Asians and Pacific Islanders are one the fastest growing racial/ethnic group among minorities in the United States and the most diverse with over 50 ethnicities/nationalities and 100 languages/dialects. The subgroups differ in language, culture and history as well as represent both extremes of socioeconomic and health issues. Tailoring HIV interventions to meet the needs of this culturally and socio-economically diverse population remains challenging.1
Asians and Pacific Islanders account for 0.8% of all U.S. AIDS cases, however, the number of estimated cases increased from 1999 to 2003 at a higher rate (35%) compared to African Americans (8%), Latinos (7%) and Native Americans (21%). Asian and Pacific Islanders are as likely as other racial/ethnic groups to engage in HIV-related risk behaviors and the least to have ever tested for HIV.2
73% of Asians and 35% of Native Hawaiians and Pacific Islanders speak a language other than English at home. For Asians, this is four times higher than the national average (18%). Communication between medical personnel and patients, and service providers and clients require a high level of English proficiency. If a client does not speak English well, language assistance is required in order to maintain quality of care. Asians are four times more likely to be limited English proficient than the general population (36% vs. 8%).3 In order to serve the Asian and Pacific Islander community, linguistic access and competency - multilingual materials, culturally competent providers and trained interpreters -- are a priority.
There are few images of Asians and Pacific Islanders living with HIV/AIDS. This perpetuates a myth that Asians and Pacific Islanders are not affected. Negative or nonexistent images hinder discussions of HIV risk and disclosure of HIV status. In addition, many Asian and Pacific Islander communities have cultural values such as the desire to keep one's family from dishonor and the avoidance of discussing personal issues.4 These values coupled with social taboos such as sex, homosexuality, drugs, illness and death make it difficult for some individuals to access HIV information or testing.
63% of Asians and 19% of native Hawaiians and Pacific Islanders in the U.S. were born outside the country.3 Similarly, among Asians and Pacific Islanders living with AIDS, 60.4% are foreign-born. The top five countries of origin are the Philippines (16%), Vietnam (6.9%), India (4.9%), China (4.3%) and Thailand (4.2%).5 Citizenship status has significant and wide-spread effect on immigrants' ability to access health services and obtain health coverage. Asians and Pacific Islanders have higher rates of being underinsured and uninsured therefore limiting their access to comprehensive prevention, care and support services.6 In addition, many may not be accessing HIV testing services for fear of deportation should they test positive for HIV.7
Men who have sex with men (MSM) make up the majority HIV infections (65.9%) and AIDS cases (71.4%) in the Asian and Pacific Islander community. Some Asian and Pacific Islander ethnic groups are disproportionately impacted. For instance, in New York City, South Asians make up 25.6% of cumulative AIDS cases are among Asians.8 In San Francisco, Filipinos (32%) and Chinese (23%) have the highest number of AIDS cases among Asian and Pacific Islander MSM.9
Among Asian and Pacific Islander women who reported with new HIV infections in 2002, 64% did not have their method of exposure identified -- the largest among all ethnic groups. This is primarily because public health follow-up to ascertain the mode of HIV exposure had not been completed. This statistic highlights the need for additional data regarding Asian and Pacific Islander women and their risk for contracting HIV.10
Due to the lack of recognition of risk, Asians and Pacific Islanders access testing at very low rates. Asians and Pacific Islanders do not tend to proactively seek out preventative health services/testing, but instead tend to seek out doctors as a last resort. About a quarter of Asian and Pacific Islander MSMs do not access testing services and nearly half of those who have tested positive are diagnosed at an advanced stage of HIV disease. Among Pacific Islanders who have tested HIV positive, over half (61%) did not feel they were at risk for HIV infection.11