Ending the silence: Asian Pacific Americans urged to increase HIV/AIDS testing

It is three in the morning and Philip, 27, wakes up from a nightmare that he soon forgets. He drinks a cup of milk and falls back to sleep.

The vivid dreams and dizziness are recurring experiences for Philip, side effects he attributes to taking Atripla, a pill he consumes daily because he has AIDS.

“Sometimes I dream about dying. It’s scary sometimes,” Philip said who agreed to speak on condition of partial anonymity. “Then I wake up in the middle of the night all of a sudden.”

The Filipino American, who identifies as gay and lives in Southern California, was diagnosed with AIDS in May of 2010. Philip says he likely contracted HIV two or three years ago.

Last year in February Philip says he was hospitalized for three days after having seizures brought on by a high temperature. An HIV/AIDS test, his first one, revealed that his T-cell count, white blood cells that are important to the immune response, was at 157. A healthy T-cell count ranges from 800 to 1,200.

“It kind of hit me really hard because I was thinking, ‘It couldn’t happen to me. It couldn’t happen to me,” Philip said who graduated with a bachelor’s degree in biological sciences. “I should know better, right? I went to college. I’m educated. But I just thought it would never be me.”

Asian Pacific Americans represent 2.8 percent of the total reported HIV/AIDS cases in California as of June 30, 2011, according to the California Office of AIDS. But despite their relatively low risk level when compared to other ethnic groups, one in three Asian Pacific Americans living with HIV is unaware of their status.

Out of 10,763 Asians Americans who are 18 years and older, 6,828 were never tested, according to a 2009 survey conducted by the Centers for Disease Control and Prevention. Out of 558 Pacific Islanders, 350 had never been tested.

“There is still this belief that if you don’t feel sick and if you don’t look sick probably there’s nothing wrong with you,” said Peter Cruz, senior program manager of prevention services at APAIT Health Center. “And so APIs won’t access medical care unless the physical symptoms start manifesting.”

That was the case for Randy, who was born in South Korea but is ethnically Chinese. He was diagnosed in 2000 with HIV. The 49-year-old put off getting treatment until he was hospitalized in 2007.
“My sister told me I was in a coma and she showed me the picture and I thought, ‘Oh, my God!’” said Randy, who asked to only use his American first name. “At that time I realized that this is my second chance to live in this world.”

When properly treated, the advancement of HIV, which progresses in stages depending on the viral load and symptoms, can be prevented or delayed. In the last stage AIDS occurs.

After one week in a coma and three weeks in the hospital Randy returned home where he eventually disclosed his AIDS status to his wife, mom and sister.

“I think in Oriental community they are not really open to talk about HIV, sex, STDs or even gay or lesbian things,” Randy said. “So when I told her [my mom] she thought that this disease is contagious and she went to my sister’s place to live for about two years.”

Married for about 21 years, Randy says he likely contracted HIV while cheating on his wife with men. The couple, however, is still together and his wife is HIV negative.

“I said, ‘we can separate if you want,’” Randy said about talking to his wife about his AIDS status. “And she said, ‘Well, we’re already living together 20 years.’ So she just said to me, ‘Isn’t that too late?’ So I just treat her good and I’m not messing around anymore.”

Many Asian Pacific Americans are diagnosed with HIV after the disease has progressed.

Forty-four percent of Asian Pacific Americans in 2004 received an AIDS diagnosis within one year of getting an HIV diagnosis, according to the CDC.

That compares to 37 percent for whites, 41 percent for American Indians and Alaska Natives, 43 percent for Hispanics and 40 percent for African Americans.

“We’ve also known for a long time that APIs are more likely to present with AIDS at a later stage than other groups and that’s because APIs are not getting HIV testing and prevention services that they need,” said Dr. Tri D. Do, an assistant professor of medicine at the University of California, San Francisco Center for AIDS Prevention Studies.

The 2010 National HIV/AIDS Strategy released by the White House emphasized the need to increase the percentage of those who know their status. The goals for 2015 are to “lower the annual number of new infections by 25 percent” by increasing from 79 percent to 90 percent those who know their HIV/AIDS status.

In Los Angeles an estimated 13,250 people living with HIV do not know it, according to the County of Los Angeles Public Health.

At the APAIT Health Center in Los Angeles 700 people were tested last year, said Cruz. The ethnic makeup of the clinic is 17 percent Latino, 13 percent African American and about 70 percent Asian Pacific Americans.

“Our goal is to reach 1,000 people each year,” Cruz said.

Adam Chang, 25, was born and raised in San Francisco, but now resides in Hawaii where he is in law school. Despite regularly getting tested, Chang was diagnosed with HIV in 2009.

“I’ve been at A&PI Wellness Center since I was about 16 or 17 and so I got my tests every six months, not necessarily always there,” said Chang. “I did everything by the book. But even if you do it by the book, you talk to a guy, you think you know the guy, you have that unprotected moment, it was just one time and that was enough.”

HIV/AIDS healthcare workers like Dr. Do say Asian Pacific Americans could be unaware of their risk for HIV because awareness and prevention services, which are culturally competent, are lacking.
For those living with HIV/AIDS like Randy, stigma and shame serve as a barrier to getting tested and seeking treatment.

“If you are sexually active you should go take a test every month … or every other month,” Randy said.

“To anyone. If you’re diagnosed with that just go to treatment right away. Get the treatment right away otherwise all the symptoms come to you.”

Recognizing the multiple factors that contribute to the low testing rates in the Asian Pacific American community, the Office of Minority Health has partnered with agencies that serve the community.

“We know that often, the messages that resonate the most with a community are the ones that are delivered by its own members,” said Dr. J. Nadine Gracia, acting deputy assistant secretary for the Office of Minority Health. “For the last four years, the Office of Minority Health has also partnered with the Hawaii AIDS Education and Training Center to train doctors and other care providers in the latest HIV treatment modalities.”

Despite being educated about HIV/AIDS, Philip says he never thought he would contract HIV.

These days Philip spends his days looking for a job and a boyfriend. A tattooed music note on Philip’s neck pays homage to his love of music. Walking through a grocery store Philip calls attention to a love song by Adele playing over the intercom, explaining with a wide smile how he plays the song at home.

A self-described hopeless romantic Philip talks of worrying about meeting the right boyfriend, one who would understand his AIDS status.

“It gets lonely. I feel like I have a lot of love to give to somebody,” Philip said, explaining that he’s still sexually active, but uses protection. “That’s why I just give it to everyone else, like my friends.”
Philip says he sometimes has regrets but there’s no sense in dwelling on the past.

“I know I can pick myself back up again,” he said.

To search for HIV/AIDS testing services in your area, visit www.cdcnpin.org/ca/.