Asian and Pacific Islander Youth: Diverse Voices, Common Challenges

By Man Chui Leung, Program Coordinator, Asian and Pacific Islander Health Forum

Since working with Asian & Pacific Islander (A&PI) youth at local, regional, and national levels for the past six years, I have seen HIV/AIDS issues that are, I believe, unique to A&PI youth. Writing about these issues is difficult, especially since I believe that we have seen only the "tip of the iceberg" regarding HIV/AIDS and A&PI youth.

Why just the tip of the iceberg? To fully understand how HIV/AIDS impacts any community, we need accurate data; yet, it is difficult to assess the true impact of HIV/AIDS on A&PIs because:

1. Data is seldom collected specifically on A&PI people, who are usually relegated to the "other" category, making it impossible to analyze the situation of these communities.
2. When collected, data for different A&PI ethnic groups are usually pooled into one monolithic A&PI category, thereby losing the opportunity to assess HIV/AIDS in each one of more than 60 separate ethnic groups that comprise the larger A&PI community.
3. A&PI people may be undercounted because they are often misclassified in medical records, which usually reflect the opinion of the provider, rather than the self-identification of the patient.
4. Currently, little research targets the larger A&PI community, and even less research focuses on specific A&PI communities or on specific groups such as A&PI youth.

Thus, policy makers, funding sources, and health care providers seldom think about the A&PI community when hearing about HIV/AIDS. A&PIs are all but invisible to AIDS policy makers, community planning groups, epidemiologists, and those who plan culturally or linguistically competent service delivery. HIV/AIDS is invisible to A&PIs, as well, because society's neglect reinforces a community-wide myth that A&PIs are not vulnerable to the epidemic. Changing both the community's norms and beliefs and the attitudes and assumptions of policy makers, funding sources, advocates, and service providers is a big challenge for A&PIs.

Despite data limitations, we know that HIV/AIDS cases continue to rise in Asia, the Pacific, and among A&PIs in the United States. We know that one out of five (19 percent) A&PIs living with HIV/AIDS is under age 25 and that female A&PI youth are affected disproportionately by the HIV epidemic. Four percent of A&PI men living with HIV and 14 percent living with AIDS are under age 25 compared to 10 percent of A&PI women living with HIV and 31 percent of A&PI women living with AIDS.¹ The A&PI community is diverse in ethnicity, immigration experience, acculturation, and geography. No common language, culture, or experience unifies this community. Therefore, planners must tailor HIV/AIDS strategies to the unique culture and language of each individual community as well as build connections between different A&PI ethnic groups. Importantly, many A&PI youth are responding proactively—raising HIV/AIDS awareness, tackling sensitive issues such as homophobia, sexism and family pressures, and becoming community leaders.

Local, regional, and national HIV/AIDS programs targeting A&PI youth integrate cultural and language programs and peer education to engage youth and encourage behavioral and social change. For example:

• In Oakland, California, Asian Health Services incorporates hip-hop into a three-session workshop. First, youth identify the hip-hop skill they would like to learn. In the second and third sessions, an HIV expert from the hip-hop community teaches the chosen skill along with important, culturally appropriate HIV/AIDS information.²
• In Los Angeles, California, the Asian Youth Center, Asian Health Care Venture, and Chinatown Service Center incorporate teen theater into prevention efforts. Young people write and produce skits focusing on topics such as HIV/AIDS, teen pregnancy, drug use, peer pressure, and HIV/STI testing and screening. They perform these skits for other youth, families, and schools.³
• In New York, New York, the Asian & Pacific Islander Coalition on HIV/AIDS sponsors bilingual and bicultural young peer advocates who conduct outreach, workshops, and counseling in different languages. The peer advocates reach immigrant youth and help bridge communication gaps between young people and their parents.⁴

Promoting leadership among A&PI youth is crucial to sustaining strategies to meet the changing needs of their communities. In 2001, a national network of A&PI youth, providers, and advocates formed to gather resources, develop leadership among youth, and address critical issues facing these youth. A steering committee—composed of youth from as far apart as Boston and Guam—was chosen to lead the National Asian & Pacific Islander Youth and HIV/AIDS Network. In early 2003, the Steering Committee convened an A&PI Youth Leadership Development Summit that brought A&PI youth together from across the United States and Pacific island jurisdictions to discuss effective local strategies, learn about different leadership styles, and decide how best to advocate and sustain leadership. Through panel discussions and workshops the Summit worked towards the goal of expanding A&PI youth's skills to become a voice that will not be marginalized or ignored.

A&PI youth face the challenges of tomorrow with proactive, diverse, creative, community-centered, and youth-led strategies. A&PI youth leaders are working to raise awareness so that the larger A&PI community, policy makers, and program planners will realize that HIV/AIDS among A&PI youth is an issue that must be addressed.

References

1. Centers for Disease Control & Prevention. HIV/AIDS Surveillance Summaries 2002; 13(2):1-44.
2. Asian Health Services. http://www.ahschc.org/ Oakland, CA: Author, 2002.
3. Chinatown Service Center. http://www.cscla.org/youth.htm. Los Angeles, CA: Author.
4. Asian and Pacific Islander Coalition on HIV/AIDS. http://www.apicha.org/apicha/main.html. New York, NY: APICHA.