Understanding the HIV Risk and Sexual Health Needs of Men Who Have Sex with Men

Article excerpt

Around the world, men who have sex with men (MSM) face stigma and discrimination. The stigma attached to male-to-male sexual behavior hinders men from seeking appropriate health care and counseling that might reduce their risk of HIV infection and results in the failure of programs and policies to address their needs. Horizons confronted this challenge in Africa and South America by using innovative techniques for finding and interviewing MSM about their experiences. While the lives of MSM in these two settings are different, Horizons results highlighted similar vulnerabilities.

Documenting the existence of MSM

The Horizons Program documented the existence of MSM within major African cities, previously unknown to national AIDS programs, and identified risk behaviors that rendered these populations especially vulnerable to HIV. Following the success of these assessments, Horizons and regional partners expanded the research agenda to include an intervention study of MSM in Senegal and of male sex workers who have sex with men in Mombasa, Kenya. In Latin America, the Horizons Program analyzed behaviors among MSM in order to develop new evidence-based approaches to risk reduction and to guide prevention programs.

Sexual behavior

In the African studies, high levels of insertive and receptive anal sex with inconsistent condom use were the norm. High proportions of multiple or concurrent sex partners were reported in all studies, but were particularly high among Mombasa male sex workers and MSM in Campinas (Brazil), Ciudad del Este (Paraguay), and Nairobi (Kenya). The prevalence of men selling sex to other men was surprisingly high in all areas studied. The large numbers of sex workers in the studies may result from the failure of peer recruitment survey methods to identify more hidden or isolated segments of the MSM population.

These studies also demonstrate that heterosexual sex is common among MSM: 30 percent of male sex workers in Mombasa reported having a female paying or non-paying sex partner in the past 30 days; 83 percent of MSM in Ciudad del Este had a female sex partner in the past six months; 88 percent of respondents in Senegal reported ever having sex with a woman; and 5 percent of MSM in Nairobi and 16 percent in Campinas reported having female sex partners in the one and two months, respectively, prior to the survey. These results underscore the fact that MSM are not sexually isolated and that potential "bridging" between homosexual and heterosexual populations by these men has broader public health implications.

Stigma, discrimination, and violence

Horizons documented a high level of physical, verbal, and sexual victimization of MSM. …