HIV/AIDS continues to take its toll on the vulnerable African and Caribbean immigrant populations in the greater Philadelphia area and this is a population that went largely unnoticed until AFAHO began advocating for and serving these communities. As the only community-based organization in the greater Philadelphia area focused solely on the health of the ACIR population (African Caribbean Immigrant Refugee), AFAHO has maintained a presence in our community through street outreach and building relationships with community establishments, braiding salons, churches, mosques, community organizations and associations, stores, restaurants and schools located in the geographic area populated by our target population. This ACIR population relies heavily on its community leaders and representatives for information and resources and AFAHO has been able to utilize its mutually benefitting relationships with community leaders to spread awareness and leverage support for our services. We continue to use these proven outlets to promote our culturally and linguistically appropriate HIV education, counseling, testing and linkage into care services.
AFAHO initiated an important and oft-cited needs assessment study in 2005 on the structural and cultural barriers to HIV/AIDS care for African immigrant women in Philadelphia. We work daily to reduce the stigma associated with HIV/AIDS in our community and bring people into care. To gain a better understanding of the risks faced by this community in Philadelphia, AFAHO staff conducted interviews and focus groups of community members. 72% of participants were women, and the process revealed many individual, interpersonal and community issues that place this population (particularly its women) at greater risk for HIV. These issues include male dominance, limited safer-sex negotiation skills among women, female circumcision, low perceptions of risk, gender-based violence including rape during times of war, the isolation of living in a foreign place, cultural barriers to discussing health and sexuality, polygamous marriages and long distance relationships where one partner continues to live in their home country with the other one living here.
Recent estimates from other U.S. cities indicate that HIV incidence among African immigrants is on the rise. For example, an analysis of 2003- 2004 HIV diagnosis data from five US states and selected localities indicated that African immigrants accounted for 0.6% of the population of the areas studied, but 3.8% of HIV diagnosis in those areas. Specifically, up to 41% of diagnoses in women, and up to 50% of diagnoses of blacks occurred among African-born individuals in the study areas, leading the authors to conclude that there is a “hidden epidemic” of HIV among African migrants living in the United States.  Africans in these localities are demographically identical to Africans in Philadelphia, and as such these studies could also define the conditions of Africans in Philadelphia.
This population (African and Caribbean) is often grouped together with African Americans under the category of “Black” in federal, state, and local demographic and epidemiological data, while the cultural practices, needs, and accessibility to services for African immigrants can differ widely from that of African Americans. In a 2008 study conducted in several states by the U.S. National Library of Medicine, up to 41% of seropositive diagnoses in women occurred among African-born individuals. Such findings highlight the necessity for the HIV prevention services we provide to this community; a community which is drastically underserved.
 Kerani R, Kent JB. HIV among african-born persons in the united states: A hidden epidemic?. JAIDS. 2008;49(1):102-106.
 The Office of Minority Health. (2011). National African immigrant project. Retrieved 11/09, 2011, from http://minorityhealth.hhs.gov/templates/content.aspx?lvl=2&lvlid=66&ID=9093
 Foley, E. E. “HIV/AIDS and African Immigrant Women in Philadelphia: Structural and Cultural Barriers to Care. AIDS Care 17.8 (2005): 1030-1043.