Health Care Seeking for HIV/AIDS among South Asians in the United States

Timely health care seeking is critical to preventing and treating HIV/AIDS. Early detection and treatment of infected individuals result in primary prevention at the population level by diminishing the risk of further viral transmission. It leads to secondary prevention for individual patients by enabling prompt management of infection complications. An examination of the factors that individuals consider barriers to disclosing their HIV/AIDS status may reveal predictors of nontreatment or of delay in seeking treatment (Hu, Flemming, & Castro, 1995; Pierre, Stein, & Mor, 1991). The health care seeking process is a continuum, ranging from reduction of exposure and prevention of new infection to obtaining appropriate treatment for existing cases. The stages along this continuum include discovering one's HIV serostatus; preventing further transmission if one is infected; and obtaining treatment to reduce the duration of opportunistic and other HIV-related illnesses. The failure to seek health care may occur at either of two intervals: (1) the procrastination interval--from the realization of probable HIV infection (the recognition of the risk of exposure and the onset of seroconversion symptoms) to HIV/AIDS testing, for which interpretable results are obtained, and (2) the treatment interval--from the receipt of the results of seropositive status to health monitoring or treatment of HIV-related symptoms such as opportunistic infections. Program developers and policy planners have recognized the significant influence of sociocultural factors on all these stages of health care seeking for the diagnosis and treatment of HIV/AIDS. This influence takes place on different levels (that is, individual, familial, community, and organization), and in different contexts (for example, social relations, cultural norms, spiritual values, and environmental aspects) (Wong, Chng, & Lo, 1998). An individual's decision to be tested for HIV may be influenced by the perceived consequences of disclosing his or her serostatus. The possible costs and benefits of disclosure may thus determine the timing of HIV/AIDS-related health care (Bechtel, Shepherd, & Rogers, 1995; Brown, DiClemente, & Park, 1992). When barriers to health care seeking are identified at the community and individual levels, researchers and program developers can foster more timely diagnosis and treatment of HIV/AIDS. This article focuses on the HIV/AIDS-related health care seeking behaviors of immigrants from Bangladesh, India, and Pakistan. LITERATURE REVIEW The cumulative number of AIDS cases in the United States reported through June 2000 was 753,907. Of those cases, 5,546 occurred in Asians and Pacific Islanders (APIs)(Centers for Disease Control and Prevention [CDC], 2000). Separate data for South Asians were not reported in national or state estimates. APIs represent nearly 3.6 percent of the U.S. population (U.S. Census Bureau, 2000) and about 1 percent of all cumulative AIDS diagnoses in the United States (CDC). Compared with other ethnic groups, a relatively small number of APIs in the United States live with AIDS. This relatively small number obscures the problem of HIV infection in this population (Sy, Chng, Choi, & Wong, 1998). The problem is also obscured by some of the most recent state data. For example, in New York State at the end of 1999, 54,971 people were reported to be living with AIDS. Among them, 387 were API, 23,941 African American, 17,242 Hispanic, 12,911 white, and 43 American Indian or Alaska Native (CDC, 2000). However, APIs are affected by a critical trend in the HIV/AIDS epidemic that can contribute to the spread of the virus: delayed diagnosis or failure to seek health care. Of all HIV-infected people in the United States, the proportion diagnosed with Pneumocystis carinii pneumonia (PCP) in 1995 was highest among APIs. In New York City, it was higher among APIs (40 percent) than among African, white, and Latino Americans (30 percent)(New York City Department of Health, Office of AIDS Surveillance, 1995). …