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 .
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
- 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 .
- Of the 475,220 persons living with HIV/AIDS, 2,996 (0.6%) were Asians and Pacific
- Of those given a diagnosis, 78% were men, 21%
were women, and 1% were children (under 13
years of age) .
- 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
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 .
- 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 .
- 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 .
- From the beginning of the epidemic through 2005, an estimated 7,659 Asians and Pacific Islanders were given a diagnosis of AIDS .
- 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 .
- 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 .
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) . 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 .
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 . 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 .
High-risk heterosexual contact is the primary
way Asian and Pacific Islander women become
infected with HIV . 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 .
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 . 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 .
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 . 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 .
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 . 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
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 . This finding points
to the importance of culturally and linguistically
relevant health services.
Cultural and Socioeconomic
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].
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 .
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
that 56,300 new HIV infections occurred in the United States in 2006 . 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
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,
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.
Understanding HIV and AIDS Data
surveillance: Through a uniform system, CDC receives reports of AIDS cases from all US states and dependent areas. Since the beginning of the epidemic, these data have been used to monitor trends because they are representative of all areas. The data are statistically adjusted for reporting delays and for the redistribution of cases initially reported without risk factors. As treatment
has become more available, trends in new AIDS diagnoses no longer accurately represent trends in new HIV infections; these data now represent persons who are tested late in the course of HIV infection, who have limited access to care, or in whom treatment has failed.
HIV surveillance: Monitoring trends in the HIV
epidemic today requires collecting information on HIV cases that have
not progressed to AIDS. Areas with confidential name-based HIV infection reporting requirements
use the same uniform system for data collection
on HIV cases as for AIDS cases. A total of 33 states
(Alabama, Alaska, Arizona, Arkansas, Colorado, Florida,
Idaho, Indiana, Iowa, Kansas, Louisiana, Michigan,
Minnesota, Mississippi, Missouri, Nebraska, Nevada,
New Jersey, New Mexico, New York, North Carolina,
North Dakota, Ohio, Oklahoma, South Carolina,
South Dakota, Tennessee, Texas, Utah, Virginia, West
Virginia, Wisconsin, and Wyoming) have collected
these data for at least 5 years, providing sufficient data
to monitor HIV trends and to estimate risk behaviors for
HIV/AIDS: This term is used to refer to 3 categories of diagnoses collectively: (1) a diagnosis of HIV infection (not AIDS), (2) a diagnosis of HIV infection and a later diagnosis of AIDS,
and (3) concurrent diagnoses of HIV infection and AIDS.
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