More than one in three Native American or Alaska Native women will be raped at some point in their lives. Most do not seek justice because they known they will be met with inaction or indifference. As one support worker said, "Women don't report because it doesn't make a difference. Why report when you are just going to be revictimized?" Sexual violence against women is not only a criminal or social issue, it is a human rights abuse. This report unravels some of the reasons why Indigenous women in the USA are at such risk of sexual violence and why survivors are so frequently denied justice. Chronic under-resourcing of law enforcement and health services, confusion over jurisdiction, erosion of tribal authority, discrimination in law and practice, and indifference -- all these factors play a part. None of this is inevitable or irreversible. The voices of Indigenous women throughout this report send a message of courage and hope that change can and will happen.