A/HRC/33/57 discrimination, abuse and bullying from their peers, caregivers and members of their communities. Indigenous status, intellectual disability and imprisonment frequently cooccur.43 69. Indigenous persons with disabilities may also experience delays in recognition of their condition owing to racism or discrimination, or even an over-diagnosis of their intellectual disability owing to cultural bias in testing.44 Moreover, “institutionalized ableism” can obscure undiagnosed illnesses among people living with disabilities, where medical abnormalities are attributed to disability rather than to a separate pathology.45 The potential for this to occur in indigenous people is significant given frequent issues with language and other communication barriers and given health professionals’ lack of education. Training and education curricula should include content regarding the needs of indigenous persons with disabilities, so as to raise the awareness of practitioners. 70. Indigenous persons living with a disability in remote areas are often required to periodically reconfirm their disability through central medical organizations to remain eligible for disability pensions, creating hardship. States and other actors should recognize and address the multiple burdens of discrimination suffered by indigenous persons with disabilities. VII. Current challenges relating to indigenous peoples and the right to health A. Communicable and non-communicable diseases 71. Indigenous peoples experience disproportionately high levels of infectious diseases such as HIV/AIDS, malaria and tuberculosis, with the risk of becoming infected with HIV increasing among those migrating to urban areas. States should recognize the higher risk profile of indigenous peoples in relation to these diseases and the multiple burden of discrimination indigenous peoples suffer upon contracting such illnesses. In addition, indigenous peoples disproportionately suffer from “neglected” tropical diseases such as trachoma, helminth infections, yaws, leprosy and strongyloidiasis.46 Widespread or mass consensual treatment for these conditions should be considered by States, where effective medications exist. It is also important that State funding for indigenous health activities is not predicated on wellness, particularly in communities already experiencing disadvantage. In the Russian Federation, an increasing incidence of tuberculosis in indigenous communities has been used as a criterion for the non-approval of or reduction in federal subsidies.47 43 44 45 46 47 18 Matthew Frize, Dianna Kenny and C.J. Lennings, “The relationship between intellectual disability, indigenous status and risk of reoffending in juvenile offenders on community orders”, Journal of Intellectual Disability Research, vol. 52, No. 6 (June 2008). Ibid. Submission by the First Peoples Disability Network. Peter Hotez, “Aboriginal populations and their neglected tropical diseases”, PLoS Neglected Tropical Diseases, vol. 8, No. 1 (January 2014). Russian Federation, federal government act No. 217 of 10 March 2009 on approval of the terms of distribution of subsidies from the federal budget to the budgets of subjects of the Russian Federation to support the economic and social development of the indigenous peoples of the North, Siberia and the Far East of the Russian Federation.