Unprotected sex among men who have sex with men: the perspective of the vulnerability framework
Background: Using the conceptual framework of the vulnerability, the study aims to investigate the association among different profiles of men who have sex with men (MSM) and unprotected oral (UOS) and anal sex (UAS).
Methods: The study is part of the Convida Project, a quantitative survey on male health, sexual identity, and risky behavior to HIV/STI in the city of Salvador, Northeast Brazil in 2003. A self-applied questionnaire was distributed at the Gay scene during eight months. The sample group of 1478 MSM was classified according to each domain of the vulnerability framework (social, programmatic and individual) based on correspondence analysis followed by cluster analysis. Logistic regression was used for modeling.
Results: Most men self identify as gay, then as bisexuals, small percentage as travesties. The association between the groups and UOS was statistically significantly for single men (OR=0,69; IC=0,48-0,99); the ones reported to be married with woman (OR=0,56; IC=0,035-0,90); those that referred little risk to HIV (OR=0,43; IC=0,31-0,59), those uncertain of what sexual act gives them more pleasure (OR=0,59; IC=0,38-93); those who negotiate safe sex (OR=0,15; IC=0,10-0,23) and those not persuasive of unsafe sex (OR=0,22; IC=0,14-0,34). For the UAS, association was statically significant with black HSH of low income (OR=0,58; IC=0,39-0,84), married with woman (OR=0,50; IC=0,27-0,91); those uncertain of what sexual act gives them more pleasure (OR=0,27; IC=0,15-0,48), and those not persuasive of unsafe sex (OR=0,42; IC=0,23-0,76).
Conclusions: The results are consistent with other studies that show the association between socio- economic and individual factors and unprotected sex among MSM. The statistical methods applied were important to identify groups of MSM through a combination of simultaneous relationships among several risk factors. Prevention programs can use these results for a better understanding of MSM relationships and promotion of safe sex among them.
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