Abstract
Condomless anal sex between male partners is the primary risk factor for HIV transmission among men who have sex with men (MSM). Correlates of condomless anal sex have been well-studied in developed countries, but they have received less attention in lower-to-middle income countries (LMIC), where MSM are often subject to stigma, discrimination, intolerance, and even the criminalization of same sex behavior. In Mexico, a LMIC where traditional views on homosexuality are common, HIV prevalence among MSM is high (16.9%), yet little research has been conducted on the correlates of condomless anal sex in this high-risk population. The present study examined correlates of condomless anal sex among 201 MSM recruited in Tijuana, Mexico, with a focus on the role of public sex venues in relation to sexual risk behavior. Eligibility requirements were: biologically male, 18 years of age or older, resident of Tijuana, and self-reported anal or oral sex with a male partner in the past year. Participants completed an interviewer-administered, demographic and psychosocial survey, and were tested for HIV and syphilis. A hierarchical multiple linear regression model was tested to identify correlates of condomless anal sex. Thirty-eight percent of participants (N = 76) reported condomless anal sex with a male partner in the past 2 months. Higher levels of condomless anal sex were associated with higher levels of depressive symptoms, greater sexual compulsivity, and more frequent seeking out of sex partners in a public venue in the past 2 months. In view of these findings, we recommend the development of multi-level, “combination” interventions, which in the Mexican context should include enhanced condom promotion and distribution, improved availability and access to mental health treatment and counseling services, and expanded HIV/STI testing in public venues.
Highlights
Research into the correlates of sexual risk behavior among men who have sex with men (MSM) has a decades-long history, as researchers have sought to identify and understand changes in sexual risk behaviors associated with sociocultural and political change as well as with technological and medical advances [1]
The present study examined correlates of condomless anal sex among 201 MSM recruited in Tijuana, Mexico, with a focus on the role of public sex venues in relation to sexual risk behavior
Direct comparisons are made difficult by varying time frames, this estimate falls within the range of estimates for condomless anal sex reported for MSM in other low- to middle-income countries (LMIC) [44, 47, 48, 70, 71]
Summary
Research into the correlates of sexual risk behavior among men who have sex with men (MSM) has a decades-long history, as researchers have sought to identify and understand changes in sexual risk behaviors associated with sociocultural and political change as well as with technological and medical advances [1]. In the past two decades it has undergone rapid social, cultural, economic, and technological change, Mexico continues to meet the criteria for a LMIC. Prevalent social mores in Mexico surrounding sexuality and masculinity tend to be highly traditional [5,6,7], and stigma associated with homosexuality continues to affect how gay men are treated, with experiences of homophobia and discrimination against MSM being common [8]. MSM in Mexico have disproportionately high rates of HIV infection (16.9% compared to 0.23% among reproductive age adults)[9], which has contributed to further stigma and discrimination [8, 10]
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