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Research on API’s, HIV and Health Disparities (RAPIHHD) Summit

November 17-18, 2008
The California Endowment
Los Angeles, California

RAPIHHD SUMMIT: POLICY RECOMMENDATIONS

In November 2008, over 75 key representatives from the scientific, policy, community, and philanthropic sectors came together for the RAPIHHD Summit, the first ever national research summit on HIV/AIDS in the API community. Building on current behavioral, clinical, and epidemiological research on HIV/AIDS and associated co-factors and co-morbidities in the API community, the objectives of the two-day Summit were to (1) summarize and cultivate a comprehensive understanding of the body of literature on HIV/AIDS in the API community to date; and (2) to collectively develop an HIV research agenda for the API community for the next 10 years, including co-factors, co-morbidities, prevention and treatment. The Summit is meant to be a starting point for longer projects and collaborations that ultimately aim to increase understanding of HIV/AIDS in the API community and to decrease the current phenomena of lack of testing, underreporting, failure to diagnose HIV until the development of full-blown AIDS, and the absence of API’s in the HIV/AIDS research that adversely affect the health of this community.

Summit organizers developed a “background paper” for research on HIV co-infection among API’s in the United States and presented this review of literature at a plenary session. Other plenary sessions included the following topics: Hepatitis B in the API Community; Data Challenges in the API Community; and Highlights on Community and Research Partnerships. Summit participants were assigned to break-out sessions throughout the two days on: (1) epidemiology/behavioral research; (2) prevention/intervention; and (3) treatment: co-infection integration. Each break-out session developed recommendations specific to their respective area, which were then vetted by the entire group.

From the discussion at the Summit, there are clear areas of need for research, funding, advocacy and coordination.

Research

  • Advocate that national longitudinal health studies, such as NHANES, BRFSS, NHIS, and National Survey on Drug Use & Health, oversample API’s and offer surveys in Asian and Pacific Islander languages.
  • Advocate that existing epidemiological sources of surveillance data at CDC, as well as state and local health departments of public health, report estimates of HIV co-infection among APIs (including both incidence and prevalence) and collect sufficient data by API racial/ethnic subgroups to generate these estimates, especially in areas with large API populations or population growth.
  • Develop research methodologies more appropriate for smaller sample sizes as well as effective strategies for recruitment, enrollment, and retention to increase API participation in clinical trials and research studies.
  • Increase the capacity of community-based organizations to develop and implement projects to conduct local research on prevalence of HIV co-infection in the API community and to evaluate the effectiveness of interventions, both “homegrown” or community-generated and evidence-based (EBIs). Components of capacity building includes developing Institutional Review Board, securing research and evaluation funding, collecting data, and disseminating findings in peer-reviewed journals and research conferences.

Funding

  • Prioritize funding for community-based participatory research focusing on HIV co-infection among API’s who are foreign-born and have limited English proficiency to better understand why populations delay testing and how to encourage earlier testing.
  • Prioritize funding for API “homegrown” and community-generated prevention interventions for rapid scaling up and replication across the US as well as for adaptation of existing EBIs in the API communities. Funding should include adequate needs assessment periods to ensure appropriate adaptation and scientifically rigorous program evaluations of such interventions. Ensure that interventions are developed for all subgroups, including women, Pacific Islanders, immigrants with limited English proficiency, and substance abusers.
  • Prioritize funding for API community-based organizations to provide culturally and linguistically responsive HIV co-infection prevention, screening, and linkage to treatment and care programs targeting API’s, including subgroups such as women, Pacific Islanders, immigrants with limited English proficiency, and substance abusers.
  • Prioritize funding for technical assistance providers to convene community-based organizations for peer learning and mentorship to build their capacity for development of culturally and linguistically responsive interventions as well as research and evaluation.

Advocacy

  • Advocate for better or more specific guidance on including API’s in community planning groups and other decision-making bodies in various jurisdictions.
  • Advocate for the appointment and hiring of API’s and API-sensitive program officers and directors at DHHS and other decision-making bodies.
  • Advocate for states to adhere to the national standards for interpretation services and fund the current mandate for such services.
  • Advocate for the provider pay-for-performance processes to include a question in the audit about provision of interpretation services.
 

Coordination

  • Develop linkages with programs targeting HBV, HCV, TB and STIs to incorporate HIV prevention messages, testing, diagnosis and treatment.
  • Provide local trainings for community-based organizations on how to adapt evidence-based interventions (EBIs). Provide education and training for service providers to improve medical competence in screening and treatment in co-infection.
  • Advocate for the uniform medical standard of practice for screenings and treatment for co-infection (i.e. consistent across all diseases) in medical and community-based settings.
  • Establish a national mentorship program to ensure API leadership and representation at various policy levels. Provide policy advocacy education on policy-making process and strategies.
  • Initiate and expand multi-language, culturally appropriate, and community-wide education programs about HIV and co-infections. Develop public messages about HIV co-infection without making vulnerable individuals feel they are being targeted because of their cultural/immigrant status (e.g. misperception about HIV diagnosis as grounds for deportation).
  • Educate API physicians, and physicians who treat APIs, about HIV and its associated co-infections.