1. If you build it, will they come? The APICHA HIV Primary Care Clinic: From inception to strategic expansion Victor K. Inada, MD—Medical Director, APICHA HIV Primary Care Clinic Asian & Pacific Islander Coalition on HIV/AIDS The APICHA Primary Care Clinic opened its doors in 2003 the newest program of the Asian & Pacific Islander Coalition on HIV/AIDS—a community-based organization with a mission to provide services to underserved Asian and Pacific Islanders in the New York City area living with HIV/AIDS. From 7 patients in 2003, the APICHA HIV Primary Care Clinic now provides HIV primary care to over 90 active patients, free HIV and syphilis testing to over 1200 clients per year, and affordable STD screening and treatment services to its community. Established in 1989, APICHA is a premier non-profit AIDS service organization based in New York City, primarily serving the vastly diverse Asians and Pacific Islanders (APIs) of the city. It was founded to combat AIDS-related discrimination and to support, empower, and enhance the quality of life of Asians and Pacific Islanders in the New York City area, particularly those living with AIDS and HIV. APICHA started as a grassroots organization. It was founded in response to the lack of services for APIs. APICHA has developed a one-stop model of service delivery incorporating a whole range of HIV services to help individuals at risk for infection to remain healthy and, for those who are infected with the virus, to access treatment. APICHA serves populations that collectively represent 12% of New York City’s total population -- speaking over 100 languages. APIs are overwhelmingly immigrants – as much as 75% in New York City. For this reason, APICHA developed programs that are responsive to the cultural and linguistic needs of its constituency. The organization has prevention programs for youth, women, and individuals that identify themselves as gay, bisexual and transgender. In early 2006, APICHA carried out a community mapping study designed to improve the understanding of the health needs and barriers facing Asian and Pacific Islanders in New York City at risk for HIV/AIDS. The study sought to assess sexual health knowledge, attitudes, and behaviors, health-seeking behaviors, and awareness of APICHA in New York City in an effort to characterize HIV/AIDS risk and ways APICHA can link high-risk groups to its health services more effectively.. The APICHA HIV Primary Care Clinic is supported by Part C Early Intervention Services of the Ryan White HIV/AIDS Treatment Modernization Act of the Health Resources and Services Administration of the U.S. Department of Health and Human Services. The community mapping project was made possible by funds from the New York City Communities of Color HIV/AIDS Coalition Outreach and Advocacy Initiative of the New York City Council. Consultant Wendy Chan of Definity Marketing managed the community mapping project and compiled initial results. APICHA MPH intern Jessie Mai performed additional statistical analyses on collected data. Background Methodology Results Conclusion Acknowledgements The study targeted men who have sex with men (MSM) and women from five Asian and Pacific Islander language groups in New York City: Chinese Hindi Japanese Korean Vietnamese Separate questionnaires collecting sexual knowledge, attitudes, and behaviors, health- seeking behaviors, awareness of APICHA, and demographic data were developed for MSM and women. Both sets of questionnaires were bilingual, featuring English and parallel translations of each of the five target languages. Flyers, community board posting (Craig ’ s List) and referral were used to recruit qualified individuals as interviewers. All interviewers were bi- or multi-lingual. At the end of the three-week period, interviewers had recruited 157 MSM and 165 women to complete questionnaires 68.8% of MSM reported ever having tested for HIV or other sexually transmitted infections (STIs). oA majority (73.1%) were tested at a free clinic, while 25.9% were tested at a private physician’s office. 57.9% of women reported having ever been tested for HIV or other STIs. oA minority (35.8%) were tested at a free clinic, while 56.8% were tested at a private physician’s office. Results MSM who have health insurance were 3.77 times as likely to have been tested for HIV or other STIs despite most men reporting that they received testing in free clinics (95% CI for OR 1.48-9.65). As with MSM, testing was higher among women with health insurance: 63.6% of the women with health insurance had been tested compared to 45.8% of women without health insurance (p=0.037). Because a large proportion of APIs in New York City are immigrants—nearly 3/4 of our sample were foreign-born—HIV prevention programs should address economic difficulties and the difficulties in accessing healthcare that face this community. oOur study found that HIV testing was higher among insured individuals, suggesting an elevated level of risk among uninsured individuals. oTherefore, the uninsured are a good target for HIV prevention and outreach efforts. Many of women’s current health behaviors, particularly being tested for HIV/AIDS, seem incidental to general health activities. oBuilding bridges between APICHA, other free clinics, and private healthcare providers where many women currently seek care may be a means to reach this underserved community. These findings build a platform on which APICHA and other groups can build more effective HIV-prevention and recruitment programs. As the nature of the HIV/AIDS epidemic and the populations afflicted change, so must the understanding of the disease and strategies to increase access to care. Conclusions