amfAR, The Foundation for AIDS Research

HIV Among Asian-Americans and Pacific Islanders—A Problem Too Often in the Shadows

api logoIn the United States from 2011 to 2015, HIV diagnoses increased by 28% among Asians and Pacific Islanders, and by 35% among Asian gay and bisexual men. Although HIV rates in these communities are still relatively low, high levels of stigma leave many living with HIV undiagnosed and untreated. To address this problem, the San Francisco Community Health Center (formerly API Wellness), a federally qualified health center serving LGBTQ people of color, started The Banyan Tree Project to end HIV/AIDS-related stigma in Asian and Pacific Islander communities in the United States through education and storytelling. The Banyan Tree Project leads National Asian and Pacific Islander HIV/AIDS Awareness Day, held every year on May 19.

To learn more about how HIV affects Asians and Pacific Islanders, amfAR spoke with Lance Toma, LCSW, chief executive officer at the San Francisco Community Health Center.


amfAR: The CDC estimates that only about 80% of Asians living with HIV in the United States have received a diagnosis, a lower rate than for any other race or ethnicity. What types of outreach efforts have you found to be most effective in increasing HIV testing among Asians and Pacific Islanders, especially MSM?

Lance Toma: For years San Francisco Community Health Center—formerly API Wellness Center—has worked to increase HIV testing rates in our Asian and Pacific Islander communities. We have known that our communities were not getting tested early enough. All the HIV testing campaign messages from the beginning of the epidemic never included APIs in a strategic way. These messaging efforts and prevention interventions never understood the deep issues of shame and stigma that are prevalent and pervasive in our communities and families. This is why we worked with CDC to launch the National API HIV/AIDS Awareness Day in 2005.

Since the late 1980s, we’ve been conducting outreach at bars and clubs, community and cultural events, religious and faith-based institutions, and bath houses and sex clubs. We continue to do this so that we can make sure our API queer community has the most up-to-date information and access to HIV testing, treatment services, prevention education, and PrEP. The bottom line is that HIV-related stigma and shame continues to permeate our communities and negatively impact our HIV testing rates and why we will continue to lag behind with respect to uptake of all the incredible biomedical prevention and treatment options currently available.

We designed the Banyan Tree Project alongside National API HIV/AIDS Awareness Day to specifically combat stigma in our API communities. We set out to address this complicated issue through a culturally tailored form of storytelling, creating short videos of first-hand accounts of API community members sharing life-changing moments related to HIV. We created a library of these videos and have shared them at community events, through national webinars, and through various social media outlets. I think these videos have been incredibly impactful in our communities, where it is equally as important to changes the hearts and minds of our family members—our aunties and uncles, our grandparents, our brothers and sisters—as it is to get out the most up-to-date HIV prevention and treatment information.


amfAR: Rates of HIV care and viral suppression are low among Asians living with HIV, even among those who have been diagnosed. Why is this the case?

Toma: In San Francisco, we are making incredible strides in our rates of retention in medical care and adherence to HIV medications, and we do all we can to focus on the most marginalized and stigmatized communities. At San Francisco Community Health Center, we have specific programs targeting the API community so our rates of viral suppression are high and we do all we can to keep our community members engaged in care and provide all kinds of support to do this. However, we know that this is not the case in other areas across the US. Our fight at the national level for API-specific and people of color-specific HIV funding has been less and less successful in recent years. Because of a marked decrease in focused funding for API and Native American communities, API- and Native-focused HIV organizations and programs across the country have closed down. We know that we must keep up our work to continue advocating for the needs for all people of color—and especially gay men and trans women of color—and particularly for APIs and Native Americans. There is still so much work to do.


amfAR: Limited knowledge of and access to PrEP is a problem in much of the country. What do you think should be done to increase its use, especially among Asians and Pacific Islanders?

Toma: At San Francisco Community Health Center, we have been focusing efforts to increase PrEP “readiness” in both the API communities and the trans community. What we have found since the introduction of PrEP is that our communities were not learning the fundamentals about this prevention method and had no motivation to go to their health care provider to request a prescription. In many ways, we still need to educate our communities on some of the basics, to dispel misinformation about PrEP, and to help move folks to this next step of “readiness.” We also see that it is about setting norms in our communities. We encourage and support our clients to talk about PrEP to friends and sexual partners on regular basis. We are harnessing all the lessons we’ve learned about what it takes to get HIV testing to our communities and apply these lessons to how we will increase acceptability of PrEP in our API communities.


amfAR: What are some of the unique challenges faced by the low-income people of color, including Asians and Pacific Islanders, served by the San Francisco Community Health Center?

Toma: This question is the getting to the core of what it will take for San Francisco and the rest of the country to end this epidemic of HIV. We are constantly figuring out how we can do better to serve the hundreds of low-income people of color living with HIV who are accessing care and support at San Francisco Community Health Center. In San Francisco, the challenges are clear and the crisis of income inequality in our city is undeniable. We are seeing extremely high rates of substance abuse and mental illness, exacerbated by housing instability. In fact, many of our clients that come through our doors are marginally housed or homeless. For us, our efforts to provide quality health care, including HIV care, for our most marginalized and stigmatized is an enormous privilege. We need to continue our efforts so that our API and Native American and trans and gay men of color communities do not get left behind. This has always defined who we are as an organization.


More from the CDC:
HIV Among Asians
HIV and Native Hawaiians and Other Pacific Islanders