Factors Associated with Inconsistent Condom Use among Men Who Have Sex with Men in Cambodia

Abstract

BackgroundCompared to the general population, men who have sex with men (MSM) are at greater risk for HIV and less understood due to their more hidden and stigmatized nature. Moreover, the discrepancy in findings in the literature merits further investigations in MSM populations from different cultures and settings. We therefore conducted this study to explore factors associated with inconsistent condom use among high-risk MSM in Cambodia.MethodsThis cross-sectional study was conducted in 2014 among 367 MSM randomly selected from Battembang and Siem Reap using a two-stage cluster sampling method. A structured questionnaire was used for face-to-face interviews to collect information on characteristics of respondents, HIV testing history, self-perception of HIV risk, substance use, sexual behaviors, mental disorders, and HIV knowledge. Multivariable logistic regression analysis was performed to identify factors independently associated with inconsistent condom use.ResultsOn average, 62.3% of respondents reported that they always used condoms over the past three months. The rates varied with types of sexual partners; the proportion of respondents who reported always using condoms was 55.1%, 64.2%, 75.9%, 73.0%, 78.1%, and 70.3%, for sexual partners who were girlfriends, boyfriends, female sex workers, male sex workers, female clients, or male clients, respectively. After adjustment, inconsistent condom use was significantly associated with age of ≥25 (AOR = 1.77, 95% CI = 1.09–2.86), self-rated quality of life as good or very good (AOR = 4.37, 95% CI = 1.79–5.67), self-perception of higher HIV risk compared to the general population (AOR = 2.37, 95% CI = 1.35–4.17), illicit drug use in the past three months (AOR = 5.76, 95% CI = 1.65–10.09), and reported consistent lubricant use when selling anal sex to men in the past three months (AOR = 2.85, 95% CI = 1.07–8.12).ConclusionsWe found risky sexual behaviors to be considerably high among MSM in this study, especially among those who used illicit drugs or were older than 25. HIV education and social marketing should be expanded and specifically designed for MSM to better educate on the increased risk of HIV with unprotected anal sex and illicit drug use as risk factors, and the importance of the use of both condoms and lubricant during anal intercourse.

Correlates of condomless anal sex among men who have sex with men (MSM) in Tijuana, Mexico: The role of public sex venues

“…In our RDS-recruited sample of MSM in Tijuana, Mexico, 38% of participants reported condomless anal sex with a male partner in the past 2 months. Although direct comparisons are made difficult by varying time frames, this estimate falls within the range of estimates for condomless anal sex reported for MSM in other LMIC [ 44 , 47 , 48 , 70 , 71 ]. Higher levels of condomless anal sex were associated with more depressive symptoms, higher sexual compulsivity scores, and partner-seeking in public venues.…”

Sexual partner characteristics and incident rectalNeisseria gonorrhoeaeandChlamydia trachomatisinfections among gay men and other men who have sex with men (MSM): a prospective cohort in Abuja and Lagos, Nigeria

“…Advancing age is associated with a longer period of exposure to high risk sexual behaviors and therefore increased likelihood of acquiring an STI such as HIV, 28 . Moreover, evidence suggests that condomless sex and inconsistent condom use are higher among older MSM than among young MSM communities, 29 which contributes to a high incidence of STIs among older sex partners. Since older MSM may transmit STIs to younger MSM, interventions targeting young individuals for education about sexual risk, partner selection and consistent condom use are critical.…”

Substance use among men who have sex with men: patterns, motivations, impacts and intervention development need

“…Condomless anal intercourse is particularly strongly correlated with alcohol use disorder (a clinical term determined by the Diagnostic and Statistical Manual of Mental Disorders) 42. This global-level association has been documented in many countries, including Australia,11 Cambodia,43 India,44 China,45 Canada46 and the USA 47. However, in many instances, interaction effects with illicit drugs or varied psychosocial factors that also influence sexual risk-taking can confound significant findings 37…”