Asian MSM Research Articles

Latent class analysis of substance use among men who have sex with men in Malaysia: Findings from the Asian Internet MSM Sex Survey

BackgroundHigh prevalence of substance use among men who have sex with men (MSM) may drive the HIV epidemic in Malaysia but patterns of substance use among Malaysian MSM have not been examined. Our study investigated specific Malaysian MSM risk groups to determine the association between their substance use and sexual risk behaviors. MethodsData from Malaysian respondents (n=1235) in a large, multinational online survey of Asian MSM in 2010 were used to identify latent classes of substance use. Subsequent covariates were included in a joint model to predict class membership. ResultsThe 3-class model was identified as the best fitting model, which included: (1) ‘negligible substance use’ for those reporting none or using any substance sparingly; (2) ‘soft substance use’ for those using poppers, ecstasy and drinking before sex; and (3) ‘amphetamine-type stimulant (ATS) use’ for those using stimulants (methamphetamine, ecstasy), erectile dysfunction drugs and recreational drug use before sex. Men in the ‘ATS use’ category were significantly less likely to not know their HIV status (AOR: 0.30, 95%CI: 0.14,0.66), more likely to have had more than 6 male sex partners (AOR: 4.83, 95% CI: 1.92–12.2), to have group sex (AOR:4.07, 95% CI: 2.31–7.15), to report inconsistent condom use (AOR:2.01, 95% CI: 1.12–3.60), to be HIV-infected (AOR:3.92, 95% CI: 1.63–8.42) and to have had any sexually transmitted infections (AOR:3.92, 95% CI:1.70, 9.08), compared to men in the ‘negligible substance use’ category. ConclusionsOur study identified subgroups of Malaysian MSM with distinct substance use patterns and HIV-related risk profiles, which provides implication for targeting HIV prevention in this subpopulation.

Pleasure, affection, and love among Black men who have sex with men (MSM) versus MSM of other races: countering dehumanizing stereotypes via cross-race comparisons of reported sexual experience at last sexual event.

Black men have historically been stereotyped as hedonistic, aggressive, and animalistic in their sexual interactions. This study sought to describe pleasure, affection, and love experienced by Black men who have sex with men (MSM) during their last male-partnered sexual event and to examine differences relative to White, Latino, and Asian MSM. A total of 21,696 (793 Black, 18,905 White, 1,451 Latino, and 547 Asian) U.S. men ages 18-87 (M Age=39) were recruited from social/sexual networking sites targeting MSM in 2010-2011. Participants reported multiple dimensions of sexual experience (pleasure, affection, and love) occurring at their last male-partnered sexual event, partner relationship, and sociodemographic characteristics. Across relationship categories, a sizeable percentage of Black MSM reported pleasure (72-87 % orgasmed, 57-82% experienced high subjective pleasure) and affection (70-91% kissed, 47-90% cuddled). Love was primarily reported for events involving main partners (felt love for partner: 96%; felt loved by partner: 97%; verbalized love to partner: 89%). Latent class analysis with MSM of all races, adjusting for partner relationship and sociodemographic characteristics, revealed three distinct profiles of sexual experience: affection and love (Class 1); affection in the absence of love (Class 2); and neither affection nor love (Class 3). Pleasure was probable across profiles. Some racial differences in profile probability were present, but no overall pattern emerged. Contrary to Black male stereotypes, Black MSM commonly reported pleasure, affection, and love at their last male-partnered sexual event and did not show a meaningful pattern of difference from other-race MSM in their likelihood of experiencing all three.

Dating preferences among self-identified gay men of Asian descent in the United States.

Author(s): Nehl, EJ; Talley, CL; Yu, F; Nakayama, KK; Lin, L; Wong, FY; Ong, PM; Takahashi, LM; Ross, MW | Abstract: Little is known about the dating preferences of Asian American gay men. To conceptualize the dating preferences among these men, the impact domains model (IDM) was used to investigate if nativity and/or acculturation might explain dating preferences. Previous studies have pointed out the problematic nature of a racist cultural stereotype that Asian American gay men prefer white partners (Choi, Yep, a Kumekawa, 1998; Han, 2008). The current findings do not support that Asian American gay men prefer white partners. In our sample, 17.1% preferred dating white men and over 20% preferred Asian men. Over 60% had no clear racial/ethnic dating preference. Multivariate analyses indicated that those reporting higher ethnic acculturation (p l.001) and were U.S.-born (p l.01) were more likely to prefer dating Asian men. In contrast, those younger (p l.001) and living on the East Coast (p l.01) were more likely to prefer dating white men. Limitations of the study include a self-report cross-sectional design with purposive recruitment to study HIV/STIs and sexual health rather than dating preferences. Additionally, the data set included only a coastal classification (East vs. West Coast) and an acculturation scale which included cultural identity, language, and competence. The complex effect of nativity and acculturation on dating preference warrants further investigation. The IDM may be useful to guide future studies of partner preference among Asian MSM. Researchers in future studies should pay attention to identifying the key behavioral, social, and affective beliefs that underlie partner preference and examine actual dating practices.

