Presentation By Thuan Tran Minnesota Department of Health National Asian and Pacific Islander HIV/AIDS Awareness Day Event May 15, 2007 Presentation By Thuan Tran Minnesota Department of Health

Asian and Pacific Islanders (APIs) According to Census 2000 Data, APIs represent the fastest growing ethnic community in the U.S. At approximately 10 million people (3.6% of total population), currently API comprise 13% of the non-white U.S. population. As of 1990, 66% of Asians and 87% of Pacific Islanders were foreign-born. Among APIs, there are many different nationalities – Chinese, Filipinos, Hawaiians, Korean, Hmong, Vietnamese, and others- and more than 100 languages, as well as cultural diversity and differing immigration experiences.

APIs in Minnesota 2000 Census Data for MN Total Population 4,919,479 Total APIs: 143,947 (3%) Asian Indian 16,887 Chinese 16,060 Filipino 6,284 Japanese 3,816 Korean 12,584 Vietnamese 18,824 Other 67,513 Native Hawaiian and other PI 1,979

HIV/AIDS HIV – Human Immunodeficiency virus AIDS – Acquired Immunodeficiency Syndrome CDC – in 1993 CDC revised the classification system for AIDS to emphasize the importance of CD4+ T-lymphocyte count (less than 200 CD4+ T-lymphocytes/uL, or a CD4+ T-lymphocyte percentage of total lymphocytes of less than 14)– and retains the 23 clinical conditions in the AIDS surveillance case definition published in 1987.(3) According the CDC, during the mid-to-late 1990s, advance in treatment slowed the progression of HIV infection to AIDS.(4)

APIs and HIV/AIDS According to the CDC, the number of APIs living with AIDS has climbed by more than 10 percent in each of the last 5 years.(4) There are an estimated 4,356 APIs living with AIDS through 2005 in the U.S.(4) A study, from the Journal of Community Health 2002, in three California metropolitan areas, showed that of the 653 APIs in the Ryan White care service system surveyed, a relatively high proportion has advanced disease and used hospital-based services(5).

HIV/AIDS Prevalence APIs in Minnesota As of 12/31/06, 83 (1%) API cases have been reported 11 APIs have died Of the 83 API cases, 53 were males and 30 females Cambodia-12, China-5, India-8, Laos-12, Thailand-8, Viet Nam-9, US born- 10, (no info. - 19) Of the 53 male API cases, 86% were among men who have sex with men (MSM), 4% heterosexuals, and 6% injection drug users (IDU) and 4% MSM/IDU Of the 30 females, 87% were among heterosexuals and 13% other (hemophilia, transplant, transfusion, mother with HIV, or HIV risk)

Risk Factors and Barriers to Prevention Race and ethnicity are not, by themselves, risk factors for HIV infection. However, Asians and Pacific Islanders are likely to face challenges associated with the risk for HIV infection, including the following: Sexual Risk Factors Substance Use Access to services due to Cultural and Socioeconomic Factors According to the National Minority AIDS Council, the poverty rate for API families is double that of white families.(6)

Barriers to Prevention Cultural avoidance of discussing issues of sexual behavior, illness and death can be barriers to HIV prevention. Although API MSM are at significant risk for HIV, the lack of peer and community support for sexual and racial diversity often are barriers to self-esteem and positive self-identity. Foreign-born APIs may have low or no English skills, and very few programs provide interventions in API languages.

Where do we go from here? Important for community planning group and the health department to collect data about unmet needs of API communities for HIV prevention and services. Culturally appropriate strategies for HIV prevention: (1) interventions that incorporate the entire family and community rather than focus solely on individual behavior change. (2) Community Mobilization, Reducing Stigma, Identify pending needs of communities (i.e. ESL classes)

Where do we go from here? (continued) For more marginalized API populations such as API gay men, peer-based programs are important. The Asian and Pacific Islander American Health Forum (APIAHF) and Asian Pacific AIDS Intervention Team (APAIT) utilize a prevention approach that addresses dual identities, community, racism, and homophobia to address positive self identify and improved self esteem. Outcome evaluations shows men who participated become more knowledgeable and more concerned about HIV infection and reported fewer partners.

Where do we go from here? (continued) Given that the World Health Organization estimates that 11 million people in Asia are living with HIV and the immigration and migration pattern of APIs, a greater focus on HIV prevention targeting APIs living in the US is critical. More resources are needed to develop, evaluate and replicate linguistically accessible and culturally appropriate HIV prevention interventions for API communities.

Where do we go from here? (continued) Community Cooperative Council on HIV/AIDS Prevention (CCCHAP) – a community planning group that advises the Minnesota Department of Health on its work related to HIV prevention. Specifically, CCCHAP identifies and prioritizes the populations in Minnesota most at risk for becoming infected with or transmitting HIV www.health.state.mn.us/divs/idepc/diseases/hiv/taskforce/index.html

Resources Asian and Pacific Islander American Health Forum (APIAHF) – funded by CDC since 1993, a national program, based in San Francisco, that provides training, technical assistance and has sought to increase the organizational and programmatic capacities of community-based organizations (CBOs) and health departments. www.apiahf.org

Resources (continued) API HIV/AIDS Resources: OMHRC, contact Henry Ocampo at 1-800-444-6472, ext. 282 Tagalog, Kmer, Vietnamese, Korean, Spanish, English API HIV/AIDS Collaborative of Minnesota Nancy Pomplun at: nancy_pomplun@yahoo.com

References 1. Centers for Disease Control and Prevention. HIV/AIDS Surveillance Report 2000. 2. US Census Bureau. The nation’s Asian and Pacific Islander population 1994. US Department of Commerce, Economics, and Statistics Administration. 1995. 3. Center for Disease Control and Prevention. HIV/AIDS Surveillance Report 1997. 4. Asian/Pacific AIDS Coalition, Asian and Pacific Islander AIDS Case Surveillance: Recommendations for Future Policy Directions, 1994. 5. Chen MS, Hawks BL. A debunking of the myth of healthy Asian Americans and Pacific Islanders. American Journal of Health Promotion. 1995. National Minority AIDS Council. HIV/AIDS & Asian and Pacific Islanders, 1999.