A Qualitative Exploration of Sexual Risk and HIV Testing Behaviors among Men Who Have Sex with Men in Beirut, Lebanon

Abstract

Men who have sex with men (MSM) may account for most new HIV infections in Lebanon, yet little is known about the factors that influence sexual risk behavior and HIV testing in this population. Qualitative interviews were conducted with 31 MSM living in Beirut, and content analysis was used to identify emergent themes. Mean age of the participants was 28.4 years, and all identified as either gay (77%) or bisexual (23%). Half reported not using condoms consistently and one quarter had not been HIV-tested. Many described not using condoms with a regular partner in the context of a meaningful relationship, mutual HIV testing, and a desire to not use condoms, suggesting that trust, commitment and intimacy play a role in condom use decisions. Condoms were more likely to be used with casual partners, partners believed to be HIV-positive, and with partners met online where men found it easier to candidly discuss HIV risk. Fear of infection motivated many to get HIV tested and use condoms, but such affect also led some to avoid HIV testing in fear of disease and social stigma if found to be infected. Respondents who were very comfortable with their sexual orientation and who had disclosed their sexuality to family and parents tended to be more likely to use condoms consistently and be tested for HIV. These findings indicate that similar factors influence the condom use and HIV testing of MSM in Beirut as those observed in studies elsewhere of MSM; hence, prevention efforts in Lebanon can likely benefit from lessons learned and interventions developed in other regions, particularly for younger, gay-identified men. Further research is needed to determine how prevention efforts may need to be tailored to address the needs of men who are less integrated into or do not identify with the gay community.

HIV Prevalence and Demographic Determinants of Unprotected Anal Sex and HIV Testing Among Men Who Have Sex with Men in Beirut, Lebanon

“…Interestingly, only half of these men reported always using condoms during vaginal sex, but the vast majority reported always using condoms during anal sex with female partners. We did not assess whether their female partners were aware that the participant had sex with men, and our qualitative research suggested that MSMW who are less comfortable with their sexuality are often fearful of their female partners becoming aware of their sex with men (Wagner et al, 2012). With anal sex often being associated with sex between men, it is possible that when MSMW have anal sex with women there may be a greater likelihood of the woman being aware of the man’s bisexuality and a mutual recognition of greater risk and need for condom use.…”

Resilience Factors as a Buffer against the Effects of Syndemic Conditions on HIV Risk and Infection among Tanzanian MSM

“…For instance, in a qualitative study conducted among MSM in Beirut, Lebanon, Wagner et al found that participants who had gained social visibility by disclosing their sexual orientation to family members, either directly or indirectly, tended to be more likely to use condoms consistently [58]. This finding supports the philosophy that underlies family-based HIV prevention programs, an innovative approach suggested by Garofalo et al for use especially among young socially marginalized MSM.…”

“…Studies have revealed that social-visibility ('' coming out'') has been associated with equivocal health outcomes [43,58]. In other words, '' coming out'' could offer protection against or predispose to HIV risk and infection.…”

“…For example, in Kenya, the HIV prevalence among the general population ranged from 6.70% in 2003 to 5.60% in 2012 (Kenya AIDS response progress report 2014) while that of MSM was 24.60% during the same period [21,51]. Likewise, whereas the national prevalence of HIV in Zambia was documented at 15.20% among heterosexual adults, it was 33.30% among MSM [56][57][58][59][60][61]. A similar trend was documented among Tanzanian MSM in Zanzibar, with 12.3% HIV prevalence while that of the local general population was 2.00% [9].…”

Qualitative research on point-of-care testing strategies and programs for HIV

“…Studies on accessing HIV testing explore testing decisions of clients, reasons for delay in accessing HIV testing, risk perceptions regarding HIV and how they relate to the act of testing, and ways to motivate clients to come forward to get tested. To elucidate, studies refer to decision-making processes for HIV testing and sero-status disclosure [9], reasons for testing/testing late among men who have sex with men (MSM) [10,11], identifying ways of motivating MSM for testing [12], clients' attitudes toward HIV testing at dental sites [13] and influence of antiretroviral therapy availability on testing decisions among the general population [14]. Studies that focus on the use of POC testing, perceptions of benefits of early diagnosis and risks of testing late or never, and attitudes toward early and timely treatment, referral, triage and linkage to care remain limited in the context of HIV POC testing.…”