Do API Lives Matter?

During the final plenary on the last day of the 2017 United States Conference on AIDS, half a dozen women took the stage. Due to the protest-friendly nature of the conference, they didn’t need to storm up the stairs, or forcibly grab microphones from the women of color seated there. Instead, they were simply invited to speak.

Why was it, they asked, that so few of their kind had been invited to speak at the conference? More so, why didn’t this last plenary — “The Power of Women & the Future of Leadership for Women of Color” — include a single Asian-American, Native Hawaiian, Pacific Islander, or Native American woman?

It was a good point. Although Asian-American, Native Hawaiian, and Pacific Islanders (AANHPI) accounted for less than six percent of the U.S. population in 2015 (according to the Census Bureau), their population is growing faster than any other racial group in the country. They represent Americans with heritage from the most populated countries of the world — including China (1.41 billion people) and India (1.34 billion) who together reflect 37 percent of the world population, according to the U.N.

The Centers for Disease Control and Prevention reports that “between 2010 and 2014, the Asian population in the United States grew around 11 percent, more than three times as fast as the total U.S. population. During the same period, the number of Asians receiving an HIV-positive diagnosis increased by 36 percent, driven primarily by an increase in HIV diagnoses among Asian gay and bisexual men.”

Meanwhile, as of 2014, Native Hawaiians and other Pacific Islanders have HIV rates nearly twice that of the white population in the U.S., according to the federal government’s Office of Minority Health Resource Center. Despite these disconcerting statistics, those providing HIV services for the AANHPI community are reportedly struggling for resources and have become “endangered species.”

At a USCA conference panel, “Novel Approaches in an Era of Resource Scarcity,” moderator Jacob Smith Yang of Asian & Pacific Islander American Health Forum reported that in 2010, there were 55 organizations providing HIV services to the AANHPI community. In the past seven years, that number has plummeted to only 12.

Yang believes the sharp decline is a direct result of losing federal funds after the National HIV Strategy directed agencies to focus on African-American and Latino communities, which have the highest rates of HIV in the country. Native Americans and AANHPIs weren’t even mentioned in the 2010 strategy, Yang says.

Five years later, the strategy offered a slight improvement, noting, “Although it is vital to focus national efforts in communities with the highest burden, HIV prevention must continue to be supported in localities with concentrations of groups such as Asian-Americans and Pacific Islanders, and American Indian/Alaska Natives.”

Henry Ocampo of the Office of Minority Health Resource Center announced while speaking at the panel, “We are in a crisis, in regards to basic funding and assistance,” noting that only 0.3 percent of the $260 million the CDC spends on HIV is currently directed to the AANHPI community.

Numerous AANHPI organizations have merged or simply faded away, advocates say. Other providers, like API Wellness — which has served the Asian and Pacific Islander American community in San Francisco for decades — are dropping references to APIs from their names and expanding their focus.

Nikki Calma, a trans woman who has worked for API Wellness for over 20 years, told USCA attendees that the organization has been “afraid San Francisco AIDS Foundation would absorb us.” Instead, the Tenderloin-based API Wellness, which has long served the broader LGBT community (in particular their 400-plus trans clients), will become more multicultural. Even their monthly “Joy Luck Club” will open to the entire community. Calma adds that the changes ahead are necessary to survive, insisting that while their name is changing in January, they will still serve the API community and “keep our values going.” In the future, Calma says, the organization may not look the same, “but our history will not be erased.”

Kunane Dreier of Life Foundation in Hawaii said it’s not just his organization — which has been around since the 1980s — that has felt the brunt of new federal funding priorities. The entire state was reportedly cut off when Hawaii was “designated a low incident state” and no longer qualified for HIV prevention funds from the CDC.  With a fraction of their old staff, Life Foundation has tried to increase collaborations and rely more on the local community. Dreier said they find ways to offer their clients other services — including transgender health care, smoking cessation programs, and needle exchanges — all of which have other, non-HIV-specific funding sources.

AANHPI organizations are having to think outside the box to survive, says Jimmy Sianipar of the Asian Pacific AIDS Intervention Team (APAIT) in Los Angeles. His organization kept running up against funding constraints because their HIV prevention efforts were limited to a brick and mortar location. They raised their own money and bought a mobile testing facility, which has enabled them to do testing at bathhouses, clubs, and recurring gay parties like Gameboy that are frequented by API gay men. APAIT also sends staff to walk the streets of Hollywood (after midnight, three nights a week) to provide outreach, hand out water, and offer free HIV testing. And the group recently opened a three-bed shelter where clients can have a hot shower, something to eat, and have a nap.

The absence of funding is being experienced in other ways as well. For example, Ben Cabangun of APIA Health Forum, argued that “a decade ago” there was a core group of researchers focusing on HIV in the AANHPI community. Now, he says, “they have moved on, to where there’s funding” and their current research revolves around trans women and other gay and bi men of color.

Jimmy Quach, from HealthRight 360 and AA Recovery Services in the San Francisco Bay Area, said most of their funding comes from the Office of Minority Health and the Substance Abuse and Mental Health Services Administration (SAMHSA). He sees the idea of Asian-Americans being a “model minority” as a major barrier to funding.

“Positive stereotypes can also harm us,” he said, including myths that Asian-Americans are all wealthy and don’t need financial support, Asians don’t use drugs, and Asians don’t have unsafe sex. Cabangun argued the latter myth is furthered by the “reticence to talk about sex and sexuality in our community.”

A policy paper written by Stanford student Siyou Song seems to agree, noting that in “Chinese-American communities, sexual education is underemphasized since STDs are related to four taboo subjects: sex, homosexuality, disease, and death. In these communities, condoms are also associated with promiscuity and are, therefore, used less frequently for fear of being perceived as salacious.”

Another issue is that data about Asian-Americans is limited and confounded by researcher’s penchant of lumping all Asians together, regardless of whether their ancestors hailed from China; other Asian nations like Japan, Korea, Vietnam; or the Indian subcontinent.

“It’s important for us to collect our own data,” Sianipar said. “We ask more questions than the county wants us to ask.” Different Asian communities have different sexual practices or other differences that could impact HIV prevention and treatment efforts.

“We’re sharing data everywhere we can,” Quach noted, saying that speaking at conferences like USCA is part of the effort to increase awareness of the need for HIV services — and funding — in the AANHPI community.

Many of the panelists worried about the future, wondering how the Trump administration will impact funding priorities. “The Secretary’s Minority AIDS Initiative [Fund] is keeping us afloat,” Ocampo noted, yet, “This administration wanted to eliminate [the entire fund].” Fortunately, there’s been pushback from the Senate.

But no one really knows what the final budget will look like and that worries Quach. He believes the AANHPI community needs to become more vocal about its needs and the lack of funds for services, posing the rhetorical question, “Where is the uproar?”

Revised 10/25/2018: Substance Abuse and Mental Health Services Administration (SAMHSA) was mistakenly identified as Science and Management of Addictions. A quote from Ocampo was misattributed to Quach.