Racial misclassification of American Indians with AIDS in Los Angeles County

American Indian/Alaska Natives (AI/ANs) appear to be underrepresented in AIDS surveillance statistics. We estimated the accuracy of racial classification and reporting completeness of AIDS among AI/ANs in Los Angeles County by surveying community-based organizations (CBOs) that provide services to persons with AIDS and then comparing the survey to AIDS surveillance data. The surveyed CBOs reviewed 6,500 records and found 60 Native American (the classification used by CBOs for AI/ANs) clients with AIDS compared with six AI/AN AIDS cases reported to the Los Angeles County AIDS surveillance registry. Racial classification was evaluated for 37 (62%) of the 60 Native American CBO clients. Only 11 (30%) of the 37 were verified as AI/ANs. The remaining 26 (70%) misunderstood the racial nomenclature and were reclassified by the CBOs as other races. Of 10 verified AI/AN clients for whom names were available, eight (80%) had been reported to the AIDS registry. However, seven (88%) of these eight were erroneously reported as other races. Racial misclassification accounts for much of the underrepresentation of AI/ANs in the Los Angeles County AIDS surveillance registry.