HIV and STI Testing among East and Southeast Asian Men Who Have Sex with Men in Toronto
Poon, Maurice Kwong-Lai, Wong, Josephine Pui-Hing, Sutdhibhasilp, Noulmook, Ho, Peter Trung-Thu, Wong, Bernard, The Canadian Journal of Human Sexuality
Abstract: This study explored the patterns of HIV and STI testing, and factors associated with HIV testing in a convenience sample of 222 East and Southeast Asian men in Toronto recruited through a gay bathhouse and a gay website. Approximately 75% of the respondents had sex with a casual partner in the previous six months (with an average of 16.7 partners). Over 25% of the respondents did not know their current HIV status and 19.8% of the total sample reported at least one incident of unprotected anal sex with a casual partner in the past six months. Half of those who had not previously been tested for HIV or STIs cited "I am at low risk for HIV and STI and don't need to be tested" as the main reason for not testing. Factors such as STI testing, history of seeking sex via bathhouses and the internet, having a casual partner or partners, and having higher numbers of casual partners in the past six months, were found to be associated with HIV testing. HIV prevention strategies need to continue to promote regular testing for HIV and STIs among Asian MSM. To increase testing, prevention efforts need to be focused on developing culturally and linguistically appropriate testing strategies that directly target altering risk perception and continue to emphasize the benefit of early testing. Testing strategies should aim to increase awareness of and access to testing and offer different methods of testing (such as finger prick HIV tests).
Since the 1970s, there has been a substantial growth in the number of East and Southeast Asian immigrants in Canada. Today they are the largest ethno-racial minority group in this country. In Toronto, over 16% of the 2.5 million residents are of East and Southeast Asian backgrounds (Statistics Canada, 2008). In the changing landscape of HIV and AIDS, reported HIV cases among people of East and Southeast Asian backgrounds in Toronto have also increased significantly, from 2.4% between 1980 and 2000 to 6.3% between 2001 and 2005. Men accounted for over 90% of these cases and the primary route of transmission was sexual contact between men. The recent Laboratory Enhancement Program data in the province of Ontario also confirmed that, from January 2009 to September 2010, approximately three quarters of the HIV infections among men of East and Southeast Asian backgrounds were via sexual contact between men (Remis & Liu, 2011).
Evidence from Canada and the U.S. suggests that H1V risk among Asian men is associated with high rates of unprotected anal intercourse among men who have sex with men (MSM). For instance, a study in Toronto found that only 53% of East and Southeast Asian MSM used condoms every time they engaged in sexual activity (Poon, Ho, & Wong, 2001). A similar study conducted in Vancouver reported that 24% of East and Southeast Asian MSM had unprotected receptive anal sex with ejaculation into their rectum with their primary sexual partners (Bhat, Yee, & Koo, 1994). U.S. studies also found comparable rates of unprotected anal sex among Asian and Pacific Islander MSM. For example, a recent study in San Francisco found that 18% of this population had engaged in unprotected anal intercourse during the past six months (Raymond & McFarland, 2009). Other U.S. studies have documented even higher rates of unprotected anal intercourse among Asian and Pacific Islander MSM, ranging from 27% to 38% during the previous three months (Choi, Coates, Catania, Lew, & Chow, 1995; Choi, Han, Hudes, & Kegeles, 2002; Choi et al., 1996; Do, Hudes, Proctor, Han, & Choi, 2006; Flores, Bakeman, Millett, & Peterson, 2009; Lai, 1999).
At the same time, research data show low rates of HIV testing among Asian MSM. A recent study, conducted in Toronto and Ottawa, reported that South and Southeast Asian MSM had the lowest rate of HIV testing (78%) among all ethnic groups (Myers et al., 2011). Prior Canadian studies have also recorded even lower rates of HIV testing (65%-69%) among East and Southeast Asian MSM (Bhat et al. …