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Originally published Tuesday, September 7, 2010 at 8:22 PM

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Helping immigrants learn to talk openly about AIDS

For African immigrants, who come from countries with high HIV/AIDS rates and where the disease is often considered a death sentence, talking about AIDS in the U.S. is often difficult. That's particularly true for immigrant women, who are often the most difficult to reach with services, say local health providers.

Special to The Seattle Times

For six months, the African woman debated whether to tell her sister, or anyone at all, that she had tested HIV-positive.

She feared the judgment of her relatives and fellow African immigrants.

Finally, as she and her sister faced each other on a small wooden bench in the living room of their apartment in Tukwila, she shared the news. Her sister's reaction was silence.

Then the sister asked her to move out. The sister's reasoning was brief: "You are putting me at risk, and my kids at risk, so I don't want you here."

The woman wasn't surprised: In her home country, she said, those infected are often considered promiscuous and unfaithful — and many consider the disease a death sentence.

For African immigrants, who come from countries with high rates of HIV and AIDS, talking about their own diagnosis is often taboo.

Solomon Tsegaselassie, a health educator for the Center for Multicultural Health in Seattle, which pays people $20 to get HIV/AIDS tests, says many immigrants won't come to the office for testing. "They want me to visit their house in the dark so people don't get suspicious," he said.

The wariness is particularly true for immigrant women, who often are the most difficult to reach with services, say local health-care providers.

HIV/AIDS cases have a very different profile in African immigrant communities than in the general population.

In Washington, males accounted for 84 percent of HIV/AIDS cases between 2003 and 2007, according to the Washington state Department of Health.

But among foreign-born black immigrants in the state, women accounted for nearly half of all HIV cases, in large part because the disease is spread more frequently by heterosexual contact in their home countries. A similar trend holds true in Oregon, as well.

A tough battle here

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Tsegaselassie, who was a health worker in his native Ethiopia, says fighting the spread of HIV/AIDS in African immigrant communities in the U.S. is in some ways more difficult than it is in Africa.

In Africa, for example, government AIDS-prevention commercials are aired constantly.

By contrast, he said many Africans in the U.S. "think there's not an HIV problem in America. They think it's an Africa problem, " he said.

If infected with the disease in America or Africa, it's not uncommon for women to hide their diagnosis from everyone in their family, fight the disease alone, and sometimes disappear from their community out of fear of condemnation, says University of Washington student Hanna Barket, who came to the U.S. as a refugee from Somalia.

Traditionally, she said, women carry the blame for the disease. "If a man became infected with HIV he wouldn't be nearly as cast out of the community," she said.

The Center for Multicultural Health, with funding from King County, is recruiting immigrants to serve as peer educators and distribute HIV/AIDS-prevention information among their fellow Africans.

One of Tsegaselassie's recruits is Getent Woldemical, a taxi driver from Ethiopia. During Woldemical's 12-hour workday, he tries to talk with other cabdrivers about HIV/AIDS as they wait in front of hotels to pick up passengers.

Woldemical originally passed out condoms, for prevention, until several drivers said they were offended by his actions. Now he passes out prevention fliers.

Another recruit is Hanna Tsegaye, who runs a small coffee stand and cafe on a taxicab lot in South Seattle, where East African drivers stop by for espresso or wraps made with injera, a spongy Ethiopian bread. Her walls are covered in Ethiopian maps, currency and newspaper comics. Next to the register is a basket of free condoms.

Tsegaye isn't HIV-positive, but she watched the disease affect people close to her throughout her life back in Ethiopia.

At a recent monthly tea with her friends, Tsegaye asked the women if they've ever been tested for HIV/AIDS. Most hadn't.

"If you have HIV, you don't want to talk about HIV even with your husband. Or your dad or mum," said Tsegaye, who acknowledges her own embarrassment talking about the disease. "You know you are sick, and you have a problem, but you are hiding yourself, until you die."

The African woman, who asked that neither her name nor home country be identified, believes she became infected during college in sub-Saharan Africa.

Her diagnosis momentarily shattered her plans to pursue a master's degree in public health in the U.S. "In my mind I grew up thinking once they tell me I have HIV, then I'm dying. That's the way I've been brought up because I never saw anyone who lived with HIV," she said.

After her first appointment at Harborview Medical Center's Madison Clinic, her outlook improved. Her physician, Dr. Judd Walson, explained that with the right medications she could live a fairly normal life. She was assigned a caseworker, counselor and other caregivers.

A federal program that provides health services for those with HIV who don't have insurance or financial resources covered her medical costs.

Eventually, Walson referred her to a women's support group called the Babes Network.

Though she was nervous about attending, she made it to a meeting and left happy to have met other women in her situation.

Amelia Vader, a program manager at Babes, says African immigrants make up about 15 of the nearly 200 women with HIV or AIDS served by the organization each year.

In general, women of color now make up the majority of new HIV cases among women, according to the state Department of Health.

"You're up against a lot trying to serve and engage these women," Vader said.

"What we've heard from women is if somebody finds out they're [HIV] positive in their community, that affects their job, it affects their kids, it affects their children's jobs, and their ability to get work," she said.

Vader says a support group can make a huge difference for immigrant women who share their HIV status only with their doctor.

"They have a lot of fear at first, but when they leave they're smiling, they're comfortable with people in our office, and they feel comfortable coming back," Vader said.

Looking ahead

The African woman's condition has improved to the point where HIV is no longer detectable in her body.

Secrecy, though, remains one of her biggest struggles.

After leaving her sister's house, she moved in with cousins for a while. There, she displayed her pill bottles openly in a medicine cabinet, hoping the cousins would figure out that she is HIV-positive.

In the future, she hopes to return to Africa with a nonprofit organization and work with people with AIDS. She wants to share the news that came to her in a Seattle clinic: "AIDS is not a death sentence."

Chantal Anderson, a University of Washington student, originally reported this story for a global health reporting class. She can be reached at chantalaanderson@gmail.com

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