Increase of HIV Prevalence Among Asian American Adolescents and Young Adults

Purpose: Although the rate of new human immunodeficiency virus (HIV) infections in the U.S. is dramatically lower than the height of the epidemic in the mid-1980s it still remains as a public health problem. Approximately 39,660 new HIV cases were reported in 2016, and more than 20% of all new HIV infections occur among adolescents and young adults (Centers for Disease Control and Prevention [CDC], 2017). People in their adolescence and early adulthood undergo significant physical and emotional changes, and this is a time for exploring norms, sexuality, and increased participation risk activities such as using alcohol, smoking, drug use and having unsafe sex (Adebayo & Gonzalez-Guarda, 2017; Ma, Malcolm, Diaz-Albertini, & Klinoff, 2016; Teitelman, Calhoun, Duncan, Washio, & McDougal, 2015). Therefore, HIV prevention for adolescent and young adult populations needs to be dealt with in a separate manner from that of the adult population. Furthermore, ethnic minorities in the U.S. have a higher HIV infection prevalence than non-Hispanic white. Asian American ethnic groups, however, have not been included in most studies primarily because of the small number of HIV cases reported among them (Choi, Wong, & Sy, 2005). The lack of population-based data from Asian Americans has often resulted in minimizing their health needs because there is limited data that clearly attests to their health problems. Only a few studies to examine the epidemiology of HIV/AIDS among adolescents and young adults in the U.S (Rangel, Gavin, Reed, Fowler, & Lee, 2006; Rosenberg & Biggar, 1998) were conducted before 2010 and they did not include Asian Americans. Given that between 2011 and 2015, the Asian American population grew around 12%, four times as fast as the total U.S. population, and given the high prevalence of HIV infection among adolescents and young adults and the lack of research among Asian Americans with HIV, it is necessary to explore the status of the HIV epidemic among young people across race/ethnicity. Therefore, we examined in this study, the prevalence of HIV by gender, age, and race, including Asian Americans, among U.S. adolescents and young adults. In addition, we assessed the general trend of HIV prevalence from 2010 to 2015.

Methods: Our dataset was taken from the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB (NCHHSTP) AtlasPlus (CDC, 2018). HIV/AIDS surveillance is annually conducted from the major reporting sources (hospitals, physicians, public/private clinics, and medical records systems) by each state’s health department across the country and reported to the CDC. The NCHHSTP AtlasPlus provides indicators related to those diseases including HIV prevalence. In this study, adolescent/young adult and adult populations were analyzed separately by categorizing the adolescent/young adult populations as ages ranging from 13 to 24 years and the adult populations as ages 25 years and more. Preliminarily, the HIV prevalence of adolescent/young adults and adult populations between 2010 and 2015 were retrieved (i.e., 36,492 and 935,034 in 2015, respectively). Cases and rates per 100,000 of sex, race, and transmission category of both groups were obtained and compared within a population and between both populations over time.

Results: Data showed that young people aged 13 to 24 accounted for 28% of all HIV infection and that there were racial disparities in HIV incidence, with the black and Hispanic groups having a disproportional number of HIV infections. HIV also disproportionately affects young men who have sex with men. Data also showed that in general, there is decline-trends in HIV infections among young people, however, in contrast to the progress seen in most demographic groups, the rate of HIV infections among Asian Americans steadily increased from 2010 to 2015, yielding the rate of 17.7/100,000 in 2015. As for the adult population, the prevalence of HIV infection among all racial/ethnic groups. By transmission category, while the rates of heterosexual contact remained the same for five years in both groups, HIV infection among men having sex with men (MSM) remained high and steadily increased from 2010 to 2015.

Conclusion: To our knowledge, this is the first report of HIV prevalence among Asian American young adults aged 13 to 24 years. The findings point out to the fact that though HIV prevalence has generally declined among young people, there is a steady increase in HIV infection rates among Asian American young people and young men having sex with men. Asian Americans are often not regarded as a high-risk group for HIV based on their stereotype as overachievers, and their perception as a “model minority” (Sabato, 2017). It appears that the prevalence of HIV among Asian Americans might be underestimated because some Asian Americans may avoid seeking testing because of language barriers, fear of discrimination, the stigma of homosexuality, immigration issues, the fear of brining shame to their families, or because they may not think Asians are at risk (Sen, Nguyen, Kim, & Aguilar, 2017; Wong et al., 2012). Given that the presence of sexual and gender minorities (SGM) is a recent challenge for Asian communities (Tan et al., 2016; Tan, Baig, & Chin, 2017), more studies are needed to increase awareness and knowledge about HIV infection and prevention among Asian American young people, especially SGM young people as well as the development of HIV screening guidelines specific to Asian American SGM young people.