Bisexual concurrency, bisexual partnerships, and HIV among Southern African men who have sex with men (MSM)

Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins School of Public Health, E7146, 615 N Wolfe Street, Baltimore, MD 21205, USA.
Sexually transmitted infections (Impact Factor: 3.4). 08/2010; 86(4):323-7. DOI: 10.1136/sti.2009.040162
Source: PubMed


The sexual behaviour of men who have sex with men (MSM) in southern Africa has been little studied. We present here the first data on bisexual partnerships and bisexual concurrency among MSM in Malawi, Namibia and Botswana.
A cross-sectional probe of a convenience sample of 537 men who have ever reported anal sex with another man using a structured survey instrument and rapid-kit HIV screening.
34.1% of MSM were married or had a stable female partner, and 53.7% reported both male and female sexual partners in the past 6 months. Bisexual concurrency was common, with 16.6% of MSM having concurrent relationships with both a man and a woman. In bivariate analyses, any bisexual partnerships were associated with lower education (OR 1.6, 95% CI 1.1 to 2.3), higher condom use (OR 6.6, 95% CI 3.2 to 13.9), less likelihood of having ever tested for HIV (OR 1.6, 95% CI 1.1 to 2.3), less likelihood of having disclosed sexual orientation to family (OR 0.47, 95% CI 0.32 to 0.67) and being more likely to have received money for casual sex (OR 1.9, 95% CI 1.3 to 2.7). Bisexual concurrency was associated with a higher self-reported condom use (OR 1.7, 95% CI 1.0 to 3.1), being employed (OR 1.8, 95% CI 1.2 to 2.9), lower likelihood of disclosure of sexual orientation to family (OR 0.37, 95% CI 0.22 to 0.65) and having paid for sex with men (OR 2.0, 95% CI 1.2 to 3.2).
The majority of MSM in this study report some bisexual partnerships in the previous 6 months. Concurrency with sexual partners of both genders is common. Encouragingly, men reporting any concurrent bisexual activity were more likely to report condom use with sexual partners, and these men were not more likely to have HIV infection than men reporting only male partners. HIV-prevention programmes focussing on decreasing concurrent sexual partners in the African context should also target bisexual concurrency among MSM. Decriminalisation of same-sex practices will potentiate evidence-based HIV-prevention programmes targeting MSM.

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    • "Their partner search is done completely online and serves to function alongside their primary heterosexual unions. Given the existing literature on men who seek male partners for sex online (Grov et al. 2013a; Moskowitz and Seal 2010; Robinson and Moskowitz 2013) and the literature looking at men who participate in concurrent relationships with men and women (Barnshaw and Letukas 2010; Beyrer et al. 2010; Icard 2008; Maulsby et al. 2012; Steward et al. 2013; Tieu et al. 2014), this is a significant gap in the research. The study sought to understand their experiences as well as their meaning making in the course of maintaining a public heterosexual persona while balancing their secret desire for sex with women. "
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    Full-text · Article · Jan 2015
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    • "In our study, MSM who reported no sex with women in the past six months were more likely to be HIV infected than those who had. This is similar to the finding reported in a study of southern African MSM engaging in heterosexual intercourse in the previous six months [22]. The men who report having sex with both men and women in Guangxi may play a role as a bridge of transmitting HIV to their female sex partners, but the risk is lower than among men who are exclusively having sex with men. "
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    ABSTRACT: Background Men who have sex with men (MSM) represent the fastest growing key population for incident HIV cases in China. We examined five consecutive years of HIV and syphilis prevalence and risk factors data among MSM in Guangxi Province with the second highest estimated number of people living with HIV/AIDS (PLWHAs) in China in 2011. Methods We collected demographic and behavioral data from national sentinel surveillance and HIV/syphilis blood samples in five annual cross-sectional surveys from 2008 to 2012. We analyzed HIV and syphilis prevalence trends stratified by social/behavioral characteristics. Results HIV prevalence climbed steadily from 1.7% (95% confidence interval [CI]: 1.0 to 3.0) in 2008 to 3.7% (95% CI: 3.0 to 5.0) in 2012. Syphilis prevalence increased steadily from 5.1% (95% CI: 4.0 to 6.0) in 2008 to 8.4% (95% CI: 7.0 to 10.0) in 2012. HIV prevalence rose notably among MSM who were ≤25 years of age, never married, did not engage in sexual intercourse with women in the past six months, and had not been tested for HIV in the past year. Syphilis prevalence rose notably among MSM who were >25 years of age, ever married or living with a partner, and engaged in sexual intercourse with women in the past six months. HIV prevalence was much higher in MSM with current syphilis than without. Finally, current syphilis was the most significant predictor of HIV infection, and age was the most significant predictor of syphilis infection. Conclusions HIV and the syphilis prevalence expansion among MSM suggest an urgent public health prevention challenge for Guangxi provincial health officials. Risk factors for each infection differed such that all MSM, each of whom might be at risk of HIV, syphilis or both, should be targets for heavy intervention.
    Full-text · Article · Jul 2014 · BMC Infectious Diseases
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    • "A research report on MSM risk in Mombasa, Nairobi and Dakar, described inconsistent condom use and multiple concurrent partners as normative behaviors [12]. One study found that men who are bisexual are more likely to use condoms than those who identify as homosexual [13]. Higher risk behavior has also been associated with depression and lower self-efficacy scores among MSM in South Africa[14]. "
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    ABSTRACT: In Uganda, men who have sex with men (MSM) are at high risk for HIV. Between May 2008 and February 2009 in Kampala, Uganda, we used respondent driven sampling (RDS) to recruit 295 MSM≥18 years who reported having had sex with another man in the preceding three months. The parent study conducted HIV and STI testing and collected demographic and HIV-related behavioral data through audio computer-assisted self-administered interviews. We conducted a nested qualitative sub-study with 16 men purposively sampled from among the survey participants based on responses to behavioral variables indicating higher risk for HIV infection. Sub-study participants were interviewed face-to-face. Domains of inquiry included sexual orientation, gender identity, condom use, stigma, discrimination, violence and health seeking behavior. Emergent themes included a description of sexual orientation/gender identity categories. All groups of men described conflicting feelings related to their sexual orientation and contextual issues that do not accept same-sex identities or behaviors and non-normative gender presentation. The emerging domains for facilitating condom use included: lack of trust in partner and fear of HIV infection. We discuss themes in the context of social and policy issues surrounding homosexuality and HIV prevention in Uganda that directly affect men's lives, risk and health-promoting behaviors.
    Full-text · Article · Dec 2013 · PLoS ONE
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