Sexual Risk Behaviors for HIV Infection in Spanish Male Sex Workers: Differences According to Educational Level, Country of Origin and Sexual Orientation

Ballester, Rafael; Salmerón, Pedro; Gil, María Dolores Garza; Gómez, Sergio Quiroz

doi:10.1007/s10461-011-9964-4

Cited by 20 publications

(22 citation statements)

References 16 publications

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“…To optimize honest reporting of sexual practices, this study was conducted in close partnership with MSMfocused healthcare centres serving two large, urban populations. Supporting the assumption of minimal reporting biases, no participants self-identified as heterosexual, even though prior studies in other settings have suggested that many MSS do not consider themselves gay/homosexual or bisexual [42][43][44][45]. Findings of this study may not be generalizable to MSM communities in other locations or to MSS who self-identify as heterosexual.…”

Section: Discussioncontrasting

confidence: 63%

“…While the majority of MSM in this study considered themselves to be bisexual, a larger proportion of MSS identified as gay/homosexual as compared to other MSM. Notably, no participants self-identified as heterosexual, which differs from prior studies conducted in other settings which have suggested that MSS are more likely than other MSM to self-identify as heterosexual [42][43][44][45]. This could reflect a unique characteristic of the MSS population in Nigeria or this finding may be influenced by the study methodology, which was conducted at MSM-focused community health centres and used an RDS-based system of participant referrals for recruitment.…”

Section: Discussioncontrasting

confidence: 59%

See 1 more Smart Citation

Stigma, access to healthcare, and HIV risks among men who sell sex to men in Nigeria

Crowell

Keshinro

Baral

et al. 2017

Journal of the International AIDS Society

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Introduction: Among men who have sex with men (MSM), men who sell sex (MSS) may be subject to increased sexual behaviour-related stigma that affects uptake of healthcare and risk of sexually transmitted infections (STIs). The objectives of this study were to characterize stigma, access to care, and prevalence of HIV among MSS in Nigeria.Methods: Respondent-driven sampling was used to recruit MSM in Abuja and Lagos into the ongoing TRUST/RV368 study, which provides HIV testing and treatment. Detailed behavioural data were collected by trained interviewers. MSS were identified by self-report of receiving goods or money in exchange for sex with men. Poisson regression with robust error variance was used to explore the impact of sex-selling on the risk of HIV.Results: From 12 initial seed participants, 1552 men were recruited from March 2013-March 2016. Of these, 735 (47.4%) reported sex-selling. Compared to other MSM, MSS were younger (median 22 vs. 24 years, p < 0.001) and more likely to identify as gay/homosexual (42.4% vs. 31.5%, p < 0.001). MSS were more likely to report perceived and experienced stigmas such as healthcare avoidance (27.6% vs. 21.5%, p = 0.005) and verbal harassment (39.2% vs. 26.8%, p < 0.001). Total HIV prevalence was 53.4%. After controlling for other factors, HIV prevalence among MSS was similar to that observed among other MSM (relative risk 0.94 [95% confidence interval 0.84–1.05]).Conclusions: These data highlight increased sexual behaviour-related stigma affecting MSS, as compared with other MSM, that limits uptake of healthcare services. The distinct characteristics and risks among MSS suggest the need for specific interventions to optimize linkage to HIV prevention and treatment services in Nigeria.

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Section: Discussioncontrasting

confidence: 63%

Section: Discussioncontrasting

confidence: 59%

Stigma, access to healthcare, and HIV risks among men who sell sex to men in Nigeria

Crowell

Keshinro

Baral

et al. 2017

Journal of the International AIDS Society

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“…Of the 88 studies, 14 were in East Asia (all of which were from China)[12], [13], [28]–[39], 16 in South Asia [3], [16], [17], [40]–[52], 15 in Southeast Asia [7], [9], [15], [53]–[64], 11 in Latin America [2], [14], [18], [65]–[72], 9 in Sub-Saharan Africa [73]–[81], 9 in Europe [8], [10], [82]–[88], and 14 in North America [1], [5], [89]–[99]. Of these, 66 [1]–[3], [7]–[9], [12], [14]–[17], [28], [29], [31]–[39], [41]–[51], [53], [55], [57], [59]–[61], [63]–[67], [70]–[72], [74]–[77], [79]–[88], [93]–[95], [100] included a biological HIV assay and had a sample size of ≥50, and thus were included in the analyses, representing 31,924 men who engaged in transactional sex with other men in 28 countries (Figure 1).…”

