Facilitators and Barriers to HIV Testing, Prevention, and Treatment among Asian and Pacific Islander Americans: A Systematic Exploration

Main Article Content

Todd Sabato


Asian American Pacific Islanders (AAPI) are the fastest growing ethnic group in the United States.  Despite such growth, AAPI face considerable challenges to HIV prevention, treatment, testing and care. The development of multilevel and multi-strategy approaches to education, prevention, and treatment requires an understanding of personal and cultural barriers, as well as implementation of culturally sensitive and specific measures.  The purpose of this article is to highlight barriers to HIV-related prevention, treatment, and care for AAPI and provide practical, application-based suggestions which may facilitate greater inclusion of AAPI in the continuum of HIV care.

Keywords: Asian American and Pacific Islanders, HIV, prevention, testing, treatment

Article Details

How to Cite
SABATO, Todd. Facilitators and Barriers to HIV Testing, Prevention, and Treatment among Asian and Pacific Islander Americans: A Systematic Exploration. Medical Research Archives, [S.l.], v. 10, n. 1, jan. 2022. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/2645>. Date accessed: 23 may 2024. doi: https://doi.org/10.18103/mra.v10i1.2645.


1. Budiman A, Ruiz NG. Key facts about Asian Americans, a diverse and growing population. https://www.pewresearch.org/fact-tank/2021/04/29/key-facts-about-asian-origin-groups-in-the-u-s/. Published April 2021. Accessed September 19, 2021.

2. National Alliance on Mental Illness. Asian American and Pacific Islander. https://www.nami. org/Your-Journey/Identity-and-Cultural-Dimensions/Asian-American-and-Pacific-Islander. Published June 2021. Accessed September 30, 2021.

3. White House Office of National AIDS Policy. National HIV/AIDS Strategy for the United States. https://obamawhitehouse.archives.gov/sites/default/files/uploads/NHAS. pdf. Published July 2010. Accessed September 30, 2021.

4. Centers for Disease Control and Prevention. Estimated HIV incidence and prevalence in the United States, 2014-2018. Centers for Disease Control and Prevention. https://www. cdc.gov/hiv/library/reports/hiv-surveillance/html. Published May 2020. Accessed September 30, 2021.

5. Villarosa L. America’s hidden HIV epidemic: Why do America’s black gay and bisexual men have a higher HIV rate than any country in the world? New York Times Magazine. https://www.nytimes.com/2017/06/06/magazine/americas-hidden-hiv-epidemic.html. Published June 2017. Accessed September 22, 2020.

6. Kim B, Aronowitz T. Invisible minority: HIV prevention health policy for the Asian American population. Policy, Politics, & Nursing Practice. 2019;20(1):41-49. doi: 10.1177/1527154419828843

7. Centers for Disease Control and Prevention. HIV and Asians. Centers for Disease Control and Prevention. https://www.cdc.gov/hiv/group/racialethnic/asians/index.html. Published September 2021. Accessed September 26, 2021.

8. Centers for Disease Control and Prevention. Summary health statistics: National Health Interview Survey, 2015. National Center for Health Statistics. https://www.cdc.gov/nchs/ data/factsheets/factsheet_summary.htm. Published November 2015. Accessed October 5, 2021.

9. Asian and Pacific Islander Ending the Epidemic Advisory Group. Implementation strategies. Asian and Pacific Islander Ending the Epidemic Advisory Group. https://www.health.ny.gov/diseases/aids/ending_the_epidemic/docs/implementation_strategies_asianpc.pdf. Published July 2020. Accessed October 5, 2021.

10. Cheng AW, Chang J, O’Brien J, Budgazad MS, Tsai J. Model minority stereotype: Influence on perceived mental health needs of Asian Americans. Journal of Immigrant and Minority Health. 2017;19:572-581. doi: 10.1007/s10903-016-0440-0

11. Fong TW, Tsuang J. Asian Americans, addictions, and barriers to treatment. Psychiatry. 2007;4(11):51-58.

12. Sue DW, Cheng JKY, Saad CS, Chu J. Asian American mental health: A call to action. Am Psychol. 2012;67:532-544.

13. Lee SJ, Wong N, Alvarez AN. The model minority and the perceptual foreigner: Stereotypes of Asian Americans. In: Tewari N, Alvarez AN, eds. Asian American Psychology: Current Perspectives. Routledge/Taylor & Francis Group; 2008:69-84.

