Transcript 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.

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
UCSF
University of California
San Francisco
Presentation Outline
 Background
 Study 1
Asian Counseling and Testing (ACT)
 Study 2
Community, Health, and Identity (CHAI)
 Directions for Future Research
Background: U.S. API Population
 Fast growing
ethnic group
in the U.S.
9%
9
8
7
6
4.5%
5
4
3
2
1.6%
1
0
1980
2000
2050
Background: U.S. API Population
 Six ethnic
groups make up
85% of the API
population.
 71% are
foreign-born.
3%
12%
22%
9%
10%
19%
10%
15%
Chinese
Filipino
Asian Indian
Vietnamese
Korean
Japanese
Other Asians
Pacific Islander
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
Background: AIDS and U.S. APIs
 87% of all
APIs with
AIDS are
male.
13%
87%
Male
Female
Background: AIDS and U.S. APIs
3%
 71% of API
men with
AIDS are
MSM.
13%
4%
4%
5%
71%
MSM
Drug injection
MSM/Drug Injection
Heterosexual contact
Blood
Unknown risk
Background: Studies of API MSM
 Few HIV prevalence studies with a
large sample of API MSM.
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
Study 1: ACT Study
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.
ACT: Sample Characteristics (N=496)
Ethnicity (%)
Filipino
Chinese
Vietnamese
Japanese
Thai
Korean
Other
Multi-ethnic
Mean age
28
27
16
4
4
3
8
10
24
Education (%)
< college education
Some college
College graduate
17
33
50
Foreign-born (%)
70
Sexual orientation (%)
Gay
82
Bisexual
13
Other
5
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
ACT: Sexual Risk Behaviors,
Past Six Months (%)
 Number of male partners (median, 2)
0
1
2-5
6+
 Unprotected anal intercourse
Any
Insertive
Receptive
6
31
44
19
47
39
35
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
Study 2: CHAI Study
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
CHAI: Characteristics of Participants
with One or More Partners in the Past Six
Months (N=193)
Ethnicity (%)
Filipino
Chinese
Japanese
Vietnamese
Other
Mean age
32
23
13
10
22
24
Education (%)
< college education 4
42
Some college
54
College graduate
Foreign-born (%)
40
Sexual orientation (%)
Gay
Bisexual
Other
93
6
1
Number of partners,
past 6 months (%)
1
2-3
4-10
11+
61
18
17
4
CHAI: Partner Characteristics (N=320)
Ethnicity (%)
White
API
Latino
African-American
Multi-racial
HIV antibody status (%)
Positive
4
Negative
63
Didn’t get tested
or didn’t know
35
43
34
12
3
8
Age difference (%)
Partner 2+ years younger
Partner within 1 year
Partner 2-4 years older
Partner 5+ years older
Ever injected drugs (%)
23
Yes
7
32
No
65
20
Didn’t know
28
25
Partner type (%)
Primary
Non-primary
37
63
CHAI: Associations of Respondent &
Partner Characteristics to Unprotected
Anal Intercourse: Multivariate Results
 Respondent’s age (being older; AOR, 1.14)
 Number of sexual partners, past 6 months
(2+; AOR, 2.78)
 Partner type (primary partner; AOR, 5.01)
 Partner’s ethnicity (API; AOR, 2.79)
AOR, adjusted odds ratio
Summary: ACT
 Low HIV prevalence
 High level of unprotected anal
intercourse
Summary: CHAI
 High rate of interracial sexual
partnerships
 Higher frequency of unprotected
anal intercourse with API partners
Conclusion

Sexual network patterns possibly
responsible for:
- high sexual risk
- low HIV prevalence
Program Implications
 Target social/sexual networks
instead of specific ethnic groups
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
Directions for Future Research
 Descriptive studies
- Sexual networks and HIV risk
 Intervention studies
- Network-based interventions