Racism-related stress, health outcomes, substance use, and PrEP attitudes among Asian sexual minority men

Racial discrimination has been linked to decreased psychological well-being and physical health. Most Asian Americans in the United States reported discrimination against Asians as a major problem and that inadequate attention is given to racial inequities affecting Asians living in the US. We described the association of racism-related stress and health outcomes among Asian American sexual minority men. We hypothesized that greater racism-related stress is associated with poor general and oral health, increased substance use, and unfavorable attitudes about PrEP. We conducted a secondary analysis of data collected in 2017-2019 through the HIV Oral Self-Testing Infographic Experiment study, a pilot behavioral randomized controlled trial testing effects of an HIV self-testing infographic in 322 emerging adult ethnic and racial sexual minority men. We examined secondary data on racism-related stress and health outcomes in 62 participants using questions derived from the Behavioral Risk Factor Surveillance System, National Survey on Drug Use and Health, PrEP Familiarity and Attitudes Questionnaire, and the Asian American Racism-related Stress Inventory (AARRSI). To describe association between AARRSI scores and health outcomes, we calculated mean total AARRSI scores across categorical variables and assessed differences between groups using one-way ANOVA, and we assessed correlation between continuous variables with scores using Spearman correlation. Findings suggested that greater racism-related stress is linked to increased substance use. More research is needed to confirm these observed trends with larger, more diverse samples, explore intersectional factors such as sexual minority identity and societal discrimination against Asians, and how the current political climate has contributed to negative experiences that amplify health risks.