A total of 641,086 cases of acquired immunodeficiency syndrome (AIDS) had been reported to CDC through December 1997. Of these, 1783 (0.3%) occurred in American Indians and Alaskan Natives (AI/ANs). AI/ANs represent <1% of the total U.S. population (272 million persons) and are characteristically diverse, comprising many tribes-of which 557 are federally recognized. Each tribe has its own traditions and culture. This report 1) describes characteristics of AI/ANs with AIDS reported to CDC through 1997; 2) summarizes trends in AIDS incidence among AI/ANs from 1986 to 1996; and 3) for the 25 states in which surveillance was conducted during 1994-1997 for human immunodeficiency virus (HIV) and AIDS, compares the characteristics of AI/ANs who had reported HIV infection (without AIDS) with those of AI/ANs who had AIDS. These findings, which highlight the characteristics of AI/ANs for whom HIV or AIDS had been diagnosed, can assist in the development of targeted prevention strategies.