HIV+ Asian-Americans: Silence & Stigma

Alex hasn't seen his family in over two decades. Alone among his relatives, Alex has lived in various cities in America, most recently and for the longest time New York. But it's not so much the geographical distance that has kept him from keeping ties with Japan.

A long-time survivor of HIV, Alex came down with a series of AIDS-related illnesses over a decade ago that, he said, nearly killed him. During that time of personal trial, he traveled back to Japan.

It did not go well. "My family didn't understand what was happening," Alex said. "In Japan, even 'cancer' is considered a forbidden word." He hasn't spoken or written to his mother or sibling since.

Like other APIs, however, Alex has had to shoulder the burden of discrimination far from his family, in the very community that prides itself on acceptance.

As a 2010 series of reports here on EDGE described, racism takes many forms, some discreet but many overt, among American gay men. From the pejorative term "rice queen" for an Anglo who likes to date Asians, to the personal profiles on hook-up sites and apps like Grindr and Manhunt that specify "no Asians," gay Asian-Americans face prejudice on several fronts.

Some club promoters try as hard as possible to discourage "too many" Asians, because they fear others will avoid such a club. Alex has noticed discrimination even in sex club ads: "One party advertises itself as open to 'blacks, whites, Latins, Arabs," he noted. "By including Arabs, they're making a point of who is not included."

The problem, in a nutshell, is a stereotype of all Asian men that is as insidious as it is widespread. In 2004, Details magazine published a one-page feature entitled "Gay or Asian?" that pretty well encapsulated the stereotype that "Asian" equates with "effeminate," whether gay or straight.

The concomitant rise in HIV rates may be depressing, but, on further reflection, probably not surprising. When people like Alex feel marginalized in matters sexual, they are often going to be willing to take more chances just for the possibility of human contact the rest of us take for granted. Some men may play into an image of subservience, while others suffer from a language barrier that makes negotiating what will happen in bed that much harder.

"Many Asian gay men have been battered in a sense that they don't have the right to insist that someone use a condom," Dr. Robert Murayama, who heads APICHA's health center, said. "A number of gay Asian men have been infected because they don't quite have the language skills to be able to negotiate safer sex."

The scope of the problem can be seen in statistics during most of this century: APIs began the 2000s representing less than 1 percent of Americans infected with HIV, but had, and continue to have, the highest percentage increases in HIV diagnoses of all racial or ethnic categories.

Pressures of Being in a ’Model Minority’

Many of the problems affecting these men are common to those in other high-risk groups. According to a study done by the University of California San Francisco's Center for AIDS Prevention Studies, they may lack family support (either from physical distance or alienation). There's a cultural avoidance of frank talk about sexual behavior, not to mention illness. Drug and alcohol abuse stemming from social discrimination becomes another problem not talked about.

The popular image of Asians as high achievers and a "model minority" has contributed to this dilemma. Having random or anonymous sexual encounters doesn't jibe with the highly studious, disciplined stereotype.

Ingrained stereotypes that all APIs are high achievers are problematic when it comes to HIV, Hyeouk Ham, a Boston University professor who has studied the issue extensively, has found. "Throw in gay lesbian bi and transgender folks on top of that," Murayama has said of the "model minority" burden.

As a result of these factors, gay APIs get tested for HIV at rates far lower than the rest of the United States. That means not only that they are unaware of their status, but they are not getting treatment until an opportunistic infection becomes a serious health threat.

An official day in May has been dedicated to getting Asian-Americans tested. But infections continue to increase while diagnoses has decreased -- which means people still aren't comfortable getting tested or dealing with how to navigate safer sex in the bedroom.

To help APIs discuss issues surrounding HIV, several groups have grown up in areas where with heavy Asian populations, such as San Francisco, Los Angeles and New York. Asian/Pacific Gays and Friends in L.A., for example, includes a weekly drop-in center where HIV-positive APIs can talk with others like themselves.

Asian and Pacific Islander Coalition on HIV/AIDS (APICHA) in New York operates a health clinic where staff members speak the language of their clients. There are support groups in English and Mandarin Chinese. In San Francisco, the Asian & Pacific Islander Wellness Center's Living Well Network encompasses a raft of meetings, social events and retreats.

Murayama also cited "so much denial about HIV in the Asian community, especially among the Asian medical community. We, unfortunately, have our own stereotypes and our own issues," he has said. "We" -- meaning Asian medical professionals -- "are not above our own internalized homophobia."

When Murayama contracted an STD years ago, he recalled his doctor, a Korean-American, as not comprehending how it happened. The anecdote reminded me of the time, several years ago, when I went to a city clinic to have an STD treated, also by a Korean-American doctor. To say his bedside manner left something to be desired would be an understatement; he made no effort to hide his disdain at the unstated way this might have happened to me.

No one is saying that the media, academia, government and HIV service organizations shouldn't be addressing the very problem of HIV infection rates among Anglo, African-American and Latino gay men. But the distressing numbers of gay APIs seroconverting means that the time has long past when there is not a concerted effort to include them in any discussions of high at-risk populations.

When Ben, a Filipino software engineer in San Francisco, was told the results of an HIV test in 2009 were positive, the first thing he thought was "What am I going to tell my parents?" His outcome was happier than Alex's. "Both of them cried," he said. "Then they dried their tears and did what they could to help me."

"Since then, they've been a great support," he added. "If anything, this has brought us closer together."

Steve Weinstein has been a regular correspondent for the International Herald Tribune, the Advocate, the Village Voice and Out. He has been covering the AIDS crisis since the early '80s, when he began his career. He is the author of "The Q Guide to Fire Island" (Alyson, 2007).

This story is part of our special report: "HIV Minority Report". Want to read more? Here's the full list.