Literature Review

Research exploring Asian/Pacific-Islander men who have sex with men (APIMSM) and their risks relating to HIV emphasizes the importance of taking a more critical and holistic approach to understanding their needs in this regard. In a systematic review looking at factors influencing HIV risk-taking behaviours in APIMSM over a 20 years, it was identified that various factors, including demographic characteristics, personal psychological resources, interpersonal relationships (e.g. family, peers, romantic and sexual), community connection, culture, and structural factors are all associated with HIV risk behaviours(4). This highlights the importance of taking an intersectional approach that looks beyond one’s individual knowledge on HIV and sexual health, but to incorporate analysis of one’s environment, including culture, community, discrimination, immigration, and structural barriers, when undergoing a study that looks at Asian gbMSM needs, experiences, and challenges related to HIV prevention(4) .

Building upon this, international students identifying as gay, bisexual, and/or men who have sex with men (ISgbMSM) may likely face additional layers of challenges as it pertains to their experience of migration, which is characterized by a period of accelerated changes to their lives, including social, economic and intimate well-being(5). Most notably, the sudden loss of support networks results in a need to establish new friendships and kinship that are safe, supportive, and reflective of their needs as gbMSM(5) . However, this loss of support networks, compounded with potential experiences of racial discrimination, language barriers, and financial challenges (e.g. employment) has been identified as factors that exacerbate outcomes of poorer mental health, substance use, and HIV infection(6). As such, the period immediately following migration for this group is has been deemed a formative time that can shape and develop long-lasting social networks, habits, and lifestyles, especially concerning factors such as sexual health practices and substance use(7,8) .

Given the significance of supportive networks, the prioritization of establishing new connections is natural given its direct impact on Asian ISgbMSM health and well-being(5,7,8), and thus the theoretical framework guiding this needs assessment will be rooted in the Network-Individual-Resources Model for HIV prevention. This model examines not only the individual-level knowledge, attitudes, and behaviour as it pertains to HIV prevention and risk, but also places value on the resources within their networks (e.g. friends, peers, sexual and romantic partners, family), and how their resources (e.g. mental and tangible benefits) interact with the individual to impact HIV risk(9). Therefore, this project sought to identify and understand the individual-level characteristics (e.g. knowledge, attitudes, behaviours) pertaining to HIV risk reduction, the networks and their resources accessed by Asian ISgbMSM, and how these characteristics shape HIV risk or resiliency. As highlighted, this model moves beyond individual-level prevention and understanding of HIV risk but incorporates the complex factors associated with ISgbMSM migration, including their interactions with their social environment and also structural challenges that may further impact their health(10) .

Despite the growing number of East and Southeast Asian international students and the HIV incidence rates within the ISgbMSM group, there is still limited to no literature on the HIV prevention needs for this group, specifically within the context of Toronto, Canada. As such, an explorative needs assessment project was conducted that aimed to identify and characterize key attributes including demographic information, length of immigration, risk behaviours and characteristics, approaches to navigating racism, homophobia and HIV stigma, the HIV/STI prevention strategies and health services currently being used by the participants and their networks.