14. Sabato TM, Silverio AQ. A forgotten population: Addressing comprehensive HIV prevention needs among American Asians and Pacific Islander. J Assoc Nurses AIDS Care. 2010;21(4):364-370. doi: 10.1016/jana.2009.11.006

15. White B. Ending Asian & Pacific Islander HIV stigma starts here. Legacy Community Health. https://www.legacycommunityhealth.org/newsblog-ending-api-hiv-stigma-starts-here/. Nd. Accessed October 13, 2021.

16. Lee JJ, Zhou Y. Facilitators and barriers to HIV testing among Asians in the United States: A systematic review. AIDS Care. 2019;31(2):141-152. doi: 10.1080/09540121. 2018.1533231

17. Foundation for AIDS Research. HIV among Asian-Americans and Pacific Islanders – A problem too often in the shadows. Foundation for AIDS Research. https://www.amfar.org /hiv-among-asian-americans-and-pacific-islanders/. Published May 201. Accessed October 15, 2021.

18. McFarland W, Chen S, Weide D, Kohn R, Klausner J. Gay Asian men in San Francisco follow the international trend: Increases in rates of unprotected anal intercourse and sexually transmitted diseases, 1999-2002. AIDS Educ Prev. 2004:16:13-18.

19. Mundell E, Reinberg S. America’s STD rate at record high again: CDC. U.S. News & World Report. https://www.usnews.com/news/health-news/articles/2021-04-14/americas-std-rate-at-record-high-again-cdc. Published April 2021. Accessed October 14, 2021.

20. Scott HM, Bernstein KT, Raymond HF, Kohn R., Klausner JD. Racial/ethnic and sexual behavior disparities in rates of sexually transmitted infections, San Francisco, 1999-2008. BMC Public Health. 2010;10:315.

21. San Francisco Department of Public Health. San Francisco Monthly STD Report. San Francisco Department of Public Health. http://www.sfdph.org/dph/files/reports/Studies Data/STD/std062008.pdf. Published June 2008. Accessed October 19, 2021.

22. Abbas A. HIV and intimate partner violence among Asian American and Pacific Islander women. Asian Pacific Institute on Gender-Based Violence. https://s3.amazonews.com/ gbv-wp-uploads/wp-content/uploads/2017/07/18174321/HIVandIntimatePartnerViolence AmongAPIWomen-2016.pdf. Published May 2016. Accessed October 10, 2021.

23. Selvey LA, Hallett J, McCausland K, Bates J, Donovan B, Lobo R. Declining condom use among sex workers in Western Australia. Front Public Health. 2018;6:342.

24. Anteneh ZA, Agumas YA, Tarekegn M. Sexually transmitted diseases among female commercial sex workers in Fine Selam town, northwest Ethiopia: A community-based cross-sectional study. HIV AIDS. 2017;9:43-49.

25. Ross MW, Crisp BR, Mansson A, Hawkes S. Occupational health and safety among commercial sex workers. Scand J Work Environ Health. 2012;38(2):105-119. doi: 10.5271/sjweh.3184

26. Nemoto T, Operario D, Soma T, Bao D, Vejrabukka A, Crisostomo V. HIV risk and prevention among Asian and Pacific Islander men who have sex with men: Listen to our stories. AIDS Educ Prev. 2003;15:7-20.

27. Rehm J, Probst C, Shield K, Shuper PA. Does alcohol use have a causal effect on HIV incidence and disease progression? A review of the literature and a modeling strategy for quantifying the effect. Popul Health Metr. 2017;15(4). doi: https://pophealthmetrics. biomedcentral.com/track/pdf/10.1186/s12963-017-0121-9.pdf.

28. Nehl EJ, Han JH, Lin L, Nakayama KK, Wu Y, Wong FY. Substance use among a national sample of Asian/Pacific Islander men who have sex with men in the U.S. J Psychoactive Drugs. 2015;47(1),51-59. doi: 10.1080/02791072.2014. 994795

29. Operario D, Choi KH, Chu PL, McFarland W, Secura GM, Behel, S, MacKellar D, Valleroy L. Prevalence and correlates of substance use among young Asian Pacific Islander men who have sex with men. Prev Sci. 2006;7(1):19–29.

30. Turner, K. The many Asian Americans. Vox Media. https://www.vox.com/first-person/22421683/ identity-asian-american-pacific-islander-aapi-heritage-month-enclaves-cities-suburbs. Published May 2021. Accessed October 9, 2021.

31. Lo CC, Runnels RC, Cheng TC. Racial/ethnic differences in HIV testing: An application of the health services utilization model. SAGE Open Med. 2018;6:108. doi: 10.1177/ 2050312118783414

32. Xiaoqing R. HIV/AIDS among Asians. Center for Health Journalism. https://centerfor healthjournalism.org/fellowships/projects/hivaids-among-asians. Published December 2009. Accessed October 10, 2021.

