Knowledge of Sexual Partners’ HIV Status among API MSM

1. 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

2. 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. • 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

3. Background • 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 • 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. • High proportion unaware of infection (62%) • 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) • 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.

4. What is unique about this population? • Culturally specific forms of homophobia, racism, anti-immigrant sentiment within US society, gay community, and communities of origin • 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

5. HIV Risk Behaviors • 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

6. Hypotheses and Research Questions • 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

7. Theoretical Model

8. Design & Methods • Secondary data analysis from the Community Intervention Trial for Youth (CITY) study, 1999-2002 of MSM aged 15-25 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

9. Design & Methods • 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

10. Sampling Results • 6,900 eligible-appearing men approached • 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 • Demographicss • 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.

12. Results • 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.

13. Results

14. Results

15. Trends and Multivariate analysis • 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). • 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)

16. Limitations • 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

17. Implications for Community, HIV Prevention Efforts • 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?

18. Acknowledgements • 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