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RESEARCH ARTICLE (Open Access)
Contents Vol 20(6)

The impact of social connections and discrimination to HIV risk among Asian gay and bisexual men in Australia

Curtis Chan https://orcid.org/0000-0002-9581-1011 A * , Limin Mao https://orcid.org/0000-0003-0995-5789 B , Benjamin R. Bavinton https://orcid.org/0000-0001-5834-8278 A , Martin Holt https://orcid.org/0000-0002-2586-8274 B , Sujith Kumar Prankumar https://orcid.org/0000-0003-2215-1275 A B , Kevin Dong C , Timothy Wark D , Timothy Chen D , Hendri Yulius Wijaya https://orcid.org/0000-0002-6275-4479 E and Horas T. H. Wong https://orcid.org/0000-0001-8473-1086 B F
+ Author Affiliations
- Author Affiliations

A The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia.

B Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, Australia.

C Western Sydney Sexual Health Centre, Sydney, NSW, Australia.

D ACON, Sydney, NSW, Australia.

E Independent Researcher, Jakarta, Indonesia.

F Sydney Nursing School, University of Sydney, Sydney, NSW, Australia.

* Correspondence to: cchan@kirby.unsw.edu.au

Handling Editor: Jami Leichliter

Sexual Health - https://doi.org/10.1071/SH23036
Submitted: 17 February 2023  Accepted: 6 September 2023   Published online: 25 September 2023

© 2023 The Author(s) (or their employer(s)). Published by CSIRO Publishing. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)

Abstract

Background

Asian gay, bisexual, and other men who have sex with men (GBMSM) are overrepresented in new HIV diagnoses in Australia. Social engagement with other GBMSM has been associated with HIV testing and pre-exposure prophylaxis (PrEP) uptake. Asian GBMSM may be socially disconnected from LGBTQ+ people, which may increase their HIV risk. This analysis assessed the contribution of social connection on HIV risk among Asian GBMSM.

Methods

Using an online cross-sectional survey of Asian GBMSM in Australia, we measured condomless anal intercourse (CLAI) in the last 6 months without PrEP or an undetectable viral load (UVL), i.e. CLAI with a risk of HIV transmission. Bivariable and multivariable logistic regression models were performed to compare demographic characteristics and social engagement of participants who had CLAI without PrEP or UVL to those who had not. Analyses were restricted to participants who reported sex with casual partners in the last 6 months.

Results

Among 509 participants who had casual partners in the last 6 months, 151 (29.7%) reported CLAI without PrEP or UVL. CLAI without PrEP or UVL was negatively associated with full-time employment, and recently being tested for HIV and was positively associated with experiencing discrimination based on sexual orientation. Social engagement with LGBTQ+ people was not associated with CLAI without PrEP or UVL.

Conclusions

CLAI without PrEP or UVL was not related to social connections with LGBTQ+ people but was more likely among Asian men who had experienced sexuality-related discrimination, suggesting that mitigating homophobia and biphobia may assist in improving HIV prevention among Asian GBMSM who live in Australia.

Keywords: discrimination, gay men, HIV/AIDS, HIV prevention, homophobia, men who have sex with men, migrant and mobile populations, pre-exposure prophylaxis, social support.

Data availability

The data that support this study cannot be publicly shared due to ethical or privacy reasons and may be shared upon reasonable request to the corresponding author if appropriate.

Conflicts of interest

BRB has received unrestricted research grants from ViiV Healthcare and Gilead Sciences, Honoraria from Gilead Sciences, Honoraria and travel from ViiV Healthcare. All other authors declare no conflicts of interest.

Declaration of funding

This study received funding from the NSW Health BBV & STI Research, Intervention and Strategic Evaluation (BRISE) program and surveillance funding from the Australian Government Department of Health.

Acknowledgements

We thank all participants in the study and their valuable contribution to improve our local responses to HIV/STIs in Australia. We also thank the advisory committee including Justin Xiao, Karan Negi, and Mahee Maque (for the NSW project phase). This project has been continuously supported by the Sydney CALD Gay Men’s Action Group.

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