Immigrants from the 43 nations of Asia and the Pacific Islands are a growing segment of New York City's population and are confronting the same challenges facing their neighbors, including HIV/AIDS.
On the 25th anniversary of the first published medical report of the disease, many in New York's API community share an unwillingness to acknowledge the growing number of HIV AIDS cases in their midst. Cultural and linguistic barriers also prevent many from learning about the reality of the disease and taking action.
The Asian and Pacific Islander Coalition on HIV/AIDS in New York's bustling Chinatown district is trying to help.
According to local recent health department figures, the rate of new HIV infections is decreasing for every racial and ethnic group except Asia and Pacific Islanders. APICHA medical director Victor Inada says this shows how important it is to educate his community.
"Unfortunately, the virus does not discriminate," he says, "and so if you are exposed to the virus you are at just as much risk as any other population." He adds that the message APICHA is trying to send is that "although numbers seem low you are still at risk. So you have to be conscious of what you're doing, if you are placing yourself at risk, whether through unprotected sex, or -- although you may be in [what you consider to be a] monogamous relationship -- whether your partner is placing him or herself at risk for HIV."
That risk is especially high for Asian and Pacific Islander women. Most never learned about the disease in their home countries, where there may be official denial of its existence. After immigrating to the United States, they may not hear or be able to read health literature about HIV. And, even if these women do learn about AIDS, they tend to see themselves as outside traditional high risk groups such as homosexual men, people with multiple sex partners where the sex is unprotected, and intravenous drug users.
Shu-Hui Wu, APICHA's associate director of client services, says they often do not realize that the man in their life is infected.
"Maybe their boyfriend or husband came overseas first and then takes the rest of the family members later on. And because these immigrant men don't have much entertainment here, they might… get some 'comfort' from sex workers." Without the knowledge of HIV AIDS, "they do not know how to protect themselves, they get infected with this illness and transmit it to their loved ones."
Cultural barriers can make it harder for these women to get the protection they need. In many Asian cultures, a wife is expected to be subordinate to her husband, and may be uncomfortable demanding that he use a condom. Cherry Ng leads APICHA workshops to teach women how to be assertive without being threatening.
"We tell them to say 'You are my partner. If you love me, you need to protect yourself and protect me. Condoms are not only to prevent pregnancy!'"
Discussion about sex is considered taboo in some Asian and Pacific Island cultures, and those with sexually transmitted diseases are often shamed and shunned. Religious beliefs can play a large part in shaping those attitudes. One woman was told by some community members that bad "karma" - or wrong actions in a previous life, explained why her mentally disabled spouse had contracted AIDS.
"…But during that time I went to some temples to learn from the doctrine and see how to solve my problem," she recalls. "And, by listening to those teachings, I realized that whatever already happened, happened. You can't do anything about it. What's more important is how you face the problem and go forward."
Going forward in one's fight against the disease can mean more than testing, diagnosis and medicine, according to APICHA'S medical director Dr. Inada.
"We also have case management services to help people navigate the very complex social systems and try to get them health insurance and help them to care of their other needs" such as housing and employment. "We try to help them take care of the 'whole person,' not just the HIV, and not just their bodies," he says.
Loneliness and isolation can be byproducts of any serious illness, and HIV-AIDS is no exception. APICHA associate director Shu-Hui Wu is proud of the center's regular "Art and Tea" program, in which clients are encouraged to create art and socialize.
"It's a support group so people don't really need to talk too much or don't need to know English that much but can be able to enjoy and support each other," she says, while pointing to a painting of an underwater scene made by one APICHA client. "Like on this wall, the client said that after he got infected with HIV, it was just like "he is swimming in a dark pond, but when he found APICHA, it was like the bright sunlight leading him to swim up toward the surface."
Twenty-five years after AIDS was first described in a medical journal, the disease is discussed on a regular basis in the Western public media - from newspapers to popular magazines to talk shows. But there are still many people who don't - or won't - recognize its danger. Those are the people that APICHA and other activists continue to target, and try to help.