Identifying Risk: A Comparison of Risk Between Heterosexual-Identifying Bisexual Men and Other Bisexual Men in Vientiane, Laos

Abstract

Men who have sex with men are a priority population for HIV control in Laos, but encompass men diverse in sexual orientation, gender identification, and behavior. Behaviorally bisexual men and their sexual partners were recruited in Vientiane, Laos, in 2010 using modified snowball sampling. Heterosexual-identifying bisexual men identified as exclusively/predominantly heterosexual and other bisexual men identified as bisexual or predominantly/exclusively homosexual. Sixty (68%) heterosexual-identifying and 38 (32%) other bisexual men were recruited; the median number of sex partners in the past year was eight and seven, respectively. Consistent condom use was low with regular (7%) and casual (35%) partners and did not differ by identity. More heterosexual-identifying (53%) than other bisexual (29%) men reported weekly alcohol consumption. Twelve (20%) heterosexual-identifying and 15 (54%) other bisexual men correctly answered all HIV-knowledge questions. High-risk behaviors for STI and HIV transmission were common. Targeted HIV prevention initiatives are needed, particularly to reach heterosexual-identifying bisexual men.

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

“…To depersonalize sensitive data, FGD participants were asked broad questions about what they know, think, or had heard from other people. Areas of exploration were informed by findings from an earlier survey of bisexual men, 11,12 health belief theory, 20 and social cognitive theory, 21 and included relationships, condom use, social norms, health beliefs, access to information and services, and desirable characteristics of services. Health belief theory considers that behavior change is motivated by perceived benefits of change, seriousness of the condition, and beliefs that one is susceptible to the condition and that the benefits of change outweigh the costs.…”

“…7 Second, bisexual men report high-risk behaviors, including low rates of consistent condom use and multiple sex partners. 11,12 Third, bisexual men commonly self-identify as heterosexual or straight, 11 and thus may be invisible to HIV prevention outreach, education, and health services. 13-16 In Laos, HIV prevention programs for MSM mostly target male-to-female transgender women (commonly known as kathoey teng ying or kathoey phom yao in Laos and herein referred to as “kathoey”) or self-identifying gay men 17,18 and may not adequately reach bisexual men.…”

Setting the Scene: Locations for Meeting Sex Partners Among Behaviorally Bisexual Men in Vientiane, Laos, and Opportunities for Health Promotion

“…Recruitment methods have been described previously (Bowring et al, 2014;van Gemert et al, 2013). In brief, starting with ten male seeds reporting sex with men and women in the previous 12 months, behaviorally bisexual men and their sexual networks were recruited in Vientiane Capital by enhanced snowball sampling.…”

“…A substantial proportion of men who have sex with men also report sex with women (Rattiphone, Khanti, Morineau, & Phimphachanh, 2010;Sheridan et al, 2009), and many of these men identify as exclusively or predominantly heterosexual (Bowring et al, 2014). A recent study by our group showed that in Vientiane, the capital of Laos, behaviorally bisexual men interlink sexual networks of men who only have sex with men, kathoey (male-to-female transgender women), heterosexual men, and women (van Gemert et al, 2013).…”

“…A recent study by our group showed that in Vientiane, the capital of Laos, behaviorally bisexual men interlink sexual networks of men who only have sex with men, kathoey (male-to-female transgender women), heterosexual men, and women (van Gemert et al, 2013). Further, behaviorally bisexual men report high risk behaviors for HIV and other sexually transmitted infections (STIs), including low rates of consistent condom use with their male, kathoey, and female sex partners, multiple sex partners in the past year, and sexual risk behavior associated with frequent alcohol consumption (Bowring et al, 2014). While HIV prevalence in Laos is low (0.2% in the general population; United Nations Program on HIV/AIDS, 2010), men who have sex with men are at increased risk of HIV infection and other sexually transmitted infections (STIs), with HIV prevalence estimated at 5.6% among men who have sex with men in Vientiane (Sheridan et al, 2009).…”