How One Seattle Clinic Is Addressing the Importance of HIV Care Within the AAPI Community

by Sarah Goh

Last year, Seattle's International Community Health Services (ICHS) was awarded a nearly $1 million grant to expand HIV prevention services for its patients.

The three-year grant is part of the Ending the HIV Epidemic initiative that allows the clinic to increase both HIV screening and the capacity of providers who can offer HIV treatment and training.

As a result, ICHS is able to expand its services while tackling the stigma attached to HIV in many Asian and Pacific Islander (AAPI) cultures. While rates of HIV are low in Asian Americans compared with other populations, Asian Americans also have the highest rate of undiagnosed HIV at 22%, or nearly 1 in 4 people, according to the CDC.

ICHS is a federally qualified health center with multiple locations throughout the Seattle region that cares for all patients regardless of their identity, ability to pay, or documentation status. It is the biggest health care provider for the AAPI community in Washington today.

When it comes to HIV care, says ICHS family medicine physician Hieu Pham, the first line of treatment is screening patients for HIV. However, stigmatization of HIV — especially within AAPI communities — has left many patients refusing to screen.

"When I say the word 'HIV' in Chinese [and Vietnamese], there's already a huge stigma attached to it," Dr. Pham said. "Patients immediately think, 'I definitely don't have the disease.'"

Many ICHS patients believe HIV is a part of Western culture — that only people from America or Europe can contract this immune-suppressing disease. In reality, HIV can be contracted not only as a result of sexual contact, but also through health care practices that aren't performed hygienically, such as blood transfusions.

"Historically, a lot of the countries that our patients come from don't have a robust health care system that screens their blood products," Dr. Pham said. "As a result, a lot of people actually can get HIV from health care … but we don't traditionally think in terms of these risk factors."

One historical example of communities acquiring HIV from health care can be seen in the Henan province of China. In a social epidemiological study, 90% of HIV cases in that province in the early to mid-'90s were found to have been caused by commercial blood donations.

However, many patients of Asian descent who grew up between the '70s and '90s are still wary of the HIV stigma and remain convinced they cannot contract HIV.

Dr. Pham says it's important for providers to reinforce the importance of HIV screening for all their patients, not just patients they assume to be at high risk.

Changing the language around HIV screening is also imperative. And if a provider is working with an interpreter, collaboration and communication around how to ask sensitive questions can both bridge the language gap and address stigma.

"I stopped saying 'HIV,'" Dr. Pham said. "I now say that there is a virus that can suppress your immune system."

In response, many patients are surprised to learn that there is a virus that has this dangerous impact. "They don't know anything about this virus, except the stigma that's associated with HIV," Dr. Pham said. "So when I frame it in this way, many more patients are more likely to get HIV screening."

In addition to cultural stigma, there is a prominent American myth that can lead to providers dismissing Asian American health disparities and perpetuating the false idea that Asian American patients cannot contract HIV. The "model minority" myth is the perception that Asian Americans do not experience racial oppression and have succeeded in integrating into mainstream culture.

In Dr. Raj Sundar's Seattle-based podcast Healthcare for Humans, he explores health care within different cultures and dedicates an episode to the extreme negative impact the model minority myth can have on patients. In terms of HIV care, the myth leads to the harmful stereotype that Asian Americans don't need access to HIV treatment since they are a "model minority" that don't experience stigmatized diseases.

"By labeling Asians as a model minority, people don't think we should get resources dedicated to certain conditions because they assume we don't have it," Dr. Pham said. "It's a myth that creates so much harm in the community."

When the first ICHS clinic opened in the Jefferson Park Clinic in Beacon Hill in 1973, many of its services catered to Chinese and Filipino elders in the community who did not have access to health care.

Today, with multiple locations in Seattle and the surrounding area, the clinic continues to serve its communities' elders, with many ICHS patients being immigrants and refugees who are navigating an unfamiliar culture with little access to their native language. Consideration of cultural aspects of care and integration of cultural humility is vital when it comes to providing health care at ICHS.

"Having this reflection of where our patients are from and how they respond to Western ways of medicine is really important," Dr. Pham said.

Keeping this in mind, the clinic provides different modalities of care that are familiar to its patients' cultures, some examples being an in-house acupuncturist and dietitians who recognize certain cultural diets.

Today, the ICHS grant is able to provide another avenue of care and reallocate its resources to combat the model minority myth and tackle the cultural stigma attached to HIV.

In its first year of grant usage, ICHS has been able to ensure a trained HIV provider at each clinic site. It has hired a program manager who overlooks HIV screening and a patient navigator who assists patients — especially those who are uninsured or undocumented — through the process of treatment.

There are currently many population-based recommendations for screening, but when it comes to HIV, this is a virus that does not respect boundaries, Dr. Pham says.

"In order to get care for the whole human being, it's really important to think about screening for all different conditions that a patient could have, regardless of who they are," Dr. Pham said. "HIV care is just a part of doing more holistic care for your patient."

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Editors' Note: This article was updated on 08/24/2023 to correct that ICHS clinics are located throughout the Seattle region, not just in Seattle.

This article is published under a Seattle Human Services Department grant, "Resilience Amidst Hate," in response to anti-Asian American, Native Hawaiian, and Pacific Islander violence.

📸 Featured Image: Winnie Lee, PA-C, assistant medical director at ICHS, reviews a patient's vital signs at ICHS' Bellevue Medical & Dental clinic in the Crossroads Neighborhood of Bellevue. (Photo courtesy of ICHS.)