Rong Xiaoqing , a recipient of the Dennis A. Part 2: Cultural tradition traps Chinese elder-abuse victims in U. Subsequent pieces will explore the high suicide rate among Chinese-American women and elder abuse in Chinese-American communities. Translated from Chinese by Rong Xiaoqing. New York — To many people, December 1 is just an ordinary day.
But other numbers may not be as reassuring. In the definitions of the authorities, amercans users and Ae model rae men are the two highest-risk populations. We included randomized controlled trials, controlled clinical trials, and studies utilizing a comparison group including pre-test, post-test design. United Kingdom Russia Ukraine. August 31, These Americanw policies did little to stop transmission of HIV; in fact, they probably promoted concealment of risk activities and made identification of HIV reservoirs more difficult. Although considered bold, these regulations were passed more than 20 years after the first case of HIV infection was identified, which was recently proven.
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While PrEP americsns to be extremely successful in suppressing the spread of HIV infection, there is some Hiv cases chinese americans california that the reduction in Amerivans risk has led to some people taking more sexual risks, specifically, reduced Hiv cases chinese americans california of condoms in anal sex. They serve as sites for networking and exchange of information important for finding employment, accessing social services, providing religious guidance, and socializing. It indicates a behavior that transmits Smericans infection, not how individuals self-identify in terms of their sexuality. Galvanized by the federal government's inactivity, the movement by AIDS activists to gain funding for AIDS research, which on chunese per-patient basis out-paced funding Monsters ball sex video more prevalent diseases such as cancer and heart disease, was used as a model for future lobbying for health research funding. Documentation of HIV transmission often present with significant holes and inconsistencies. Sterling Publishing. Under legislation enacted by the United States Congress inpatients found importing anti-HIV medication into the country were arrested and placed on flights back to their country of origin . A survey completed by members will also look at social networks in the organization, religiosity, and HIV knowledge and attitudes. QuickFacts: United States. Languages Add links.
That is mainly because getting tested is so much easier, and less intimidating.
- Source: MMWR 55, no.
- On this date in the U.
- A region may refer to a country or subdivision, national HIV records are often complicated incomplete or even nonexistent.
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- Initially, infected foreign nationals were turned back at the U.
We utilized the techniques of evidence-based medicine to identify the best evidence for effective HIV prevention interventions. We developed a standard set of inclusion and exclusion criteria based on the methodological quality of the study and our ability to extract information specific to API participants. Following a rigorous search of the literature and an application of our inclusion criteria, we identified 2 methodologically sound controlled intervention trials. We found that certain components produced positive results.
Cultural sensitivity and skills training were present in the successful intervention. Examples of positive outcomes included decreasing the number of sexual partners, decreasing the frequency of unprotected anal intercourse, and increasing knowledge about HIV. These outcomes are associated with decreasing HIV infection.
Only 1 of the 2 studies was of high methodological quality. The most significant research gaps identified were the paucity of literature conducted within the Asian American and Pacific Islander community in general and, specifically, the lack of interventions targeted toward API men who have sex with men MSM. We identified only one published intervention for this group. In addition, we did not identify any published interventions for API adolescents, and only one study among API heterosexuals.
In sum, we found some evidence that interventions aimed toward decreasing HIV risk infections in API can be successful, though more research is urgently needed.
Future interventions should incorporate those components that have been demonstrated to be effective in order to better prevent further harm to the API community from the HIV epidemic.
Evidence-based medicine is "the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. Central to this practice is the identification of the best evidence to answer specific clinical questions, and the critical appraisal of that evidence.
One such approach is to conduct a systematic review. Systematic reviews cull from the methods of meta-analysis and combine a comprehensive and detailed search for relevant studies, a critical appraisal of the quality of included studies, a qualitative synthesis of study findings and, if appropriate, a meta-analysis of the data to determine the combined effect size of similar interventions.
Using these methods, we have prepared the present report to identify the best evidence for effective HIV prevention interventions that are of use in Asian American and Pacific Islander API populations throughout the United States. Although we are entering the third decade of the HIV pandemic, there is as yet no cure or vaccine.
