SAN FRANCISCO -- A recent posting on the community page of a Korean-language news site in Los Angeles warned male readers about a female employee at a local Karaoke club. The woman – described as an undocumented immigrant – allegedly resides in Korea Town and moonlights as a sex worker in local bars.
"She uses several names," the author says, "and works as a maid during the day… she is HIV positive." While unconfirmed, the comments are a rare and highly public acknowledgement of a problem that most in the Korean community are loathe to discuss openly.
Indeed, even as attendees at the XIX International AIDS Conference in Washington D.C. -- which closed last month -- spoke openly for the first time ever of a possible cure, attitudes among Korean Americans remain steeped in stigma and prejudice.
Among Asian and Pacific Islanders in L.A. County, says Steve Cha, health educator with APAIT Health Center -- which advocates for medically underserved communities impacted by HIV/AIDS – Koreans rank "about seventh or eighth" in terms of infection rates. Filipinos top the list, followed by Thais, Vietnamese and Japanese, respectively.
Los Angeles is home to the largest Korean community outside Korea. Pointing to recent statistics, Cha says APIs in the area made up about 3 percent of total reported cases last year, out of which some "77 individuals" were Korean.
"The data [on Korean American infection rates] might not look like a big issue," notes Cha. "But the numbers are misleading."
One reason is because the U.S. Centers for Disease Control lumps together data from the API community, rather than breaking the numbers down by ethnicity. Another has to do with the fact that Koreans, who are not alone in this, are highly reluctant to get tested.
According to Cha, over half of APIs at risk of infection – including sex workers and men who sleep with other men (MSM) -- "have never been tested." Cha says issues of language, fear of being identified with the sex trade, and fear of alienation are behind the low numbers.
"The Koreans who do come in are often monolingual [speaking only Korean] and are court mandated" to be there, suggesting a connection to sex work, explains Cha.
Statistics show that nationwide, just over 26 percent of Koreans have been tested for HIV, compared to 30 percent for the overall API population, 36 percent for Hispanics and close to 50 percent for blacks. This is despite the fact that among APIs, infection rates are on the rise.
According to the U.S. Centers for Disease Control and Prevention, while the number of new reported cases of HIV infection among Pacific Islanders nationwide declined somewhat in 2010, among Asians there was a 5 percent jump. Asian women in particular, warns the U.S. Department of Health and Human Services, are 20 times as likely to be diagnosed with HIV than White women.
"The science of HIV and treatment is coming along, and everyone is excited," Yvette Calderon, adult urgent-care director at Jacobi Medical Center in New York, told reporters at the Washington conference, the first to be held in the United States in 22 years. "We forget there's a real-life implementation that has to occur."
A "Foreigner" Disease
The stigma that surrounds HIV/AIDS in the Korean American community finds its counterpart in the rampant stereotypes that exist in Korea itself, where for many the disease is still largely associated with foreigners.
An editorial in early July that appeared in the Korea Daily, one of South Korea's largest print papers, took to task a program aired by the broadcasting giant MBC. Titled, "Shocking Report on Relationships with Foreigners," the show highlighted the case of a young woman recently diagnosed with the virus. She had, as the show notes, recently been in a relationship with a foreigner.
The editorial's author, Jae-hyun Roh, acknowledges such concerns as students getting involved while studying abroad. But he blasts the show's producers for propagating a common belief that Koreans are somehow immune from the disease.
If AIDS is a "foreigners' disease," Roh asks, rhetorically, "are Koreans all right?" The article was followed by a social media campaign that drew some 8,000 followers calling for an end to "xenophobia and prejudice."
During the conference in Washington, South Korea announced that it was lifting long-standing restrictions on inbound travelers with HIV/AIDS. One of eight countries to do so since 2010, it was praised for its decision, though foreigners working in the country – including the high number of English teachers there -- are still required to undergo HIV testing. No similar requirement exists for Koreans working in similar positions.
Voice of America reported in July on a case involving an English teacher from New Zealand suing the government over the testing requirement. "Lisa Griffin contends South Korea uses HIV tests as a proxy for racial discrimination," the report noted. "She says the mandatory tests stigmatize foreigners as people who are a high-risk for AIDS, which leads to local hostility against them."
Vincent Crisostomo, a long time community activist who in 2011 helped organize the 10th International Congress on HIV/AIDS (ICAAP) in Busan, South Korea, describes attitudes in the country as "very discriminatory."
While he admits infection rates are not as high as those found in developing countries around Africa and other parts of Asia, for example, he says that as with Koreans in the United States, taboos and stigma help to obscure the actual number of those living with the disease.
A report put out by the Korea Federation for HIV/AIDS Prevention noted that in 2011 there were 7,656 known cases of HIV infection in South Korea. Of those, some 6,292, or 82 percent were still living at the time.
The report also highlighted the low level of awareness among adults regarding the disease and routes of transmission. It is an ignorance that, for those affected, translates into a social ostracism that often carries with it tragic consequences.
"I'm told," says Crisostomo, "that the number one killer for those infected with HIV in South Korea is suicide."
Doesn't Affect Us
Diana Lee is program manager with the center for Pan Asian Community Services in Atlanta, Georgia, a city that in recent years has seen dramatic increases in its resident Asian population.
It has also seen the sharpest rise in HIV infections in the United States.
"Calls come in [to the center] about immigration issues or other matters," says Lee, who points out that unlike more established Asian communities in New York and San Francisco, which have been around for generations, Atlanta's Asian community is still predominantly immigrant.
"Then they ask about HIV." Lee says a number of the callers are surprised the center even offers such services. "But Asians don't have HIV," is something she's heard more than once.
The center is the first social services agency, and the only one providing HIV/AIDS care, targeting APIs in the southeast region. Lee, who does outreach to try and raise awareness around HIV, says it's common for her to encounter hostility from fellow Koreans.
"They demand to know why we're wasting they're time," she says, adding many in the community feel the issue "is not something that affects us."
And when it does, it is cause for shame. Lee points to one client, born in Korea but raised in the United States, who has completely "isolated himself" from family and friends. "He does not reach out… he fears he could transmit the disease. He is depressed and has no social relations."
Korean culture places a high degree of value on interpersonal connections. They are the bread and butter, so to speak, of society. For someone to be so shut off can be devastating. Worse still, however, is that because of the stigma, a large number of Koreans remain woefully ignorant of where to go and what to do if they are diagnosed.
"They have no idea," says Lee.
A-Symptomatic Until it's Too Late
Lee admits that change is "going to take time."
Both she and Cha with APAIT agree that part of the problem has to do with attitudes regarding sex. "They think of it as a gay disease," says Cha, who recalls that 70 percent of Koreans in California voted in favor of Proposition 8, which sought a constitutional ban on same sex marriage.
Such attitudes, they say, make it difficult to even broach the subject of HIV/AIDS. For those that do want to reach the community, Cha says the first step is locating stakeholders, which most often means the local church, a "less than chatty environment" when it comes to issues of sexuality.
As far as what it may take to get the message across, Cha offers a somewhat grim prognosis.
"HIV/AIDS is A-symptomatic until it hits you hard, and that may be a metaphor for the Korean American community."
Aruna Lee contributed to this story.