Factors Influencing Access to Sexual Health Care Among Behaviorally Bisexual Men in Vientiane, Laos

Bowring, Anna L; Pasomsouk, Nakhornphet; Higgs, Peter; Sychareun, Vanphanom; Hellard, Margaret; Power, Robert

doi:10.1177/1010539515612909

Cited by 6 publications

(4 citation statements)

References 37 publications

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“…Additionally, apone clients – men who are sexually oriented towards other men but typically do not openly identify as gay – had seven‐times higher risk of HIV positivity at baseline than thange . Across Asia, non‐disclosure of sexual identity has been associated with higher levels of condomless sex and a lower uptake of testing for HIV and STIs , which may explain some of the increased vulnerability to HIV observed among apone clients in this study. Awareness of sexual orientation is an important precursor to provider‐initiated HIV testing , and non‐disclosure of sexual behaviours may hinder the provision of relevant and tailored sexual health information, including assessments of eligibility for biomedical HIV prevention options.…”

Section: Discussionmentioning

confidence: 77%

HIV incidence and factors associated with testing positive for HIV among men who have sex with men and transgender women in Myanmar: data from community‐based HIV testing services

Veronese

Traeger

Oo³

et al. 2020

J Intern AIDS Soc

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Introduction In Myanmar, men who have sex with men (MSM) and transgender women (TW) are disproportionately affected by HIV, despite national HIV program scale‐up. However, limited HIV surveillance capacity prevents monitoring of epidemic trends and program impact. This study aimed to estimate HIV prevalence and incidence and explore associated sexual risk behaviours among MSM and TW clients attending HIV testing clinics in Myanmar. Methods An electronic data management system was implemented in two community‐based, MSM and TW ‐tailored HIV testing clinics in Myanmar in August 2016. Unique client identifiers enabled prospective monitoring of service engagement, testing frequency and outcomes. We estimated HIV incidence and rate of HIV diagnosis at baseline testing visit among clients over a 15 month period. Correlates of HIV diagnoses were identified using multivariable logistic regression. Results 2794 MSM and TW were tested for HIV. At their baseline test, 38% of clients reported any previous testing and 93% reported being sexually active over the previous three months, with 74% reporting sex with casual male partners and 28% reporting consistent condom use with casual partners. 291 clients tested positive for HIV for the first time at baseline (10.4%; 95% CI: 9.3 to 11.6). Twelve incident cases were detected among 279 clients receiving ≥2 tests (incidence = 10.1 per 100 person‐years; 95% CI: 5.73 to 17.8). HIV diagnosis at baseline was significantly associated with being a transgender woman or a non‐openly disclosing man who has sex with men, age 26 to 39 years, and reporting no testing history. Conclusions High HIV incidence and new diagnoses being associated with reporting no testing history points to undiagnosed HIV driving transmissions in Myanmar. Repeat testing was uncommon. HIV programs in Myanmar must focus on promoting frequent HIV testing alongside adequate coverage of education and primary prevention interventions among MSM and TW.

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Section: Discussionmentioning

confidence: 77%

HIV incidence and factors associated with testing positive for HIV among men who have sex with men and transgender women in Myanmar: data from community‐based HIV testing services

Veronese

Traeger

Oo³

et al. 2020

J Intern AIDS Soc

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“…Indeed, the differing experiences and perspectives among the various sexual and gender identities, even within the same identity group, documented in this study highlights the importance of service provision that can appropriately cater for different groups and their heterogenous needs. In Laos, for example, behaviorally bisexual men demonstrated reluctance to attend MSM- specific services [23], underscoring the importance of identifying as the intended recipient of HIV services. In this study, attendance at MSM-specific services was believed to present a high risk of association with the MSM community.…”

Section: Discussionmentioning

confidence: 99%

“…Myanmar’s National Strategic Plan for HIV and AIDS 2016–2020 includes a target of reaching 90% of MSM and TW with combination HIV prevention services and prioritizes the engagement of non-disclosing, or ‘hidden’ MSM [4]. A growing body of evidence from the region highlights the ways in which non-disclosure of sexual identity affects HIV service utilization [11, 23, 24], yet much remains unknown about the barriers faced by hidden MSM in Myanmar in accessing HIV services, hindering the development of culturally-relevant and responsive HIV prevention approaches. This formative research was undertaken to better understand the challenges and experiences of MSM and TW in accessing HIV testing, prevention and care and was conducted as part of a broader implementation science study to improve MSM and TW’s access and retention in the HIV Care Cascade in Myanmar [25, 26].…”

Section: Introductionmentioning

confidence: 99%

“We are not gays… don’t tell me those things”: engaging ‘hidden’ men who have sex with men and transgender women in HIV prevention in Myanmar

