National Asian + Pacific Islander HIV + AIDS Awareness Day (NAPIHAAD) is observed annually on May 19, and it began 16 years ago thanks to a group in California called API Wellness. Up to this point, the faces of the AIDS crisis were predominantly white gay men, and presently, the most at-risk demographic is African American men. Nowhere in the picture has there been a spotlight on the Asian and Pacific Islander (API) community. Consequently, this has resulted in low testing rates, stigma, and elevated rates of contraction of HIV. This observance day seeks to end the silence and shame surrounding HIV and AIDS in Asian and Pacific Islander communities, help prevent HIV transmission, and help those who are living with HIV. And what better way to break the silence on this year’s NAPIHAAD than by sharing the powerful story of our friend Evan. Listen below as he tells his story of challenges, hardships, resilience, and hope!

According to the CDC, 66.5% of Asian Americans and 43.1% of Native Hawaiian or Other Pacific Islanders have never been tested for HIV. Native Hawaiians and Other Pacific Islanders (NHOPI) make up 0.2% of the U.S. population and account for a very small percentage of new HIV diagnoses in the United States—less than 1% in 2016. However, HIV affects NHOPI in ways that are not always apparent.

Gay and bisexual men accounted for 65% (35) of HIV diagnoses among NHOPI in 2016, and HIV diagnoses increased 51% (from 55 to 83) among NHOPI overall from 2011 to 2015 in the United States and six dependent areas. In 2015, an estimated 1,100 NHOPI were living with HIV; 82% had received a diagnosis, and, as of 2014, 60% received HIV medical care, 43% were retained in care, and 50% had a suppressed viral load.

Asians, who make up 6% of the U.S. population, accounted for 2% (970) of the 40,324 new HIV diagnoses in this country and six dependent areas in 2016. Of Asians who received an HIV diagnosis in 2016, 84% (825) were men and 15% (145) were women; gay and bisexual men accounted for 90% (740) of HIV diagnoses among all Asian men. In 2015, an estimated 15,800 Asians were living with HIV in the U.S.; 80% had received a diagnosis, and, as of 2014, 57% received HIV medical care, 46% were retained in care, and 51% had a suppressed viral load. Most recent data from the CDC reports that among Asian Americans, infections rose by 42 percent overall between 2010 and 2016. Among gay and bisexual Asian men, the increase was more dramatic, as they saw a rise of over 50 percent over the same time period. The numbers are reflected in 2019 data, which states that 91 percent of all male infections were by male-to-male sexual contact, while 94 percent of female infections came from heterosexual contact.

Why is this small demographic taking on such a large burden of HIV infection, proportionate to size of the community, and why is there such little information on it? The CDC makes their own suggestions as to why the disparity is so great. It is suggested that cultural factors, such as language barriers and immigration issues, may add to the barrier to health care (though, of course, this only addresses access to care for Asian immigrants, and not Asian Americans who have lived here for several generations). Barriers to care can prevent one from even knowing that they’re infected to begin with, let alone accessing treatment or pre-exposure prophylaxis (PrEP). The CDC also poses the fact that there simply isn’t enough research being done on this demographic. According to the CDC website, “There are only a few targeted prevention programs due to limited research.”— According to the CDC, 66.5% of Asian Americans and 43.1% of Native Hawaiian or Other Pacific Islanders have never been tested for HIV—They continue, “Race/ethnicity misidentification could lead to an underestimation of HIV cases.”

“We need to encourage APIs, especially those who are transgender and young [men who have sex with men], to start talking, get tested, and discuss PrEP with their doctors,” said Lance Toma, chief executive officer at API Wellness. “Everyone needs to know that saving face can’t make us safe.” Toma continued, adding that low PrEP utilization rates are due to a lack of awareness about the drug, misconceptions regarding its affordability, misinformation about its effects, and fear of community stigma about sex.

It is known that daily PrEP use can reduce the risk of getting HIV from sex by more than 90 percent. Among individuals who inject drugs, it reduces the risk by more than 70 percent. But within the API community, 20 percent of those with HIV didn’t know they were infected, only 58 percent of those who knew were treated for their HIV, and of them, only 46 percent were retained in care.“Although API HIV/AIDS infection rates appear low [at only 6 percent of total infections], those statistics are deceptive as a significant amount of under-reporting occurs due to stigma,” Toma said. “Stigma prevents people from discussing HIV/AIDS with their communities and providers which is one reason why APIs are the least likely race to get tested for HIV.” If you do not know your HIV status, CAP recommends getting tested regularly. CAP offers free testing to all at multiple locations. We also have experienced PrEP Navigators and Insurance Navigators who are here to help in getting access to Health Insurance, PrEP, and PEP!