At this time, our principal means for deterring the further spread of HIV remains behavioral prevention interventions. Thus, developing and implementing interventions that focus on behavioral prevention are of utmost importance. API represent the fastest growing ethnic community in the U. In addition, API are a diverse group, comprised of multi-generational Americans and immigrants from countries such as Vietnam, the Philippines, India, and China.
The cultural differences among API make prevention efforts more complicated, as efforts may need to be targeted for different ethnicities.
Furthermore, even though the API population has a higher education level than the U. Potential language barriers also exist, which may also hinder prevention efforts. These factors underscore the necessity for examining evidence for prevention interventions aimed at API, focusing on the primary risk groups. However, differences in risk are also present within the API population itself. In India the primary modes of transmission are heterosexual sex and injection drug use.
In China the primary mode of transmission appears to be injection drug use. Engaging in anal intercourse increases the risk of HIV transmission when condoms are not used. During the late s and early s, dramatic increases in condom use for anal intercourse among MSM were observed. However, those promising changes have not continued. Recent statistics have documented a significant increase in unprotected anal intercourse among MSM, and an increase in HIV infections has followed.
In addition, the positive changes demonstrated in the White gay community have not occurred in the API gay community. Furthermore, lessons learned from the primarily White gay community may not apply to the API gay community. However, when HIV risk behavior has been examined specifically for API gay men, they have exhibited relatively increased risk. Given the statistics specifically regarding HIV infection combined with other, more longstanding, societal problems, prevention efforts specifically targeting API MSM are all the more imperative.
Drug use presents particular risks for HIV transmission. Indeed, injecting is a far more efficient mode of transmitting HIV than sexual intercourse. Some studies have reported that during the initial period of the epidemic, needles and syringes were used up to an average of 9 times before they were discarded. Due to factors such as these, drug and alcohol use in general and injection drug use in particular have been major risk factors for HIV infection in the United States.
However, national HIV reporting does not include data from several large states with significant HIV and injection drug use epidemics among API, such as New York, and, therefore, may underestimate the number of infections.
Important ethnic differences may exist among API injection drug users in the U. Many researchers believe that the true percentage of HIV infections due to injection drug use is difficult to estimate given the illegal nature of drug use and the hesitancy of injection drug users to admit to this behavior. Thus, evidence regarding the relative efficacy of behavioral interventions targeting drug use among API is important to evaluate in order to continue to impact rates of HIV infection in this group positively and to ensure that all injection drug users have access to prevention programs.
Although heterosexual contact is the primary mode of HIV transmission around the world, in the U. Nonetheless, it is the fasting growing route of infection. A final note of consideration is that the HIV infection rate for API women may be greatly underestimated, as this group has the lowest HIV testing rates of any ethnicity. However, even though heterosexual contact is the source of a significant proportion of the new cases of HIV infection and is the largest mode of transmission of HIV infection for API women, there is a dearth of literature regarding baseline risk behaviors for this population.
Most of the data specific to API risk behavior in the U. Additional information needs to be gathered regarding the HIV risk behavior of API heterosexuals that, in turn, can be used to inform the design of interventions to prevent further infections in this population.
A large proportion of the young adults currently infected with HIV or diagnosed with AIDS were most likely infected during their adolescence. Psychological factors unique to this age group place adolescents at increased risk due to their lack of perceived vulnerability.
Grunbaum et al. There is also evidence that significant differences exist among adolescent API sub-populations. There has been some suggestion that traditional HIV prevention literature for adolescents would not be as applicable to API youth because of its lack of emphasis on the importance of family and community, and its focus on individual behaviors.
Once an accurate estimation of risk is made for this population, an evaluation of effective behavioral interventions aimed at API adolescents can follow to prevent further increases in HIV infection. For API women these numbers are substantially higher than for other ethnic groups. As alluded to in the above sections, several factors may have contributed to the paucity of information regarding HIV risk behavior in API. Two of the three states with the highest numbers of API in their population California and Hawaii do not require HIV reporting, and New York only implemented its reporting system in Second, CDC reported that, compared to other racial and ethnic groups, API men and women comprise the largest proportion of HIV testing in anonymous sites, which is usually not accounted for in national surveillance reports.
