HIV/AIDS Behaviors and Interventions in Chinese Americans

(August 2008) The prevalence of HIV/AIDS increased faster among Asians and Pacific Islanders in the United States than in any other group between 2001 and 2004.1 Asians and Pacific Islanders are the only major U.S. racial or ethnic group with a statistically significant annual increase in the rate of new HIV infections during the first half of the decade, a time when blacks and Hispanics saw their rates decrease (see table).

HIV/AIDS Diagnosis Rates for U.S. Males and Females by Race/Ethnicity, 2004

Race/Ethnic Group Diagnosis Rate Estimated Annual Percentage Change 2001 to 2004
Asians and Pacific Islanders
American Indian
Asians and Pacific Islanders
American Indian

*Statistically significant.
Source: MMWR 55, no. 5 (2006): 121-25.

Though the overall diagnosis rates for Asians and Pacific Islanders are lower than the rates for other minority groups and, in the case of males, lower than rates for whites, the increase in rates for this group is a public health concern. It was the focus of two presentations given as part of the PRB Policy Seminar series on June 18. Frank Wong, associate professor in the Department of International Health at Georgetown University’s School of Nursing and Health Studies, and John Chin, associate professor in the Department of Urban Affairs and Planning at Hunter College of the City University of New York, focused on aspects of HIV issues in the Asian/Pacific Islander community, and specifically in Chinese populations in the United States. Dr. Wong described a study he is currently undertaking in the Washington, D.C., area regarding sociocultural factors associated with high-risk behaviors in Asian/Pacific Islander men who have sex with men (MSM). Dr. Chin discussed his study of the role of religious institutions in educating the Chinese immigrant population about HIV.

HIV/AIDS and Sexual Attitudes Reflect Chinese Culture

Nearly two-thirds of all Asians and Pacific Islanders with HIV in the United States are men who have sex with men. In 2005, 81 percent of newly diagnosed HIV cases in Asians/Pacific Islanders were men, the majority of whom are foreign-born. Their cultural heritage shapes their attitudes toward sex and HIV/AIDS.

In Chinese culture, homosexual behavior is often viewed as a taboo subject; the sexual sphere in general is considered highly private. These factors, along with the high value placed on family roles, especially marrying and having children, lead men to keep their homosexual behavior secret as they fulfill their traditional roles of father and husband. This secrecy makes it difficult to initiate outreach efforts in this community. Preliminary data from Dr. Wong’s study of MSMs in the Washington, D.C., area show widespread misconceptions or lack of knowledge among the group regarding basic facts about HIV and AIDS and methods of protection. Just over one-quarter of respondents reported having had unprotected sex in the last month. These findings highlight the need for outreach.

Role of Religious Institutions in New York City

Dr. Chin’s presentation highlighted two studies, both funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, that examine attitudes in Chinese immigrant religious institutions regarding HIV prevention programs. The studies focus specifically on institutions in New York City, where the Asian/Pacific Islander population grew 73 percent during the 1990s. Asians and Pacific Islanders in New York are more likely to be foreign-born than those in the United States as a whole, and nearly one-half are of Chinese descent.

Community institutions touch nearly every aspect of new immigrants’ lives. They serve as sites for networking and exchange of information important for finding employment, accessing social services, providing religious guidance, and socializing. Studies have shown that, given their role as custodians of immigrants’ cultural identities, these institutions may strictly enforce traditional values, discourage heterogeneity of opinions, and provide moral guidance for their members. Religious institutions specifically were considered because of the influence these organizations have in shaping the values of their immigrant members and their potential to promote values and norms that support discussion of HIV prevention and the reduction of HIV-related stigma in the community.

Chinese immigrant religious institutions could be helpful partners in the fight against HIV in their communities, yet few of these organizations are undertaking any HIV programs. Dr. Chin and his colleagues believe that by studying social networks within institutions, they may gain a better understanding of how to effect change and innovation toward greater constructive involvement in HIV.

Dr. Chin’s initial study showed these institutions were reluctant to become involved in HIV education for a variety of reasons. Some of the leaders interviewed saw HIV education as conflicting with such religion-based traditional norms and values as abstinence outside of marriage, and believed that a religious education would provide protection against HIV. Leaders at other institutions expressed fears that becoming involved in the topic would hurt the image of the organization. Yet the researchers saw some hope in the religious leaders’ belief in compassion: Some leaders commented that in the face of sickness they would help in any way they could.

In-Depth Study Planned

The results of this initial study were used to frame another study scheduled to take place between 2007 and 2012: an in-depth qualitative and quantitative analysis of 21 organizations chosen from an initial telephone survey of 200 Chinese religious institutions in New York City. Interviews with core leaders, innovators, and members of the 21 organizations will address views on potential HIV involvement and organizational change. A survey completed by members will also look at social networks in the organization, religiosity, and HIV knowledge and attitudes. The researchers hope that gaining a better understanding of organizational change in these types of institutions, and of the relationships between social networks, religiosity, and organizational innovativeness may make it possible to develop strategies for partnering with religious organizations to provide HIV education and to reduce HIV-related stigma. The findings will be disseminated to key stakeholders and with them, the researchers will begin developing intervention strategies to put their findings to work in the Chinese immigrant community in Manhattan.

The Eunice Kennedy Shriver National Institute of Child Health and Human Development Demographic and Behavioral Science Branch supported both Dr. Wong’s and Dr. Chin’s research and the PRB seminar series. As part of its mission, the Branch supports both domestic and international studies of the relationship among social, economic, and cultural contexts and how these influence sexual behavior and disease transmission.

Melissa Kornblau was a 2008 Bixby intern at PRB.


  1. “Racial/Ethnic Disparities in Diagnoses of HIV/AIDS: 33 States, 2001-2004,” MMWR 55, no. 5 (2006): 121-25.