Veronese

Clouse²,

Wirtz³

et al. 2019

BMC Public Health

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BackgroundIn Myanmar, HIV is concentrated among key populations, yet less than half of the estimated 250,000 men who have sex with men (MSM) and transgender women (TW) report recent HIV testing. As many as 50% of MSM and TW may conceal their same-sex preferences and behaviors, yet little is known about the barriers faced by those who are locally regarded as ‘hidden’ – that is, MSM who do not disclose same-sex preferences and/or identify as gay. This study explored specific barriers to accessing HIV testing and other prevention services among ‘hidden’ MSM to inform appropriate models of service delivery.MethodsIn-depth interviews with MSM (n = 12) and TW (n = 13) and focus group discussions (FGD) with MSM and TW community members, leaders and key informants (n = 35) were undertaken in Yangon during June – September 2015. Participants were recruited by word-of-mouth by trained peer data collectors. Responses to questions from semi-structured guides were transcribed and coded using Atlas Ti. Codes were based on key domains in the guides and applied to transcripts to identify and analyze emerging themes.ResultsFear of stigma and discrimination and the need to meet gender expectations were key reasons for non-disclosure of same-sex preferences and behaviors; this typically manifested as avoidance of other MSM and settings in which sexual identity might be implicated. These concerns influenced preference and interaction with HIV services, with many avoiding MSM-specific services or eschewing HIV testing services entirely. The difficulties of engaging hidden MSM in HIV prevention was strongly corroborated by service providers.ConclusionHidden MSM face multiple barriers to HIV testing and prevention. Strategies cognizant of concerns for anonymity and privacy, such as One-Stop Shop services and online-based health promotion, can discretely provide services appropriate for hidden MSM. Enhanced capacity of peer-service providers and mainstream health staff to identify and respond to the psychosocial challenges reported by hidden MSM in this study may further encourage service engagement. Overarching strategies to strengthen the enabling environment, such as legal reform and LGBTI community mobilisation, can lessen stigma and discrimination and increase hidden MSM’s comfort and willingness to discuss same-sex behavior and access appropriate services.

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“…There were 14 studies about MSM-SW which contained data on women as clients, presumably in their home countries (Bowring et al, 2017;Bowring, Pasomsouk, et al, 2015;Bowring, van Gemert, et al 2015;Cai et al, 2010;Estcourt et al, 2000;Ford, Wirawan, Fajans, & Thorpe, 1995; Gil-Llario, Ballester-Arnal, Salmeron-Sanchez, Morell-Mengual, & Gimenez-Garcia, 2015; Katsulis & Durfee, 2012;Liu et al, 2012aLiu et al, , 2012bMannava, Geibel, King'ola, Temmerman, & Luchters, 2013;Pisani et al, 2004;Pleak & Meyer-Bahlburg, 1990;Sethi et al, 2006;Ziersch, Gaffney, & Tomlinson, 2000). All of the studies on MSM-SW had a public health perspective, most were cross-sectional (k = 11), and they covered ten different countries (Tables 1 and 2).…”

Section: Studies About Msm Who Sold Sex To Men and Sometimes To Womenmentioning

confidence: 99%

Women Who Trade Sexual Services from Men: A Systematic Mapping Review

Berg

Molin

Nanavati

2019

The Journal of Sex Research

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Self-portrait of a young man for rent', by Sterry (2002), is a memoir of the author's experiences working as a teenage gigolo with a primarily female clientele in the early 1970s. Sterry recounts the circumstances leading up to his situation, characterized by desperation, need for love, and sexual assault. According to a recent comparative study (McCarthy, Benoit, & Jansson, 2014), both immediate circumstances like limited education, and negative experiences from early life, especially childhood poverty, abuse and family instability, are independently associated with adult sex work. According to reviews, paid male sexual services are largely invisible in the global sex trade, but in growing demand. Dennis (2008) concluded that in Western countries, more adolescent boys than adolescent girls participate in sex exchange for money, and men comprise about 20-30% of the individuals arrested as vendors of sexual services each year. Recently, a content analysis of 499 male escort websites across 60 countries found that while most escorts advertise to other men, 11% of the sites were specifically for female clients and 10% for heterosexual couples (Kumar, Minichiello, Scott, & Harrington, 2017). Another website survey found comparable numbers (Scott & Minichiello, 2017). Similarly, Lee-Gonyea, Castle, and Gonyea's (2009) review identified 17% of websites that advertised male escorts as catering to female clientele only and an ongoing study conducted in the UK found that 66% of escorts advertised to female clients (Smith & Kingston, in Kumar et al., 2017). Indications of a growing market for women who seek paid sexual services with men are not only found online. Since the 1990s, Japan has seen a rapid increase in the number of host clubsvenues where men work as hosts to 'entertain' a mostly migrant female clientelewith over 200 clubs in Tokyo alone (Mahdavi, 2018). The entertainment varies by club and location, but most hosts describe it as selling romance, love and sex to their clients (

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Factors Influencing Access to Sexual Health Care Among Behaviorally Bisexual Men in Vientiane, Laos

Cited by 6 publications

References 37 publications

HIV incidence and factors associated with testing positive for HIV among men who have sex with men and transgender women in Myanmar: data from community‐based HIV testing services

HIV incidence and factors associated with testing positive for HIV among men who have sex with men and transgender women in Myanmar: data from community‐based HIV testing services

“We are not gays… don’t tell me those things”: engaging ‘hidden’ men who have sex with men and transgender women in HIV prevention in Myanmar

Women Who Trade Sexual Services from Men: A Systematic Mapping Review

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