Finally, the diversity of the API population in terms of culture and language provides a significant barrier to prevention efforts eg, translating materials into several languages, ensuring the cultural sensitivity of prevention messages. In sum, API in the U. Thus, it is imperative to review our current knowledge of prevention interventions for the major behavioral risk groups systematically, so that future prevention efforts can be implemented in the most effective manner, thereby preventing additional negative consequences from HIV in the API community.
To locate and describe available randomized controlled trials, controlled clinical trials, and other types of controlled intervention studies evaluating the effects of behavioral prevention interventions for HIV in API in the U.
To summarize the effectiveness of these interventions among API and identify the best evidence for effective interventions for future research, policy, and public health practice priorities and directions. We included studies that evaluated the effects of behavioral, social, or policy interventions on at least one outcome measure related to HIV transmission.
We included randomized controlled trials, controlled clinical trials, and studies utilizing a comparison group including pre-test, post-test design. Behavioral interventions: These are interventions that aim to change individual behaviors only without explicit or direct attempts to change the norms of the community or the target population as a whole.
Social interventions: These are interventions that aim to change not only individual behaviors but also social norms or peer norms. Policy interventions: These are interventions that aim to change individuals' behavior, peer or social norms or structures through administrative or legal decisions.
Examples include needle exchange programs, condom availability in public settings and mandated HIV education in all schools in a district. We included studies that reported any type of outcome measure related to HIV transmission including knowledge, attitudes, intentions, self-reported risk behavior, and biological outcomes.
The aim was to identify published and unpublished reports of U. This report incorporates only studies for API, reports of other ethnic minority populations have been previously submitted. For each of these databases, we developed sensitive search strategies consisting of both controlled vocabulary terms where available and free text terms see Table 1 for full search strategies.
We subsequently entered or downloaded all search results into an electronic register using BiblioScape, CG Information, Duluth, Georgia. We scanned the titles and abstracts where available and classified them according to their relevance to the review relevant, not relevant, unclear and for those citations deemed to be relevant also according to the study population minority population, other population, unclear and the type of study outcome evaluation, other study, unclear see Table 2 for definitions.
In addition, we contacted researchers whom we knew to have conducted relevant research. We identified these researchers by their having published studies that had been identified as meeting the inclusion criteria eg, HIV prevention intervention research with minority participants. We identified additional investigators through agency Web sites as having, or having had, grants funded in the area of HIV prevention intervention research.
We obtained full reports for all relevant outcome evaluation studies deemed to be relevant. We reassessed these reports for confirmation of their relevance to the review, and we coded them using a standardized coding strategy see Table 3 and Table 4 for full coding strategy.
We reviewed studies for relevance based on types of participants, interventions, outcome measures, and study design. Two independent reviewers abstracted appropriate information using a standardized data abstraction form. Information retrieved from the studies included details of the interventions and other study characteristics. Any disagreements were resolved between the two reviewers, and when necessary, by a third party.
We stratified studies according to percentage of API population, study design, targeted risk group of intervention and quality in order to better evaluate and summarize outcome information. Each of these studies are discussed in the text below with the highest quality studies listed first and studies of lesser quality ratings in descending order.
We assessed quality of the studies in several ways that took into account our inclusion criteria and methods used in previous systematic reviews. We assessed randomization according to the standards of the Cochrane Collaboration. If the study merely mentioned the word "random" but did not give an adequate description, it received partial credit for this category 1 point. If the authors did not give any description or described using such allocation methods as a day of the week or dates of birth, the study did got no credit for randomization.
If proper methods were utilized to protect against any contamination of the intervention the possibility that participants in different groups could have significant contact with each other, thereby adversely effecting the integrity of the intervention , the study received full credit for this category 1 point.
If proper methods were not taken or if the methods taken were unclear, the study did not receive full credit. If the study design did not warrant a need to protect against contamination, this criterion was not used, and the study could receive a maximum of four points. If the study included information regarding the training or makeup of the facilitators, we credited the study for this category 1 point.
