Transcript Knowledge of Sexual Partners' HIV Status among API MSM

Knowledge of Sexual
Partners’ HIV Status
among API MSM
HIV Prevention Conference 2005
Atlanta, GA
Tri Do, MD, MPH
University of California, San Francisco
Center for AIDS Prevention Studies
Positive Health Program, San Francisco General Hospital
Tri D. Do, Esther S. Hudes, Kristopher Proctor, Chung-Sook Han,
Kyung-Hee Choi
Learning Objectives
Describe the patterns of knowing the HIV
status of main and non-main sexual partners
among Asian and Pacific Islander men who
have sex with men.
Identify the correlates of knowing partners’
HIV status.
Identify public health strategies to increase
knowledge of partner HIV status.
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Disclosures
No financial disclosures, conflicts of interest, or off-label
use of FDA-approved medications or products
This research was supported by the Centers for Disease
Control and Prevention (CDC) Cooperative Agreement
#U62/CCU913658
Background
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Asian and Pacific Islanders, including men who have sex with
men, are typified as a low risk population with high risk
behaviors with “model minority” risk behaviors
HIV prevalence in API MSM 2.6-27%
Rising HIV seroprevalence (10%), incidence (1.8%), reported
sexual risk behaviors
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High proportion unaware of infection (62%)
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Choi et al (2004). An opportunity for prevention: prevalence, incidence, and sexual risk for HIV among young Asian
and Pacific Islander men who have sex with men, San Francisco. Sex Transm Dis, 31(8), 475-480.
McFarland et al (2005). Report on HIV surveillance among MSM in San Francisco, SF Dept of Public Health.
Presentation at UCSF Center for AIDS Prevention Studies May 2005.
Do et al (2005). HIV testing patterns and unrecognized HIV infection among young Asian and Pacific Islander men
who have sex with men in San Francisco. AIDS Educ Prev, 17(6), In Press.
Many HIV+ diagnosed at a late stage (46% with AIDS
diagnosis) and with a PCP diagnosis (OR 1.4-1.9)
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Eckholdt, H. M. & Chin, J. (1997). Pneumocystis carinii pneumonia in Asians and Pacific Islanders. Clinical Infectious
Diseases, 24, 1265-1267.
Wong et al (2004). HIV testing and awareness of care-related services among a group of HIV-positive Asian
Americans and Pacific Islanders in the United States: findings from a supplemental HIV/AIDS surveillance project.
AIDS Educ Prev.
What is unique about this
population?
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Culturally specific forms of homophobia, racism,
anti-immigrant sentiment within US society, gay
community, and communities of origin
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Familial pressures
Model minority status
Lack of role models
Difficulty finding relationships
Isolation, lack of social support, self-esteem
Varying cultural backgrounds, immigration experiences,
and acculturation levels
Low perception of HIV risk
Risk-protective behaviors and attitudes
HIV Risk Behaviors
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Sexual networks, partner choices
Age, sexual position, race/ethnicity
Serostatus of partner
Early analysis by Choi et al found increased UAI with main
partners (49%) compared to non-main partners (25%, p <
0.001)
Similar reports of UIAI and URAI with main partner, but
increased with fewer reports of URAI (16%) than UIAI (29%)
with non-main partners
Correlates of HIV testing include: ethnicity, knowing places to
get tested, having main partner, social support, UAI within 3
months
Hypotheses and Research
Questions
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HIV testing is correlated with knowing
partner HIV status
More acculturated men more likely to know
their partner’s HIV status
Knowledge of partner status may not
necessarily be based on directly asking – i.e.
high rates of assumption of status
Decreases in knowledge of partner HIV
status over time
Theoretical Model
Design & Methods
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Secondary data analysis from the
Community Intervention Trial for Youth
(CITY) study, 1999-2002 of MSM aged 1525 years
Sites in Seattle, WA and San Diego, CA
exclusively recruited API MSM
Asian, Native Hawaiian, Pacific Islander, or
mixed
TSS sampling approach, recruiting from
bars, clubs, special events, sex venues
Any same-sex sexual contact in the past
year
Design & Methods
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Demographics (age, education, race/ethnicity, nativity or place of
birth), sexual orientation, social support, peer norms, and sexual risk
Information on specific sexual risk behaviors was embargoed at the
time of analysis.
For sexual risk behaviors we asked about unprotected anal
intercourse in the previous three months, sexual partnerships, and
ever having traded sex for material goods or shelter.
For sexual partnerships, we asked participants whether they had any
sexual contact with a man whom they considered to be a main
partner “such as a lover or boyfriend” or non-main partner “who was
not your main partner” in the last year.
Scales for social support around sexual concerns and one for
perceived peer norms around condom use.
Informed consent obtained, received $15 compensation upon
completion, and were given information on safer sex and HIV testing
in their locale
Approved by the institutional review boards of the University of
California, San Francisco and the Centers for Disease Control
Sampling Results
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6,900 eligible-appearing men approached
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3,741 were ineligible (54%)
36 did not speak English (<1%)
1,889 declined to be interviewed (27%)
leaving 1,123 (16%) eligible persons
1,028 (92%) gave informed consent, but 120 (11%) had already
participated within the last 12 months
908 (13%) were included in the present sample
– Equal numbers between Seattle and San Diego
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Demographicss
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Equal proportions of subjects were born in the U.S. or were foreign-born
Median age upon arrival to the U.S. (9-10 years old)
Median length of stay in the U.S. among foreign-born (12-13 years)
Over two-thirds were gay-identified; 11-22% were bisexual; few
identified as heterosexual.
Results
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Sexual Risk
32 to 38% of participants reported any UAI
in the 3 months before the interview
URAI and UIAI with the last three months
were (22% to 30%) – similar to proportions
at other sites
4 to 6% had ever traded sex for material
goods or shelter.
Results
Results
Trends and Multivariate
analysis
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Knowledge of Main Partner Status
– No change over time
– Tested for HIV in the past year (adjusted odds ratio (AOR)
range 2.9 - 4.7) in three study years
– Greater social support (AOR 1.7, 95%CI 1.1 – 2.8)
– Having been born in the U.S. (AOR 4.3, 95%CI 1.6-11.4)
– Those who reported ever trading sex for goods or shelter
(AOR 0.2, 95%CI 0.02-0.9).
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Non-Main Partner Status
– Greater social support around discussions of sexuality and
sexual matters (AOR 2.0, 95%CI 1.1-3.7)
– HIV test within the last year (AOR 8.0, 95%CI 1.8-36.0)
Limitations
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Need data on sexual risk behaviors by
partner
Self-reported information in a highly
stigmatized setting
Venue-based recruitment
Limited to two cities
Brief interviews in the field – no in-depth
interviews conducted
Primary purpose of survey was not to study
knowledge of partner HIV status
Implications for Community,
HIV Prevention Efforts
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Increase negotiated safety discussions
Programs that help API MSM ask “How do they
know what they know”
Encourage HIV testing for self and partners
Address cultural barriers to accessing prevention
and testing services
Increase community cohesion, social support e.g.
MPowerment programs
If low prevalence before due to HIV prevention
strategy, why are those trends increasing?
Acknowledgements
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Kyung-Hee Choi, PhD was the Principal Investigator
of the Young Asian Men’s Study (YAMS)
Estie Hudes, PhD provided statistical support
K Proctor and CS Han oversaw the data collection
and study implementation
The field staff of the Young Asian Men’s Study
(YAMS) in Seattle and San Diego for their dedicated
work on this project
The national CITY project team