Nationally, HIV incidence among African immigrants is six times higher than in the general population and nearly twice that of US-born Black individuals.1,2 According to research published by researchers Brisola Ojikutu and Chioma Nnaji, African immigrants are less likely to test for HIV and often present late to care.3,4 Further, their research indicates that HIV-related stigma is higher among African immigrants than among other groups, further exacerbated by a confluence of risk factors and systemic barriers attributed to the social marginalization because of the multiple identities held based on race, nativity, immigration status, ethnicity, and language.3
Earlier this quarter, African Sisterhood Empowerment, a project of Multicultural AIDS Coalition, Inc. (MAC), held a summit for African immigrant women living with HIV to deepen their understanding of HIV prevention, treatment, and care, in addition to discussing the impact of stigma on their ability to engage and stay engaged in care.
The sessions were facilitated by sexual health providers and educators who provided safer sex practices and condom use, U = U and viral suppression, and how to practice to disclose and condom negotiation with sexual partners with both HIV positive and HIV-negative partners.
But behind this work is the spirit of a longtime community health worker and activist who is relentless in ensuring African immigrant women living with HIV have a space to learn, connect, and reimagine how stigma drives their health. The We Are United Initiative team spoke with Chioma Nnaji, MPH, MEd, a longtime community health activist and Program Director at the Multicultural AIDS Coalition, Inc. (MAC). Chioma organizes communities of color to address root causes of the epidemic, advocates for policy change, and leads programs created for, by, and with those most impacted by HIV inequities.
Below, Chioma provided her mantras and wisdom behind the work of MAC and AFIA, and the transformational impact of the African Sisterhood Empowerment (ASHE) network.
When did you fall in love with community, or where did your passion for community work come from?
“My love for the community began long before I ever stepped into the HIV field. Both my mother and father were deeply involved in leading and participating in community initiatives, and they raised me, and my two sisters, to stay rooted in our culture, our people, and our values. So in many ways, community was already in my blood.
But I didn’t realize how foundational it would become until 2002, when I entered the HIV field. At that time in Massachusetts, we were experiencing disproportionate rates of new HIV cases among African immigrants, but the community was completely invisible in local and state plans. To truly understand what was happening, I had to ground myself where it mattered most — in community. That meant building relationships, listening closely, and creating space for real stories to surface.
I watched women who looked like my aunties, sisters, and cousins navigate stigma, immigration challenges, and cultural isolation with almost no support. That changed me. And because the community was invisible, the health and care systems around us were not designed to meet their needs. That is how the Africans For Improved Access (AFIA) program at MAC was born — out of necessity. This led to community-defined solutions and leaders taking a role in addressing HIV.
Years later, we saw progress, but we were still far behind when it came to national advocacy and representation. Then one day, a close friend said to me, “We need a space for African immigrant women living with HIV.” She was right. African immigrant women were most impacted among Black communities, and this was being seen across metropolitan areas in the US. I wasn’t sure if the field was ready to have this discussion — and honestly, I wasn’t sure if I had the time or capacity — but I leaned back into community. And with funding, we established the African Sisterhood Empowerment (ASHE), the first peer-led national network for African immigrant women living with HIV.”
Describe the work that your organization does to facilitate access to HIV education, prevention, treatment, and other sexual health services.
“MAC has a long history of supporting communities that have been marginalized due to social and political conditions that fuel the HIV epidemic, including discrimination based on race/ethnicity, sexual orientation and gender identity, and immigration status.
Within MAC, AFIA started as a community coalition including community members, providers, and the Massachusetts Department of Public Health, addressing the HIV rates among African immigrants, then quickly evolved into an HIV direct care service provider operating under the Multicultural AIDS Coalition in 2000. The AFIA program was built on the principle that community-led approaches are central to identifying and implementing sustainable HIV prevention, linkage to care, and treatment strategies.
Over the years, AFIA grew to win the trust of the community, long-term support from the state health department, investment from city and federal agencies, and partnerships with researchers seeking to improve health outcomes for African immigrants. One worthy achievement is establishing September 9th as National African Immigrant and Refugee HIV and Hepatitis Awareness Day (NAIRHHA Day).
Convening ASHE is another unique way of meeting the needs of African immigrant women living with HIV. ASHE is led by peers who also serve as Regional Coordinators and are located in four regional hubs. Through regional and national activities, ASHE has served as a place of solace and self-efficacy where women learn more about their bodies, living with HIV, and their sexual agency. Most recently, ASHE members led the development of their own advocacy platform — their voices, their priorities, their vision. ASHE hasn’t just strengthened the support network for African immigrant women living with HIV, but it has amplified their voices and pushed their experiences into the center of the conversations about HIV and women’s wellness.”
What lessons have you learned while working in the community?
“Working in and with the community has taught me that HIV work is never just about HIV. It’s about immigration status, culture, language, faith, family dynamics, and the heavy weight of stigma. If I had to sum up what I have learned and continue to build on, I would say:
It is always about relationships — always.
Trust takes time, and you earn it by showing up consistently. You have to lean into the process because community work is not linear, and it rarely follows your timeline
You must constantly challenge yourself to grow, unlearn, and stretch beyond your comfort.
People are different, and that difference is a strength — not a barrier — in community work.
Sustainability in community partnerships and leadership requires vulnerability.
Community “know-how” is transformational, and the wisdom people carry about themselves, their families, and their communities must be trusted.”
How has your organization changed your community for the better?
“One of the biggest shifts we have made is making African immigrants visible in the HIV response. AFIA changed that by consistently showing up in our communities, building trust, and walking with people through testing, care, disclosure, and stigma. And ASHE took that foundation and built something even more powerful. Because of ASHE:
Women who once felt isolated now have a sisterhood — women cooking together, praying together, learning together, and healing together.
Women who used to fear disclosure are now sharing strategies, finding legal support, and even becoming peer mentors.
ASHE members are re-engaging in HIV care, addressing issues with providers, and advocating for themselves in the healthcare system.
Women are navigating incredibly hard realities together — intimate partner violence, immigration stress, housing insecurity, weight gain and body changes, dating stigma, and mental health challenges.
We’ve created safe spaces — sometimes in WhatsApp chats, sometimes at dinner tables, sometimes around a fire — where women can talk openly about sex, pleasure, relationships, fear, and survival. ASHE’s national presence has shifted the narrative. We’ve hosted sessions at major conferences, led storytelling events like Twefeeko, and built an advocacy platform designed by women, not for them.”
What is your organization’s legacy in the community?
“For ASHE, the mantra says it all:
“ASHE? Power!
Power? Power that makes change happen.”
Through ASHE, we’ve built more than a program — we’ve built a movement. A space where African immigrant women living with HIV are leading, healing, and supporting one another.”
“Zimakoma Chonchi” — a Chichewa phrase meaning ‘this is how sweet it feels.’
The mission of the Multicultural AIDS Coalition, Inc. is to mobilize communities of color to end the HIV epidemic. MAC supports broader efforts to eradicate conditions that fuel the epidemic, including substance abuse, sexually transmitted infections, lack of healthcare access, homelessness, incarceration, and discrimination based on race, sex, ethnicity, sexual orientation, and gender identity.
ASHE continues to demonstrate the power of community-led solutions in ending the epidemic and uplifting the voices of African immigrant women living with HIV. To learn more about the ASHE or the ongoing work of the Multicultural AIDS Coalition, Inc., visit their website here.
This interview is supported by We Are United, an initiative of the Conexiones Positivas Fund in partnership with the CDC’s Let’s Stop HIV Together campaign. To learn more about U = U, visit this CDC resource here.