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  Fast growing ethnic group in the U.S. 9% 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 patterns possibly 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