HRSA

Asian/Pacific Islanders and HIV/AIDS in the United States

The term “Asian/Pacific Islander” (A/PI) is used to refer to approximately 40 cultures—representing more than 100 languages and dialects—that vary widely in region of origin, tradition, and religion.1 A/PIs are concentrated in several parts of the country, particularly the West Coast, the New York City metropolitan area, and Hawaii.

Surveillance

  •  In 2004, the estimated AIDS rate among A/PIs was just 3.7 cases per 100,000 population.2 However, advocates remain concerned about the misclassification of data and undercounting of AIDS cases in the A/PI community. Such issues, along with small sample size, may hinder the development of an accurate understanding of the needs of the A/PI population.
  • During 2004, an estimated 488 new AIDS cases were reported among A/PIs, an increase of 2.1 percent over 2003 and of 39.4 percent over 2000.3 
  • At the end of 2004, an estimated 4,045 A/PIs were living with AIDS in the United States; 644 were women, 3,384 were men, and 17 were children.4

Men

  • For A/PI men living with AIDS, men who have sex with men (MSM) was the HIV exposure category in an estimated 72 percent of cases, compared with an estimated 75 percent of cases among Whites.4
  • In 2002, HIV/AIDS was the seventh leading cause of death among A/PI men ages 15 to 19; for A/PI men ages 25 to 34, HIV/AIDS was the sixth leading cause of death.5

Women

  • Among A/PI women living with AIDS, heterosexual contact (an estimated 76 percent of cases) was more likely to have been the HIV exposure category than for women of any other race in 2004.4 
  • In 2002, HIV/AIDS was the eighth leading cause of death for A/PI women ages 25 to 34. For women ages 35 to 44, HIV/AIDS was the seventh leading cause of death.6

CRITICAL ISSUES

During the past decade, immigration was responsible for almost 90 percent of the growth in the A/PI population in the United States. Many of these new U.S. residents are unfamiliar with the American health system and have difficulty obtaining services.7

Although the rates of HIV/AIDS infection are lower among A/PIs than among other population groups, it is projected that infection rates will increase because A/PIs represent a growing proportion of the U.S. population.8,9 

A/PIs living with HIV/AIDS often experience tension between respecting family and community values and accessing specialized systems of HIV/AIDS care.10 A/PI perceptions about family relationships and responsibilities, as well as cultural beliefs about health and illness, can have tremendous repercussions.8 These issues, coupled with providers’ lack of cultural competence, may influence A/PIs’ service-seeking behavior and deter them from disclosing their status.8 Moreover, the stigma associated with having HIV/AIDS may cause A/PIs to underreport their status or forego testing.9

In one study, A/PI participants reported that the perceived consequences inherent to “owning” their HIV status made them reluctant to pursue supportive networks. Many A/PIs who took part in the study also admitted to feeling unworthy of help.8 

One study recently found that A/PIs and Blacks were most likely of all racial and ethnic groups to seek primary care in hospital outpatient clinics instead of through publicly funded health clinics, emergency rooms, private offices, or private community-based organizations. Among study participants, only Hispanics were more likely than A/PIs to lack health insurance. A/PIs were significantly less satisfied than other racial and ethnic groups with physician courtesy, respect, sensitivity, friendliness, and concern. A/PIs were also less satisfied with the degree of provider emphasis on preventing illness and promoting good health.7 

Asians and Pacific Islanders and the Ryan White CARE Act

The Health Resources and Services Administration (HRSA) has funded the Asian and Pacific Islander Coalition on HIV/AIDS in New York to evaluate the effectiveness of multilingual and cultural case management services for A/PIs living with HIV. HRSA also has funded the Asian and Pacific Islander Wellness Center in San Francisco to develop a manual for health service providers who serve A/PIs living with HIV.

HRSA has collaborated with the Asian and Pacific Islander American Health Forum and other community partners representing minority MSM in a research project on access to care for MSM of color. Results are currently influencing the HRSA-Centers for Disease Control and Prevention (CDC) collaborative response to the epidemic among these populations.

In collaboration with the African-American AIDS Policy and Training Institute, the Asian and Pacific Islander Health Forum, Bienstar, and the National Native American AIDS Prevention Center, HRSA conducted a research project involving key informant interviews and structured roundtable discussions to identify barriers to care for MSM of color and develop solutions. The results of the publication Improving Care for HIV-Positive Men of Color Who Have Sex With Men: Barriers and Recommendations are shaping the process through which HRSA and the Centers for Disease Control and Prevention (CDC) are collaboratively responding to the epidemic among young MSM of color.

To increase access to quality care for minorities and respond to the need for additional minority providers of state-of-the-art HIV/AIDS care in underserved communities, the CARE Act funds the National Minority AIDS Education and Training Center program to expand clinical expertise in minority communities. More information is available at www.nmaetc.org.

Capacity-building and planning grants have been targeted to underserved communities to expand the number of service settings available to vulnerable minority populations.

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A/PI Women Living With AIDS, by Exposure Category 2004 This pie chart depicts A/PI women living with AIDS, by exposure category, 2004. IDU 15.8%, heterosexual contact 76.2%, other 7.9%.A/PI Men Living With AIDS by Exposure Category 2004 This pie chart depicts A/PI men living with AIDS, by exposure category, 2004. MSM 72.5%, IDU 9.3%, MSM/IDU 4.8%, Heterosexual contact 11.4%, other 2.2%

 

 

 

 

 

 

References

1  President’s Advisory Commission on Asian Americans and Pacific Islanders. Asian Americans and Pacific Islanders; A People Looking Forward. Executive Summary. Washington, DC: Author; 2001. p. 4.

2  Centers for Disease Control and Prevention (CDC). HIV/AIDS Surveillance Report. 2004;16:14. Table 5a.

3  CDC. HIV/AIDS Surveillance Report. 2004;16:12. Table 3.

4  CDC. HIV/AIDS Surveillance Report. 2004;16: 21. Table 11.

5  Anderson RN, Smith BL. Deaths: leading causes for 2002. Natl Vital Stat Rep. 2005;53(17):42. Table 1. Available at: www.cdc.gov/nchs/data/nvsr/
nvsr53/nvsr53_17.pdf.

6  Anderson RN, Smith BL. Deaths: leading causes for 2002. Natl Vital Stat Rep. 2005;53(17):47. Table 1. Available at: www.cdc.gov/nchs/data/nvsr/
nvsr53/nvsr53_17.pdf.

7  Pounds MB, et al. Ryan White CARE Act service use by Asian/Pacific Islanders and other clients in three California metropolitan areas (1997-1998). J Community Health. 2002;27: 6:403-17.

8  Kang E, et al. Multiple dimensions of HIV stigma and psychological distress among Asians and Pacific Islanders living with HIV illness. AIDS Behav. 2005; 9(2): 145-54.

9  Wilson PA, Yoshikaw H. Experiences of and responses to social discrimination among Asian and Pacific Islander gay men: their relationship to HIV risk. AIDS Educ Prev. 2004;16(1): 68-83.

10  Asian and Pacific Islander American Health Forum. HIV counseling, testing, and referral interventions for Asian and Pacific Islanders. April 2004. Available at: www.apiahf.org/programs/
hivcba/resources/
publications/APIHF_
CTRinterventions.pdf.

U.S. Department of Health and Human Services - Health Resources and Services Administration - HIV/AIDS Bureau
5600 Fishers Lane - Room 7-05 - Rockville, MD 20857 - 301-443-1993 - www.hab.hrsa.gov