Men Who Have Sex with Men (MSM) and Factors Associated with Not Using a Condom at Last Sexual Intercourse with a Man and with a Woman in Senegal

Abstract

BackgroundMen who have sex with other men (MSM) are a vulnerable population in Africa that has been insufficiently explored. Given the high rate of bisexuality among MSM (73% in the past year), it is important to understand their risk-taking behaviors regarding both men and women.Methodology/Principal FindingsA socio-behavioral survey was carried out in 2007 among 501 MSM recruited using the snowball sampling method. We explore in this article why a condom was not used during last sexual intercourse with a man and with a woman, taking into account the respondent's characteristics, type of relationship and the context of the sexual act. In the survey, 489 men reported that they had had sexual intercourse at least once with another man during the previous year, and 358 with a man and with a woman. The main risk factors for not using a condom at last sexual intercourse with another man were having sex in a public place (aOR = 6.26 [95%CI: 2.71–14.46]), non-participation in an MSM prevention program (aOR = 3.47 [95%CI: 2.12–5.69]), a 19 years old or younger partner (aOR = 2.6 [95%CI: 1.23–4.53]), being 24 years or younger (aOR = 2.07 [95%CI: 1.20–3.58]) or being 35 years or over (aOR = 3.08 [95%CI:1.11–8.53]) and being unemployed (aOR = 0.36 [95%CI: 0.10–1.25]). The last sexual intercourse with the respondent's wife was hardly ever protected (2%). With women, the other factors were a 15 years or younger partner (aOR = 6.45 [95%CI: 2.56–16.28]), being educated (primary: aOR = 0.45 [95%CI: 0.21–0.95], secondary or higher: aOR = 0.26 [95%CI: 0.11–0.62]), being a student (aOR = 2.20 [95%CI: 1.07–4.54]) or unemployed (aOR = 3.72 [95%CI: 1.31–10.61]) and having participated in a MSM prevention program (aOR = 0.57 [95%CI: 0.34–0.93]).ConclusionHaving participated in a prevention program specifically targeting MSM constitutes a major prevention factor. However, these programs targeting MSM must address their heterosexual practices and the specific risks involved.

High levels of unprotected anal intercourse and never testing for HIV among men who have sex with men in Nigeria: evidence from a cross-sectional survey for the need for innovative approaches to HIV prevention

“…In this study, 43.4% of participants reported UAI at last sex. The level of UAI reported by participants is consistent with reports of low consistent condom use among MSM in other West African countries 15 16 -for example, in Senegal, UAI at last sex with a man was reported at 23.2% among a sample of 501 MSM 16 and, in a convenience sample of MSM in Cameroon, 57% reported UAI in the previous 6 months. 15 Participants who lived in Ibadan, who were married or cohabitating with a woman, self-identified as bisexual or straight, were HIV-positive and who had not tested for HIV prior to the survey were more likely to report UAI.…”

HIV epidemic among key populations in west Africa

“…Unprotected anal intercourse at last sex was reported by 43.4% of MSM enrolled in a cross-sectional survey conducted in three cities in Nigeria and by 57% of MSM in a study conducted in Douala, Cameroon [44,45], underscoring the high levels of risky behavior among these men. At the sexual network level, studies from Senegal and Nigeria have documented a substantial percentage of MSM who report having both male and female concurrent sex partners [8,46]. Bisexual concurrency may establish a bridge between male and female sexual networks and have implications for HIV transmission in the general population [47,48].…”

Innovative Strategies for Scale up of Effective Combination HIV Prevention Interventions in Sub-Saharan Africa

“…Data on MSM are limited in some countries due to social marginalisation, stigma and punitive laws. The impact of MSM is believed to be linked to the heterosexual epidemic as, according to studies done in Botswana, Malawi, Namibia and Senegal, many MSM in the region also engage in heterosexual sex [9,10].…”