APICHA Broadens Its Primary Care

Lower Manhattan Asian healthcare provider moves beyond HIV-positive base

With the aid of a $500,000 grant in state healthcare funds, the Asian & Pacific Islander Coalition on HIV/ AIDS has launched an ambitious expansion of its primary care program, enabling the group to offer ongoing health services to a broader population than the HIV-positive clientele it had historically served.

The launch of the more comprehensive program was funded through the New York Health Care Efficiency and Affordability Law — which is providing money to 31 other community-based programs across the state as well — and was formally announced at an open house last month at APICHA’s offices on Lower Broadway near Chinatown.

In recent years, the group’s primary care facility served about 200 HIV-positive people, the bulk of them Asian and Pacific Islander (API) gay and bisexual men. Already, the facility has enrolled about 100 additional HIV-negative clients in its expanded primary care program.

The goal is to serve as many as 400 new clients by the fall.

“This grant opens the way to providing a broader range of medical services, particularly for gay/ bisexual/ [men who have sex with men, or MSM] APIs at high risk for acquiring HIV infection who are not receiving medical care at other clinics,” said Dr. Robert Murayama, APICHA’s chief medical officer. “It is a wise investment in prevention.”

Murayama noted the group’s established track record of cultural competency in serving New York’s diverse API population, which includes a wide range of languages.

As it ramps up its broadened primary care program, APICHA is also seeking designation as a federally-qualified community healthcare center, a type of institution for which the Obama administration’s new healthcare legislation provides financial incentives. According to Zaheer Mustafa, APICHA’s public affairs coordinator, the federal designation is “a stamp of approval [that] reflects the quality of the medical care” and opens up funding opportunities at all levels of government.

Although APICHA was founded 21 years ago by six Japanese-American women to serve the largely unmet needs of API gay men affected by HIV/ AIDS, the organization has gained a strong reputation among other people of color communities, and the population generally, across New York. Mustafa cited statistics that roughly 79 percent of APICHA’s clients come from people of color communities, with APIs making up roughly half of the total. Over the years it has provided primary care to HIV-positive New Yorkers, women living with the virus, many of them heterosexual, also began accessing services there. About two percent of the group’s clients are transgender.

With its base it Lower Manhattan, APICHA has traditionally served the Chinatown community, where a significant percentage of its clients continue to come from, but its geographic reach is citywide, with significant representation from other parts of Manhattan, Queens — particularly among Flushing’s large API population — and Brooklyn. About 12 percent of the city’s population is Asian and Pacific Islander.

In addition to primary care, APICHA has carried out HIV testing — at a rate of about 3,000 people each year, according to Mustafa — done STD screenings for about 150 people annually outside of primary care, and offered a variety of individual and group support services for populations including gay men, young people, and women.

Even as APICHA has enhanced its profile as a community-based health care facility welcoming to all types of New Yorkers, it recognizes the unique role it has in the city’s Asian and Pacific Islander communities.

A power point presentation presented by Murayama highlighted a range of health disparities experienced by API communities — based on genetic predispositions, behavioral choices, and cultural and economic barriers to care.

Tuberculosis is 24 times more common among Asians than in the general population, and hepatitis B affects up to ten percent of API immigrants to the US. Vietnamese women are only half as likely as whites to have had a Pap smear in the previous three years, and are twice as likely to die from cervical cancer once it develops. Asian-born women living in the US, especially those from Viet Nam, China, and the Philippines, have a four-times greater risk of dying from breast cancer than women from the same cultural groups born in America. Cambodian and Vietnamese men smoke at rates up to twice that of males generally in the US.

Murayama’s presentation acknowledged that statistics on the API LGBT community in the US remain limited. The 2000 Census identified about 4,700 API same-sex couples in New York and 38,000 nationwide, though the count of gay and lesbian households from ten years ago is widely considered very conservative.

A study carried out by the National Gay and Lesbian Task Force found that members of the Asian LGBT community in the US reported discrimination both within their ethnic communities and in the wider queer community. A survey of South Asians living in Southern California found many respondents inhibited by family traditions from coming out. Fully two-thirds reported that they lived a “double life,” with pressure from family members — greatest among older respondents — to marry a partner of the opposite sex.

Like other AIDS services groups, APICHA sees a strong link between discrimination and lack of social and economic supports and HIV risk. Murayama cited a study by the Center for American Progress that found that one quarter of lesbian and gay APIs experience psychological distress, a figure two-and-a-half times higher than the general population and, significantly, four times greater than the heterosexual Asian population. Meanwhile, Census figures show that one-fifth of the US API population lacks health care insurance.

As it gears up to better serve the health care needs of the API LGBT community, with or without HIV, APICHA applauded recent statements out of the White House recognizing the health disparities the group aims to address. In a proclamation issued last month in honor of Asian and Pacific Islander Heritage Month, President Barack Obama acknowledged the “significant education and health disparities,” the “high risk for diabetes and hepatitis,” and the rising number of HIV/ AIDS cases. Significantly, a letter from the White House Office of Minority Health noted, “The number of HIV/ AIDS cases among AAPIs may be higher than reported because of underreporting or misclassification of Asian Americans and other Pacific Islanders.”

“It is very encouraging to know that the president of the United States understands our community is severely affected by HIV and that health disparities persist,” Therese R. Rodriguez, APICHA’s chief executive officer said in response to the White House proclamation. “This is a great step forward for us — a community too often excluded, underfunded, and underserved.”