Co-infection as a new paradigm of health inequities and access to care: Results from a study of Asians living with HIV and Hepatitis B/C in Los Angeles, California

Scholars, policy makers, and service providers have sought to “de-silo” epidemiology, policy design, and service delivery to eliminate health disparities/inequities in disadvantaged populations. New paradigms are needed, however, to move this effort to the next stage. We propose in this paper a “co-infection” approach that highlights infection with HIV and Hepatitis B/C among Asian Pacific Islanders (APIs) in Los Angeles, CA as an example of how “co-infection” highlights severe gaps in medical and social service systems stemming from complex needs associated with concurrent illnesses. We present results from a recent study (2007-2009) of HIV/viral hepatitis co-infection, using interviews/questionnaires and blood tests of HIV positive Asians (English, Chinese, and Vietnamese speaking) (N=16), and interviews with medical and social service providers (N=24). The interviews for both sets of study participants focused on service needs, use, and gaps, and the factors enabling or obstructing access to prevention, testing, treatment, and care. The survey for the HIV positive Asians expanded questions used in the national HIV Cost and Services Utilization Study (HCSUS). The blood tests were used to confirm HIV status, and to determine infection with viral hepatitis (Hepatitis B or C). The results indicate that there are severe gaps in medical and social services for APIs living with HIV/viral hepatitis co-infection, and that APIs have relatively little knowledge about viral hepatitis, and whether they have been vaccinated or infected. Implications of these results for developing comprehensive systems of care for co-infected APIs, and other disadvantaged populations, are presented.