ICHS expanding HIV prevention services for King County’s Asian American community
International Community Health Services (ICHS) has been awarded federal grant funding totalling nearly $1 million to expand linguistically and culturally appropriate HIV prevention services for Asian American patients.
The grant is a part of the Ending the HIV Epidemic (EHE) initiative launched in 2019 by the U.S. Department of Health and Human Services (HHS). It seeks to reduce the burden of new HIV infections in the US by 90% by 2030.
ICHS is one of 64 community health centers nationwide to receive grant funding from the Health Resources and Services Administration (HRSA), an agency of HHS. ICHS is participating in a collaborative with other health systems, facilitated by King County Public Health, to advance health equity and expand EHE strategies in the wake of COVID-19.
The HRSA funding will support ICHS in integrating HIV prevention services into primary care at ICHS clinics, uproot stigma around HIV, and expand access to-life-saving medications for ICHS patients, particularly Asian American patients. Asian Americans currently have the highest rate of undiagnosed HIV among any race/ethnicity.
“ICHS is well poised to provide linguistically and culturally appropriate HIV prevention services to people that need it most,” says John Marrin, ICHS HIV/PrEP program lead.
‘The time is now’
More than 1.1 million Americans are currently living with HIV and many more are at risk of infection. While new HIV diagnoses have declined significantly from their peak, “progress on further reducing [cases] has stalled with an estimated 38,000 Americans being newly diagnosed each year.” according to the CDC.
However, new safe and effective tools are available today to prevent and treat HIV. In particular, highly effective antiretroviral medications named pre-exposure prophylaxis (PrEP) can reduce the risk of getting HIV when taken as prescribed.
“Yet, tools alone won’t end the [HIV] epidemic,” said HRSA administrator Carol Johnson in the grant announcement. “We need to support trusted community leaders in their work to engage people in care.”
Ending the HIV pandemic will take a broad, coordinated effort, says Marrin. It's going to take public health officials and community health centers to collaborate and work together to ensure that services are readily available for underserved communities who need it the most.
Gaps in HIV Care
HIV can affect anyone regardless of sexual orientation, race, ethnicity, gender, country of origin, age, or where they live.
However, due to a range of social, economic, and demographic factors, new infections are highly concentrated among certain groups.
Gay, bisexual, and other men who have sex with men are the most affected group in the U.S. Racial and ethnic minorities, especially Black people and Latinos, and people born outside of the U.S are also disproportionately affected by HIV.
Upon first reading the data, HIV rates among the Asian American populations are relatively low compared to other groups. However, health advocates have pushed back on the notion that HIV is not a health concern for the Asian American community.
According to CDC, of those who were Asian living with HIV in the United States, almost 1 in 4 are undiagnosed, which is the highest rate of undiagnosed HIV among any race/ethnicity (compared this to 13% of all persons living in the US that were not diagnosed).
The low rates of HIV detection is likely driven by an underinvestment in screening and services for the Asian American community says Marrin.
Put plainly, “If we don't test, we won't know.” says Dr. Hieu Pham, ICHS physician and family medicine residency director.
A 2021 survey conducted by the Coalition Against Anti-Asian Violence found 64% of 48 major HIV care organizations surveyed do not have HIV programs or services targeting the Asian community. Language barriers and cultural stigma were major factors in the lack of testing for Asian American patients.
The ‘model minority’ myth promotes racial bias and harmful stereotypes that impact Asian Americans health and wellbeing. Dr. Jessica Guh, past ICHS provider speaks about how the model minority myth perpetuates health disparities for Asian Americans in this 2021 KCTS9 documentary.
Since people with undiagnosed HIV do not know to get needed care, and are at a higher risk of spreading the virus to others, ensuring that they can access testing and accessing services is necessary to address the HIV epidemic.
“The only way to end the HIV epidemic is to provide testing to all populations, including Asian/Asian Americans,” says Pham.
“HIV prevention is primary care”
ICHS served nearly 28,000 patients in more than 70 languages in 2020. Deeply rooted in the Asian Pacific Islander community, ICHS provides high-quality, culturally and linguistically relevant health services as well as health education, insurance enrollment, and community outreach to immigrant and refugee communities. In 2020, 68% of ICHS patients were of Asian descent, and an additional 1% were Native Hawaiian or other Pacific Islander.
Many ICHS staff members are bilingual, and are first-generation immigrants themselves. Representative care has been found to shape patient experiences and doctor-patient relationships.
Research shows that medical providers who give patients culturally competent care — which respects a person’s heritage and values — see improved patient outcomes.
“ICHS provides really excellent primary care to the diverse, underserved patient communities that we serve.” said Marrin. “I think what this grant will really allow us to do is to help all of our patients see that HIV prevention is primary care and is not something that they need to go see a specialist for.”
ICHS plans to advance HIV prevention in four ways. First, by increasing HIV screening. Everyone ages 15 to 65 should be tested at least once in their lives says Marrin. Currently, a bit less that 40% of patients have had the one time screening. ICHS will also ensure that people who may be at risk for HIV can access HIV screenings often.
Dr. Hieu Pham, ICHS Physician and Family Medicine Residency Director
There's a lot of trust that gets built between patient and provider. That is further amplified when the care is linguistically and culturally congruent. It's such that I can see my patient for a diabetes visit and offer HIV screening at the same time to help them know their status. And patients respond really well to that, knowing that trust, and that what I am doing is in their interest.
Second, by expanding access to PrEP. The goal is for all at-risk patients to know that there are medications out there that can prevent HIV and making sure that they have access to it, says Marrin. By expanding access to PrEP, patients can decrease the risk of getting HIV.
Third, for the small number of patients who do test positive for HIV, ICHS will ensure that they're linked to care as quickly as possible. Within ICHS such as with Dr. Hieu Pham, ICHS physician and certified HIV specialist or externally with other clinics. “ICHS has good working relationships with other infectious disease clinics across the metro,” says Marrin. “Where we can refer patients who need to be seen closer to home or are more appropriate for an HIV specialist outside of primary care.”
And fourth by actively building a medical home that is open, non-judgemental and welcoming to everyone in the community. “We're addressing stigma or misinformation that exists in the community and helping all of our staff to do so as well.” says Marrin.
The grant is supporting ICHS in opening two new job positions. A HIV Patient Educator which will provide direct patient care support and a HIV Program Administrator which will work with medical teams to create trainings, conduct outreach, and collaborate with a diverse set of stakeholders to ensure patients needs are met.
HIV PrEP champion providers are also empowered at each ICHS clinic site to be leaders in ICHS’ HIV prevention services. Hieu Pham, physician at ICHS’ International District Clinic in Seattle; Scott Sato, physician assistant-certified at ICHS’ Holly Park Clinic in Seattle; William Hoskyn, doctor of nursing practice at ICHS’ Shoreline Clinic; and John Marrin, advanced registered nurse practitioner at ICHS’ Bellevue Clinic.
Marrin credits the work of ICHS providers Dr. Hieu Pham, Scott Sato, and Dr. Grace Wang, past ICHS medical director, for being a driving force behind ICHS’ HIV prevention services expansion.
Currently ICHS offers same day walk-in HIV PrEP services at its Shoreline Medical & Dental Clinic along Aurora Ave N for existing patients.
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Are you eligible for PrEP?
Learn more about ICHS’ HIV Prevention services at: https://www.ichs.com/services/prep
ICHS patients may make an appointment to speak with an ICHS medical provider by calling (206) 788-3700.