In 2008, the Banyan Tree Project worked with Amy Hanaiali'i Gilliom, Joan Chen, and James Kyson Lee to be spokespeople and star in our public service announcements.
A&PI Wellness Center's Anti-Stigma Programs
What is HIV-related stigma?
Stigma discredits individuals in the eyes of others (Goffman 1968). This framework includes the creation of labels, linking of labels with stereotypes, separating "us" and "them," and status loss and discrimination (Link & Phelan, 2001).
An example of stigma is the common belief that people with HIV/AIDS deserve what happened to them because they did something immoral or illegal. To expand further, one may label someone with HIV, then link stereotype those with the disease, separating those with HIV, and then discriminating against them. In the realm of public health, HIV-related stigma manifest through fear of discrimination can often lead to delay of diagnosis and increased risk of transmission (Heijnders & Van Der Meij 2006). For instance, someone may delay or not even get an HIV test because they did something that their family would consider immoral. In that case, this "perceived stigma" presents a barrier to getting tested.
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Risky behavior is often linked to stigma and discrimination. HIV-related stigma can be based within the A&PI community itself or stigmatizing behavior can also be compounded by belonging to another marginalized group, as cited above. Additionally, HIV is seen as a "demon-plague" in the A&PI community, brought on by unacceptable behavior, such as homosexuality, drug use, or patronizing commercial sex workers (Kang, et al. 2003).
Testing and prevention are stymied by stigma as mentioned above. Sexual silence within A&PI communities contributes to lower HIV testing rates. A lack of culturally competent testing sites can cause anxiety and tension when seeking services and testing (Nemoto, Operario, et al., 2003).
In China, another study found "65% of respondents believed that that HIV-infected people should be ostracized, forced out of their villages, distanced as friends, or deprived of educational or employment rights." The same article concluded that "[t]he observed association between stigmatizing beliefs and risky behaviors… may reflect an attempt to reconcile the conflict [respondents] experience when they engage in behaviors that they know are unsafe and socially unacceptable" (London 2006).
Asian & Pacific Islander Wellness Center's own research reflects that stigma exists within the A&PI community. In 2004, A&PI Wellness Center conducted a street intercept survey of the Chinese community finding 47.5% of respondents agreed that people living with HIV/AIDS (PLWHA) should not be allowed to work in public schools. Furthermore, 60.5% agreed that PLWHA should not be allowed handle food in restaurants, and 61.4% agreed that PLWHA should not be allowed to work with patients in hospitals.
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How does HIV-related stigma affect the A&PI community?
As mentioned above, HIV-stigma delays testing and can lead to unsafe sex practices. For example, from 2001 to 2006, the number of A&PI men who have sex aged 13-24 more than doubled (CDC, 2008). In a study of young Asian and Pacific Islander men who have sex with men, more than half used "party drugs," and drugs and alcohol were associated with unprotected anal intercourse (Choi, McFarland, et al. 2002) diminishing their capacity to practice safe sex.
HIV risk does not lie entirely with men who have sex with men. A&PI women are also at higher risk when practicing unsafe sex, which is also the primary way that A&PI women become infected (CDC, 2007). Focus groups of A&PI women indicated that cultural taboos against talking about sex and safer sex practices exist. Gender dynamics also make it difficult for women to get men to wear condoms during sex. Many women also reported that fear of retaliation through domestic violence as another reason they did not practice safe sex (Jemmott, Maula & Bush, 1999).
Stigma impedes utilization of medial care, serostatus disclosure and medical treatment adherence among A&PIs. This stigma is perpetuated by self-attribution and blame for acquiring HIV, and real or perceived inclusion in marginalized groups such as substance users, patrons of sex workers, and homosexuals (Kang, Rapkin & DeAlmeida, 2006). An HIV testing survey of A&PIs in Seattle found that while 90% of participants perceived themselves at some risk for HIV infection, only 47% had been tested during the survey period (Kahle, Freedman & Buskin 2005). CDC's Behavioral Risk Factor Surveillance System found A&PIs are significantly less likely than members of other races/ethnicities to report having been tested for HIV (Zaidi, Crepaz & Song, 2005).
