Synergizing HIV testing and viral hepatitis B screenings among hard to reach Asian & Pacific Islander communities through non-traditional approaches: Data from 2007-2013

Despite having similar routes of transmission, Hepatitis B enjoys little stigma among hard-to-reach Asian & Pacific Islander (A&PI) communities in the San Francisco Bay Area, while HIV is highly stigmatized. Successful community campaigns have been effective in mobilizing A&PIs to screen, access treatment, and talk about Hepatitis B. Unfortunately, HIV testing rates among A&PIs in San Francisco are low--the least likely community to test when compared to all other racial and ethnic groups. To increase testing and reduce HIV stigma among A&PIs, an integration model was developed using Hepatitis B as a gateway to educate about HIV's common risk factors. Implementation modalities included a mobile co-location approach targeting cultural festivals, street fairs, and cultural centers. Pre/Post questionnaires were utilized to measure changes in HIV/Hep B knowledge. Through our approach from June 2007 to January 2013, a total of 1210 community members were screened for Hepatitis B. 90% of those screened have never been tested for HIV. Of those screened for Hepatitis, 13% were tested for HIV at the same time as their Hepatitis screening, while 88% accepted a referral to an HIV testing clinic. Among those screened, we observed an 8% HIV positivity rate and an 18.6% Hepatitis B positivity rate. Results of the post screening knowledge questionnaire indicate that 80% of respondents stated they were not aware of the risk of HIV. 75% did not know how HIV is transmitted. 60% stated they would be comfortable discussing HIV with their families moving forward. A synergistic approach increased access of HIV and Hepatitis clinical services to hard-to-reach, immigrant, monolingual A&PI communities. This model suggests that leading prevention and education efforts with a less stigmatized health issue can assist in addressing barriers of discussing health issues that comprise higher cultural stigma.