We found that approximately 10% of this sample of MSM from Vancouver self-identified as having Asian ancestry. While this represented the largest ethnic minority in our sample, this proportion is far below the estimated 40% of the population of Greater Vancouver who have Asian heritage . This raises important questions regarding the underlying structure of the MSM population in Vancouver and how well venue- and event-based time-location sampling can appropriately sample this population. Other studies from large cities in North America have generally found that individuals of Asian ethnicity are underrepresented in studies of MSM [12–14]. However, it is worth noting that approximately 9.1% of the new positive HIV tests reported in men in BC over the 2003 – 2009 period were among men with Asian ethnicity , and this proportion appears to be increasing in recent years .
We found that HIV risk behaviour did not differ substantially between Asian and non-Asian MSM in our sample, except that Asian MSM were less likely to report more than five lifetime sexual partners, which may be partly a result of the younger age of Asian participants in this study. In particular, self-reported HIV negative or unknown sero-status Asian MSM reported unprotected anal intercourse with a known HIV positive or unknown serostatus partner at the same frequency as non-Asian MSM. Despite this, Asian participants in our study were less likely to have ever tested for both HIV and hepatitis C and this association remained for study participants under the age of 35 years, even after adjusting for other important determinants of testing such as having told a health care provider that they have male sex partners.
HIV prevalence, however, was found to be significantly lower among Asian MSM (3.7%) in our study compared to non-Asian MSM (19.0%), and ancillary risk factors for HIV transmission such as use of alcohol prior to sex and ever using injection drugs were reported at a lower frequency among Asian men in this sample. This may imply that the HIV risk environment for Asian MSM is different than for other MSM. It is also worth noting that while Asian MSM reported being less likely to attend gay bars, they were just as likely to look for sex partners in gay bars as non-Asian MSM.
Lower HIV testing rates in our sample may be due to a lack of awareness of local HIV testing services or guidelines [16, 17]. However, we found that testing for gonorrhea or chlamydia was not significantly lower in Asian MSM, suggesting that perceptions around HIV risk may be different from risk for other STIs in this population. Previous studies have indicated that Asian immigrants were less likely to use health care services due to cultural and language barriers [17, 18]. This is similar to studies in the United States where lower HIV testing rates are found amongst Asians and Pacific Islanders as a group [19, 20].
Lower testing rates may also be due to less knowledge and less perceived risk for HIV and other STIs [17, 21]. This suggests that more sexual health promotion services targeting younger Asian MSM should be implemented. In addition, disclosure to health care professionals about male sexual partners was independently and strongly associated with testing for HIV/STI. Therefore, any barriers within the healthcare setting which preclude a patient’s comfort in disclosing same sex sexual partners ought to be addressed to ensure proper care and timely testing. Healthcare providers may require further training in sensitivity and cultural competence to foster improved patient rapport. Cultural barriers such as homophobia in Asian societies  may play a crucial role, making Asian MSM less inclined to disclose information about same-sex sexual partners.
Our study revealed that nearly 40% of Asian MSM spoke a language other than English as their first language. This highlights the need to provide health care and prevention programs in languages other than English, especially in large metropolitan areas.
Readers should be cautious when interpreting our findings. The data presented here can be considered representative of the population of Asian MSM who attended the community venues sampled in the survey, and may not represent all Asian MSM in Vancouver. The venues we sampled may not have been ones that are most commonly frequented by Asian MSM. Furthermore, only those who were comfortable disclosing personal information and providing blood samples would have participated in this research study, thereby potentially excluding participants who may be even less likely to get tested. Because this survey was only administered in English, it may have limited participation of those who do not feel comfortable reading in English. As well, the relatively small proportion of individuals who self-identified as having Asian heritage may have limited our ability to demonstrate associations with some of the outcomes we observed. Finally, self-reported behavioural data may be subject to social desirability bias.