Intercontinental dispersal of HIV-1 subtype B associated with transmission among men who have sex with men in Japan.

Transmission clusters of HIV-1 subtype B uniquely associated with the epidemic among men who have sex with men (MSM) in East Asia have recently been identified. Using the Los Alamos HIV sequence database and the UK HIV drug resistance database, we explored possible links between HIV MSM epidemics in East Asia and the rest of the world by using phylogenetic and molecular clock analyses. We found that JP.MSM.B-1, a subtype B MSM variant that accounts for approximately one-third of the infections among Japanese MSM, was detected worldwide, in the United Kingdom (n=13), mainland China (n=3), the United States, Germany, Canada, and Taiwan (n=1 each). Interestingly, 10 United Kingdom samples plus two from Germany and the United States formed a distinct monophyletic subgroup within JP.MSM.B-1. The estimated divergence times of JP.MSM.B-1 and the latter subgroup were ∼1989 and ∼1999, respectively. These dates suggest that JP.MSM.B-1 was circulating for many years in Japan among MSM before disseminating to other countries, most likely through global MSM networks. A significant number of other Asian MSM HIV lineages were also detected in the UK HIV drug resistance database. Our study provides insight into the regional and global dispersal of Asian MSM HIV lineages. Further study of these strains is warranted to elucidate viral migration and the interrelationship of HIV epidemics on a global scale. We previously identified several transmission clusters of HIV-1 subtype B uniquely associated with the epidemic among men who have sex with men (MSM) in East Asia. Using the Los Alamos HIV sequence database and the UK HIV drug resistance database, we explored the possible interplay of HIV MSM epidemics in the different geographic regions and found previously unrecognized interrelationships among the HIV-1 epidemics in East Asia, the United Kingdom, and the rest of the world. Our study provides insight into the regional and global dispersal of Asian MSM HIV lineages and highlights the importance of strengthening HIV monitoring efforts and the need for implementing effective control measures to reduce HIV transmission on a global scale.

Editorial Commentary: The Next Tsunami? HIV Spread in Asian Men Who Have Sex With Men

Over the past few years, human immunodeficiency virus (HIV) incidence has appreciably decreased in several countries [1]. However, in many parts of the world, HIV is spreading increasing rapidly among men who have sex with men (MSM) [2]. This trend of the epidemic becoming increasingly concentrated among MSM has been particularly marked in several urban epicenters throughout Asia in recent years, and in the current issue of Clinical Infectious Diseases, Yang et al describe a worsening epidemic of HIV and syphilis among MSM in 2 cities in Jiangsu Province in eastern China [3] . The authors found that HIV prevalence initially ranged between 13.6% and 16%, with syphilis prevalence ranging between 14.9% and 29.9%, but subsequent annualized HIV incidence was >12.5%. These rates are extremely high, and portend a worsening HIV/AIDS epidemic among Chinese MSM. Similar findings have been noted in several other recent studies from China [4–9] and nearby countries [10, 11], and contribute to a growing worrisome body of literature suggesting that AIDS in Asia is disproportionately becoming an MSM epidemic. The rapid spread of HIV among Asian MSM is particularly concerning because the majority of the world’s population lives in Asia, with an increasing number of individuals living in urban epicenters. Some MSM have female, as well as male partners, and/or inject drugs, so transmission outside their core group is highly likely. The potential for amplified transmission in these densely populated megacities can greatly erode the encouraging trends seen in the other parts of the world. Why is this happening? Recent work has suggested that the HIV epidemic in MSM has multifactorial causes [12, 13]. Individual behavior remains relevant, as the more partners that an individual has over time, the increased likelihood of HIV acquisition; but other factors are also involved. Specific biological factors that potentiate HIV spread are unique among MSM, particularly anal intercourse, which increases susceptibility to HIV and other sexually transmitted infections, and role versatility—that is, an an anal-receptive partner who becomes readily infected with HIV can subsequently be the insertive partner and be more efficient in transmitting HIV to new partners who are receptive. In addition, MSM may be part of specific sexual networks that can potentiate HIV spread. As the prevalence of HIV increases in a specific population, it is much easier to become infected with any new partner. This is particularly true in socially marginalized populations such as MSM and those who are poorer, given decreased social mobility and increased likelihood of choosing partners from an area with a high-HIV-prevalence pool. MSM may also frequent unique sexualized venues that may contribute to HIV transmission, such as bathhouses and saunas, as well as the increasing array of opportunities on social media to meet new partners rapidly [14–16]. Sexualized venues may increase the likelihood that individuals are exposed to partners with acute HIV infection, who may be particularly infectious, and this may potentiate the further spread of epidemics. Recently there also has been attention paid to the fact that societal rejection of homosexuality may result in internalized homophobia, a negative affective state that may be self-medicated with recreational drugs [17, 18]. Data suggest that bullying and other adverse experiences with heterosexuals may lead to early developmental stress, depression, lack of self-efficacy, and subsequent risk-taking behaviors [19] . In many settings around the world, criminalization and discrimination in healthcare settings also impede HIV Received and accepted 10 March 2014; electronically published 18 March 2014. Correspondence: Kenneth Mayer, MD, The Fenway Institute, 1340 Boylston Street, Boston, MA 02215 (khmayer@gmail. com). Clinical Infectious Diseases 2014;58(12):1760–2 © The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals. permissions@oup.com. DOI: 10.1093/cid/ciu176

