East and Southeast Asian women are being erased from the SRHR conversation

SexPlus Week in Canada marked a time to spotlight the urgent gaps in sexual health care, education and access that continue to shape the lives of many communities. It also marked a time to reflect on how the sexual and reproductive health of East and Southeast Asian women is rarely centered in research, policy or public health conversations. Often lumped into broad racial categories like Asian or Asian/Pacific Islander, their unique experiences, barriers, and risks are erased and often overlooked.

These women, whether immigrants, second-generation Canadians or long-standing members of their communities, navigate complex intersections of culture, stigma and health care access. From China and Japan to Indonesia and the Philippines, their diverse identities shape how they engage with sexual health resources. But systemic neglect, cultural taboos and policy failures continue to place their well-being at risk. Following SexPlus  Week, let’s break the silence. Why are East and Southeast Asian women so often left out of conversations about sexual and reproductive health? Why does the research fail to capture their realities? How can we move beyond stereotypes, address the research gaps and create real change?

Limited research and identified risk factors

Despite the importance of sexual health, research focusing exclusively on the prevention of sexually transmitted infections (STIs) and HIV among East and Southeast Asian women remains limited. However, existing studies indicate that while these women may be less likely to be sexually active than the general population, those who are sexually active engage in behaviors that could increase their susceptibility to STIs and HIV.

Substance use — including alcohol consumption, illicit drug use, binge drinking, and substance use prior to sexual activity — has been identified as a significant factor contributing to risky sexual behaviors. Acculturation also plays a pivotal role in shaping STI/HIV risk behaviors and engagement with sexual health resources. Higher levels of acculturation have been associated with an increased likelihood of engaging in risky sexual behaviors, while also fostering greater self-efficacy in risk reduction and sexual health engagement.

Comparative studies suggest that East and Southeast Asian women tend to have lower levels of HIV knowledge and lower rates of sexual health care utilization than other populations. Cultural norms, language barriers, financial constraints, and strong parental influences contribute to lower engagement with healthcare services.

Effective prevention strategies

Given the cultural and linguistic diversity within this population, STI/HIV prevention programs must be tailored to be culturally and linguistically appropriate. Effective interventions should integrate gender, youth culture and ethnocultural practices. Partnerships with cultural institutions such as religious organizations and educational institutions have proven beneficial in promoting HIV awareness. Additionally, engaging parents and healthcare providers can improve knowledge dissemination and preventative behaviors.

Research on STI/HIV prevention efforts among East and Southeast Asian women engaged in sex work highlights the necessity of addressing socioeconomic challenges, immigration status, exposure to violence, substance use and cultural and linguistic barriers. Interventions must consider the broader context of their work and involve relevant stakeholders, including clients and massage parlor owners, to promote safer practices. A significant research gap exists in understanding the sexual health and STI/HIV prevention needs of transgender East and Southeast Asian women.

The importance of understanding the issue

Developing evidence-based programs to support the sexual health of East and Southeast Asian women in Canada requires a nuanced understanding of the factors influencing their health care access and STI/HIV prevention behaviors. This population is ethnically diverse, comprising newly immigrated individuals as well as people born in Canada. Understanding the intersection of cultural identity, social determinants and gender norms within East and Southeast Asian communities is essential for developing effective interventions.

The complexity of the HIV epidemic across East and Southeast Asia underscores the necessity for targeted responses. While most countries in the region report adult prevalence rates below 1%, variations in cultural attitudes, access to health care and governmental responses significantly impact prevention and treatment efforts. For East and Southeast Asian women in Canada, additional challenges include immigration-related barriers, socioeconomic status and the intersection of gender, race, and ethnicity in health care experiences.

Recent studies indicate an increasing prevalence of HIV among East and Southeast Asian populations in Western nations. Despite expanding literature on HIV prevention, research specifically addressing the sexual health needs of East and Southeast Asian women remains insufficient.

Overview of research findings

A comprehensive review of existing literature highlights multiple factors influencing sexual health, HIV risk and prevention behaviors among East and Southeast Asian women. However, few studies have focused exclusively on this population. Two studies specifically sampled East and Southeast Asian women: a quantitative study in the United States that examined perceived HIV susceptibility and a qualitative study in Australia exploring sexual health care access among Vietnamese Australian women. Research conducted by Nemoto et al. examined the sexual health and HIV prevention needs of East and Southeast Asian women working in massage parlors in San Francisco, providing crucial insights into this subgroup. Despite these contributions, further dedicated research is necessary.

Comparative studies explored sexual health, HIV risk and prevention behaviors among East and Southeast Asian populations based on gender and ethnicity. A Canadian study analyzed reproductive health behaviors among Indian, Indo-Canadian, Euro-Canadian, and Canadian East Asian women, with the latter comprising 40% of the sample. Several studies focused on sexual risk behaviors and HIV prevention among Asian youth and immigrant students, with only one study specifically examining transgender women. Additionally, research explored the role of Asian religious institutions, including Chinese religious organizations, in HIV prevention efforts.

Challenging the “model minority” stereotype

A recurring theme is the “model minority” stereotype, which assumes that East and Southeast Asian populations engage in fewer high-risk sexual behaviors and have lower STI/HIV rates. Some studies reinforce this stereotype, reporting lower rates of sexual activity and HIV risk behaviors compared to other ethnic groups. For example, So et al. found that Asian-American young adults had the lowest prevalence of sexual activity and unprotected sex in the past 30 days compared to other demographics. Similarly, Song et al. reported that Asian-born students in Australia were less likely to have had sex and had fewer sexual partners despite being older than their Australian-born peers.

However, other studies contradict this notion, highlighting STI/HIV risk behaviors among sexually active East and Southeast Asian women. Lee et al. found that although Asian/Pacific Islander youth reported lower rates of lifetime sexual activity, those who were sexually active were more likely to engage in unprotected sex. Additionally, substance use rates among this demographic are increasing, with lifetime drinking rates at 91.5%  and marijuana use at 68%  — the second highest among studied ethnic groups. The heterogeneity of Asian populations must be acknowledged when addressing sexual health, as STI rates and risk behaviors vary significantly across ethnic subgroups.

Understanding the unique sexual health challenges faced by East and Southeast Asian women in Canada and the United States is essential for developing effective STI and HIV prevention programs. Research highlights the influence of acculturation, substance use and cultural barriers on sexual health outcomes. Implementing culturally competent interventions that address these factors can enhance HIV knowledge, health care utilization and risk reduction behaviors among this diverse population.

Leisha Toory is the founder of the Human Rights Award-nominated Period Priority Project, a consultant with the United Nations Institute for Social Development and United Nations Institute for Training and Research, an Amnesty Canada Gender Rights Specialized Team member, and holds a BA in Political Science from Memorial University.