Amsterdam 2015
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| Abstract #2205 - Cape to Casablanca: MSM in Africa | ||||
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Session: 20.4: Cape to Casablanca: MSM in Africa (Parallel) on Wednesday @ 16.30-18.00 in C104 Chaired by Theo Sandfort, Mike Ross Authors: Presenting Author: Dr. Joanne Mantell - HIV Center for Clinical & Behavioral Studies, Columbia University, United States |
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| Additional Authors: | ||||
| Aim: Kenya has a concentrated HIV epidemic among men who have sex with men (MSM). Selling and buying sex are relatively common in this population. Male sex workers (MSW) have higher prevalence of unprotected receptive anal intercourse, HIV and other STIs, and more sexual partners than MSM in general. This qualitative study elucidates the social and economic dynamics of sex work for MSW, providing insights into HIV transmission in this marginalized population vulnerable to harms. | ||||
| Method / Issue: As part of formative research to guide HIV intervention development, we conducted in-depth semi-structured interviews (60-90 minutes) with 25 men aged 23 to 35 years recruited from nine bars and nightclubs in Mombasa who reported selling sex to men. Eligibility criteria were being >18 years regular patron of the venue having had anal or vaginal intercourse with a client met at that venue in the last 3 months willingness to be audio-recorded and being visibly sober. | ||||
| Results / Comments: Participants employed a number of strategies to solicit clients in bars and clubs: holding eye contact, circling a potential client’s table or asking to sit down with that person, dancing seductively, wearing tight (and sometimes feminine) clothing, following men into the toilets, as well as accepting referrals from other male and female sex workers, clients, bouncers and managers. The majority of participants had male clients only, but a few also reported having female clients. The costs of sexual transactions were determined by participants’ estimations of clients’ wealth, based on the value of his car, cellphone, and clothing. Prices were also negotiated based on clients’ sexual attractiveness, type of sex act, number of rounds of sex, and duration of time spent with the client. Condom use was largely determined by financial considerations few MSWs reported refusing condomless anal sex given sufficient payment. Participants reported that sometimes they did not charge some clients for sex or paid other sex workers for sex ~ to have fun or when they “want a fuck”. MSW reported solidarity and comradery with other male and female sex workers – helping each other getting clients, giving money, sharing sexual health knowledge, and warning about clients who cause harm – but also were in competition for clients. Due to the illegality of both homosexuality and sex work, participants were often compelled to pay bribes to the police and commissions to bouncers in bars and clubs. | ||||
| Discussion: While MSW have considerable agency in terms of negotiating the terms of sexual transactions, their sexual decisions were also informed by considerations of economic survival. The risk of HIV infection was weighed against the financial incentive to forgo condoms for anal sex. This study highlights the vulnerable socio-economic contexts of MSW’ professional and sexual lives, which future HIV interventions with this population must address. | ||||
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