Ten Reasons to Address HIV/AIDS in Asian American and Pacific Islander Communities

Ed. note: This is cross-posted on blog.AIDS.gov. See the original post here.

Each year on May 19, we take time to reflect on the impact of the HIV epidemic on Asian Americans and Pacific Islanders (AAPIs). This includes listening to members of AAPI communities as they discuss how HIV has affected their lives and the lives of those they care about. Recently, my team asked our colleagues at The Banyan Tree Project, the group that sponsors National Asian and Pacific Islander HIV/AIDS Awareness Day, for their top reasons why it is so important to respond to HIV in AAPI communities. From their concerns, I offer this synthesis:

• Low HIV testing rates and late testing. According to the CDC, more than one-third of Asians develop AIDS soon after being diagnosed, which may mean they are not receiving adequate care and treatment in time to prevent the development of AIDS.
• Too many AAPIs are unaware of their HIV status. Also according to CDC [PDF 1.07KB], nearly one in four (22.7%) Asians living with HIV, and more than one in four (26.7%) Native Hawaiian/other Pacific Islanders living with HIV, don’t know it. Without knowledge of their HIV status, these individuals are unable to take advantage of HIV medicines (known as antiretroviral therapy) that can both extend their lives and reduce the risk of transmission to others.
• High HIV stigma. HIV-related stigma is a primary barrier to HIV testing and access to services in AAPI communities. For this reason, it is important to build a community where AAPIs living with, and at risk for HIV, feel safe, respected and accepted.
• Not enough conversation about HIV and sexual health. Stigma also discourages AAPI people from talking openly about sexual health and HIV, which can have a detrimental health impact.
• Culturally relevant HIV services are not always available. AAPIs represent many diverse countries of origin, cultures and customs, and require health services that are culturally relevant. Yet, HIV prevention, care and treatment services are not always available to AAPIs in culturally suitable ways, which decreases the likelihood that they will know about or choose to access these services. HIV services that are respectful of and responsive to individuals’ cultural needs are critical.
• Linguistically relevant HIV services are also needed. English language fluency is a barrier to health care for many AAPIs. According to the U.S. Census, in 2011, 76.5% of Asian Americans spoke a language other than English at home. Native Hawaiians and other Pacific Islanders also speak a variety of different languages at home. HIV services and materials should be responsive to AAPIs’ linguistic needs.
• Some providers do not always encourage HIV testing. CDC recommends that all individuals between the ages of 13 and 64 get tested for HIV at least once as part of routine medical care, and that gay and bisexual men and others at high risk for HIV infection be tested more frequently. Yet, some health care providers and HIV prevention practitioners do not always encourage AAPIs and others to get tested. Providers should continue to increase their awareness of the importance of HIV testing for all individuals.

I would like to share some other health concerns affecting AAPIs at risk:

• High hepatitis B infection. AAPIs are one of the groups hardest hit by hepatitis B (HBV), which can lead to liver cancer. People living with HIV who are co-infected with HBV are at increased risk for serious, life-threatening health complications.
• High tuberculosis case rates. Tuberculosis (TB) rates remain high among AAPIs. TB and HIV can work together to shorten the lifespan of people doubly infected.
• Other health conditions. Many AAPIs are affected by other health conditions, such as cancer, heart disease, stroke and diabetes, which can further threaten the health of those at risk for and living with HIV.

In spite of these challenges, many important advances can reduce the health burdens experienced in AAPI communities. These include the U.S. Department of Health and Human Services’ enhanced National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care (CLAS Standards), the recent release of the updated Action Plan for the Prevention, Care and Treatment of Viral Hepatitis, and the increased access to quality health coverage offered through the Affordable Care Act.

As we commemorate National Asian and Pacific Islander HIV/AIDS Awareness Day, we continue to listen to the voices of those within AAPI communities. I encourage you to visit the Banyan Tree Project’s Taking Root: Our Stories, Our Communities project, where AAPI living with or affected by HIV relate their personal stories. By listening to one another with compassion, we can break down the barriers of stigma and discrimination and work together to improve the lives of those living with and affected by this disease.

Howard K. Koh, M.D., M.P.H., is the Assistant Secretary for Health, U.S. Department of Health and Human Services.