Negotiating safety, access, disclosure and self care: Resiliency pathways of Asian MSM PHAs Christian Hui1, Alan Li1,2,3, Alvi Dandal1,6, Richard Utama1, & Maurice Poon1,5 1Asian Community AIDS Services, , 2Committee for Accessible AIDS Treatment, 3Regent Park Community Health Centre, 5York University, 6University of Toronto
Introduction According to recent epidemiological data, reported HIV cases among people of East and Southeast Asian backgrounds in Toronto have risen significantly, from 2.4% between 1980 and 2000 to 6.3% between 2001and 2005. Over 90% of these cases were men and the primary route of transmission was sexual contact between men (Remis, Swantee & Liu, 2011). However, little is known about the lived experience of HIV+ Asian MSM in Canada. This study, initiated by Asian Community AIDS Services, seeks to fill this gap. Guided by community-based action research principles, this research team is composed of community members (including HIV positive and negative Asian MSM), service providers, policy makers and researchers, overseen by a community advisory committee comprised of the stakeholders from the target community.
Findings The Asian MSM PHAs identified 1) disclosure of HIV status to family, 2) negotiating sex in light of criminalization, and 3) combating racism and HIV stigma as key challenges that affect their physical, mental and sexual health. To counter such challenges, they have identified diverse strategies at the personal, interpersonal and community levels which they consider as facilitators for resiliencies:
Personal/Individual Level: • Acceptance of HIV diagnosis as affirmative experience; • Ability to practice self care and self-efficacy; • Strong sense of self and cultural identity; • Ability to negotiate service access and disclose one’s HIV status; • Identification with anti-oppression and social justice values “I am not attached to the other person’s judgment of me. If they’re not understanding of it, then I have no time for that, because as for me, it’s my truth. And if you’re not comfortable with it, at least I’m exposing you to it, because I am at least gonna make it easier for the next person that you run into.”
Community/Societal Level: • Connection to cultural competent services; • Connection to supportive professional service providers; • Availability of cultural specific PHA only safe spaces; • Access to capacity building programs (treatment literacy, service information, peer counseling, etc.) • Access to social assistance and income support
Method The data presented in this poster were drawn from a larger study that explored factors contributing to Asian MSM’s resilience against HIV infection. Twelve HIV+ Asian MSMs participated in a focus group. The following are the demographics of the participants: Age: 1 participant between the age of 2029; 1 between the age of 30-39; 6 between the age of 40-49; 3 between the age of 50-59; 1 above the age of 59. Ethnicity: 7 East Asians; 2 Southeast Asians; 2 Mixed Race; 1 West Asian Sexual orientation: 8 Gays; 1 Bisexual;1 Queer; 1 Questioning In the focus group we asked participants to discuss (1) specific life events and transitions they found significant to them; and (2) the strategies and mechanisms they have employed to negotiate these events and transitions. The focus group was audio-taped and transcribed. Using a thematic analysis, we identified key challenges faced and the resiliency strategies used by participants.
Inter-personal Level: • Supportive families; • Supportive friends and "chosen family"; • Positive peer support and role models
“All through the years when I had my difficulties with all my losses, apart from all the losses, I knew that there are people out there who really listened to me, and really be there for me. And that is what I have to be thankful for. Especially my healthcare provider, my psychologist, my close friends that are there who are willing to be there to help me through difficult times.”
“…that’s where my importance in friendship comes in, because family are like the people you are stuck with, because you have to be. But at least you get your chosen family if you build it and that’s why I value my friendships more…”
Recommendation Culturally appropriate programs that facilitate knowledge of self-care, mental and emotional health, HIV treatment literacy, systemic racism and peer-based capacity programs should be more readily available for Asian MSM PHAs. Skill development in disclosure, negotiating sexual practices, and increasing knowledge about HIV-related laws will enable Asian MSM PHAs to connect to support and address concerns related to criminalization and safer sex practices. In-depth analysis of the actual pathways undertaken by our participants will help inform resiliency interventions for further study.
Acknowledgement This projected is funded by the Canadian Institute for Health Research.
Reference Remis, R. S., Swantee, C., & Liu, J. (2010). Report on HIV/AIDS in Ontario 2008. Toronto, Canada: University of Toronto.