May 19, 2009
On the fifth annual National Asian & Pacific Islander HIV/AIDS Awareness Day, we focus our attention on concrete steps to reduce the impact of HIV on Asians and Pacific Islanders in the United States.
Asian and Pacific Islander communities in this country are incredibly diverse, comprising more than 40 different ethnic groups and over 100 languages and dialects.1 To turn the tide against HIV/AIDS in these communities, public health officials and caregivers face the challenge of communicating about HIV prevention in linguistically appropriate and culturally relevant ways.
In addition to the stigma of men having sex with men and taboos against discussing sexual matters in some Asian and Pacific Islander communities, this communication challenge may influence some members of these groups to avoid or delay getting tested for the virus. Only 30 percent of adult Asians and Pacific Islanders have ever been tested for HIV -- a lower percentage than any other U.S. ethnic or racial group2 -- and almost 40 percent of Asian Americans who are diagnosed with HIV learn their status fewer than 12 months before being diagnosed with AIDS.3 Moreover, about 30 percent of HIV-infected Asians and Pacific Islanders do not know they are infected, the highest rate among U.S. ethnic and racial groups.4 Limited HIV testing and delayed diagnosis among Asians and Pacific Islanders seriously endangers their health and that of their sexual partners. This is unacceptable; collectively we must work to overcome barriers to testing and treatment wherever they exist.
The National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, strongly endorses testing for HIV during routine medical care, as the Centers for Disease Control and Prevention and the American College of Physicians recommend. Through regular testing, new HIV infections can be identified promptly, and individuals who test positive gain the opportunity to receive counseling and treatment to prolong their lives and reduce their chances of infecting others.
Stigma associated with men having sex with men and cultural taboos against discussing sexual matters may also create difficulties for Asians and Pacific Islanders around negotiating condom use. This has important repercussions, because high-risk sexual contact with a man accounts for at least three quarters of new HIV infections among male Asians and more than half of new HIV infections among female Asians.5 To address the challenge of negotiating condom use, which affects many ethnic groups, NIAID supports research to develop new tools that men and women can implement independently to protect themselves from HIV during sex. Notably, researchers are developing and testing a variety of microbicides -- gels, creams or foams intended to prevent the sexual transmission of HIV when applied topically inside the vagina or rectum. A recently completed NIAID clinical trial of a microbicide called PRO 2000 found the experimental product to be 30 percent effective. Although the result fell just short of statistical significance, it was the first sign that a microbicide might work in people. More definitive results will come from a larger clinical trial of PRO 2000 being conducted by the Medical Research Council of the United Kingdom and scheduled to conclude later this year. Meanwhile, NIAID will soon begin clinical tests of a different microbicide, one that contains the antiretroviral drug tenofovir. Many other NIAID studies of microbicides at earlier stages of development also are under way.
Another approach to HIV prevention that people at high risk for HIV could implement independently would involve taking antiretroviral drug regimens to protect themselves from infection. This strategy, known as pre-exposure prophylaxis (PrEP), is based on the concept that blocking the replication of HIV immediately after exposure to the virus may prevent infection. Initial results from NIAID-sponsored clinical trials testing PrEP are expected later this year.
On this day, I thank Asians and Pacific Islanders who have participated in the fight against HIV/AIDS. I also urge members of these communities to embrace routine testing for HIV, to overcome stigma associated with HIV infection and men having sex with men and to participate in HIV/AIDS clinical research. Together, we can curtail the HIV/AIDS epidemic among Asians and Pacific Islanders in the United States.
Each year, the NIH Office of AIDS Research produces a Trans-NIH Plan for HIV-Related Research that identifies strategic priorities for all areas of HIV/AIDS research. The plan is developed in collaboration with experts from the NIH institutes and centers, other government agencies, non-governmental organizations and HIV/AIDS community representatives. The Fiscal Year 2010 Trans-NIH Plan for HIV-Related Research contains a chapter specifically devoted to research addressing HIV/AIDS in special populations, including Asians and Pacific Islanders.
Visit National Asian & Pacific Islander HIV/AIDS Awareness Day for more information. See www.aidsinfo.nih.gov/ for information about HIV/AIDS prevention, treatment and clinical trials.
Dr. Fauci is director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health in Bethesda, Maryland.