If this description were not included, credit was not given.
AIDS Behav ;16 1 Under legislation enacted by the United States Congress in , patients found importing anti-HIV medication into the country were arrested and placed on flights back to their country of origin . California enacts a new law reducing intentional HIV exposure from a felony to a misdemeanor. In the earlier years of the epidemic, especially in Africa, health systems where completely overwhelmed and millions of people died without government recordkeeping, there is little way of knowing how many people contracted HIV, to get around the problem to get the total cumulative number of HIV infections, HIV death data is taken into account in the table below where those living with HIV are summed with those died of HIV for a cumulative HIV infection figure, nevertheless, the data of credible death estimates exist only for the specific years where available. El VIH es una amenaza de salud grave para las comunidades latinas, quienes se encuentran en gran desventaja respecto de la incidencia de esta enfermedad en los Estados Unidos. However, the security clampdown following the September 11 attacks in meant this was no longer an option.
Hiv cases chinese americans california. Top Navigation
Systematic Review of HIV Behavioral Prevention Research in Asian Americans and Pacific Islanders
Rong Xiaoqing , a recipient of the Dennis A. Part 2: Cultural tradition traps Chinese elder-abuse victims in U. Subsequent pieces will explore the high suicide rate among Chinese-American women and elder abuse in Chinese-American communities. Translated from Chinese by Rong Xiaoqing. New York — To many people, December 1 is just an ordinary day. But the daylight will soon give way to the long night, just like on any other day in the winter, and the next morning, the world will move on, the spotlight will shift, and this day and the message it carries may soon be forgotten.
From then on, December 1 became a reminder of the helplessness and desperation that overcome Chan on that doomed day. But he also anticipates its arrival because it means that he has survived one more year. But the emotional turmoil the anniversary creates for Chan is very complex. There is self-loathing for having patronized a brothel in Chinatown — that may well have been the source of the virus — when he had just been smuggled into this country.
And there is fear that more people, including his own children, who still believe he has hepatitis B, will find out what his disease really is. The Asian community has the lowest HIV infection rate in the United States, but the increase in new infections is alarming.
And in New York, Asians are the only ethnic group that has seen consistent growth in new infections in recent years. This is a diverse community where new immigrants and native-born people and people from different subgroups often have different needs for services. For example, most Asians consider sex to be a taboo topic, and believe one should stay away from doctors unless really sick.
They can also be relatively quiet and not particularly good at sharing their thoughts with others. Altogether, this leaves Asian people with HIV in a double shadow caused by the virus and the bias in their own culture, and makes AIDS prevention in the community more challenging.
According to the U. Because of the relatively lower prevalence rate, Asians have long been considered a safe group that is almost immune from HIV.
But other numbers may not be as reassuring. For Hispanic and African American men, the figures were down 4. And there is a lot more the numbers do not show. In the definitions of the authorities, drug users and homosexual men are the two highest-risk populations.
And CDC statistics show that while drug users are not statistically significant among Asian infections, homosexual men made up more than half of the 1, newly diagnosed Asian cases nationwide between and This makes men-on-men sex the number one cause of HIV infection in the Asian community, which is also the case in the broader population. It was not a coincidence that this was at the same time when there was a high tide of smuggling that brought hundreds of thousands Chinese to this country.
Chin said all the clients she got then were young and middle-aged men who had to take a zigzag route through many different countries before they eventually landed in the United States. Nowadays, both sex workers in Chinatown and their patrons are a little bit more sophisticated, and condoms are more popular. But Chin and her colleagues are not totally relaxed. He remembers that in the first workshop he offered in Africa, he asked people to raise their hands if they had family members or friends who had died from AIDS.
Nobody did. According to the New York DOH, only 6 percent of Asians have ever been pushed to take an HIV test by their doctors, 24 percent lower than the citywide average and the lowest among all ethnic groups. Therefore, experts suspect the prevalence rate in Asians might have been underestimated.
