Bisexual Concurrency, Bisexual Partnerships, and HIV Among Southern African Men Who Have Sex With Men

Noting that the "sexual behavior of men who have sex with men (MSM) in southern Africa has been little studied," the authors presented the first data on bisexual partnerships and bisexual concurrency among MSM in Botswana, Malawi, and Namibia.

A structured survey instrument and rapid-kit HIV screening were used to obtain a cross-sectional probe of a convenience sample of 537 men who had ever reported anal sex with another man.

Of the MSM, 34.1 percent were married or had a stable female partner, and 53.7 percent reported both male and female sex partners in the previous six months. Bisexual concurrency was common, with 16.6 percent of MSM reporting concurrent relationships with both a man and a woman. Bivariate analyses showed any bisexual partnerships were associated with lower education (odds ratio [OR] 1.6, 95 percent confidence interval [CI] 1.1 to 2.3); higher condom use (OR 6.6, 95 percent CI 3.2 to 13.9); less likelihood of having ever tested for HIV (OR 1.6, 95 percent CI 1.1 to 2.3); less likelihood of having disclosed sexual orientation to family (OR 0.47, 95 percent CI 0.32 to 0.67); and being more likely to have received money for casual sex (OR 1.9, 95 percent CI 1.3 to 2.7). Bisexual concurrency was associated with higher self-reported condom use (OR 1.7, 95 percent CI 1.0 to 3.1); being employed (OR 1.8, 95 percent CI 1.2 to 2.9); lower likelihood of disclosure of sexual orientation to family (OR 0.37, 95 percent CI 0.22 to 0.65); and having paid for sex with men (OR 2.0, 95 percent CI 1.2 to 3.2).

"The majority of MSM in this study report some bisexual partnerships in the previous six months. Concurrency with sexual partners of both genders is common. Encouragingly, men reporting any concurrent bisexual activity were more likely to report condom use with sexual partners, and these men were not more likely to have HIV infection than men reporting only male partners," the authors concluded. "HIV prevention programs focusing on decreasing concurrent sexual partners in the African context should also target bisexual concurrency among MSM. Decriminalization of same-sex practices will potentiate evidence-based HIV prevention programs targeting MSM."