Examining barriers to care: Provider and client perspectives on the stigmatization of HIV-positive Asian Americans with and without viral hepatitis co-infection

Abstract

Between 1999 and 2003, Asian Americans and Pacific Islanders (APIs) in the US experienced more rapid growth in the number of AIDS cases than any other racial or ethnic group. In addition, the prevalence of HBV and HIV co-infection is estimated to be significantly higher among APIs in the US than in other racial/ethnic groups. High rates of HIV and hepatitis B or C (HBV and/or HCV) co-infection, in concert with language and cultural barriers, create significant challenges to effective coordination of treatment. The purpose of this study is to identify barriers to care and treatment in APIs with HIV with and without hepatitis co-infection. Specifically, we analyze results from semi-structured interviews with health care providers (N=23) and Asian Americans who are HIV and hepatitis (HBV and/or HCV) co-infected (N =17) in order to clarify how stigma in particular may impede/limit access to coordinated health care provision. Providers and clients recognize the need for integrated, culturally and linguistically appropriate access to care while simultaneously acknowledging that stigma is a severe barrier to access to care. This article sheds light on the complexities of the stigma experienced by HIV and hepatitis co-infected Asian Americans and suggests a need for further research and renewed efforts by caregivers to reduce stigma in these communities.

Keywords:

• HIV-viral hepatitis co-infection
• barriers to care
• stigma
• Asian Americans

Acknowledgements

The authors thank the University of California, California HIV/AIDS Research Program for support of this project via grants to APAIT (#CR07-SSF-531) and UCLA Urban Planning (#CR07-LA-532). In addition, Dr Meyer's time was supported in part by the Veteran's Administration/Robert Wood Johnson Clinical Scholars Program. We also thank the two anonymous reviewers for their helpful comments and suggestions. The contents and views expressed here are the authors' only. All errors and omissions remain the responsibility of the authors.