HIV Risk, Substance Use, and Suicidal Behaviors Among Asian American Sexual-Minority Women

Background & Purpose: Asian American sexual-minority adolescents often face rejection in their family and cultural community because non-heterosexuality is seen as a threat to the family system and a rejection of typical male and female familial roles (Chung & Katayama, 1998). This can create identity confusion and social isolation that contributes to a hostile and stressful social environment for Asian American sexual-minority females. Therefore, the sense of normlessness and social stigma can lead to mental health complications, substance use, and suicidality (Durkheim, 1951; Hahm et al., 2008; Meyer, 2003) among them . This study examined the role of being a sexual minority on 3 risky health behaviors: HIV risk, substance use, and suicidal behaviors among unmarried Asian American women. Thus, our hypothesis was that, after controlling for ethnicity, age, level of education, birthplace, and acculturative stress, being a sexual minority would be independently associated with increased odds of HIV risk, substance use, and suicidal behaviors among young Asian American women. The analysis that follows describes the general characteristics, HIV risk, substance use, and suicidal behaviors in a sample of young Asian American women and compares differences in the proportions of these risks between heterosexual and sexual-minority Asian American women.

Methods: This study was part of a larger cross-sectional study (Asian Women’s Health Initiative Project, AWSHIP) designed to examine the prevalence of HIV risk behaviors and mental-health functioning among Chinese, Korean, and Vietnamese women who are children of immigrants, ages 18 to 35 using computer-assisted survey interviews (CASI). Sexual minority status was assessed by asking participants, “How do you describe your sexual orientation?” The sexual orientation in our study was established on a question with nonexclusively heterosexual as the definition of sexual minority. Of the 704 Asian American women who completed the survey, χ² tests were used to compare the prevalence of the behavioral outcomes of interest among women by sexual-minority status. Additionally, we fit a series of multiple logistic regression models to estimate the relative contribution of sexual-minority status on the health risk behaviors including HIV risk (multiple sex partners, anal sex, sex while drinking or taking drugs & risky sexual partners), substance use (illegal drug use, marijuana use & binge drinking), and suicidal behaviors (suicidal ideation & attempts).

Results: Approximately one out of five Asian American women identified themselves as a sexual minority (18%). Overall, Asian American sexual minority women reported higher proportions of health risk behaviors, compared to exclusively heterosexual counterparts. After controlling for ethnicity, age, level of education, birthplace, and acculturative stress, being a sexual minority woman was associated with 2 to 3 time greater odds of being engaged in HIV risk behaviors; 1.5 to 3 times greater odds of using various substances, and 2 times greater odds of ever having suicide ideation.

Conclusions: Asian American sexual minority women have alarming risks of HIV, substance use, and mental health problems. These findings suggest that rigorous screening is necessary to identify this group and underscore the need for better assessment, and for better provision of services.