There are 4.1 million American Indian and Alaska Natives who self-identified on the 2000 U.S. census. This is a highly heterogeneous group representing over 500 federally recognized tribes and speaking over 300 distinct languages (Duran & Walters, 2004). Although there are cultural distinctions among tribes, there is a common experience of social and cultural oppression, including "removal from tribal lands, ethnocide, genocide, racism, poverty and alcoholism" (Simoni, Sehgal, & Walters, 2004, p. 33). In addition, Native American children have been forcibly removed and placed in boarding schools and non-Indian custodial care. Indians have been forced to relocate to urban settings, where over 60 percent now live (Duran & Walters, 2004; Walters & Simoni, 1999). Experiencing this trauma has led to a cumulative and intergenerational effect characterized as a "soul wound" among Native American people. Duran and Walters (2004) reported that "many researchers have concluded from anecdotes, community-based observations, and preliminary evidence that historically traumatic events might be related to poor mental health outcomes among Native people such as 'historical trauma response'; posttraumatic stress disorder; alienation; depression; alcohol abuse; and HIV risk" (pp. 194-195). In addition to historical trauma, Native Americans currently face higher rates of interpersonal violence at a rate of 2.5 times the national average (Simoni et al., 2004; Vernon & Jumper-Thurman, 2005). Historical trauma and trauma from interpersonal violence contribute to risk factors for HIV infection.