Sexual practices and sex-seeking behaviours among East and Southeast Asian men who have sex with men in Toronto: Implications for HIV prevention

This study explored sexual practices and sex-seeking behaviours in a sample of 222 East and Southeast Asian men recruited through two gay venues. Over half of the respondents reported having a current regular partner; the rate of unprotected anal sex with their regular partner was high (45.1%). Among all respondents, 74.8% (166) reported having casual sex with an average of 16 partners in the previous six months; 26.5% of these 166 respondents reported unprotected anal sex with their casual partners. Respondents used multiple venues to seek sex, but bathhouses and the internet were most commonly cited. Bivariate analysis demonstrated that respondents who sought men for sex via both bathhouses and the internet in the past six months were most likely to have had a casual partner, to have had unprotected anal sex with a casual partner, and to have had prior HIV and STI testing. In comparison to respondents who used only bathhouses to seek sex, respondents who used only the internet had fewer casual partners but were more likely to have unprotected anal sex with a casual partner. Given these findings, additional research is needed to further explore the individual and structural factors that shape the condom use behaviour of these sub-populations. HIV prevention efforts must include culturally relevant information about HIV and STI transmission to promote condom use. It is also critical to develop culturally and linguistically appropriate online prevention education for Asian MSM who seek sex primarily through the internet.

Risks for HIV and other sexually transmitted infections among Asian men who have sex with men in Vancouver, British Columbia: a cross-sectional survey.

BackgroundIndividuals of Asian heritage represent the largest ethnic minority in Canada. Approximately 10% of the new HIV diagnoses in men in British Columbia occur among Asian-Canadians. However, the HIV risk patterns of Asian men who have sex with men (MSM) have not been extensively studied.MethodsParticipants aged ≥ 19 years were enrolled in a venue-based HIV serobehavioural survey of MSM in Vancouver, Canada. We compared the demographic characteristics, risk behaviours, and prevalence of HIV and other sexual and blood borne infections between Asian and non-Asian MSM using bivariate analysis and logistic regression confounder modelling.ResultsAmongst 1132 participants, 110 (9.7%) self-identified as Asian. Asian participants were younger than non-Asian participants (median age 29 vs. 32 years; p < 0.001), but otherwise did not differ from other study participants. HIV prevalence was lower among Asian MSM compared to Non-Asian MSM (3.7% vs 19.0%, p <0.001). Among men who self-reported as HIV negative or unknown we found no differences in unprotected anal intercourse (UAI) with a discordant or unknown serostatus partner in the previous six months (11 vs. 13%; p = 0.503). However, Asian MSM were less likely to report ever using injection drugs (10.8% vs. 19.2%; p = 0.043) or using alcohol before having sex (52% vs. 64.4%; p = 0.017).ConclusionsAsian MSM in our study reported similar rates of UAI as non-Asian MSM, but had a lower prevalence of HIV infection. Other factors, such as the use of drugs and alcohol, in relation to sex, may partly explain these differences. However this requires further investigation.