Section: Resultsmentioning

confidence: 99%

Global Burden of HIV among Men Who Engage in Transactional Sex: A Systematic Review and Meta-Analysis

et al. 2014

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BackgroundMen who engage in transactional sex, the exchange of sex for money, goods, or other items of value, are thought to be at increased risk of HIV, but there have been no systematic attempts to characterize HIV burden in this population. We undertook a systematic review and meta-analysis to quantify the burden in this population compared with that of men in the general population to better inform future HIV prevention efforts.MethodsWe searched seven electronic databases, national surveillance reports, and conference abstracts for studies of men who engage in transactional sex published between 2004–2013. Random effects meta-analysis was used to determine pooled HIV prevalence and prevalence ratios (PR) for the difference in HIV prevalence among men who engage in transactional sex as compared to general population men.FindingsOf 66 studies included representing 31,924 men who had engaged in transactional sex in 28 countries, pooled biological assay-confirmed HIV prevalence was 10.5% (95% CI = 9.4 to 11.5%). The highest pooled HIV prevalence was in Sub-Saharan Africa (31.5%, 95% CI = 21.6 to 41.5%), followed by Latin America (19.3%, 95% CI = 15.5 to 23.1%), North America (16.6%, 95% CI = 3.7 to 29.5%), and Europe (12.2%, 95% CI = 6.0 to 17.2%). Men who engaged in transactional sex had an elevated burden of HIV compared to the general male population (PR = 20.7, 95% CI = 16.8 to 25.5).ConclusionsThe global burden of HIV is disproportionately high among men who engage in transactional sex compared with the general male population. There is an urgent need to include this population in systematic surveillance as well as to scale-up access to quality HIV prevention programs.

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“…Moreover, over two-thirds of participants reported being offered more money to not use a condom with a client. Previous studies have documented sex workers accepting additional financial incentives in exchange for unprotected sex, leading to an increased risk for HIV acquisition (Ballester-Arnal et al, 2014; Ballester, Salmeron, Gil, & Gomez, 2012; Muldoon et al, 2015; Nemoto et al, 2012; Patterson et al, 2012). A study of female sex workers in India conducted by Erausquin et al between 2006 and 2010 identified accepting additional financial incentives for unprotected sex as a risk factor for HIV and STIs (Erausquin, Reed, & Blankenship, 2014).…”

Section: Discussionmentioning

confidence: 99%

Transactional sex and the challenges to safer sexual behaviors: a study among male sex workers in Chennai, India

et al. 2016

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Male sex workers (MSW) are a significant but invisible population in India who are at risk for HIV/STI. Few studies from India have documented HIV risk factors and motivations for sex work in this population. Between 2013 and 2014, a community-based convenience sample of 100 MSW in Chennai (south India) completed a baseline risk assessment as part of a behavioral intervention. Participants were ≥18 years, and reported current sex work. We report medians and proportions, and Wilcoxon-Mann-Whitney and chi-square tests are used to examine differences between sex work and sexual behavior measures by income source. Participants were engaged in sex work for 5.0 years (IQR=2.3-10.0), and earned 3,000 (IQR=2000-8000) Rupees (<50 USD) per month from sex work. Sixty-four percent reported ever testing for HIV and 20.2% for any STI. The most common reasons for starting sex work were money (83.0) and pleasure (56.0%). Participants reported 8.0 (IQR=3.0-15.0) male clients and 7 (IQR=4.0-15.0) condomless anal sex acts with male clients in the past month. Compared to participants with an additional source of income, those whose only source of income was sex work reported more male clients in the past month (10.0 vs. 6.0, p=0.017), as well as more condomless anal sex acts with male clients (8.0 vs. 5.0, p=0.008). Nearly 70.0% were offered more money not to use a condom during sex with a client, and 74.2% reported accepting more money not to use a condom. Three-quarters reported having experienced difficulty using condoms with clients. MSW in India engage in high levels of sexual risk for HIV/STIs. Money appears to be a driving factor for engaging in sex work and condomless sex with clients. HIV prevention interventions with MSW should focus on facilitating skills that will support their ability to negotiate sexual safety in the context of monetary disincentives.

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Sexual Risk Behaviors for HIV Infection in Spanish Male Sex Workers: Differences According to Educational Level, Country of Origin and Sexual Orientation

Cited by 20 publications

References 16 publications

Stigma, access to healthcare, and HIV risks among men who sell sex to men in Nigeria

Stigma, access to healthcare, and HIV risks among men who sell sex to men in Nigeria

Global Burden of HIV among Men Who Engage in Transactional Sex: A Systematic Review and Meta-Analysis

Transactional sex and the challenges to safer sexual behaviors: a study among male sex workers in Chennai, India

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