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Revised August 2008

In recent years, the number of AIDS diagnoses among Asians and Pacific Islanders has increased steadily. Although Asians and Pacific Islanders account for approximately 1% of the total number of HIV/AIDS cases in the 33 states with long-term, confidential name-based HIV reporting, the Asian and Pacific Islander population in the United States is growing [1].

STATISTICS

HIV/AIDS in 2005
(The following bullets are based on data from the 33 states with long-term, confidential name-based HIV reporting. For a list of the 33 states, see the box, before the References section.)

• An estimated 417 Asians and Pacific Islanders were given a diagnosis of HIV/AIDS, representing 1.1% of the 37,331 cases diagnosed that year [2].
• Of the 475,220 persons living with HIV/AIDS, 2,996 (0.6%) were Asians and Pacific Islanders [2].
• Of those given a diagnosis, 78% were men, 21% were women, and 1% were children (under 13 years of age) [2].
• The numbers of HIV/AIDS cases may be larger than reported because of underreporting or misclassification of Asians and Pacific Islanders.

Race/ethnicity of persons (including children) with HIV/AIDS diagnosed during 2005

Note: Based on data from 33 states with long-term, confidential name-based HIV reporting.

Transmission categories for Asian and Pacific Islander adults and adolescents living with HIV/AIDS, 2005

Note. Based on data from 33 states with long-term, confidential name-based HIV reporting.

AIDS in 2005
(For information about AIDS surveillance, see the box, before the References section.)

• Of the estimated 483 Asians and Pacific Islanders who received an AIDS diagnosis in 2005, 389 (81%) were men, and 92 (19%) were women. One Asian and Pacific Islander child (under 13 years of age) received a diagnosis of AIDS [2].
• The rate of AIDS diagnosis, by race/ethnicity, was lowest for Asians and Pacific Islanders (3.6 per 100,000 population), compared with 54.1 per 100,000 for blacks (including African Americans), 18.0 per 100,000 for Hispanics, 7.4 for American Indians and Alaska Natives, and 5.9 per 100,000 for whites [2].
• An estimated 4,276 Asians and Pacific Islanders were living with AIDS, representing 1% of the 421,873 people known to be living with AIDS in the 50 states and the District of Columbia [2].
• From the beginning of the epidemic through 2005, an estimated 7,659 Asians and Pacific Islanders were given a diagnosis of AIDS [2].
• An estimated 97 Asians and Pacific Islanders with AIDS died in 2005. From the beginning of the epidemic through 2005, an estimated 3,383 Asians and Pacific Islanders with AIDS died, representing less than 1% of the 530,756 persons in the 50 states and the District of Columbia who died with AIDS [2].
• Of persons given a diagnosis of AIDS during 1997–2004, 81% of Asians and Pacific Islanders were alive 9 years after diagnosis, compared with 75% of whites, 74% of Hispanics, 67% of American Indians and Alaska Natives, and 66% of blacks [2].

Race/ethnicity of adults and adolescents living with HIV/AIDS, 2005

Note. Based on data from 33 states with long-term, confidential name-based HIV reporting.

RISK FACTORS AND BARRIERS TO PREVENTION

Although the proportion of diagnoses of HIV infection and AIDS for Asian and Pacific Islander adults and adolescents remains small relative to other racial/ethnic groups, no evidence indicates significantly lower levels of risk behaviors among this group [3, 4]. Asians and Pacific Islanders are likely to face challenges associated with the risk for HIV infection, especially in some regions of the country and for some specific ethnicities within the broader Asian and Pacific Islander group.

Sexual Risk Factors

Most of the Asians and Pacific Islanders who are infected with HIV are men who have sex with men (MSM) [2]. A cause for concern is research that points to rising levels of risk behaviors among Asian and Pacific Islander MSM in certain areas of the country, for example, indications that an HIV epidemic is emerging among young Asian and Pacific Islander MSM in San Francisco [5].

The findings of other studies support this concern. In a San Francisco study of 503 Asian and Pacific Islander MSM aged 18–29 years, the overall HIV prevalence was nearly 3%. This prevalence varied significantly by ethnicity, ranging from 0% for Vietnamese MSM to 13.6% for Thai MSM. Being of Thai ethnicity, having been born in the United States, being older, or having ever attended a circuit party or special MSM social event was associated with HIV infection. Of these 503 men, 48% reported having had unprotected anal intercourse during the past 6 months [6]. Another study conducted in San Francisco showed that the rates of unprotected anal intercourse and sexually transmitted diseases among young Asian and Pacific Islander MSM during 1999–2002 surpassed the rates for white MSM [7].

