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Bisexual practices and bisexual concurrency and among men who have sex with men (MSM) in Peri-Urban Cape Town, South Africa
S. Baral1, C. Beyrer1, E. Burrell2, L.-G. Bekker3
1Johns Hopkins Bloomberg School of Public Health, Center for Public Health and Human Rights, Department of Epidemiology, Baltimore, United States, 2Desmond Tutu HIV Foundation, Mother City Men's Health Project, Cape Town, South Africa, 3University of Cape Town, Institute of Infectious Disease and Molecular Medicine, Cape Town, South Africa
Background: HIV is increasingly recognized among MSM in Africa. Concurrency has been reported as a driver of HIV spread in the region, but has only been evaluated among heterosexual partnerships. This study explores associations with HIV, risks, human rights, and bisexual practices and concurrency among MSM in peri-urban Cape Town.
Methods: An anonymous probe of 200 men, reporting ever having had sex with another man, recruited through venue-base sampling in the townships surrounding Cape Town using a structured survey instrument and OraQuick©-HIV screening kit.
Results: HIV prevalence was 25.5%(51/200). Univariate associations with HIV were being older than 26 years old(p< 0.05), unemployed(p< 0.05), less educated(p< 0.05),received money for casual male sex(p< 0.05),not always wearing condoms with men(p< 0.06),reporting >4 male partners in previous 6 months(p< 0.01), and having been blackmailed (p=0.06). Independent associations with HIV included unemployment(aOR=3.4,95%CI=1.5-7.5,p< 0.01), higher age(aOR=3.5,95%C=I1.6-7.8,p< 0.01), less condom use with men(aOR2.2,95%CI=1.0-4.7), less educated (aOR=4.0,1.3-12.5,p< 0.05), blackmailed(aOR3.7,95%CI=1.2-11.3), and more male partners(aOR=2.5,95%CI=1.0-6.3,p=0.06). Active bisexual practices were reported by 17.1%(34/199), and a total of 8%(16/200)reported having a regular female partner. Bisexual practices were associated with always wearing condoms (p< 0.001), not having disclosed sexual orientation to either family or health care worker(p< 0.05),having received money for casual sex with a man(p< 0.05) and a lower prevalence of HIV(p< 0.05). Bisexual concurrency was reported by 5%(10/200)and associated with being older than 26(p=0.05).
Conclusions: MSM are a high-risk group for HIV infection in South Africa. Importantly, MSM practicing active bisexuality reported higher rates of condom use and were less likely to be infected with HIV. However, they were less likely to disclose their sexual orientation and more likely to have received money for casual sex. These data highlight a need to better characterize bisexual practices in South Africa and to investigate all potential biomedical and behavioral interventions to decrease HIV risk among MSM.
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