HIV testing among Asian Americans: How do cultural and socio-psychological factors influence uptake? Restricted; Files Only
Luu, Minh (Summer 2023)
Published
Abstract
Abstract
HIV testing among Asian Americans:
How do cultural and socio-psychological factors influence uptake?
By Minh Luu
HIV testing is the single entry-point to effective HIV diagnosis, prevention, and care continuum cascade. Asian Americans, while engaging in comparable levels of HIV risk behaviors compared to other ethnic groups, seem to have less likely chance of getting HIV tested. Existing literature has pointed to a host of underlying cultural and socio-psychological factors associated with HIV testing behaviors, including the intention of testing. However, no prior research has been conducted to better understand the interrelationships of these factors among Asian American men, the group of heightened risk for HIV infection. This dissertation research program aims to fill this gap in the literature by leveraging a mixed methods approach primarily guided by the theory of planned behavior (TPB) to examine factors related to HIV testing intention among a group of Asian American men.
The research program included three research studies. In the first study, I examined psychometrics of the homonegativity scale – a salient construct that was hypothesized to associate with HIV testing intention among Asian Americans. I used data from a cross sectional survey study among a group of general Asian Americans for this study. As this scale had not been validated in this population group, the finding was important to guide my Study 2 that included homonegativity as a main factor hypothetically associated with HIV testing intention. In the second study, I investigated the collective influence of the TPB constructs and other cultural and socio-psychological factors, including homonegativity, on HIV testing intention using path analysis techniques. For this study, I analyzed a nationally collected dataset via the internet from a group of Asian American men. In the last study, I analyzed qualitative focus group discussion data collected from a group of Asian American men who have sex with men (MSM) to further support important findings from Study 2, especially to gain deeper insights of the relationship between those factors and HIV testing intention among Asian American MSM – our population of interest for future research.
In Study 1, we found that the homonegativity scale was reliable and valid among the study samples. Results showed the scale had a four-factor structure. Acculturation, gender role beliefs, and length in immigration were significantly associated with homonegativity. Findings from Study 2 suggested that social norms, attitude about HIV testing, and perceived HIV risk had both direct and indirect effects on HIV testing intention, with homonegativity as the mediating factor. Among them, social norms had the strongest total effects on HIV testing intention. Study 3’s results proved that homonegativity posed a barrier to HIV testing practices among Asian American MSM, while suggesting that there were bold differences in social norms about HIV testing between the general Asian American community and Asian American MSM groups.
The findings advanced our knowledge in HIV research among the Asian American population. My studies validated the psychometrics of the homonegativity scale as well as enriched existing literature with novel findings related to the factors associated with HIV testing intention among a group of Asian American men - an understudied population in the U.S.
Table of Contents
TABLE OF CONTENTS
Summary and Specific Aims. 12
CHAPTER 1: Introduction. 14
Introduction and Literature Review.. 14
Global HIV and public health. 19
HIV in the U.S. and HIV research among Asian Americans. 22
Factors associated with HIV among Asian Americans. 25
Limitations in the existing literature. 37
Theoretical Framework and Conceptual Model 38
Conceptual Model 38
Significance of the study. 42
Chapter 1 References. 44
CHAPTER 2: 64
Psychometric Properties of the Modern Homonegativity Scale among a sample of Asian Americans. 64
Abstract 64
Introduction. 65
Methods. 70
Study Measures. 71
Statistical Analysis. 73
Results. 75
Sample Characteristics. 75
Psychometric Evaluation of the MHS. 76
Discussion. 79
Conclusion. 81
Tables. 83
Table 1. Characteristics of the study participants*. 83
Table 2. Polychoric Correlation Coefficients Matrix of the Homonegativity scale (n = 198) 84
Table 3. Polychoric correlations between the MHS-G and selected measures (n = 193) 85
Table 4. Results of the Exploratory Factor Analysis: Factor loadings and model fit indices (n=198) 86
Table 5. Multivariable linear regression analysis of factors associated with Homonegativity (n = 193) 87
Appendix 2.A: Descriptions of the Modern Homonegativity Scale for Gay Men (MHS-G) 88
Appendix 2.B: Polychoric Correlation Coefficients Matrix of the MHS-G Sub-Scales. 90
Chapter 2 References. 91
CHAPTER 3: 98
Factors associated with intention of HIV testing among Asian American Men: A Path Analysis. 98
Abstract 98
Background. 99
Conceptual Model 106
Methods. 106
Data Collection. 106
Measures. 107
Analysis. 111
Results. 112
Study sample and examination of the variables. 112
Final path model 113
Discussion. 115
Conclusion. 121
Tables and Figures. 122
Table 1. Characteristics of the study samples (N=425) 122
Table 3. Models regressing on two endogenous variables: Homonegativity and HIV Testing Intention (n=425) 125
Figure 1. Conceptual Model Guiding the Path Framework. 126
Figure 2. Initial Hypothesized Path Model 127
Figure 3. Final Path Model Standardized Results. 127
Table 5. Final Path Model Standardized Results (N=425) 129
Appendix 3: Description of endogenous and exogenous variables. 131
Chapter 3 References. 132
CHAPTER 4: 170
Homonegativity as a barrier to HIV testing intention among Asian American MSM: A qualitative study. 170
Abstract 170
Introduction. 171
Methods. 175
Participants and Data Collection. 175
Data Analysis. 177
Results. 178
Sample characteristics. 178
Research findings. 179
Discussion. 187
Limitations. 192
New Contribution to the Literature. 193
Tables. 195
Table 1. Themes Matrix. 195
Chapter 4 References. 201
CHAPTER 5: Discussion. 211
Summary of Findings. 212
Implications for Public Health Research and Practice. 214
Implications on measurement in behavioral health research. 215
Implications on the research and practice of HIV testing among Asian American men and Asian American MSM... 216
Strengths and Limitations. 221
Conclusion. 223
Chapter 5 References. 224
About this Dissertation
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