High Sexual Risk But Low HIV Prevalence Among Asian And Pacific Islander (API) Men Who Have Sex With Men (MSM)

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High Sexual Risk But Low HIV Prevalence Among
Asian And Pacific Islander (API) Men Who Have Sex
With Men (MSM)

• Kyung-Hee Choi
• Center for AIDS Prevention Studies (CAPS)
  University of California, San Francisco, San
  Francisco

UC
SF
University of California San Francisco
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Presentation Outline

• Background
• Study 1
• Asian Counseling and Testing (ACT)
• Study 2
• Community, Health, and Identity (CHAI)
• Directions for Future Research

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Background U.S. API Population

• Fast growing ethnic group
• in the U.S.

9
4.5
1.6
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Background U.S. API Population

• Six ethnic groups make up 85 of the API
  population.
• 71 are foreign-born.

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• Background AIDS and U.S. APIs
• A small number of AIDS cases
• - 6,1032 AIDS cases as of December 2001
• - 0.76 of all U.S. AIDS cases

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Background AIDS and U.S. APIs

• 87 of all APIs with AIDS are male.

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Background AIDS and U.S. APIs

• 71 of API men with AIDS are MSM.

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• Background Studies of API MSM
• Few HIV prevalence studies with a large sample of
  API MSM.

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• Research Questions
• What is the prevalence of HIV among API MSM?
• 
  ACT Study
• What can explain the current levels of HIV
  prevalence among API MSM?
• 
  CHAI Study

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Study 1 ACT Study
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• ACT Methods
• 496 API MSM aged 18 to 29 years.
• Recruited from 30 randomly selected gay venues in
  San Francisco from January 2000 to September
  2001.
• Completed interviewer-administered
  questionnaires.
• Tested for HIV, hepatitis B, chlamydia, syphilis,
  and gonorrhea.

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ACT Sample Characteristics (N496)
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• ACT Prevalence of HIV, HBV, STDs
• HIV Infection
• - 2.6 HIV-positive
• HBV Infection
• - 28.5 markers for past or current HBV
  infection
• - 8.7 markers for chronic HBV infection
• STD Infection
• - 2.9 positive for chlamydia
• - 0.5 positive for syphilis
• - 0.4 positive for gonorrhea

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• ACT Sexual Risk Behaviors,
• Past Six Months ()
• Number of male partners (median, 2)
• 0
  6
• 1
  31
• 2-5
  44
• 6
  19
• Unprotected anal intercourse
• Any 47
• Insertive
  39
• Receptive
  35

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• ACT Predictors of HIV Infection Multivariate
  Results
• Having larger number of sexual partners
• in the lifetime (AOR, 1.003)
• Older age (AOR, 1.26)
• Lifetime attendance of a circuit party
  (a series of parties held for MSM special events
  AOR, 4.31)
• AOR, Adjusted odds ratio

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Study 2 CHAI Study
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CHAI Methods

• 303 API MSM aged 18 to 39 years
• Recruited from informal social networks and gay
  venues in Los Angeles from July 1999 to March
  2000
• Completed interviewer-administered questionnaires

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CHAI Characteristics of Participants with One or
More Partners in the Past Six Months (N193)
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CHAI Partner Characteristics (N320)
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CHAI Associations of Respondent Partner
Characteristics to Unprotected Anal Intercourse
Multivariate Results

• Respondents age (being older AOR, 1.14)
• Number of sexual partners, past 6 months (2
  AOR, 2.78)
• Partner type (primary partner AOR, 5.01)
• Partners ethnicity (API AOR, 2.79)
• AOR, adjusted odds ratio

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Summary ACT

• Low HIV prevalence
• High level of unprotected anal intercourse

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Summary CHAI

• High rate of interracial sexual partnerships
• Higher frequency of unprotected anal intercourse
  with API partners

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Conclusion

• Sexual network patterns possibly responsible for
• - high sexual risk
• - low HIV prevalence

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Program Implications

• Target social/sexual networks
• instead of specific ethnic groups

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Study Limitations

• Limited generalizability to those
• - English-speaking, acculturated, and educated
• - frequent gay-identified venues
• - live in areas with a high concentration of
  APIs
• Underreporting of
• - respondents risk behavior
• - sexual partners risk behavior

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Directions for Future Research

• Descriptive studies
• - Sexual networks and HIV risk
• Intervention studies
• - Network-based interventions