3. Promoting HIV Testing in Diverse Populations
Asian and Pacific Islander Populations
Although Asians and Pacific Islanders comprise only approximately 1% of the total number of HIV cases in the 40 states that have used confidential name-based HIV reporting since 2006, the number of diagnoses in this diverse population group has been steadily increasing. In addition, HIV cases among Asian/Pacific Islanders may be underreported due to factors such as misclassifications of individual patients in medical records. Furthermore, the US Asian and Pacific Islander population is growing. [Census Bureau Overview 2010]. Although the proportion of diagnoses of HIV infection and AIDS for Asian and Pacific Islander adults and adolescents remains small compared with other racial/ethnic groups, no evidence indicates that risk behaviors among this group are significantly lower. [Hou S-I 1997, Peterson 2001]
As of 2009, the rate of AIDS diagnosis by race or ethnicity was lowest for Asians (6.4 per 100,000 population) compared to 66.6 per 100,000 for African Americans, 22.8 per 100,000 for Latinos, 9.8 for American Indian/Alaska Natives, and 7.2 per 100,000 for whites. [CDC Surveillance 2009] Approximately two-thirds of HIV-infected male Asian/Pacific Islanders are MSM. [CDC Surveillance 2005] High-risk heterosexual activity and IDU—at 16% and 11%, respectively—were the next-highest risk categories. In certain areas of the country, such as San Francisco, indications are emerging that levels of risky behaviors among Asian/Pacific Islander are rising. [Raymond 2006.] The findings of other studies support this concern. In a San Francisco study of 503 Asian/Pacific Islander MSM 18 to 29 years of age, HIV prevalence was nearly 3%—ranging from 0% for Vietnamese to 13.6% for Thais. [Choi 2002] Another San Francisco study found that rates of unprotected anal intercourse and sexually transmitted diseases among young Asian/Pacific Islander MSM during 1999 to 2002 were higher than rates in white MSM. [McFarland 2004] Several studies have shown that among Asian/Pacific Islander MSM the use of methamphetamines and other drugs is an important factor associated with behavioral risk factors for HIV infection—including infrequent condom use, commercial sex activity, and low rates of HIV testing. [Nemoto 2002, Choi 2002]
At 80%, high-risk heterosexual contact represents the primary risk factor among HIV-infected Asian/Pacific Islander women, followed by IDU at 16%. [CDC Surveillance 2005] A 1999 study reported that cultural taboos against discussing sexual topics and power differentials between genders are among the reasons for difficulty in getting Asian/Pacific Islander women’s partners to use condoms. Other concerns include domestic violence, lack of knowledge about HIV disease, and lack of culturally and linguistically appropriate HIV prevention programs and materials. [Jemmott 1999]
