN Community Health, a non-profit that empowers patients affected by infectious diseases and sexually transmitted infections (STIs) by providing knowledge and awareness while dissolving barriers and stigma. We talked to her about her work and culturally responsive care in Indigenous health.
Hi Alyson! Your current work in Indigenous health sounds fascinating. Can you tell us a little more about it?
I help address prevention through HIV testing and STI testing throughout the state of Arizona. We have 2 mobile units that go throughout the state providing testing and reducing stigma on HIV and STIs.
Have you done any work with syphilis prevention? Our teams are seeing rising cases of syphilis in the Great Plains.
Oh, definitely. In the Native American communities, we do a lot of training on Syphilis 101 – what is it, how can we stop it, and we also do syphilis testing. We do rapid testing or we pull the blood to confirm or see how progressed the titer is.
I also work specifically with the tribes here in Arizona – specifically getting our services out to them. Because of their lack of funding for HIV and STI testing, we use our services as a non-profit to go into their areas with their permission. They’ve been seeing a high number of syphilis cases so we support them wherever they need the help.
I know you earned a Master’s degree in global health. What inspired you to pursue that academic path?
Growing up on the reservation, I saw firsthand health disparities that impacted the communities around me – whether it was limited access to healthcare, underfunded facilities, or historical trauma that affects behaviors.
Something in me wanted to help people get access to healthcare. I wanted to find ways to address systemic barriers and develop community-driven solutions that are sustainable.
Pursuing my Master’s helped me explore challenges through a broader perspective and develop culturally appropriate interventions that centered around Indigenous voices. I looked at how tribes around the world are handling different health issues and how that could help my Navajo reservation or any reservation.
What is working globally can help locally. I don’t think we’re thinking to that level.
I saw that you interned with the Arizona Advisory Council on Indian Health Care on improving vaccine access and confidence in Native communities. What was the result?
I mainly contributed to development of grant proposals – getting funding for that initiative to increase vaccine confidence and accessibility in Arizona. It included community assessment needs and different ways we could allocate the money such as through performing community assessments and culturally tailored materials and partnerships with Native-led organizations to rebuild healthcare systems.
It had a lasting impact on Native communities in Arizona.
Speaking of vaccine confidence – we know that patient mistrust is an ongoing issue. What’s your advice to facilities and non-Native providers in earning that trust?
Building trust takes time. It starts with building genuine relationships with the clients or population you’re working with. One of the most important things providers can do is listen.
Listen to patients’ concerns with empathy and without judgment, recognizing how historical trauma, systemic discrimination, and past medical mistreatment have impacted their trust in healthcare, rather than dismissing their experiences. You need to actually get to the core of “why this is happening and how can I fix it.”
It helps to hire Indigenous staff if you can – I know it’s not easy. But incorporating Indigenous staff helps with representation in marginalized populations. They have similar backgrounds, they experienced the same things. So they in turn will trust that individual more than someone who is non-Native.
I think that will always be the hard part. That individual has to get down to their level and understand the why. That’s the only way to build trust.
Incorporating the traditional healing practices, creating a culturally safe space – that also goes a long way to showing commitment to the community and transparency in their healthcare decisions. And being consistent with your community engagement, not just during a pandemic or syphilis outbreak but being there even when times are good. That establishes credibility and helps the relationship flourish.
Those are incredible insights. Do you have any ideas on how facilities can collaborate with community leaders to deepen patient engagement – and ultimately improve Indigenous health outcomes?
Collaboration with community leaders is essential for sustainability of the trust you’re trying to build. Forming advisory boards of respected public health officials who come from different reservations, cultural leaders and elders and Indigenous healthcare workers – that can provide insight on culturally appropriate strategies and ways to do things.
The AZ Advisory Council on Indian Healthcare was created because they saw this need when it came to access.
Partner with existing community organizations that already have the trust built in the population, with stakeholders who’ve already built that. Tailored interventions, tailored pamphlets – offering space to hear them out, listen to them – that really makes a difference.
What are the biggest mistakes you see in terms of Indigenous health and cultural competency?
The one-size-fits-all solution is the biggest mistake everyone is making when working with Indigenous communities. I know it’s easy; it saves money. I know for a lot of healthcare entities, their hardest challenge is their budget. It’s the reason they do the one-size-fits-all for everyone. But every community and tribe are diverse. What works in one Tribal community doesn’t work in all.
Another common issue is the lack of representation in staffing, language, access, or even educational materials. When Indigenous patients don’t see themselves reflected in their care, it can disconnect them from wanting to pursue care.
What doesn’t work, you can fix. Constantly doing evaluations, looking for ways to fix it, that’s really nice when health entities do that and the outcomes are really good. If you genuinely want to work with Tribal or other marginalized populations, you must invest in them to achieve meaningful results and build trust. This requires time, resources, and unwavering commitment.
If it was a perfect world, everyone would be able to do it. It’s hard but with the right person in there, it’s possible.
What are your plans for the future?
My continued goals is working with Tribal communities to address health needs and improve health outcomes and anything in the realm of making Indigenous populations healthier. That could be through public policy and program development – even community engagement. I wear a lot of hats in the role I’m already in.
I’m passionate about Native language and culture and revitalization because I grew up speaking Navajo before English. I believe those are all deeply connected to our wellbeing and what goes into our health. Over the long term, I see myself in a role where I can bridge the two together.
By bridging traditional knowledge with modern health approaches, we can create sustainable changes when it comes to working with Indigenous populations and healthcare.
Thank you, Alyson!
