HIV Prevention Among NYC Asian Immigrants
New York Academy of Medicine Study Focuses on Community Institutions
The New York Academy of Medicine's Office of Special Populations is conducting a study assessing the role of community institutions in encouraging or impeding health promotion and disease prevention in Asian immigrant communities in New York City.
The study, entitled "Asian Immigrant Community Institutions in NYC and HIV," is funded through a three-year grant from the National Institute of Child Health and Human Development, a branch of the National Institutes of Health. The study focuses on a cross-section of the two largest Asian and Pacific Islander (API) immigrant communities: Chinese and Indian. From among the estimated 700 API institutions in New York City, the study will ultimately collect data from approximately 140 interviews with leaders and members of 20 participating institutions.
The Role of Institutions"We'd really like to generate information that helps the community, and to help funders understand the role that institutions play in serving the community and recognize that they have an important role in how to look at the community," said John Chin, the study's principal investigator. "I don't think a lot of people understand that something can be done with these institutions to do work in the community. Our hope is that it opens up an avenue to doing effective HIV prevention in immigrant communities."
The year-old study focuses on social norms, defined as peoples' attitudes, values and behavioral codes of conduct, and what role immigrant institutions play in setting such standards. Chin said, "There is a lot of research that focuses on individual behavior and attitudes and very little that focuses on institutions. For immigrant communities, institutions are really important because that's who immigrants turn to for information to somehow guide them or interpret the world."
During the first year of the project, Chin and his colleagues spent a majority of their time cataloguing and approaching potential institutions including churches, temples, ethnic publications, business associations, social clubs and political associations. Also, an interview guide was compiled to provide staff with guidelines for conducting interviews, which are largely held in English.
Project Coordinator Mamatha Bhagavan said that, in addition to basic questions on perceptions of personal health and knowledge of HIV, "a lot of the questions revolve around how the individual is thinking about the community institution: what kind of role they play in the community institutions, what kind of social network exists within the institution and how they get their information, how social norms are generated, maintained or challenged." She adds, "We give the interviewees scenarios and vignettes just to kind of tease out their reactions to somebody with HIV or with the potential to contract the disease. We try to lift the stigma, the hidden stigma and get a sense of their attitude toward HIV." The interview inquires further on how the institution perceives social norms and the risk of community members contracting the disease.
The Persistence of StigmaAccording to Chin, stigma towards HIV remains an issue in the API community, "Immigrant communities have an investment in making a certain kind of social structure. Immigrants face a lot of pressures when they come to this country. They have to survive in this country but also have a desire to maintain culture. It becomes a kind of foundation for their survival. Shared culture has a lot of benefits to it, like being an automatic screener." Introducing subjects such as HIV, homosexuality, marital infidelity or prostitution shakes up the structure that these institutions try to maintain.
Some organizations may not necessarily understand the context in which they are being approached because they may not associate themselves specifically with HIV. For example, one church group expressed their desire not to participate by saying that the study was not a part of their religious mission and very much outside the work of the church. Some even question the validity of addressing HIV, which they may not perceive as a threat, especially with the advent of SARS. "SARS is a big thing even though nobody has SARS in, for example, Chinatown, but people do have HIV in Chinatown."
Bhagavan added "The organizations that we have come across are in total denial of the fact that they are at risk or that they engage in high risk behavior. They just deny it. They think that they're not a risk, it's not within their community, it doesn't happen. They are still struggling with admitting that there is a chance that members of the community are actually at risk."
Still, Chin said "Many of our meetings with institutions have been very, very positive. They are providing tremendous support and services to these communities. Some at least have an openness to saying that if HIV is a problem then they'll deal with it." He adds, "There's still a lot of stigma, but also I think we sometimes assume that we're not able to overcome that stigma. I think that in our study we'll find that there are ways of getting through that." Both Chin and Bhagavan convey that despite stigma they have not been rudely turned away.
Chin said the findings from the research will aid policy makers, those writing reports, benevolent institutions, service organizations, HIV prevention efforts, and even HIV care. "Hopefully this study would give them insights on what is going on in the community and how they can work effectively in the community. They can then understand that these institutions are essential to the health of the community and they need to be folded into any kind of strategy like with SARS, HIV and any kind of public health strategy where I think immigrants are often ignored," he said.
Chin, a former deputy executive director at the Asian Pacific Islander Coalition on HIV/AIDS (APICHA), said "I'm not sure how effective groups like APICHA have been in reaching the larger immigrant community. I think they are really good at reaching the high-risk populations, like MSM (men who have sex with men) and people who are infected. If you ask folks at these institutions if they have heard of APICHA a lot of them haven't."
Bhagavan added "I also think that we have arbitrarily classified organizations as mainstream or marginalized. So organizations like APICHA and a few other organizations like the domestic violence hotline are serving on the periphery of the community. I think more mainstream organizations will be churches or temples, cultural organizations."
The research team includes Chin, Bhagavan, two co-investigators with doctoral degrees in anthropology and public health, and a research assistant who speaks both Cantonese and Mandarin. Each goes on-site to interview institution members and regularly attends cultural events. Following the interview portion of the study, the team will spend the following two years transcribing, coding and analyzing the interviews. By the end of the three years the group will apply for more funding to conduct a follow-up study.
Chin said "We think it's particularly important to look at Asian immigrant community institutions and not just the social service organizations that are already reaching the traditionally high-risk populations. The epidemic in Asia is really developing and if that epidemic starts to cross over to here then the institutions are going to be on the front lines for being able to address that."
Kevin C. Lo is a writer born and raised in New York City, who has worked with the AIDS Action Committee of Massachusetts.
This article was provided by Body Positive. It is a part of the publication Body Positive.