A Bay Area Health Charity Bridges Cultural Gap to Help New Immigrants

Five years ago, when officials at San Francisco’s Asian & Pacific Islander Wellness Center

learned that Burmese refugees were starting to move to nearby Oakland in big numbers — many of them with HIV/AIDS — they knew they had a problem on their hands. The charity, which serves Bay Area Asians and Pacific Islanders who have HIV/AIDS, or are at risk for the disease, had staff members and volunteers who were fluent in Samoan, Visayan, Tagalog, Nepali, and many other languages, but Burmese was not one of them.

In fact, the charity knew very little about the Bay Area’s newest residents, who, fleeing a military dictatorship in their home country, were being resettled by church groups and the United Nations High Commissioner for Refugees.

“What we did is figure out a way to respond to the needs of the Burmese community,” says Lance Toma, the charity’s executive director. The organization began reaching out to the new arrivals, and discovered that it needed someone with expertise in dealing with HIV/AIDS patients, says Mr. Toma. It recruited a Burmese woman and trained her as a case manager.

It wasn’t long before the group’s approach paid off. Not only was the charity able to offer direct assistance to Burmese refugees, providing them with health and safety information, accompanying them to medical appointments, and giving other types of aid, but knowledge about HIV/AIDS began to spread among the new arrivals.

This summer, when the charity sought to hire more Burmese case managers, it found many qualified applicants. One of the new “homegrown” experts is Nandar Soe, who came to America from Myanmar (the country once called Burma) nine years ago and, before joining the staff of the Asian & Pacific Islander Wellness Center, served as an informal advocate for Burmese refugees, helping them apply for asylum and surveying their needs. As a new case manager, her focus is on helping refugees with HIV/AIDS and also serving as a bridge to their new country.

“There would be a big gap if we weren’t here,” says Ms. Soe. “It’s very difficult for them to assimilate, and we’ve become almost a second identity for them.”

Innovative Hiring

This organic approach to meeting the needs of its clients is typical of the charity. When it was founded 20 years ago, says Mr. Toma, numerous organizations had begun to respond to the AIDS crisis in San Francisco, but none specifically focused on Asians and Pacific Islanders, an umbrella term that encompasses more than 40 ethnic groups and 100 different languages.

“There wasn’t even an acknowledgment that this was a community that had specific needs,” says Mr. Toma. San Francisco’s population is 32 percent Asian and Pacific Islander, according to U.S. Census figures.

Today, the organization provides health services and education to more than 20,000 people in four Bay Area counties. Its 50 staff members, along with a fleet of more than 75 volunteers, speak 22 languages among them, including Burmese. But the ability to communicate with its clients requires more than linguistic competency, Mr. Toma says. “We work with people who are really marginalized: sex workers, queer youth, women in massage parlors,” he says. “To be effective, you have to understand their worlds.”

Acquiring what the charity refers to as “cultural competency” has also required an innovative approach to hiring. “There are a limited number of people who have the knowledge and experience to fill these positions,” says Mr. Toma. “What we’ve learned to do is train from the ground up.”

At the heart of that training process is the charity’s peer-leadership program, an effort through which clients of the organization receive small stipends while being trained to become experts who can in turn educate their peers about HIV/AIDS, testing and prevention, and the services that are available to them. Former clients now serve among the charity’s staff members and belong to the group’s Board of Directors, says Mr. Toma.

“They become the pool that we look to when we’re trying to fill positions,” he says.

Asians and Pacific Islanders with HIV/AIDS are also represented throughout the organization. A fifth of the charity’s staff members have HIV, while more than a third of the staff positions in the medical-care service department are reserved for people with HIV.

Stigma of AIDS

But even an organization that looks and sounds like the individuals it serves can have trouble communicating with them. Mr. Toma notes that a deep-seated stigma concerning HIV/AIDS persists among many of the ethnic groups that the Asian & Pacific Islander Wellness Center most needs to reach.

The charity recently conducted a survey of Cantonese speakers in San Francisco and discovered that more than half of them believed that people with HIV/AIDS should not be permitted to work in schools, while 60 percent said that they should be banned from employment in hospitals and restaurants.

In May 2005, the charity embarked on a campaign that it hopes will overcome discrimination among San Francisco’s Chinese residents toward Asians and Pacific Islanders with HIV/AIDS. The first step: prominent newspaper ads and posters at bus stops that feature local Chinese leaders who have HIV.

“We’re beginning to work with the moms and the dads, the aunties and the uncles, and the granddads and the grandmas to address this whole idea of shame,” says Mr. Toma. “It gets passed down from the elders and has a direct impact on why HIV remains a silent epidemic in our community.”