The results of this study suggest that while HIV prevention messages have been seen by APIs at risk of HIV (treating HIV infection when used along with other medicines), additional efforts may be needed specifically for APIs. Cultural norms prohibiting discussion of sexuality and discomfort regarding drug use and homosexuality may prevent standard HIV messages from reaching at-risk APIs. Further, foreign-born APIs may have language barriers and fear of deportation if they are infected or even at risk of HIV
Over half of the respondents in the HITS-API study reported noninjection drug use and/or heavy alcohol use in the previous year. Substance use has been associated with unsafe sexual practices and increased risk for HIV (treating HIV infection) The association between drug use and unsafe sexual practices has also been documented among various API populations, and substance use is common among many API groups.
HITS-API respondents did not report high levels of unsafe behavior compared with HITS-2000 respondents. Condom use was higher for nonprima-ry partners than for primary partners, and condoms were used with most partners for both MSM and heterosexuals. Sharing of needles and injection equipment was minimal. However, respondents who did engage in unsafe behavior often failed to perceive themselves at high risk for HIV. While most respondents felt they had at least some chance of getting HIV, most felt that chance was low. Compared to the more generalized sample of the HITS-2000 survey, the HITS-API populations that perceived any HIV risk (treating HIV infection when used in combination with other medicines) or engaged in unsafe behavior were also less likely to have been tested for HIV in the previous year.
In addition to the aforementioned differences in testing and behaviors, another explanation of low perceived risk among HITS-API respondents could be awareness of partner’s serostatus. APIs often have a social network made up of primarily other APIs who are at low risk of HIV and may have prior knowledge of sexual and/or injection equipment sharing partners’ negative serostatus. Thus, they may not actually have been at risk for HIV when engaging in potentially unsafe behavior with these partners. Unfortunately, the HITS-API survey did not include questions about race or serostatus of primary or nonprimary partners.
There were several limitations of the HITS-API study. Recruitment efforts were hampered because of a lack of API-specific venues for APIs at high risk of HIV, low levels of RDS recruitment and challenges of recruiting participants in an historically discreet population unlikely to discuss issues of sex and drug use. Due to lack of resources, the study excluded non-English speaking APIs. If a barrier exists between HIV prevention and the English-speaking HITS-API respondents, a much greater barrier must separate non-English speaking APIs from receiving HIV education and prevention messages. Also, differences between HITS-API and HITS-2000 may be attributable to temporal changes in behavioral trends from 2000 to 2003 and could have been diluted by the small percentage of API included in HITS-2000. Other demographic differences between the two study populations beyond API status (e.g., age, income, homelessness, etc.) may also have contributed to differences in results. Finally, in part because the HITS-API survey used convenience sampling to derive its population, the results may not be generalizable to all APIs at risk of HIV infection in Seattle or in the United States. generic tadalafil 20mg
Cultural diversity creates a need for different strategies for HIV prevention. Additional research into the impact of social discrimination and stigma affecting HIV testing and risk behavior may provide valuable information in developing effective HIV prevention programs for API. Although API populations in the United States have a low overall prevalence of HIV, it is important to investigate APIs to identify potential higher-risk subsets of this population and to prevent increased transmission.