33. Baguso GN, Turner CM, Santos G, Raymond HF, Dawson-Rose C, Lin J, Wilson EC. Successes and final challenges along the HIV care continuum with transwomen in San Francisco. J Int AIDS Soc. 2019;22:e25270. doi: 10.1002/jia2.25270

34. Li F, Juan BK, Wozniak M, Watson SK, Katz AR, Whiticar PM, McCormick T, Qiu YS, Wasserman GM. (2018). Trends and racial disparities of late-stage HIV diagnosis: Hawaii, 2010-2016. Am J Public Health. 2018;108(4):S292-S298. doi: 10.2105/AJPH .2018.304506

35. Maramba DC. AANAPISIs: Ensuring success for Asian American and Pacific Islander students. American Council on Education. https://www.higheredtoday.org/2017/10/30/ aanapisis-ensuring-success-asian-american-pacific-islander-students/. Published October 2017. Accessed October 14, 2021.

36. Day JC. Black high school attainment nearly on part with national average. United States Census Bureau. https://www.census.gov/library/stories/2020/06/black-high-school-attainment-nearly-on-par-with-national-average.html. Published June 202. Accessed October 12, 2021.

37. Anderson J. Asian American and Pacific Islander students in focus: Demographics and enrollment data. CSBA Research and Policy Brief. https://www.csba.org/-/media/ CSBA/Files/GovernanceResources/GovernanceBriefs/Brief-AAPI-Demographics-Enrollment-May2021.ashx?la=en&rev=e74c4f3f09924d4ea0a90a0b5d8ce870#:~:text= High%20School%20Graduation%20Rates&text=Graduation%20rates%20for%20Asian%20American,percent%20for%20Pacific%20Islander%20students. Published May 2021. Accessed October 12, 2021.

38. Zajacova A., Lawrence EM. The relationship between education and health: Reducing disparities through a contextual approach. Annu Rev Public Health. 2018;39:273-289. doi: 10.1146/annurev-publhealth-031816-044628.

39. Iwamasa GY. Recommendations for the treatment of Asian American / Pacific Islander populations. Asian American Psychological Association. https://www.apa.org/pi/oema/ resources/ethnicity-health/asian-american/psychological-treatment.pdf. Published 2012. Accessed October 11, 2021.

40. World Population Review. Asian American population by state. World Population Review. https://worldpopulationreview.com/state-rankings/asian-population. Nd. Accessed October 16, 2021.

41. Park M, Giap TT, Lee M, Jeong H, Jeong M, Go Y. Patient- and family-centered care interventions for improving the quality of health care: A review of systematic reviews. Int J Nurs Stud. 2018;87:69-83.

42. Centers for Disease Control and Prevention. Promoting cultural sensitivity: A practical guide for tuberculosis programs that provide services to persons from China. Atlanta, GA: U.S. Department of Health and Human Services; 2008.

43. Handtke O, Schilgen B, Mosko M. Culturally competent healthcare – A scoping review of strategies implemented in healthcare organizations and a model of culturally competent health provision. PLoS One. 2019;14(7):e0219971. doi: 10.1371/journal.pone. 02119971.

44. Howard University College of Medicine. BESAFE: A cultural competency model for Asians and Pacific Islanders. Howard University College of Medicine. https://www. aetcnmc.org/documents/API_BeSafe.pdf. Published 2009. Accessed October 23, 2021.

45. Burke A, Kaczmarczyk JM. Complementary and alternative medicine issues in serving diverse populations. Cultural Competence in the Clinical Care of Patients with Diabetes and Cardiovascular Disease. Health Resources & Services Administration, Bureau of Primary Health Care, Institute for Healthcare Improvement; 2003.

46. Hsu FLK, Freedman M. Family and kinship in Chinese society. J Am Orient Soc. 1973;93(1):85. doi. 10.2307/600530.

47. Yee, AH. A comparative study of Macau’s educational system: Changing colonial patronage and native self-reliance. Comp Educ. 1990;26(1):61-71. Doi: 10.1080/0305006900260106.

48. Beller T, Pinker M, Snapka S, Van Dusen D. Korean Health. https://bearspace. baylor.edu/Charles_Kemp/www/korean_health.htm. Published 2007. Accessed October 25, 2021.

49. Frye BA. Use of cultural themes in promoting health among Southeast Asian refugees. Am J Health Promot. 1995;9(4):269-280.