HIV and Native Hawaiians and Other Pacific Islanders

Although Native Hawaiians and Other Pacific Islanders (NHOPI) account for a very small percentage of new HIV diagnoses^a in the United States (US) and dependent areas,^b HIV affects NHOPI in ways that are not always apparent because of their small population sizes. In 2017, NHOPI made up 0.2% of the US population.^c

The Numbers

HIV Diagnoses

Source: CDC. Diagnoses of HIV infection in the United States and dependent areas, 2017 pdf icon[PDF – 6 MB]. HIV Surveillance Report 2018;29.

From 2010 to 2016, HIV diagnoses decreased 16% among NHOPI overall in the 50 states and the District of Columbia. But trends varied by gender.

Source: CDC. NCHHSTP AtlasPlus. Accessed April 25, 2019.

Living With HIV

Source: CDC. Diagnoses of HIV infection in the United States and dependent areas, 2017 pdf icon[PDF – 6 MB]. HIV Surveillance Report 2018;29.
CDC. Selected national HIV prevention and care outcomes pdf icon[PDF – 3 MB] (slides). Accessed April 25, 2019.

Deaths

In 2016, there were 14 deaths among adult and adolescent NHOPI with diagnosed HIV in the US and dependent areas. These deaths may be due to any cause.

Prevention Challenges

There are some behaviors that put everyone at risk for HIV. These behaviors include having anal or vaginal sex without protection (like a condom or medicine to prevent or treat HIV), or sharing injection drug equipment with someone who has HIV. Factors that particularly affect NHOPI include:

• Socioeconomic factors. Poverty, inadequate or no health care coverage, language barriers, and lower educational attainment among NHOPI may contribute to lack of awareness about HIV risk and higher-risk behaviors.
• Cultural factors. NHOPI cultural customs, such as not talking about sex across generations, may stigmatize sexuality in general, and homosexuality specifically, as well as interfere with HIV risk-reduction strategies, such as condom use.
• Limited research. Limited research about NHOPI health and HIV infection and small population numbers have resulted in a lack of targeted prevention programs and behavioral interventions for this population.
• Data limitations. The low reported number of HIV cases among NHOPI may not reflect the true burden of HIV in this population because of race/ethnicity misidentification. This could lead to an underestimation of HIV infection in this population.

What CDC Is Doing

CDC and its partners are pursuing a high-impact prevention approach to maximize the effectiveness of current HIV prevention interventions and strategies and improve surveillance among NHOPI. Funding state, territorial, and local health departments is CDC’s largest investment in HIV prevention.

• Under the new integrated HIV surveillance and prevention cooperative agreement, CDC awarded around $400 million per year to health departments for surveillance and prevention efforts. This award directs resources to the populations and geographic areas of greatest need, while supporting core HIV surveillance and prevention efforts across the United States.
• In 2019, CDC awarded a new cooperative agreement to strengthen the capacity and improve the performance of the nation’s HIV prevention workforce. New elements include dedicated providers for web-based and classroom-based national training, and technical assistance tailored within four geographic regions. The Asian and Pacific Islander American Health Forumexternal icon is funded under this effort.
• Under the flagship community-based organization cooperative agreement, CDC awarded about $42 million per year to community organizations. This award directs resources to support the delivery of effective HIV prevention strategies to people at greatest risk. Special Service for Groups/APAITexternal icon is funded under this effort.
• The CDC publication Effective HIV Surveillance Among Asian Americans and Native Hawaiians and Other Pacific Islanders pdf icon[PDF – 312 KB] provides recommendations for improving HIV surveillance activities for health departments in states with high concentrations of Asians and NHOPIs. CDC continues to collect and report data for Asian and NHOPI populations separately in annual, supplemental, and special surveillance reports and annual program monitoring reports.

• Through its Let’s Stop HIV Together (formerly Act Against AIDS) campaigns and partnerships, CDC provides NHOPI with effective and culturally appropriate messages aimed at stopping HIV stigma and promoting HIV testing, prevention, and treatment. The stigma materials include stories and issues relevant to NHOPI, as do the following:
  • Doing It encourages all people to know their HIV status and protect themselves and their community by making HIV testing a part of their regular health routine.
  • Start Talking. Stop HIV. helps gay and bisexual men communicate about testing and a range of HIV prevention strategies.
  • HIV Treatment Works shows how people living with HIV have overcome barriers to stay in care and provides resources on how to live well with HIV.
  • Partnering and Communicating Together (PACT) to Act Against AIDS is raising awareness about testing, prevention, and retention in care among populations disproportionately affected by HIV, including NHOPI.

^a HIV diagnoses refers to the number of people who received an HIV diagnosis during a given time period, not when the people got HIV infection.
^b Unless otherwise noted, the term United States (US) includes the 50 states, the District of Columbia, and the 6 dependent areas of American Samoa, Guam, the Northern Mariana Islands, Puerto Rico, the Republic of Palau, and the US Virgin Islands.
^c The US Census Bureau’s population estimates include the 50 states, the District of Columbia, and Puerto Rico.