What is the Banyan Tree Project?

May 19 is National Asian & Pacific Islander HIV/AIDS Awareness Day.

By Barrett White


In 2005, we celebrated the first Asian and Pacific Islander HIV Awareness Day. The effort was spearheaded by a group in California, API Wellness. The faces of the AIDS crisis were predominantly White gay men, and presently, the most at-risk demographic is African American men. Nowhere in the picture has there been a spotlight on the Asian and Pacific Islander (API) community. Consequently, this has resulted in low testing rates, stigma, and elevated rates of contraction of HIV.

Shortly after celebrating the first API HIV Awareness Day, API Wellness created the Banyan Tree Project, which aims to address the disparities that API individuals face in HIV care and stigma. The campaign slogan, “Saving face can’t make you safe,” addresses the issue of morality and reservation regarding sex and HIV—in essence, not addressing it does no one any good.

According to the CDC, Asian Americans, who make up only 6 percent of the population of the U.S., make up 2 percent of all HIV infections. The Banyan Tree Project hopes to address this disparity by bringing awareness to the mainstream to help normalize HIV care. Destigmatization is the first step.

Most recent data from the CDC reports that among Asian Americans, infections rose by 42 percent overall between 2010 and 2016. Among gay and bisexual Asian men, the increase was more dramatic, as they saw a rise of over 50 percent over the same time period. The numbers are reflected in 2019 data, which states that 91 percent of all male infections were by male-to-male sexual contact, while 94 percent of female infections came from heterosexual contact.

Why is this small demographic taking on such a large burden of HIV infection, proportionate to size of the community, and why is there such little information on it? The CDC makes their own suggestions as to why the disparity is so great. It is suggested that cultural factors, such as language barriers and immigration issues, may add to the barrier to health care (though, of course, this only addresses access to care for Asian immigrants, and not Asian Americans who have lived here for several generations). Barriers to care can prevent one from even knowing that they’re infected to begin with, let alone accessing treatment or pre-exposure prophylaxis.

The CDC also poses the fact that there simply isn’t enough research being done on this demographic. According to the CDC website, “There are only a few targeted prevention programs due to limited research.”— According to the CDC, 66.5% of Asian Americans and 43.1% of Native Hawaiian or Other Pacific Islanders have never been tested for HIV—They continue, “Race/ethnicity misidentification could lead to an underestimation of HIV cases.”

To the CDC’s credit, there is an effort to mend the gap by collecting and analyzing data, conducting prevention research, and working with national and local Asian American HIV prevention groups, such as the Banyan Tree Project.

“We need to encourage APIs, especially those who are transgender and young [men who have sex with men], to start talking, get tested, and discuss PrEP with their doctors,” said Lance Toma, chief executive officer at API Wellness. “Everyone needs to know that saving face can’t make us safe.”

Toma continued, adding that low PrEP utilization rates are due to a lack of awareness about the drug, misconceptions regarding its affordability, misinformation about its effects, and fear of community stigma about sex.

It is known that daily PrEP use can reduce the risk of getting HIV from sex by more than 90 percent. Among individuals who inject drugs, it reduces the risk by more than 70 percent. But within the API community, 20 percent of those with HIV didn’t know they were infected, only 58 percent of those who knew were treated for their HIV, and of them, only 46 percent were retained in care.

“Although API HIV/AIDS infection rates appear low [at only 6 percent of total infections], those statistics are deceptive as a significant amount of under-reporting occurs due to stigma,” Toma said. “Stigma prevents people from discussing HIV/AIDS with their communities and providers which is one reason why APIs are the least likely race to get tested for HIV.”

Locally, statistics reported by the Houston Health Department reflect the national average. Roughly 4 percent of all HIV diagnoses in the City of Houston are categorized as “Other, Non-Hispanic” (presented alongside the categories White Non-Hispanic; Black Non-Hispanic; and All Races Hispanic). Of that 4 percent of all diagnoses, 76 percent were male. It bares clarification that “Other, Non-Hispanic” could include Houston’s API population, as well as Native American and biracial peoples.

May 19 is National Asian and Pacific Islander HIV Awareness Day. If you do not know your HIV status, Legacy recommends getting tested regularly. Legacy offers free testing to at-risk individuals at all of our clinics across the Houston and Beaumont areas. At our Montrose clinic, we have implemented our PrEP Rx campaign, where one can bypass the check-in lines and go directly to the pharmacy for HIV testing. With a negative diagnosis, one will be streamlined into preventative care. Should a positive diagnosis come back, one will be streamlined into post-exposure care to help you continue to live a happy and healthy life by achieving a suppressed viral load.

To learn more about Legacy’s HIV testing and PrEP Rx programs, or to make an appointment with a Legacy provider, click here.