High-risk heterosexual contact is the primary way Asian and Pacific Islander women become infected with HIV [2]. In focus groups, Asian and Pacific Islander women noted cultural taboos against discussing sexual topics and power differentials between genders as reasons for difficulty in getting their partners to use condoms. Domestic violence is also a concern, as is lack of knowledge about HIV/AIDS and lack of culturally and linguistically appropriate HIV prevention programs and materials [8].

Substance Use

The use of methamphetamines and other drugs has been shown to be an important factor associated with unprotected anal intercourse among Asian and Pacific Islander MSM. According to a study of Filipino American methamphetamine users in the San Francisco Bay Area, methamphetamine use was strongly associated with behavioral risk factors for HIV infection, including infrequent condom use, commercial sex activity, and low rates of HIV testing [9]. In a study of young Asian and Pacific Islander MSM, more than half used “party drugs,” including MDMA (3,4- methylenedioxymethamphetamine, or “ecstasy”), inhaled nitrates, hallucinogens, crack, and amphetamines. The use of drugs or alcohol was associated with unprotected anal intercourse [10].

Low HIV Testing Rates

HIV testing is an important consideration for Asians and Pacific Islanders. Testing rates are lower for Asians and Pacific Islanders as a group, despite their risk factors for HIV infection. Data from an HIV testing survey in Seattle indicated that of the Asians and Pacific Islanders surveyed, 90% perceived themselves at some risk for HIV infection, yet only 47% had been tested during the past year [11]. Also, CDC’s Behavioral Risk Factor Surveillance System found that Asians and Pacific Islanders are significantly less likely than members of other races/ethnicities to report having been tested for HIV [12].

Low HIV testing rates also affect the stage of HIV disease at which diagnosis is made. CDC surveillance shows that for many Asians and Pacific Islanders, the diagnosis of HIV infection is made late in the course of disease. In 2004, 44% of Asians and Pacific Islanders received an AIDS diagnosis within 1 year after their HIV infection was diagnosed. This is in comparison to 37% of whites, 40% of blacks, 41% of American Indians/Alaska Natives, and 43% of Hispanics [2]. Increasing the number of Asians and Pacific islanders who are tested will allow those who are infected to begin health-sustaining treatment and can help to reduce further transmission of the virus.

A study that showed an increase in testing (from 63% to 71%) between its first and fourth years (1999 to 2002) found that recent testing was most significantly and consistently associated with knowledge of testing sites to which respondents felt comfortable going [13]. This finding points to the importance of culturally and linguistically relevant health services.

Cultural and Socioeconomic Diversity

Among Asians and Pacific Islanders, there are many nationalities—Chinese, Filipinos, Koreans, Hawaiians, Indians, Japanese, Samoans, Vietnamese, and others—and more than 100 languages and dialects. The subgroups differ in language, culture, and history. Because many Asians and Pacific Islanders living in the United States are foreign-born, they may experience cultural and language barriers to receiving public health messages. Additionally, many health surveys are administered only in English and perhaps Spanish, a situation that may cause miscommunication or exclude Asians and Pacific Islanders who do not speak English.

As a group, Asians and Pacific Islanders represent both extremes of socioeconomic and health issues. For example, although more than a million Asian Americans live at or below the federal poverty level ($20,650 for a family of 4 living in the 48 contiguous states or the District of Columbia), Asian American women have the longest life expectancy of any racial or ethnic group. Tailoring prevention interventions to meet the needs of this culturally and socioeconomically diverse population remains challenging [14, 15].

Data Limitations

The low number of HIV cases among Asians and Pacific Islanders may not reflect the true burden of the epidemic on this population. Not all states with large Asian and Pacific Islander populations have been conducting HIV surveillance long enough to be included in CDC’s surveillance. For example, California, where a large proportion of Asians and Pacific Islanders live, began HIV surveillance only during the past few years; thus, its HIV data are not included in CDC surveillance reports.

Additionally, race/ethnicity misclassification in medical records may contribute to the underreporting of HIV/AIDS among Asians and Pacific Islanders [12].

Limited Use of Services

Because of language and cultural barriers, lack of access to care, and other issues, many Asians and Pacific Islanders underuse health care 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 disease and used hospital-based services. Few of them, however, used HIV case management services, housing assistance, substance use treatment, or health education services [16].

PREVENTION

CDC estimates that 56,300 new HIV infections occurred in the United States in 2006 [17]. Populations of minority races/ethnicities are disproportionately affected by the HIV epidemic. In the United States, Asians and Pacific Islanders are emerging as a group that is at risk for HIV infection.

