Los Angeles Asian HIV-Hepatitis Co-Infection Study

Jury Candelario, Special Service for Groups; Lois Takahashi, UC Los Angeles
Social and Behavioral

Asian and Pacific Islanders (APIs) in California have been increasingly affected by viral hepatitis (HBV or HCV) and HIV/AIDS. Viral hepatitis and HIV share transmission routes, most notably unprotected anal sex and sharing needles. Although the absolute magnitude of APIs who are currently living with HIV/AIDS is small, accounting for approximately 1% of AIDS cases, the number of AIDS cases increased more rapidly for APIs between 1999 and 2003 than for any other racial and ethnic group. Further, APIs have high rates of co-infection with HBV and although they have similar rates of co- infection with HCV, they are at higher risk from long-term complications, such as cirrhosis or hepatocellular carcinoma.

APIs living with HIV are a vulnerable group who frequently are unable to access medical care and social services. Identifying barriers to health care and treatment for HIV, HBV and HCV in this underserved population provides a unique opportunity to understand the factors which contribute to the ability of this population to access care. This project may also provide insight as to barriers to care experienced by other similar populations with limited English proficiency and high numbers of immigrants, such as the Latino population. Finally, this study will serve as the bases to develop a model to coordinate care and social services for all populations living with HIV and HBV or HCV co-infection.

Using qualitative in-depth interviews with HIV-infected and HIV/HBV or HCV co-infected APIs as well as their medical providers, this research project has four specific aims:

  1. To estimate the prevalence of Hepatitis B and C infection in Asian American and Pacific Islanders (APIs) who are living with HIV infection.
  2. To assess common and unique barriers to access to care and treatment, use of services, mediators linking use of services to outcomes, and baseline health status for APIs living with HIV and hepatitis co-infection. Results will be compared to APIs with HIV but without hepatitis co- infection.
    A. Individual barriers, use of services, mediators of health outcomes, and health outcomes will be assessed through interviews of APIs living with HIV and hepatitis co-infection and compared with interviews of APIs living with HIV alone.
    B. Systemic and structural barriers and mediators will be assessed through interviews with medical and social service providers.
  3. To form a collaboration of community and healthcare partners that will use this data to develop and initiate the implementation of an intervention to improve access to health care and treatment, appropriate use of services, and health outcomes for APIs living with HIV, with and without hepatitis.

This proposed research project is one of the first science-based attempts to conduct a needs assessment of HIV-hepatitis co-infection in this hard-to-reach immigrant community. The proposed project is attentive to the needs of California's rapidly growing immigrant population, and to the widening concerns about the globalization of diseases. Los Angeles is a major entry point to both immigrants and travelers to/from Asia, where viral hepatitis infection rate remains high and HIV/AIDS infection is escalating. This study consequently will provide data about an underserved population, but also will help to identify the overlapping social and service obstacles and opportunities related to HIV and viral hepatitis infection.