HIV prevention among Asian and Pacific Islander American men who have sex with men: a critical review of theoretical models and directions for future research.

Nationally, the incidence of AIDS is increasing at a higher rate among Asian and Pacific Islander American men who have sex with men (API MSM) than among white MSM. Furthermore, current HIV prevention efforts are inadequate to slow the rapidly rising HIV epidemic in the gay API community, and little attention has been paid to the applicability of existing behavior change models to APIMSM. This paper reviews the five major models of health behavior change used in HIV prevention for the MSM population: the health belief model, theory of reasoned action, social learning theory, diffusion theory, and the AIDS risk reduction model. Although some of these models have been useful in designing risk reduction programs for API MSM, recent empirical data suggest that the models do not adequately address environmental influences affecting API MSM and limit our choices in prevention strategies to the level of the individual. We propose an ecological model for health promotion as a potentially useful theoretical framework, and suggest prevention strategies directed at the individual, the family, the general API community, and the mainstream gay community to reduce HIV risk among API MSM.