“Hard to crack”: Experiences of community integration among first- and second-generation Asian MSM in Canada.

Asians are the largest racial minority in Canada making up 11% of the population and represented over 60% of new immigrants between 2001 and 2006. We examined the experiences of community integration for first-generation (n = 27) and second-generation (n = 22) Asian Canadian men who have sex with men (MSM) in their ethnic and gay communities. Through focus group interviews, we explored their level of connectedness and the level of discrimination they experienced in the two communities. Findings indicate that Asian MSM in general perceived their ethnic community as homophobic, stemming from a combination of seeing sex as taboo, stereotypes about being gay, and the affiliation with religion. Although the literature indicates that immigrants rely on the support of their ethnic communities, our finding suggest that this is not the case for Asian immigrant MSM, who in our sample reported feeling less connected compared to their second-generation counterparts. For the gay community, our sample reported mixed experiences as some regarded it as welcoming, whereas others described it as racist. However, these experiences did not differ by generational status. Many were aware of explicit messages stating "No Asians" in dating contexts, while at the same time being aware that some older White men were interested in dating Asians exclusively. Barriers to integration in both communities may contribute to feelings of isolation. Theoretical implications are discussed.

HIV Infection Among Ethnic Minority and Migrant Men Who Have Sex With Men in Britain

To examine human immunodeficiency virus (HIV) infection among men who have sex with men (MSM) from different ethnic and migrant groups living in Britain. In 2007-2008, a diverse national sample of MSM living in Britain was recruited through Web sites, in sexual health clinics, bars, clubs, and other venues. Men completed an online survey that included questions on HIV testing, HIV status, and sexual behavior. Nine hundred and ninety-one ethnic minority MSM, 207 men born in Central or Eastern Europe (CEE), 136 men born in South or Central America, and 11,944 white British men were included in the analysis. Self-reported HIV seropositivity was low for men of South Asian, Chinese, and "other Asian" ethnicity (range, 0.0%-5.8%) and for men born in CEE (4.5%) but elevated for men born in South or Central America (18.7%), compared with white British men (13.1%) (P < 0.001). There were no significant differences between these groups in high-risk sexual behavior (P = 0.8). After adjusting for confounding factors in a multivariable model, substantial differences in the odds of HIV infection remained for South Asian and Chinese MSM as well as for migrants from CEE, but not for other groups, compared with white British men; for example, South Asian men, adjusted odds ratio 0.43, 95% confidence interval 0.23, 0.79, P = 0.007. There were marked differences in self-reported HIV seropositivity between ethnic minority, key migrant, and white British MSM in this study but not in high-risk sexual behavior. This highlights the importance of health promotion targeting MSM from all ethnic and migrant groups in Britain.

Sexual Mixing and HIV Risk Among Ethnic Minority MSM in Britain

We conducted a cross-sectional online survey of men who have sex with men (MSM) living in Britain in 2007-2008 to examine sexual mixing among ethnic minority MSM. The sample comprised 115 black, 112 South Asian, 47 Chinese and 4,434 white MSM who reported unprotected anal intercourse (UAI) in the previous 3months. In each ethnic minority group, MSM were three times more likely to report UAI with a partner of the same ethnicity than would be expected by chance alone (χ(2)>8.43, p<0.05). Nonetheless, most (>80%) ethnic minority MSM reported UAI with men from an ethnic group other than their own. In multivariable analysis there was statistical evidence that, compared with white British MSM, self-reported HIV seropositivity remained low for South Asian and Chinese MSM after adjusting for UAI with partners of the same ethnicity (e.g. South Asian MSM, adjusted odds ratio 0.35, 95% CI 0.19-0.66). This analysis suggests that differences in self-reported HIV seropositivity between ethnic minority and white MSM in Britain cannot be explained by sexual mixing with partners from the same ethnic group.

Politics of desire: Exploring the ethnicity/sexuality intersectionality in South and East Asian men who have sex with men (MSM)

‘Intersectionality’ has been used to interrupt dominant discourse surrounding LGB experiences, and has exposed their heterogeneity. Complexities of negotiating desire within a matrix of race/ethnicity and sexuality in South and East Asian men who have sex with men (MSM) has been under-explored in Black and Minority Ethnic LGB research. Our internet survey found discordance between sexual identities and sexual practices amongst Asian MSM. Many did not access LGB physical and cyberspaces, and some experienced abuse attributed to their race/ethnicity. Feeling undesired was read as a function of racism, but racism from Asian MSM, manifesting as dispreference for certain races/ethnicities, was also found. We also explored intersections between internalised racism and homophobia which affect the lived experience of diasporic Asian MSM.