Many Asians, for example, do not learn that they are infected until they are in the late stages of the disease. According to a report the CDC did in 34 states, Even worse, in the eyes of family members, friends, coworkers, and employers, being HIV positive often sends out a message that the patient has done something wrong. Despite the proven medical facts that HIV only spreads through sexual intercourse, contact with infected blood, and from a mother to her unborn baby, many in the community still believe casual contacts with infected people can put them at risk.
People with HIV are treated as if they are highly contagious even by their own families. The fear of discrimination pushes them into even deeper isolation. The patient, a young second generation Chinese living with his parents, told Murayama that since his parents heard he got HIV, his life has been totally changed.
For his research about the religious institutions and AIDS prevention, which will be finished in , Chin and his team have already interviewed people at 27 Buddhist temples and 45 Christian churches that serve Asian members and found only three temples and 14 churches have ever had activities for AIDS prevention.
Afraid of being discriminated against or alienated because of their status, many Asians will try their best to keep it a secret after getting a positive test. But sometimes, the price for this self protection is endangering the health of others. When she left her two small kids with her mother in Malaysia and came to New York to make a living in , the then year-old Fang was strong and healthy. Like many new immigrants, the single mother held two jobs as a garment factory worker and a home attendant so she could send money back home.
A few years later, she met a Chinese man who told her he was a U. Fang thought she had found love and luck. Fang has not seen the man again, but she got sick not long after he left. She started to cough. I immediately started to cry. My kids were still small, and my mother was old. How would they survive without me sending money home?
Chin, the director of the CPC program, noted the number of female clients at the program has jumped 25 percent in the past five years. Persuading patients to disclose to their families, especially their spouses, is a major challenge for the social workers at CPC, said Chin. But they also know how dangerous it is for the clients to keep their secret from spouses. We have to stick to the law.
And applicants for green cards or citizenship could be declined if they were found to have HIV. The new law may impact all immigrant communities, but the Asian community, where 70 percent of diagnosed patients are foreign-born, may need extra attention.
With an HIV-positive population of 4. With greater freedom of travel, Asians living in the United States and their peers in Asia will have a better chance of passing the virus to one another. The populations go back and forth. The infection is both ways. Still, service providers in the Asian community are all thrilled by the repeal of the old law.
With the stigma and fear forced on the patients by the government now gone, they are expecting it to be easier to persuade community members to take the HIV test. And the infected people interviewed for this story — many of whom halted their green card or citizenship applications because of the old requirement — reacted even more emotionally.
A year-old man, when told about the revised law, covered his face with both hands and cried uncontrollably, apparently overwhelmed by the good news. But service providers are worried that greater demand for prevention services in the community may catch them off guard because of the lack of funding.
The allocation of government funding is largely based on the total number of infection cases, and therefore the Asian community gets the smallest share of funding from federal and local governments. Given that these two are the major community-based organizations that focus on the Asian population, service providers complain the city no longer funds prevention programs in the community.
When some contracts end, others open. Many organizations that get city funding have Asian clients. She pointed out the former is a big hospital that is hard to navigate, and the latter is an organization serving lesbian, gay, bisexual and transsexual youths in the East Village. If all of this makes the picture sound a bit gloomy, some still believe a change can be made. Among them is William Ching.
To the year-old new college graduate, the only way leading to understanding and better care for HIV-positive people is to break the silence. As a start, Ching posted a touching and encouraging story about himself. Ching was found HIV positive in July during a routine health check. But when he pulled himself up from the shock and started to look for others in the same situation for advice, he was hit again, this time, by disappointment.
Few are minority young people, and almost no Asians. It was not an easy task. The pressure comes first from the family. He also felt the bias from the community. A couple of months ago, he answered an advertisement looking for someone to share an apartment, but he was declined when the south Asian landlord found his story online. He is now traveling around the country to collect HIV stories from minority youths. We are not less human than anyone else, and we deserve to be happy.
This story was supported by a Dennis A. Join Now Login Search form Search. Facebook page. Twitter page. Youtube page. Fellowship Story Showcase. By Rong Xiaoqing. Sing Tao Daily. Tuesday, December 1, The numbers and beyond According to the U. Hope rising from young people If all of this makes the picture sound a bit gloomy, some still believe a change can be made.