Men who have sex with men and women in Lima: understanding a hidden and vulnerable population
Background: The HIV epidemic in Peru is concentrated among men who have sex with men (MSM). HIV prevalence is 10-20%, 25-50 times higher than in the general population. 76% of MSM report sex with women at least once in their lives. However, men at highest risk in lower-income communities include a number of bisexually active men who are not seen, nor self-identify, as homosexual or bisexual.
Methods: A formative study was developed to assess men who have sex with men and women (MSMW). We conducted in depth-interviews with two different groups:
1) 29 MSMW recruited through coded invitation coupons delivered by gay-identified MSM in low-income areas;
2) 25 MSMW recruited through internet-based announcements and chat-based contacts by gay- or transgender-identified staff.
Additionally we conducted a short on-line questionnaire, as well as semi-structured interviews in a gay chat room.
Results: Differences based on socio-economic levels were identified according to three different aspects:
1) circumstances related to sexual relationships with men: in group 1 sex occurs in the neighborhood, usually with acquaintances; while in group 2 sexual encounters are mostly in hidden or anonymous places;
2) sexual practices: men in group 1 expressed a lack of a relationship with male partners, claiming that their insertive role did not imply true sexual involvement; conversely, men in group 2 showed a less rigid attitude towards sexual practices and roles, and even expressed affinities with partners;
3) compensated sex: for men in group 1 compensated sex is a legitimate economic strategy vis-a vis poverty, while men in group 2 declined participating in it.
Conclusions: Male bisexual behaviour is complex and not limited to a single pattern. This study reveals the need of new research to understand the diversity and complexity of male sexuality, and the role of additional factors such as socioeconomic dynamics around sexuality and the HIV epidemic.
-Abstract available at link below-