African immigrants make up a small, but growing percentage of the people of color affected by HIV/AIDS locally. Sammie Fick, a case manager for the Madison Clinic at Harborview Medical Center, works with a large number of African immigrants and refugees. She recently talked with STEP about providing care to that community and the challenges that face African immigrants accessing care.

"I think people need to understand that there is a large group of Africans [living here] who are positive," said Fick. The largest African group represented among her clients is Ethiopians. She also has Somalian and Sudanese clients, as well as small numbers of people from many other East and West African countries.

Currently, Africa-born Africans are not separated from African Americans for AIDS case reporting in Washington State. Fick sees this as a barrier to reaching these communities. "I think it misses a whole separate population that needs a very specific approach. One that is culturally sensitive to the extreme diversity amongst the African groups. There are so many different cultures, religions, and languages."

Fick has been struck by the extreme stigma of HIV/AIDS in the African communities. "I've worked in HIV since 1988, with lots of different groups, but I've never seen such fear. People who come here literally hide. We try to normalize it by saying 'You know, if you ran into another Ethiopian [at Madison Clinic], they'd probably be here for the same reason.'" One of Fick's Ethiopian clients explained that part of this stigma was due to the connection of HIV/AIDS to illicit sex. Another factor contributing to the fear felt by many of Fick's clients may be their immigration status.

"A lot of the people are not here on a legal basis. Often times, as part of their immigration process they find out they're positive and they're very scared. They don't know what will happen to them. If they do get kicked out of the country now, they are really in big trouble, because they have HIV and they'll die" [because treatment is not available in their home country].

"A lot of what I do in a first visit is try to establish immigration status. I talk with them in a comforting way. I tell them, 'This is how I can help people who are undocumented.' So they don't have to disclose to me right away. You have to figure out what category a person is in -- how they came here, what status they have, so you know how to refer them on."

A small number of Fick's African clients have come to the United States as part of a special refugee program, after being held in camps overseas because of their HIV status. In September of 2000, 10 cities were selected as sites to provide resettlement care for HIV-positive refugees. "During the process of being designated a refugee," Fick explains, "a person goes through a medical screening, and part of that is an HIV test. If they turn up positive at that time, they're put in this other type of track [to immigration]." Thirty-five individuals will come to Seattle through this program, and the majority will receive care through the Madison Clinic at Harborview and the Country Doctor Clinic. "So far they have all been African, but they could come from other countries. They could come from Russia, South East Asia, wherever there is political uprising and people living with HIV and AIDS."

Fick believes that much more outreach is needed to provide care to the African immigrant communities. "We've gotten together with some of the staff [at Madison Clinic] who are from the African communities, and we are trying to problem solve. One suggestion was to not just focus on HIV in those communities, that they would feel targeted. Instead combine it with other health services, like education about diabetes or breast cancer. Another suggestion was to go to the churches and talk to community leaders about HIV, to get them started talking about it more. They've identified an Ethiopian physician who could do community health talks, but it hasn't moved past the planning stage."

When asked about any efforts currently being made to reach African immigrants living in Seattle, Fick responded, "People [AIDS service organizations, the Public Health Department] are aware, and they're talking about it, but it just needs to be decided how to approach it, and what agency has the time and money. We also have to be careful, to figure out how to reach out in the best, most effective, most culturally sensitive way."