To reduce the incidence of HIV, CDC released Revised Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Health-Care Settings in 2006. These recommendations advise routine HIV screening of adults, adolescents, and pregnant women in health care settings in the United States. They also address the need to reduce barriers to HIV testing. In 2003, CDC announced an initiative, Advancing HIV Prevention. This initiative comprises 4 strategies: making HIV testing a routine part of medical care, implementing new models for diagnosing HIV infections outside medical settings, preventing new infections by working with HIV-infected persons and their partners, and further decreasing perinatal HIV transmission.

CDC, through the Minority AIDS Initiative supports efforts to reduce the health disparities experienced in communities of persons of minority races/ethnicities who are at high risk for HIV infection. CDC provides funds to community-based organizations that focus primarily on Asians and Pacific Islanders and provides indirect funding through state, territorial, and local health departments to organizations serving this population. An example of CDC-funded projects focused on the Asian and Pacific Islander population include an organization in New York City that provides client services, education, training, and technical assistance to Asian and Pacific Islander MSM who are at high risk, female and transgender sex workers, and female sex partners of men who are HIV-positive or at high risk for HIV infection.

REFERENCES

1. US Census Bureau. The Asian population: 2000. Census 2000 Brief. Available at http://www.census.gov/prod/ 2002pubs/c2kbr01-16.pdf. Accessed April 30, 2007.
2. CDC. HIV/AIDS Surveillance Report, 2005. Vol. 17. Rev ed. Atlanta: US Department of Health and Human Services, CDC: 2007:1–46. Accessed June 28, 2007.
3. Hou S-I, Basen-Engquist K. Human immunodeficiency virus risk behavior among white and Asian/Pacific Islander high school students in the United States: does culture make a difference? Journal of Adolescent Health 1997;20:68–74.
4. Peterson JL, Bakeman R, Stokes J, and the Community Intervention Trial for Youth Study Team. Racial/ethnic patterns of HIV sexual risk behaviors among young men who have sex with men. Journal of the Gay and Lesbian Medical Association 2001;5:155–162.
5. Raymond HF, Chen S, Truong H-H, et al. Trends in sexually transmitted diseases, sexual risk behavior, and HIV infection among Asian/Pacific Islander men who have sex with men, San Francisco 1999–2005. Sexually Transmitted Diseases. Published online, August 28, 2006.
6. Choi K, McFarland W, Neilands TB, et al. Low HIV prevalence but high sexual risk among young Asian American men who have sex with men: HIV prevention opportunities. XIV International Conference on AIDS; July 2002; Barcelona, Spain. Abstract MoPeC3434.
7. McFarland W, Chen S, Weide D, Kohn R, Klausner J. Gay Asian men in San Francisco follow the international trend: increases in rates of unprotected anal intercourse and sexually transmitted diseases, 1999–2002. AIDS Education and Prevention 2004;16:13–18.
8. Jemmott LS, Maula EC, Bush E. Hearing our voices: assessing HIV prevention needs among Asian and Pacific Islander women. Journal of Transcultural Nursing 1999;10:102–111.
9. Nemoto T, Operario D, Soma T. Risk behaviors of Filipino methamphetamine users in San Francisco: implications for prevention and treatment of drug use and HIV. Public Health Reports 2002;117(suppl 1): S30–S38.
10. Choi K, McFarland W, Chu PL, et al. Heavy “party” drug and polydrug use and associated sexual risk for HIV among young Asian men who have sex with men. XIV International Conference on AIDS; July 2002; Barcelona, Spain. Abstract E10725.
11. Kahle EM, Freedman MS, Buskin SE. HIV risks and testing behavior among Asians and Pacific Islanders: results of the HIV Testing Survey, 2002–2003. Journal of the National Medical Association 2005;97:13S–18S.
12. Zaidi IF, Crepaz N, Song R, et al. Epidemiology of HIV/ AIDS among Asians and Pacific Islanders in the United States. AIDS Education and Prevention 2005;17: 405–417.
13. Do TD, Hudes ES, Proctor K, Han C-S, Choi K-H. HIV testing trends and correlates among young Asian and Pacific Islander men who have sex with men in two U.S. cities. AIDS Education and Prevention 2006;18:44–55.
14. CDC, Office of Minority Health. Asian American populations. Available at http://www.cdc.gov/omh/
    Populations/AsianAm/AsianAm.htm. Accessed April 30, 2007.
15. US Department of Health and Human Services. The 2007 HHS poverty guidelines. Available at http://aspe.hhs.gov/poverty/07poverty.shtml. Accessed April 30, 2007.
16. Pounds MB, Conviser R, Ashman JJ, Bourassa V. Ryan White CARE Act service use by Asian/Pacific Islanders and other clients in three California metropolitan areas (1997–1998). Journal of Community Health 2002;27:403–417.
17. Hall HI, Ruiguang S, Rhodes P, et al. Estimation of HIV incidence in the United States. JAMA. 2008;300:520-529.