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News Flash: Asians and Pacific Islanders Have the Lowest HIV Testing Rates

By David Stupplebeen

November 22, 2010

For our World AIDS Day 2010 section, we wanted to capture the diversity of the AIDS community. So, we reached out to people across the world -- mostly those who have never written for us before -- and asked them to guest blog. These columns are written by people who are living with HIV, have been affected by HIV, or work in the field.

Which racial/ethnic group also has the highest increase in annual rate of new HIV infections?1 That's right -- Asians and Pacific Islanders.

David Stupplebeen

David Stupplebeen

If this surprises you, you're not alone. We don't often hear the words "HIV" and "Asians and Pacific Islanders" spoken in the same breath. Maybe that's one reason two -- thirds of A&PIs have never been tested for HIV -- the lack of information certainly makes it easy to assume A&PIs are unaffected by the disease. If you are A&PI, you are far less likely to get tested for HIV than your African -- American or Latino peers.

But the signs of a burgeoning epidemic among A&PIs have been flashing red for the last decade. CDC data show that A&PI men and women had the highest annual rate of increase in new HIV infections, more than any other racial or ethnic group. While there are more African -- Americans, Latinos or gay White men living with HIV, the rate of newly diagnosed HIV infections in their communities has stayed the same, or in some cases, decreased.2 Not so for the relatively small, but growing A&PI community. A preliminary analysis of the CDC data shows that the annual HIV rate among the A&PI population will exceed that of Latinos in five years and African Americans in ten years, if left unchecked.3 An unparalleled opportunity exists to implement strong HIV prevention strategies for A&PIs, but action must be taken now.

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We know that HIV has an enormous impact on our African American, Latino and White MSM brothers and sisters. It's vital that the epidemic be addressed in these communities. It's also vital that we acknowledge and address the epidemic in the many communities, like A&PIs, that are not prioritized in the National HIV/AIDS Strategy. The epidemic continues to grow while we look the other way -- the rate of new HIV infections has nearly tripled among young gay and bisexual A&PI men. Worse, one in three A&PIs living with HIV don't even know it.4 Let's take a look at this problem, first from the funder and provider perspective. A&PIs aren't prioritized as a population for HIV prevention because the number of A&PIs living with HIV/AIDS is considered "too low." But if 1 in 3 A&PIs living with HIV don't know it, and two -- thirds have never been tested, is it any wonder rates appear "too low?" If you don't know you're at risk, why bother to get tested? Clearly, there are issues with under -- reporting and under -- testing; using the lack of data as a reason to deny resources to a community in need is circular logic.

In the last ten years, half of A&PI -- serving HIV/AIDS organizations have closed their doors due to funding cuts. Existing HIV/AIDS providers may not be culturally or linguistically competent enough to work with A&PIs or understand their needs. They may not provide materials or do outreach in any of the over 100 languages and dialects A&PIs speak. They may not know that A&PIs comprise 40 different ethnic groups, believing a "one size fits all" model will suffice. Given the lack of services for A&PIs, can we really be surprised that two -- thirds of A&PIs have never been tested for HIV?

Reports often categorize A&PIs as "Other", making it impossible to quantify the epidemic for A&PIs at the national level. Worse, tracking reports are sometimes completely missing data for A&PIs. For instance, California's HIV trend data does not break out A&PIs from "Other" and some CDC reports exclude A&PIs altogether. The National HIV/AIDS Strategy calls for improved surveillance but fails to set forth a strategy to improve HIV testing and prevention efforts for this community.

When A&PIs do get tested, it is often very late: A&PIs are the most likely to develop an AIDS diagnosis within 12 months of testing positive for HIV. A diagnosis of HIV/AIDS is highly stigmatized, often leading to rejection by family, friends and the greater A&PI community. This stigma can be so brutal that many A&PIs living with HIV/AIDS abandon their families and friends and move to a different city or state to seek treatment.

Even when families care for a person living with HIV, they often feel disgraced and alienated from the larger community. In its worst form, HIV stigma can cause a family to shame and isolate the individual living with HIV, seeking to hide them from the rest of the world. In one case, an HIV -- positive man revealed his status to his family living in the Marshall Islands. They immediately asked him to return home so they could care for him. He flew home and the family did take care of him -- by forcing him to live in a shack on a hill away from both the family and the community. His relatives climbed the hill once a day to drop off food and water, but refused to speak to him. When he died in his shack alone, they burned it down with his body still inside.

Tragedies like this highlight the importance of this year's World AIDS Day theme: "Universal Access and Human Rights." We need to do more to make sure that A&PIs have ways to access information and testing and increase awareness in the community so people living with HIV/AIDS can exercise their right to access care when and where they want. We cannot wait until HIV infections among A&PIs are too pervasive to ignore.

David Stupplebeen is the Media & Communications Coordinator for the Asian & Pacific Islander Wellness Center.

References

  1. Hariri S and McKenna MT. Epidemiology of Human Immunodeficiency Virus in the United States. Clinical Microbiology Reviews, July 2007:20, no 3:478-488. Accessible at: http://cmr.asm.org/cgi/content/full/20/3/478
  2. Supra, notes 2 and 3.
  3. Dr. Tri Do, email message, June 2, 2010.
  4. Campsmith ML, Rhodes, PH, Hall HI and Green TA. Undiagnosed HIV Prevalence Among Adults and Adolescents in the United States at the End of 2006 (Abstract). JAIDS: Journal of Acquired Immune Deficiency Syndromes. 15 April 2010:53,5;619-624. Abstract accessible at: http://journals.lww.com/jaids/Abstract/2010/04150/ Undiagnosed_HIV_Prevalence_Among_Adults_and.9.aspx




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