Heterosexual Behaviours among Men Who Sell Sex to Men in Coastal Kenya
OBJECTIVE:
African
men who have sex with men often sell sex to men, and MSM who sell sex (MSM-SW)
often also have female partners. We compared sexual risk behaviour of MSM-SW
who were sexually active with female partners (bisexual MSW) to MSM-SW with
only male partners (exclusive MSW).
METHODS:
: A
novel, validated daily event and partner diary self-completed by 82 MSM who
sold sex over a follow-up period of 42 days with weekly review. Cumulative
individual counts of sex and condomless sex were compiled by partner
characteristics. The incidence of specific partnerships and sex acts were
compared within and between bisexual and exclusive MSW.
RESULTS:
Most
(59%) MSM-SW reported female partners during follow-up. The majority of both
male and female partners were cash-paying clients originating locally. Bisexual
MSW reported a similar rate of condomless sex with male and female partners,
but significantly fewer male partners than exclusive MSW. Bisexual MSW had
lower HIV prevalence, were more likely to only report insertive anal sex roles,
and reported lower frequencies of condomless receptive anal sex than exclusive
MSW.
CONCLUSION:
Bisexually
active male sex workers in coastal Kenya create HIV and other sexually
transmitted infection transmission pathways to partners and clients in both MSM
and heterosexual networks, but differed from exclusive MSW in having lower HIV
acquisition and transmission risks. Epidemiological projection methods are
liable to overestimate bridging potential of MSM-SW and MSM populations without
account for systematic differences in risk within these populations.
- 1Nuffield Department of Population Health, University of Oxford, Oxford, UK, Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya, Departments of Medicine, Global Health and Epidemiology, University of Washington, Seattle, Washington, USA, Centre for Topical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK eDepartment of Global Health, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands.
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