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

Abstract

Objectives 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. Methods 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. Results 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). Conclusions 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.

Prevalence and Correlates of Sexual Partner Concurrency Among Australian Gay Men Aged 18–39 Years

“…We used a direct measure by asking participants to report on whether they had overlapping sexual partners. While a number of other studies used similar measures [25,[41][42][43], some employed what is commonly referred to as a calendar method in which participants provide dates for the beginning and end of each sexual partnership [24,26,28,39,44,45]. Overlapping dates are then treated as concurrency.…”

Measuring the Global Burden of Disease

“…Avahan, the India AIDS Initiative funded by the Bill & Melinda Gates Foundation (19), has found that structural activities can be feasible and cost-effective, and can contribute to more sustainable HIV prevention when integrated into a package of prevention activities. Pathfi nder International, a key partner of Avahan, and its local implementing nongovernmental organization partner in Kolhapur are implementing a structural intervention that provides supported peer-led outreach, crisis response services and community mobilization to street-based sex workers, whose visibility makes them vulnerable to arrest and to violence from police, clients, and gangs (26).…”

“…Such laws contradict the commitment made by governments in the Political Declaration on HIV/AIDS in 2006 "to promote a social and legal environment that is supportive of and safe for voluntary disclosure of HIV status" (25). Countries in North America and Western Europe have long criminalized HIV transmission, and about 20 countries in sub-Saharan Africa have also chosen to do so in the past six years (26).…”

“…In Senegal, four fi ft hs (82%) of the surveyed men who have sex with men said that they also have sex with women (25). In Malawi, one third of men who have sex with men were married or cohabiting with a woman (26), as were two thirds of those surveyed in the Nigerian state of Enugu (27). No data < .1% .1% -<.5% .5% -<1% 1% -<1.5% 1.5% -2.5% Number of people newly infected with HIV…”

Anti-Homosexual Legislation and HIV-Related Stigma in African Nations: What Has Been the Role of PEPFAR?

“…Widely held negative views about gay men and men who have sex with men in Africa, even among health care workers and academics associated with HIV care and research [73], have restricted optimal support and care for African men who have sex with men, or even research on their behalf [74][75][76][77]. Criminalization reinforces those negative views, undermines care and research, and fuels the epidemic.…”