Among the Hmong
Caring Choices program working past barriers to HIV testing
When Stacey Vangkhang began health outreach within Butte County’s Hmong community last month, she experienced some culture shock.
Vangkhang is of Hmong descent and speaks the language of this ethnic minority group from southeast Asia. She hails from Portland, though, coming to Chico to study social work; in her part of Oregon, Hmong families live scattered in different cities, not as proximate as here.
“Up there the Hmong community is very small,” she said. “The community here is mostly closely knit—they are really tight; they marry within the race. So that was something new to me.
“Just going back to Portland, we’re not always together; we don’t have family gatherings. It’s more isolated compared to down here, where everyone basically knows everyone.”
So, even though Vangkhang can express herself with fluency, she’s had to grow familiar with nuances of North State Hmong life—distinct from her own and vital to gaining acceptance.
Hmong people have specific beliefs pertaining to health, including superstitions related to blood loss and stigmas surrounding certain diseases. Since her work relates to HIV and AIDS, Vangkhang has confronted these beliefs head-on.
She works as a program coordinator for Caring Choices, the Chico-based nonprofit founded in 1993 by nurse Barbara Hanna to benefit HIV/AIDS patients. To help fund Vangkhang’s project, the Minority Aids Initiative (MAI), Hanna sought a $36,500 grant from the U.S. Centers for Disease Control and Prevention (CDC) for HIV education and testing in the county’s Hmong community.
Asian-Americans comprise nearly 5 percent of the county’s population; Hmong, 4,100 approximately, constitute the largest group. Hanna cited CDC studies indicating 1 in 5 Asians living with HIV in the U.S. don’t know they’ve contracted the disease—twice as many as the American population as a whole—and no Asian-Americans in Butte County have been found to have contracted HIV in the testing results reported to public health officials for 2015-16.
“This lack of identification of HIV-positive test results in our local community may not accurately reflect the true prevalence rate of HIV in this minority population,” Hanna said. “Difficulties with language, access to medical care, poverty level, transportation to medical providers and concerns about stigma and shame to their families may be barriers for some Asian-Americans in seeking out HIV testing services and care, which may contribute to underestimating the true burden of HIV in this population.”
Caring Choices received one of 11 grants from the CDC to address this issue. After receiving the funds in February, the organization planned its strategy. The approach: Hold informational meetings on HIV/AIDS, followed on different days by free screenings, at the Hmong Cultural Center of Butte County. Not only is the center a focal point for the Hmong community, it’s also located in the area where the greatest number of Hmong families live—in Oroville.
Neither the July nor August session drew attendees. After consulting with specialists at Butte County Public Health—including two fellow Hmong residents—Vangkhang has a keener understanding of why.
“If we advertise the presentation as focused entirely on HIV, it wouldn’t bring people in, because there’s a lot of stigma associated with it,” she said. “Their neighbors or their family members or their friends might question them … so we completely changed our approach, and now we’re focusing on different health topics [besides just HIV].”
Those include nutrition, exercise, breast-cancer screenings and routine doctor visits.
Vangkhang also is pursuing a different setting. She’s reached out to Butte College and Chico State, where she’s on track to complete her master’s degree in May. Caring Choices also is open to discussions and testing in homes, at group meetings or in its office, which the nonprofit shares with the medical business Hanna founded in 1979, Home and Health Care Management.
“It’s an oral swab, not a finger stick,” Vangkhang stressed of the test administered. “That was a concern for some people, because anything that has to do with blood, that’s a cultural thing—some people believe that if their blood is taken, their blood wouldn’t be replenished.”
The key consideration is getting people tested.
“It takes less than an hour [to get the result],” Hanna said. “And, if something was positive, we have staff here [at Caring Choices]—so it’s not just finding out about your status, it’s connecting you to medical care, and that’s the link here.”
Hanna’s nonprofit sprung out of her professional endeavors. She came to Chico from the Bay Area in 1971 to study nursing and graduated in 1975. After a brief stint on the East Coast, she returned; soon she started her home-care agency.
In the late 80s, when the AIDS outbreak hit epidemic levels, she noticed a gap in services available to her patients fighting the disease. That inspired her to start Caring Choices. The organization has a five-member board, of which she’s president, and has expanded beyond Chico to serve eight counties, with branch offices in Redding and Marysville.
The services, too, have expanded. Caring Choices acts as a disaster response center for Butte and neighboring counties; when activated, as happened July 7 for the Wall Fire, the organization dispatches volunteers to work at shelters and assist aid organizations. It also partners with Home and Health Care Management to offer medication assessments and caregiver respite, free, for seniors.
Still, the crux of the original mission remains.
“Our HIV and AIDS programs, they’re broad,” Hanna said. “We provide case management, both nursing and social workers, to help keep people as healthy as possible. After they’re diagnosed, we provide referrals … and we have nurses and social workers who specialize in their care and treatment.”
Caring Choices has additional programs—including housing, nutrition and medication assistance—for HIV patients.
The wide range of services is a product of necessity and inspiration. Staff and board members come up with ideas that lead to programs—such as MAI, the program Vangkhang is fine-tuning.
“Even though we had this plan, we have to adapt,” Hanna said. “That’s OK—this is a new program.
“Thomas Edison would always say, ‘I found 1,000 ways not to build a light bulb,’ until learning how to make it work. That’s equally important.”