Strategies for Managing Racism and Homophobia among U.S. Ethnic and Racial Minority Men Who Have Sex with Men

Despite widespread recognition that experiences of social discrimination can lead to poor physical and mental health outcomes for members of minority groups, little is known about how U.S. ethnic minority men who have sex with men (MSM) manage their experiences of racism and homophobia. We conducted six focus group discussions (n = 50) and 35 in-depth interviews with African American, Latino, and Asian and Pacific Islander MSM (aged 18 or older) recruited in Los Angeles. This process revealed five strategies that MSM of color employed in order to mitigate the impact of racism and homophobia. To minimize opportunities for stigmatization, men used (a) concealment of homosexuality and (b) disassociation from social settings associated with stigmatization. To minimize the impact of experienced stigma, men (c) dismissed the stigmatization and (d) drew strength and comfort from external sources. Men also actively countered stigmatization by (e) direct confrontation. More research is needed to understand the efficacy of these coping strategies in mitigating negative health consequences of stigmatization and discrimination.

Internet Sex Ads for MSM and Partner Selection Criteria: The Potency of Race/Ethnicity Online

The explosive growth in Internet use by men who have sex with men (MSM) to find sexual partners has been noted in the research literature. However, little attention has been given to the impact of participating in this online sexual marketplace for MSM of color, despite race and ethnicity as frequently used selection criterion in personal ads or profiles. Six focus group discussions (n = 50) and 35 in-depth qualitative interviews were conducted with African American, Latino, or Asian and Pacific Islander MSM in Los Angeles, which included discussion of their use of Internet sites to meet or interact with other MSM. Men reported race and ethnicity as a pervasive and powerful factor in facilitating or derailing Internet-mediated sexual encounters. The racialized interactions that MSM of color reported ranged from simple expressions of race-based preferences, to blatantly discriminatory or hostile interactions, and often demeaning race-based sexual objectification. Experiences of rejection and a perceived hierarchy of value in the sexual market based on race had definite costs for these MSM using these online sites. Furthermore, the private and solitary nature of seeking partners online meant that there was little to buffer the corrosive aspects of those negative experiences. These online dynamics have implications for the power balance in Internet-mediated sexual liaisons, including sexual decision making and sexual risk.

AIDS among Asians and Pacific Islanders in the United States

Objective: To characterize Asians and Pacific Islanders in the United States with reported acquired immunodeficiency syndrome (AIDS). Methods: AIDS surveillance data reported through June 1998 were analyzed. Characteristics of cumulative case patients, rates of AIDS incidence in 1996 through 1997, and trends from 1982 through 1996 were analyzed. Results: Through December 1998, 4,928 Asian and Pacific Islander adults and 46 Asian and Pacific Islander children with AIDS were reported in the United States. Of the total cases, 89% were in men, and 79% of those were in men who have sex with men (MSM). Five states, which account for 63% of the Asian and Pacific Islander population in the United States, reported 78% of the cases: California (45%), Hawaii (12%), New York (15%), Texas (3%), and Washington (3%). Of the 92% of Asian and Pacific Islander patients with country of birth information, 59% were foreign-born, a percentage that corresponds to the distribution in the general population. The overall incidence rate per 100,000 for 1996 through 1997 was 12.8 (21.3 for men; 3.3 for women). The highest rate was in the Northeast (15.9), followed by the West (13.8), South (10.6), and Midwest (5.7). Tuberculosis, reported for 6% of Asians and Pacific Islanders, was higher among foreign-born than among U.S.-born Asians and Pacific Islanders (8% and 4%, respectively). Between 1982 and 1996, AIDS incidence among MSM increased and peaked in 1994. Among heterosexual contacts and injection drug users, incidence has increased but remained low. Conclusions: The AIDS epidemic among Asians and Pacific Islanders in the United States has primarily affected MSM and is concentrated in a few states where most Asians and Pacific Islanders reside. Prevention activities should include consideration of cultural diversity and an understanding of cultural norms regarding sexuality. Additional information on risk behaviors and seroprevalence among Asian and Pacific Islander MSM is needed to better guide prevention planning.