HIV-Positive Asians and Pacific Islanders in New York City are Missing Out on Health Care if They are Undocumented Immigrants or Speak Little/No English

NEW YORK CITY, Nov. 9 ??? HIV-positive Asians and Pacific Islanders living in New York City are much less likely to receive health care services and much more likely to experience barriers to care if they are undocumented immigrants or speak little or no English, according to a study by The New York Academy of Medicine in the current issue of The Journal of Health Care for the Poor and Underserved.

These immigrants face formidable language and cost barriers to getting HIV care, often don???t know where to go for services, and have confidentiality concerns that deter them from seeking medical care, according to John Chin, PhD, lead author of the study and Senior Research Associate in the Academy???s Division of Health Policy. It is essential that more health care centers equip themselves to address multiple Asian and Pacific Islander (API) languages and cultures, or develop strong linkages with organizations that can do so, in order to provide competent care to these HIV-positive immigrants, Chin said. His study details the successes of a lower Manhattan community-based AIDS service organization that developed a corps of part-time, multi-lingual peer advocates, among other enhancements, to help clients who primarily speak an Asian language.

APIs constitute the fastest growing ethnic/racial group in New York City, with more than one in ten New Yorkers describing themselves as Asian in the 2000 census. Yet this group remains vastly underserved in terms of health care needs. Seventy-eight percent of APIs in New York are foreign-born, and 49 percent have limited English proficiency, compared to 24 percent for all New Yorkers. In New York City, 72 percent of cumulative AIDS cases among APIs have been among the foreign-born. HIV stigma remains unusually strong in API communities, which compounds language and cultural barriers to initiating and staying in health care.

???Inadequate access to and inconsistent utilization of care among APIs living with HIV, as a result of language and cultural barriers and HIV stigma, are vital concerns in New York City,??? Chin said. ???The shortcomings in the health care system and high levels of HIV stigma in API communities must be addressed in order to help these immigrant patients live healthier lives.???

The study reports on results of the Bridges Project, a New York City-based intervention designed to reduce care disparities for APIs living with HIV/AIDS. The Project was developed by the Asian and Pacific Islander Coalition on HIV/AIDS (APICHA), an AIDS service organization in lower Manhattan. It was based at two sites in Manhattan and Queens. The study took place from 1996 through 2001 and involved 116 participants, 58 of whom had complete baseline data. Most were men and had some form of private or public health insurance. Nearly half were undocumented immigrants, gay, and/or unemployed. More than half said an Asian language was their primary language, and more than one-third had not completed high school.

Bridges Project staff used a variety of practical measures to increase access to and quality of care for HIV-positive APIs. To help patients with limited English proficiency, they provided language interpretation and escorted clients to care. Knowing that patients??? cultural values and traditions are poorly understood by many health care providers, Project staff trained medical providers in cultural competency at hospitals and clinics offering HIV primary care citywide. Asians who lacked insurance were provided with case management services to guarantee that they received all benefits for which they were eligible. Case managers also connected clients to a wide range of important supportive services, many of which clients had difficulty accessing on their own due to language and cultural barriers. The Bridges Project also created formal links between APICHA and other community health care providers, facilitating cross-referrals.

Follow-up assessments showed that the Bridges Project successfully increased rates of primary care use and reduced rates of barriers so that undocumented and non-English-speaking APIs ultimately received the same level of primary care services as documented immigrants and English-speakers. The rates of barriers to care that patients experienced also decreased, to the point where the groups were experiencing similar rates of barriers.

APICHA???s model of care, which is able to accommodate clients from a wide range of languages and cultural backgrounds, may serve as a helpful template for other organizations interested in servicing this population, or other populations with similar issues, Chin said. ???One important lesson is that language capacity of providers is essential but not sufficient alone for providing culturally competent care since even participants who were proficient in English expressed the importance of a provider???s ability to understand their culture,??? he said. Participants in just this small study hailed from 13 different countries of origin, including China, India, Pakistan, Bangladesh, Japan, Thailand, the Philippines, Vietnam, Malaysia, and Korea. Many of these countries are home to multiple languages and cultures, making it even more challenging to meet API patients??? needs, Chin said.

As of December 2004, 1,168 APIs in New York City were reported as diagnosed with full-blown AIDS, accounting for a substantial portion (16 percent) of the 7,317 cumulative reported AIDS cases among APIs in the United States. APIs tend to delay getting HIV-related services, leaving themselves more vulnerable to opportunistic infections and development of AIDS than other racial/ethnic groups. Between 1994 and 2000, U.S. APIs had the highest rate of AIDS at the time of their initial HIV diagnosis.

This study and the Bridges Project were supported in part by a grant from the HIV/AIDS Bureau???s Special Projects of National Significance Program of the Health Resources and Services Administration in the U.S. Department of Health and Human Services. Founded in 1847, The New York Academy of Medicine is an independent, non-partisan, non-profit institution whose mission is to enhance the health of people living in cities worldwide through research, education, advocacy, and prevention. Visit us online at www.nyam.org.

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Posted on November 9, 2006

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Andrew J. Martin
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