HIV Infection among Asians in the United States and Dependent Areas

Fast Facts

Asians have one of the lowest rates of HIV infection compared to other racial/ethnic populations.
Asian gay, bisexual, and other MSM are especially affected by HIV.
Misidentification of race may lead to the underestimation of HIV infection rates in Asians.

image of an Aisan family standing in a huddle

Despite being a rapidly growing population, Asians have experienced stable numbers of new HIV infections in recent years. Overall, Asians continue to account for only a small proportion of new HIV infections in the United States and dependent areas.^a

The Numbers

New HIV Infections^b

In 2010, Asians accounted for 2% (950) of the estimated 47,500 new HIV infections in the United States.
From 2008 through 2010, the number of estimated new HIV infections among Asians remained stable.

HIV and AIDS Diagnoses^c and Deaths

In 2011, Asians accounted for 2% (982) of an estimated 50,199 HIV diagnoses in the United States and 6 dependent areas. Of the adult and adolescent Asians diagnosed with HIV infection in 2011, 84% (821) were men and 16% (153) were women.
Eighty-six percent (705) of the estimated 821 HIV diagnoses among Asian men in the United States and dependent areas in 2011 were attributed to male-to-male sexual contact. Ninety-two percent (141) of the estimated 153 HIV diagnoses among Asian women were attributed to heterosexual contact.^d
In 2009, Asians accounted for 1% (15,400) of the estimated 1.1 million people living with HIV infection in the United States and 6 dependent areas.
In 2011, an estimated 492 Asians were diagnosed with AIDS in the United States and 6 dependent areas (representing 2% of the estimated 32,561 AIDS diagnoses), a number that has remained relatively stable since 2008.
By the end of 2010, an estimated 3,212 Asians with an AIDS diagnosis had died in the United States and 6 dependent areas.

Estimated Diagnoses of HIV Infection among Adult and Adolescent Asians, by Transmission Category and Gender, United States and 6 US Dependent Areas, 2011

Shown here are two pie charts, titled, Estimated Diagnoses of HIV Infection Among Adult and Adolescent Asians, by Transmission Category and Gender, United States and 6 US Dependent Areas, 2011. The first pie chart depicts estimated diagnoses of HIV infection among 821 adult and adolescent Asian men, by transmission category. The distribution of transmission is as follows: Male-to-male sexual contact = 86%; Heterosexual contact = 8%; IDU* = 3%; Male-to-male sexual contact/IDU = 3%; Other† = 1%. The second pie chart depicts estimated diagnoses of HIV infection among 153 adult and adolescent Asian women, by transmission category. The distribution of transmission is as follows: Heterosexual contact = 92%; IDU = 7%; Other = 1%.
Legend: *Injection drug use. †Other transmission risk factors include hemophilia, blood transfusion, perinatal exposure, and risk factors not reported or identified.

Prevention Challenges

A number of unique factors contribute to HIV infection in Asian communities:

Sexual risk factors are the main transmission route for HIV among Asians. Like other racial/ethnic groups, most of the Asians who are diagnosed with HIV infection are gay, bisexual, and other men who have sex with men (MSM). High-risk behaviors, including unprotected anal intercourse, multiple sexual partners, and substance use, may contribute to higher risk of infection in these groups. High-risk heterosexual contact is the main way Asian women become infected with HIV.
Substance use can lead to sexual behaviors that increase the risk of HIV infection. Although substance use (with the exception of injection drug use) does not cause HIV infection itself, it is an associated risk factor because of its ability to reduce inhibitions and impair judgment. Asians, as a whole, have among the lowest rates of substance use compared with other racial/ethnic groups. However, higher rates of substance use have been reported among Asian lesbians, gay men, and bisexual men and women, compared to Asian heterosexual men and women.
Cultural factors may affect the risk of HIV infection. Some Asians may avoid seeking testing, counseling, or treatment because of language barriers and/or fear of discrimination, the stigma of homosexuality, immigration issues, or fear of bringing shame to their families. Traditional Asian cultures emphasize male-dominated roles that highlight Asian women’s lack of sexual negotiating power in female-male relationships and may contribute to heterosexual HIV transmission among Asian women.
The “model minority” stereotype that assumes Asians always have high socioeconomic and educational achievement, obtain good medical care, and are in overall good health may have contributed to the lack of interest in studying this population and resulted in fewer studies and published literature.
Low HIV testing rates and late testing among Asians have been reported despite this population’s levels of HIV risk similar to other racial/ethnic groups. CDC reports that only 3 in 10 Asians have ever been tested for HIV. Low testing rates and late testing have been linked to short intervals between an HIV and AIDS diagnosis, which may indicate inadequate care and treatment among Asians because of poverty, acculturation and immigration issues, and language barriers.
Due to the diversity among Asians, there may be race/ethnicity misidentification that could lead to the underestimation of HIV infection rates in this population. Similarly, HIV and AIDS diagnoses and deaths among Asians may be higher than reported. Inaccurate surveillance can result in fewer prevention programs that focus on key populations.

What CDC Is Doing

The Centers for Disease Control and Prevention (CDC) and its partners are pursuing a High-Impact Prevention approach to advance the goals of the National HIV/AIDS Strategy (NHAS), maximize the effectiveness of current HIV prevention methods and improve surveillance among Asians. Activities include:

Support and technical assistance to health departments and community-based organizations to deliver effective prevention interventions for Asians, such as The Banyan Tree Project .
The CDC publication “Effective HIV Surveillance among Asian Americans and Native Hawaiians and Other Pacific Islanders” (April 2013) that outlines successful HIV surveillance activities for health departments in states with high concentrations of Asians and Native Hawaiians and Other Pacific Islanders.
Let’s Stop HIV Together, a phase of the Act Against AIDS (AAA) campaign, addresses stigma andraises awareness.
The Care and Prevention in the United States (CAPUS) Demonstration Project that supports increased testing and optimizes linkage to, retention in, and re-engagement with care and prevention services for newly diagnosed and previously diagnosed racial and ethnic minorities with HIV.
The Comprehensive Human Immunodeficiency Virus (HIV) Prevention Programs for Health Departments (Funding Opportunity Announcement [FOA] PS 12-1201) is a 5-year, $339 million HIV prevention FOA for health departments in states, territories, and select cities, including those serving Asian clients.

^aDependent areas: American Samoa, Guam, the Northern Mariana Islands, Puerto Rico, the Republic of Palau, and the US Virgin Islands.
^bNew HIV infections refer to HIV incidence, or the number of people who are newly infected with HIV, whether they know it or not.
^cHIV and AIDS diagnoses refer to the estimated number of people diagnosed with HIV infection regardless of stage of disease at diagnosis and the estimated number of people diagnosed with AIDS, respectively, during a given time period. The terms do not indicate when they were infected.
^dHeterosexual contact with a person known to have, or to be at high risk for, HIV infection.