Kyung-Hee Choi

1. 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

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

3. Background: U.S. API Population 9% • Fast growing ethnic group in the U.S. 4.5% 1.6%

4. Background: U.S. API Population • Six ethnic groups make up 85% of the API population. • 71% are foreign-born.

5. 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

6. Background: AIDS and U.S. APIs • 87% of all APIs with AIDS are male.

7. Background: AIDS and U.S. APIs • 71% of API men with AIDS are MSM.

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

9. 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

10. Study 1: ACT Study

11. 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.

12. ACT: Sample Characteristics (N=496)

13. 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

14. 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

15. 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

16. Study 2: CHAI Study

17. 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

18. CHAI: Characteristics of Participants with One or More Partners in the Past Six Months (N=193)

19. CHAI: Partner Characteristics (N=320)

20. 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

21. Summary:ACT • Low HIV prevalence • High level of unprotected anal intercourse

22. Summary:CHAI • High rate of interracial sexual partnerships • Higher frequency of unprotected anal intercourse with API partners

23. Conclusion • Sexual network patternspossibly responsible for: - high sexual risk - low HIV prevalence

24. Program Implications • Target social/sexual networks instead of specific ethnic groups

25. 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

26. Directions for Future Research • Descriptive studies - Sexual networks and HIV risk • Intervention studies - Network-based interventions