Role of immigration in HIV infection among Asian immigrants living with HIV in New York City

Background: The US Asian/Pacific Islander (API) population continues to increase rapidly, three times faster than the general population. A recent MMWR report showed that, among all racial groups, US APIs had the only statistically significant percentage increase in HIV/AIDS diagnosis rates (2001-2004). Similar trends are evident in NYC, where foreign-born cases make up 72% of API AIDS cases. Yet, little is known about HIV among API immigrants and ways the immigration process increases risk. Methods: The data reported are from a needs assessment of APIs with HIV/AIDS in NYC, which involved in-depth qualitative interviews (n=35) and quantitative surveys (n=89). This analysis relies primarily on 17 of the 35 qualitative interviews. Results: Vulnerabilities created by the immigration process appeared to increase HIV risk. First, several undocumented Chinese heterosexual male immigrants believed they were infected prior to entering the US during long stays in Southeast Asia, where they were separated from family and frequented sex workers. Second, several gay men believed they were infected soon after coming to the US, where they engaged in unprotected sexual activity after finding new sexual opportunities for which they were unprepared. Many female participants said they were infected by their male partners; the dynamics of immigration may have been a factor in several cases. Conclusion: API immigrants may be at increased risk for HIV infection during the immigration process and immediately following. Support and education for new API immigrants may be key to reducing risk for uninfected new immigrants and for partners of HIV-positive new immigrants.