3. Promoting HIV Testing in Diverse Populations
Factors That Impede HIV Testing Among Asian/Pacific Islanders
Although the proportion of diagnoses of HIV infection and AIDS for Asian and Pacific Islander adults and adolescents is small relative to other racial/ethnic groups, comparable levels of risk behaviors occur within these population. [Hou 1997, Peterson 2001, Nemoto 1998]. Testing rates are lower for Asians and Pacific Islanders as a group, despite their risk factors for HIV infection. Kahle and colleagues reported that among Asians and Pacific Islanders surveyed in Seattle, 90% perceived themselves at some risk for HIV infection, yet only 47% had been tested during the past year. [Kahle 2005] The CDC’s Behavioral Risk Factor Surveillance System also found that Asian/Pacific Islanders are significantly less likely than members of other races/ethnicities to report having been tested for HIV. [Zaidi 2005]
A large diversity of nationalities comprise the population of Asian/Pacific Islanders—Chinese, Burmese, Filipinos, Koreans, Hawaiians, Indians, Japanese, Samoans, Vietnamese, and others—with > 100 languages and dialects. Because many Asian/Pacific Islanders living in the United States are foreign-born, they may experience cultural and language barriers to receiving public health messages, including those regarding HIV risk factors and the importance of being tested. In addition, many health surveys are administered only in English and sometimes Spanish, a situation that may cause miscommunication or exclude Asian/Pacific Islanders who speak little or no English.
Because of language and cultural barriers, lack of access to care, and other issues, many Asians and Pacific Islanders underuse healthcare and prevention services. A study of the use of HIV services by 653 Asians and Pacific Islanders showed that a relatively high proportion had advanced HIV disease and used hospital-based services. Few of them, however, used HIV case management services, housing assistance, substance use treatment, or health education services. [Pounds 2002]
Practical implications of these factors may include:
- Lack of appropriate linguistic and cultural competencies among physicians and other healthcare providers
- Cultural inhibitions regarding discussing sexual behavior, death, and illness, preventing the spread of useful prevention, testing, and treatment information
- Women’s reluctance to consider their own health concerns on a level equal to that of their families, possibly resulting in delay to seek care until they are already ill
