HIV testing and management: findings from a national sample of Asian/Pacific islander men who have sex with men

Objectives

We examined reasons for and barriers to participating in HIV voluntary counseling and testing for Asian/Pacific Islander (A/PI) men who have sex with men (MSM) in the U.S.

Methods

We collected data between June 2007 and September 2009 in a study known as Men of Asia Testing for HIV, using a cross-sectional community-based participatory design. This national study was conducted in seven U.S. metropolitan cities through a coalition of seven community-based organizations.

Results

Participants included 445 self-identified A/PI MSM aged ≥18 years. Perception of being at risk was the number one reason for testing behaviors. For first-time testers, structural barriers (e.g., language barriers with health professionals) and fear of disclosure (e.g., sexual orientation not known to parents) were deterrents for nontesting in the past. Among previously known HIV-positive men, 22% were not seeing a doctor and 19% were not taking any HIV medications.

Conclusions

HIV testing, care, and treatment policies would be less than optimal without addressing barriers to testing, including stigma related to sexual orientation, among A/PI MSM.Men who have sex with men (MSM) continue to have the highest human immunodeficiency virus (HIV) infection rates in the U.S., with MSM of color being disproportionately affected by the disease.¹ Compared with MSM of other racial/ethnic groups, Asian/Pacific Islander (A/PI) MSM have the highest proportion of acquired immunodeficiency syndrome (AIDS) cases, with a majority of them being non-U.S.-born.^2,3 Research attributes this disparity to low testing rates^4–6 and late diagnosis, which are often associated with advanced AIDS symptoms⁷ as well as late entry into care.^8,9Voluntary counseling and testing (VCT) has been a successful standard of HIV prevention since the emergence of the epidemic in the U.S. and other developed countries.^10–14 This prevention strategy has also been adopted by other developing countries.¹⁵ Nonetheless, the uptake of VCT is still less then optimal.¹⁶ For example, combining multiple datasets from the 2000 to 2005 National Health Interview Surveys, Ostermann et al. found little change in lifetime and past year testing, respectively. However, individuals who perceived higher risks of contracting HIV were more likely to plan for and engage in actual HIV testing.¹⁷Meanwhile, the literature consistently indicates that the stigma of having HIV and/or being a sexual minority is a major barrier or determinant for efficacious or effective prevention, intervention, and treatment, especially among marginalized, vulnerable, or underserved populations.¹⁸ Using a qualitative methodology (i.e., in-depth interview), Yoshioka and Schustack found three major barriers to disclosure of HIV status among a sample of HIV-positive men of Asian descent in the U.S.: (1) protection of family from shame, (2) protection of family from obligation to help, and (3) avoidance of communication regarding highly personal information (including same-sex sexual orientation).¹⁹Collectively, these articles in the literature lend to the postulation that the effectiveness of VCT hinges on at-risk individuals having well-informed information regarding the attitudes, beliefs, and practices of HIV testing.²⁰ Although a small number of cross-sectional studies have been conducted,^6,7,9,21 little to no national data are available addressing HIV testing and HIV management among A/PI MSM. To that end, we used data from a national study of HIV prevention to describe and examine (1) reasons for and barriers to HIV testing among a national sample of A/PI MSM, and (2) care and treatment among those who have tested HIV-positive in the past, by nativity (U.S.-born vs. non-U.S.-born).