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

Factors to Consider When Promoting and Providing HIV Prevention and Treatment

Language Appropriate Education and Services

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.

Shame and Stigma

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.

Immigration Issues

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

Highly-Impacted Populations

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

Testing Behavior

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

Suggestions for Effective Services and Campaign Messages

• Prevention efforts and testing messages must be culturally and linguistically tailored to reach the different populations as there is no single approach that will effectively reach all Asians and Pacific Islanders.

• Incorporate supportive images of family and social networks that will facilitate accessing accurate health information and services.

• Peers play a strong role in personal development and decision-making. Continue to provide peer-based programs that can promote and sustain an individual's behavioral changes through community support.

• Actively address myths, stereotypes and stigma of HIV, drug use, sex and sexuality.

• Produce materials and offer services in the language preferred by your target population. Plan to have interpretation services readily available.

• Increase the linguistic capacity of your services through recruitment of bilingual and multilingual staff and volunteers.

• Increase prevention and testing efforts on emerging risk populations such as Pacific Islanders, South Asians, Southeast Asians, transgenders and women using culturally appropriate curriculum and materials that take into primary consideration current and historical marginalization of these groups.

• Build alliances with faith-based organizations, businesses, social centers and other institutions which are vital to community life and cultural values to expand infrastructure and increase community involvement in HIV prevention work.

• Programs that assist individuals in recognizing and building non-verbal and other indirect communication skills can be a culturally appropriate way in developing negotiation skills with partners as well as dealing with other community members, families and friends on HIV-related issues.

• Integrate voluntary HIV counseling, testing and referral as part of a comprehensive strategy for HIV prevention.

• Recognize the needs and concerns of immigrants in your interventions as they may significantly differ from those who are U.S.-born.

• Comprehensive, culturally-appropriate services must be available to those who test positive for HIV, including access to translation and interpretation services.

• Provide trainings to staff that can increase levels of cultural awareness and sensitivity.

• Adhering to standards of confidentiality is important in establishing trust with the community you are working with. Do not assume the client has disclosed their personal health information, sexual orientation, drug use history, or HIV status to their family members and friends.

References

1. CDC, Office of Minority Health. Asian American populations. May 2004

2. Choi KH, Wong F, and Sy FS. HIV/AIDS among Asians and Pacific Islanders in the United States. AIDS Education and Prevention: An Interdisciplinary Journal. 2005

3. United States Bureau of the Census. The Asian population: 2000. Census 2000 Brief.

4. Yoshioka MR, Schustack A. Disclosure of HIV Status: Cultural Issues of Asian Patients. AIDS Patient Care and STDs. Vol. 15, Number 2. 2001

5. Zaidi IF, Crepaz N, Song R, Wan CK, Lin LS, Hu DJ, and Sy FS. Epidemiology of HIV/AIDS among Asians and Pacific Islanders in the United States. AIDS Education and Prevention: An Interdisciplinary Journal. 2005

6. The Henry J. Kaiser Family Foundation, Health Insurance coverage and Access to Care Among Asian Americans and Pacific Islanders, June 2000.

7. Kahle EM, Freedman MS, and Buskin SE. HIV Risks and Testing Behavior among Asians and Pacific Islanders: Results of the HIV Testing Survey, 2002-2003.

8. New York City Department of Health, custom data request for cumulative AIDS data through January 9, 2002.

9. San Francisco Dept of Public Health, Office of AIDS. AIDS Surveillance Quarterly Report, September 2005.

10. CDC, HIV/AIDS Surveillance Report 2002, Vol. 14.

11. Do TD, Choi KH, and Chen S. Unrecognized HIV Infection and Barriers to Testing among Young Asian and Pacific Islander Men who have Sex with Men.