Motivations and barriers for using condom among men who have sex with men in Cambodia
L. Dianna1, L. Cheaty1, C. Rotsothea1, L. Vandy1, S. Thy2, H. Sakphea2, G. Mundy3, S. Dina2, D. Borapich2, Chris Jones, Mary Warsh, Nou Sovann
1Population Services International/Cambodia, Strategic Information, Phnom Penh, Cambodia, 2Population Services International/Cambodia, Communication & Marketing, Phnom Penh, Cambodia, 3Population Services International, Research & Metrix, Washington DC, United States
Background: In Cambodia, HIV prevalence among men who have sex with men (MSM) is much higher than among the general population (8.7% vs. 0.9%). Among MSM, consistent condom use is low and risky sexual behaviors are common. PSI/Cambodia is leading a HIV-prevention program to promote safe sexual behaviors among MSM. To inform this program, PSI/Cambodia conducted a qualitative study to understand the context, motivations and barriers associated with consistent condom use among MSM.
Methods: In 2009, PSI/Cambodia conducted a qualitative study using the PEER methodology. MSM were trained as interviewers and purposively selected 24 informants from the MSM population. Feminized and non-feminized MSM 18 to 30 years old were included in study. Each participant provided narrative accounts of their behavior during two in-depth interviews.
Results: Study findings suggest that having multiple sexual partners is the norm among MSM. Interviewees also reported that seeking out new sexual partners is part of daily routine and transactional sex is common. MSM generally understand the health risks of unprotected sex, yet condom use is inconsistent and decisions around condom use are often motivated by factors such as having previously tested negative for HIV, being offered more money for sex without condoms, and the sexual partner’s appearance. If MSM do not have a condom, they are very likely to have unprotected sex even though they understood the risk.
Conclusions: Following this study, PSI/Cambodia will design an integrated interpersonal communications program addressing the factors that influence decisions around condom use including beliefs about using a partner’s appearance to assess risk and risk perception of having multiple partners. The program will also improve access to condoms. Activities will be implemented with partner organizations that have developed working relationships with MSM populations in Cambodia and have previously addressed the sexual risks of HIV transmission with this population.