Abstract
BackgroundStigma differentially influences HIV and STI care among MSM, especially regarding partner notification practices. Recognizing the heterogeneous behaviors/identities within the category “MSM,” we used mixed-methods to assess sexual risk behaviors among men who have sex with men only (MSMO) and behaviorally bisexual MSM (MSMW) with HIV and/or other STIs.MethodsMSMO/MSMW recently diagnosed (< 30 days) with HIV, syphilis, urethritis, or proctitis completed a cross-sectional survey assessing sexual risk behaviors, anticipated disclosure, and sexual partnership characteristics (n = 332). Multivariable generalized estimating equation models assessed characteristics associated with female compared to male partners in the last three partnerships. Follow-up qualitative interviews (n = 30) probed partner-specific experiences (e.g., acts and disclosure).ResultsAmong all participants, 13.9% (n = 46) described at least one of their last three sex partners as female (MSMW). MSMW (mean age of 31.8) reported a mean of 3.5 partners (SD = 4.5) in the past 3 months and MSMO (mean age 30.6) reported a mean of 4.6 partners (SD = 9.7) in the past 3 months. MSMW were more likely to report unprotected insertive anal sex (77.9%) than MSMO (43.1%; p < 0.01). Cisgender female partners were associated with condomless insertive sex in the last 3 months (aPR: 3.97, 95%CI: 1.98–8.00) and classification as a “primary” partnership (2.10, 1.34–3.31), and with lower prevalence of recent HIV diagnosis (0.26, 0.11–0.61). Planned notification of HIV/STI diagnoses was less common for female than for male partners (0.52, 0.31–0.85). Narratives illustrate internal (e.g., women as ‘true’ partners) and community-level processes (e.g., discrimination due to exposure of same-sex behavior) that position homosexual behavior and bisexual identity as divergent processes of deviance and generate vulnerability within sexual networks.ConclusionsMSMW recently diagnosed with HIV/STI in Peru report varying partnership characteristics, with different partner-specific risk contexts and prevention needs. Descriptions highlight how behaviorally bisexual partnerships cut across traditional risk group boundaries and suggest that HIV/STI prevention strategies must address diverse, partnership-specific risks.
Highlights
Stigma differentially influences Human immunodeficiency virus (HIV) and Sexually transmitted infections (STI) care among Men who have sex with men (MSM), especially regarding partner notification practices
MSMW recently diagnosed with HIV/STI in Peru report varying partnership characteristics, with different partner-specific risk contexts and prevention needs
Descriptions highlight how behaviorally bisexual partnerships cut across traditional risk group boundaries and suggest that HIV/STI prevention strategies must address diverse, partnership-specific risks
Summary
Stigma differentially influences HIV and STI care among MSM, especially regarding partner notification practices. While HIV prevalence among MSMW has been reported to be less than that among men who have sex with men only (MSMO), recent research shows that MSMW are less likely than their MSMO counterparts to access HIV prevention and testing services [2, 5] They are at higher risk for other sexually transmitted infections (STIs) than both MSMO and men who have sex with women only [4, 6,7,8]. Stigma has been described as a central mechanism increasing HIV vulnerability among gay, bisexual, and other men who have sex with men, all of whom violate societal expectations of gender roles and sexual behaviors, and often experience homoprejudice [10]. An in-depth understanding of sexual and gender politics, and how they inform partner expectations and disclosure practices, is critical to the development of successful interventions to promote sexual health among MSMW [15,16,17,18]
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