Male Sex Workers Who Sell Sex to Men Also Engage in Anal Intercourse with Women: Evidence from Mombasa, Kenya

Priya Mannava,Marleen Temmerman,Stanley Luchters,Nzioki King’Ola,Scott Geibel

doi:10.1371/journal.pone.0052547

Abstract

ObjectiveTo investigate self-report of heterosexual anal intercourse among male sex workers who sell sex to men, and to identify the socio-demographic characteristics associated with practice of the behavior.DesignTwo cross-sectional surveys of male sex workers who sell sex to men in Mombasa, Kenya.MethodsMale sex workers selling sex to men were invited to participate in surveys undertaken in 2006 and 2008. A structured questionnaire administered by trained interviewers was used to collect information on socio-demographic characteristics, sexual behaviors, HIV and STI knowledge, and health service usage. Data were analyzed through descriptive and inferential statistics. Bivariate logistic regression, after controlling for year of survey, was used to identify socio-demographic characteristics associated with heterosexual anal intercourse.ResultsFrom a sample of 867 male sex workers, 297 men had sex with a woman during the previous 30 days – of whom 45% did so with a female client and 86% with a non-paying female partner. Within these groups, 66% and 43% of male sex workers had anal intercourse with a female client and non-paying partner respectively. Factors associated with reporting recent heterosexual anal intercourse in bivariate logistic regression after controlling for year of survey participation were being Muslim, ever or currently married, living with wife only, living with a female partner only, living with more than one sexual partner, self-identifying as basha/king/bisexual, having one’s own children, and lower education.ConclusionsWe found unexpectedly high levels of self-reported anal sex with women by male sex workers, including selling sex to female clients as well as with their own partners. Further investigation among women in Mombasa is needed to understand heterosexual anal sex practices, and how HIV programming may respond.

Highlights

It is well acknowledged that anal intercourse (AI) is an efficient mode of HIV transmission [1,2,3,4,5,6]
Within various populations sampled in studies undertaken in South Africa, percentages reporting heterosexual AI over different time periods ranged from 43% among female sex workers [10], 42% among truck drivers [11], 10% and 14% among patients of sexually transmitted infection (STI) clinics [12], and 3.6%–15% within the general population [13,14]
Separate analyses of data from both surveys showed that several socio-demographic characteristics of men surveyed in 2006 were significantly different (p,0.05) from those surveyed in 2008, but that reported sexual behaviors with women were similar (Table 1)

Summary

Introduction

It is well acknowledged that anal intercourse (AI) is an efficient mode of HIV transmission [1,2,3,4,5,6]. Recent studies have estimated the probability of HIV-1 transmission per unprotected receptive male-to-male AI act at 1.4% [7] and 1.7% per maleto-female AI act [8], compared to a much lower probability of transmission in the range of 0.08–0.3% for receptive vaginal intercourse [8]. A study on female college students in Togo found that 12% had ever engaged in AI [15], whilst 35% of males and females aged 18–27 years sampled in a large, national Zimbabwean study reported heterosexual AI over the past two months [16] These findings, coupled with the estimated increased risk of HIV transmission from AI, highlight the need to better understand heterosexual AI in sub-Saharan Africa [17]

Methods

Results

Conclusion