HIV Treatment Education in 2002
The popular image of Asian and Pacific Islanders (APIs) is that of the "model minority": well educated and well off. When it comes to HIV care, however, their educational and economic status doesn't guarantee access. Their rich cultural diversity poses its own set of challenges and perplexities in utilizing the HIV care system and in delivering HIV care.
Like other ethnic minorities, APIs are not just one cluster of people. In the United States, APIs consist of 49 ethnic groups speaking more than 100 languages. Although there are some basic cultural similarities, APIs, with their different cultural and linguistic backgrounds, don't possess one common identity. Comprised of different generations and classes and shaped by such factors as being American born versus being a recent immigrant, each API group has established its own unique society and culture.
Since APIs comprise only four percent of the U.S. population, however, they have historically been perceived and categorized as a single population. Government funding for HIV care is usually allocated to the API community as a whole. Tailoring a program to a specific target population in the API community and providing culturally and linguistically sensitive and comprehensive HIV care service is time consuming and expensive.
In San Francisco, for example, where APIs comprise 35 percent of the population, they speak more than 14 languages. HIV care service agencies, faced with limited funds and human resources, are forced to prioritize ethnic groups within this population depending on the HIV/AIDS prevalence and incident rate in each ethnic group. It is a challenge for service providers to deliver comprehensive HIV services to all of the API ethnic groups.
People with HIV often face multiple issues, such as mental health problems, substance use, low income and lack of housing. These issues interfere with both their opportunity and their willingness to access HIV care. In order to maximize service delivery and to help them opt for positive life changes, referrals need to be made to appropriate service providers, but not all referral agencies have the language capacity and cultural sensitivity to deal with API clients. In such cases, clients may not be able to access medical care because of unsolved immediate problems. Especially for newcomers, marginal populations and multiple-diagnosed individuals among APIs, HIV treatment can still be unavailable or ineffective for this reason.
Recruiting community members to be HIV workers and/or peer leaders in order to deliver effective HIV care can be difficult in a particular community if its population is quite small. Misconceptions about and social stigma surrounding HIV/AIDS may also discourage community members from working in the field. The emergence of HIV/AIDS activism and leadership among APIs with HIV can be slow or stagnant for the same reason. In practice, however, peer-based HIV care, activism and strong leadership are crucial both for improving HIV care and for promoting behavioral changes which will allow people to improve their health and to reduce the risk of an AIDS diagnosis.
The Asian & Pacific Islander Wellness Center in San Francisco has established a team approach to HIV treatment advocacy including case managers, peer advocates, treatment advocates, a psychotherapist and a psychiatrist. Providing services in seven Asian languages, team members accompany clients to their medical appointments in order to assist them in communicating with healthcare providers, in learning how to utilize medical facilities, and in improving their adherence to treatment protocols. To maximize language capacity and cultivate future leadership, the agency recruits and trains clients to be peer leaders who can help other clients with medical appointments and other chores. In order to provide primary HIV care for uninsured APIs and API newcomers, the agency has an on-site HIV clinic once a week in collaboration with the San Francisco Department of Public Health. This collaboration has enabled agency care staff to work with the clinic staff as a team in steering clients to learn about HIV treatment and increase their adherence to HIV medications and medical care.
In addition to one-on-one work with clients, the agency provides monthly support groups, a weekly psychotherapy group, an annual clients' retreat, seasonal parties, bimonthly HIV agency field trips, bimonthly HIV treatment forums and a weekly weight training program in order to build an API HIV community to provide peer support and to recognize and develop future leaders. In the process of implementing these programs, care staff, peer leaders and clients participate in activities designed to create a community atmosphere.
Even with all of the agency's efforts, there are still challenges in providing comprehensive HIV care services and building a sense of community. Finding ways to increase the participation of monolingual clients in agency activities and increase the degree of integration between immigrants and American born clients in such activities are challenges that the agency is facing. It remains a challenge to provide equal service across the different cultural and linguistic divides of the API community while operating under a limited budget.
Yukihiro Ippei Yasuda is a Treatment Advocate, Asian & Pacific Islander Wellness Center, San Francisco, California.
This article was provided by AIDS Community Research Initiative of America. It is a part of the publication ACRIA Update. Visit ACRIA's website to find out more about their activities, publications and services.