These low testing rates also affect the stage of HIV disease at which diagnosis is made. CDC surveillance shows that for many A&PIs, the diagnosis of HIV infection is made late in the course of disease. In 2004, 44% of Asians and Pacific Islanders received an AIDS diagnosis within 1 year after their HIV infection was diagnosed. This is in comparison to 37% of whites, 40% of blacks, 41% of American Indians/Alaska Natives, and 43% of Hispanics (CDC 2005).
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The Response: A&PI Wellness Center's Campaigns
To respond to HIV-related stigma in the A&PI community, we have developed three major campaigns: the Banyan Tree Project, One Mind Opened, and TalkAIDS. Below are brief descriptions of each of these social marketing campaigns.
Banyan Tree Project
The Banyan Tree Project is a CDC-funded national campaign, culminating with the National Asian & Pacific Islander HIV/AIDS Awareness Day every May 19th. Events leading up to this day are designed to address the needs of the A&PI community to get tested and the real facts about HIV. Visit the Banyan Tree Project web site for more information, giveaways, and to see our public service announcement.
One Mind Opened
"One Mind Opened" was the first large scale anti-stigma social marketing campaign that A&PI Wellness Center undertook. Focusing on the Chinese and Vietnamese communities in the Bay Area, the campaign included a street intercept survey, bus shelter ads, and a booklet featuring different stories about HIV in these communities. Click here to find out more about this groundbreaking campaign, along with information on how to do something similar in your own community.
"TalkAIDS" was an extension of the "One Mind Opened" campaign. Developed in 2007, A&PI Wellness Center developed a campaign targeting the Chinese community. The campaign included a public service announcement and newspaper ads featuring actress Joan Chen. We also completed a pre- and post-campaign survey, which revealed that communication about HIV increased after the PSA aired and the ads ran, and in some cases lowered indicators of stigma. Our TalkAIDS page features more about the development of the campaign, our research findings, and a downloadable copy of the PSA for you to view and share!
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Want to develop an anti-stigma campaign in your community?
We can help with that! Our capacity building assistance (CBA) program can help tailor our anti-stigma campaign to meet your unique challenges. We can help you with program design, event planning and media relations to get your message out. Please visit our CBA page to find out more information and to place your request or contact Sapna Mysoor at (415)292-3400 x 352 or at firstname.lastname@example.org.
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CDC. HIV/AIDS Surveillance Report, 2005. Vol. 17. Rev ed. Atlanta: US Department of Health and Human Services, CDC: 2007:1–46.
Choi K, McFarland W, Chu PL, et al. Heavy "party" drug and polydrug use and associated sexual risk for HIV among young Asian men who have sex with men. XIV International Conference on AIDS; July 2002; Barcelona, Spain. Abstract E10725
Goffman, E. Stigma: Notes on the management of a spoiled identity. New York: Simon and Schuster.
Heijnders M & Van Der Meij S. The fight against stigma: An overview of stigma-reduction strategies and interventions, Psychology, Health & Medicine. 11(3):353. August 2006.
Jemmott LS, Maula EC, Bush E. Hearing our voices: assessing HIV prevention needs among Asian and Pacific Islander women. Journal of Transcultural Nursing 1999;10:102–111
Link BG & Phelan JC. Conceptualizing Stigma, Annual Review of Sociology. 27:363. 2001.
Kang E, Rapkin B, DeAlmeida C. AIDS Patient Care and STDs. October 1, 2006, 20(10): 712-723. doi:10.1089/apc.2006.20.712
Kang E, Rapkin BD, Springer C, Kim JH. The "demon-plague" and access to care among Asian undocumented immigrants living with HIV disease in New York City. Journal of Immigrant Health. 2003;5(2): 49-58.
Nemoto T, Operario D, Soma T, Bao D, Vajrabukka A, and Crisostomo V. "HIV Risk and Prevention Among Asian/Pacific Islander Men Who Have Sex With Men: Listen to Our Stories." AIDS Education and Prevention, 15(A): 7-20, 2003.
Zaidi IF, Crepaz N, Song R, et al. Epidemiology of HIV/ AIDS among Asians and Pacific Islanders in the United States. AIDS Education and Prevention 2005;17: 405–417
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This web page was supported by Cooperative Agreement Number 1U65PS002095-01 from The Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention.