AIDS Action Weekly Update Special Edition
Report From the HIV Prevention Leadership Summit
Atlanta, Georgia, June 16-19, 2004
June 25, 2004
Advancing Prevention for All Populations
Debunking the "Model Minority" Myth: Prevention for Asians and Pacific Islanders
There were four sessions at HPLS that focused specifically on APIs:
From these sessions, a picture about HIV infection and prevention in API communities emerged that suggests APIs are as much at risk for HIV as other ethnic groups in the United States. In fact, the API communities in the U.S. are in danger of a severe epidemic. What little data exist for API communities indicate that HIV is on the rise. According to the CDC and Prevention (CDC), there was a 25% increase in the number of AIDS cases among APIs from 1999 to 2002. Further epidemiological data show the rate of new AIDS cases among API women is doubling every year. Moreover, API HIV organizations maintain that the true number of HIV infections among APIs is much higher than reported. Often APIs are misclassified as another ethnic group, they say.
The Need for HIV Prevention Services for APIs
Because Asians and Pacific Islanders are as much at risk for HIV as other minority groups in the U.S., API presenters at HPLS contended that effective HIV prevention services for APIs are urgently needed. Presenters reminded summit attendees that the 2000 U.S. Census showed that Asians are the fastest growing U.S. population, with annual growth rates among some API ethnicities as high as 115%. This population upsurge needs to be taken into account when community planning groups allocate resources for prevention activities, they said. Additionally, presenters pointed out that the rates of sexually transmitted diseases (an indicator of risk behavior that could lead to HIV infection) among APIs are often higher than the national average. The National Minority AIDS Education and Training Center reports, for example, that "Hepatitis is 25 to 75 times more common in certain API subgroups than in the general U.S. population."
Obtaining funding for these prevention services, though, is the biggest challenge for API prevention organizations, according to a series of joint reports by the Asian and Pacific Islander Health Forum and the Asian and Pacific Islander Wellness Center (both of which receive CDC funds to conduct HIV prevention capacity building within API communities), which were distributed at HPLS. In one of these reports, entitled Resource Inventory of HIV Prevention Services in Southeast Asian American Communities, the agencies write that a common misperception exists among U.S. health care providers that APIs are not at high risk for HIV. They attribute this perception to the stereotype of APIs as "the model minority," which supposes that APIs have a higher economic status, higher education rates and a healthier population than other ethnic groups in America.
This stereotype distorts the reality of many API communities in the U.S., which have low education rates and high poverty rates, according to the collaborative report. This is particularly true for Southeast Asian communities. Studies presented in the Resource Inventory found that only 10% of Southeast Asian Americas have a college degree, while 67% of Laotians, 66% of Hmong and 47% of Cambodians in the U.S. live in poverty. "The below-average economical status of Southeast Asians indicates that this group is less likely to have access to health insurance," states the report. "These facts indicate the importance of targeting Southeast Asians in HIV prevention efforts as they are less likely to obtain these critical services elsewhere."
Barriers to HIV Testing and Prevention Services in API Communities
Despite the need for more prevention services, numerous barriers were reported at HPLS in disseminating HIV prevention messages and in testing for HIV among APIs. The most obvious of these barriers is the number of languages spoken among API communities. The National Minority AIDS Education and Training Center reports that there are over 28 Asian and 19 Pacific Islander groups that speak over 100 different languages and dialects in U.S. API communities. Since it is estimated that 75% of APIs in the U.S. are new immigrants with little or no English proficiency, HIV prevention messages need to be made available in multiple languages in order to be effective. "Few community based organizations have the capacity to carry out such services," notes the Resource Inventory, published by the Asian and Pacific Islander Health Forum and the Asian and Pacific Islander Wellness Center.
In addition to language barriers, representatives of API organizations at HPLS reported several cultural barriers APIs face in accessing HIV prevention services and testing. They described how many immigrant APIs (immigrant populations account for the majority of new infections among APIs) fear that by seeking out services for HIV they will lose their residency status. Additionally, they told how APIs tend to resist openness about sexuality and sexual behavior. This silence keeps many APIs from taking control of their sexual health and testing for HIV, they said.
The lack of openness about sexual diversity contributes to high stigma of those infected with HIV, said Presenter Lawrence Ozoa of the Asian and Pacific Islander Wellness Center. At the HPLS session called National API MSM Knowledge, Attitudes, Beliefs and Behaviors Survey, Mr. Ozoa led workshop participants through the results of a recent survey of API men who have sex with men (MSM). Notably, 43% of the survey's respondents refused to disclose their HIV status. Ozoa suggested that this lack of disclosure represented a fear on the part the survey's participants of being identified. He explained how the stigma associated with being HIV positive not only brings shame on the individual, but also on the whole family. Workshop participants agreed with this assessment. "Everything is about the family, not the individual," said one participant.
The CDC, Cultural Competence and the Pacific Islands
One geographic area where the HIV prevention needs of APIs are beginning to be addressed in a culturally competent way is the Pacific Islands. There are six Pacific Island jurisdictions that receive funding from CDC for HIV prevention efforts; they are American Samoa, the Federation of Micronesia, Guam, the Marshall Islands, the North Mariana Islands and Palau. Representatives of these six jurisdictions met with CDC officials at an HPLS roundtable titled HIV Prevention Community Planning in the Six US Affiliated Pacific Island Jurisdictions on Friday, June 18. The purpose of the roundtable was to strategize about ways to make HIV community planning groups more effective in the Pacific Island jurisdictions.
Last year at a meeting in Guam, representatives of the Pacific Island jurisdictions told the CDC's Dr. Robert Janssen that the guidelines for community planning groups were misfit for the Pacific Islands. In fact, they placed an undue burden on local health department officials who strived -- with mounting frustration -- to follow the model each year so that their jurisdiction would continue to receive funds for HIV prevention activities.
The HPLS roundtable began with a recap of the Guam discussions. Members of the Pacific Island health departments reported how the recruitment and retention of API volunteers representing high risk populations was nearly impossible. Because homophobia remains pervasive on the islands, some men "cannot serve [openly] on the API," said Louisa Helgenberger, the HIV/AIDS Prevention Program Manager for the Federation of Micronesia. Similarly, HIV stigma from the larger culture has prevented individuals living with HIV from serving on CPGs.
These difficulties make recruitment and retention of API members a full time task for Pacific Island health department officials. This is a particularly large burden, given the health departments on the Pacific Islands are small compared to most state health departments. Consequently, health department officials on the Pacific Islands have to "wear many hats," as one official expressed it at the roundtable.
Following the meeting in Guam, the CDC issued program announcement 04069. This program announcement was in response to the constant struggle on the part of the Pacific Island jurisdictions to conform to the CDC guidelines. It provides the Pacific Islands with the opportunity to create a new model for their CPGs that is culturally relevant.
CDC Project Officer Victoria Rayle commented that the CDC finally understood that the "one size fits all" model for CPGs does not work for the Pacific Island jurisdictions. She acknowledged that the CDC was slow to change the guidelines for the Pacific Islands, but she expressed her relief that a more culturally competent model could now be developed. Responding to a question from a health department official regarding the guidelines for the new model(s) to be developed, she emphasized that the new model needed to be a "community involvement process for planning and program implementation," as mandated by Congress. However, beyond that principle guideline, she told the Pacific Island jurisdictions that they had a "pretty open canvas to paint." She emphasized that the new model would be "driven by the Pacific."
For more information on APIs and HIV, link to:
This article was provided by AIDS Action Council. It is a part of the publication AIDS Action Weekly Update.