Relationship dynamics and sexual risk behaviour of male partners of female sex workers in Kampala, Uganda

Abstract

Male regular partners of female sex workers represent an important population to reach with HIV-prevention interventions. In this paper we discuss the relationship dynamics and HIV/STI risk behaviour of men involved with self-identified female sex workers (FSW) in Kampala. Between 2011 and 2014 we conducted repeat in-depth interviews with 42 male partners of FSWs attending a clinic for women at high risk of HIV-infection in Kampala. Men publicly struggled with the stigma of dating women who are considered to be engaged in a shamed profession, but privately saw meaning in these relationships. In coping with the stigma, some described the work of their partners in terms that distanced them from sex work, while others struggled to have the control that `being a man' demanded since they could not monitor all movements of their partners. Dealing with HIV disclosure was hard, and seeking support difficult for some of the men leading to missed opportunities and guilt. Despite challenges, relationships with sex workers offered men some benefits such as access to much needed care and treatment. A few men also admitted to being motivated by material and financial benefits from sex workers who they perceived as being rich and this was one factor that helped them sustain the relationships. These findings offer insights into the complex relationship dynamics within high risk sexual partnerships but the findings suggest that effective interventions that are couple centred can be established to promote better health.

Sexual Behaviour Risk Among Male Regular Partners of Female Sex Workers

“…Alcohol use prevention counselling models have demonstrated positive effects in Africa [36]. However, significant challenges to the development of such interventions that include the difficulty of reaching these populations, the stigma, high mobility have been cited [7,35]. Thus, the development of appropriate prevention interventions requires understanding the social-cultural contexts of the MRPs and their FSW partners [29].…”

“…MRPs engage in risky sexual behaviours that put them at a higher risk for HIV infection compared to other men in the general population [6][7][8]. For example in Senegal, the overall HIV prevalence among male partners of FSWs was 19.8% compared to <1% in the general population [9].…”

“…In Ghana, for instance, the social networks among MRPs were the source of increased HIV prevalence in the general community [11]. More recent behavioural studies have identified multiple and concurrent sexual relationships, alcohol use, limited condom use and concomitant STIs as the most critical components contributing to HIV transmission and acquisition in these key populations [7,12,13]. However, evidence suggests that unprotected sex among 1 MRC/UVRI & LSHTM Uganda Research Unit, Entebbe, Uganda 2 London School of Hygiene and Tropical Medicine, London, United Kingdom…”

The meaning of fatherhood to men in relationships with female sex workers in Kampala, Uganda: The struggle to model the traditional parameters of fatherhood and masculinity

“…Men who acknowledge that they have fathered a child with a sex worker do, nevertheless, find ways to fit the children and the mothers of those children into their lives [ 17 ]. Previous research has shown that while men who establish relationships with sex workers find meaning in these sexual partnerships, they can also face a dilemma over the nature of that bond in viewing a woman both as a provider of paid sex, but also a long-term partner [ 18 , 19 ]. This may affect how such men engage with their social roles as fathers who share the parenting role with women in sex work.…”

Conflicted masculinities: understanding dilemmas and (re)configurations of masculinity among men in long-term relationships with female sex workers, in Kampala, Uganda

“…A man may start a relationship with a sex worker as a client through a casual encounter intended to meet sexual desires, and then develop a long-term relationship (Hammond and van Hooff 2020). Such relationships are challenging for both the woman and the man, as they attempt to define their relationship differently from that of the woman's encounters with clients (Bhattacharjee et al 2018;Warr and Pyett 1999;Mbonye et al 2016). Besides dealing with negative social perceptions, couples in these relationships may be disadvantaged economically, have higher HIV infection rates and have children from previous relationships (Onyango et al 2019;Warr and Pyett 1999).…”