Homonegativity, sexual violence and condom use with women in men who have sex with men and women in West Africa

Abstract

Objective: The study aimed to explore longitudinal interactions between homonegativity and sexual behaviors with female partners among HIV-negative West African men who have sex with men and women (MSMW). Design and method: The community-based cohort CohMSM ANRS 12324 – Expertise France enrolled MSM in Togo, Burkina Faso, Côte d’Ivoire and Mali. Sociobehavioral data were collected every 6 months. Using 30-month follow-up data, a multiprobit analysis was performed to investigate the relationship between psychosocial and behavioral variables ex-ante (t − 1) and ex-post (t). Results: MSMW (n = 326) accounted for half of all participants in CohMSM. They reported inconsistent condom use with women in 39% of visits. Perceived and internalized homonegativity at t − 1 tended to lead to sexual violence toward women at t (P < 0.1), which was associated with inconsistent condom use with them at t (P < 0.05). Conclusion: Given the high HIV prevalence in West African MSM, widespread condom-less sex with women in MSMW, and the aggravating effect of social and internalized homonegativity, more research in the MSMW subpopulation is needed to assess the risk of HIV bridging to women and to design support activities.

Sexual behaviours and risk with women in MSM in sub-Saharan Africa

“…Implications for HIV epidemics and future research Based on quantitative behavioral indicators and qualitative data, our multilevel synthesis supports the hypothesis that MSMW in SSA may act as a bridging population for HIV transmission in women. Furthermore, it is plausible that the estimated proportions of MSMW in MSM are underestimated here, given that MSMW may be more concealed and thus more challenging to access than exclusive MSM [128]. On the other side, the data presented here are limited to the proportions of MSM engaging in sexual activity and at-risk behaviors with women, which does not necessarily imply that HIV bridging to women occurred.…”

“…This probably influences the pressure experienced by MSM to have sex with women. Ongoing work from our systematic review showed that the proportion of selfidentified bisexual MSM, a group with potential overlap with MSMW, was significantly lower in South Africa, compared with other Southern African countries [128].…”

“…Self-identifying as a bisexual man or having female partners may help to cope with social or internalized heteronormative pressure, which is probably less present in South Africa where same-sex marriage is legal (protective laws and policies may effectively reduce self-stigma in stigmatized populations) [128].…”

Characteristics of HIV/sexually transmitted infections among men who have sex with men and women in Bangkok, Thailand

“…21 A previous report from West Africa revealed that inconsistent condom usage with wife/girlfriend was reported in 57% of MSMW. 22 Since MSMW have sex with both genders, there is the possibility that they will transmit HIV and other STIs from a male partner to a female partner or vice versa. 23 Another issue is that MSMW were found to be less likely to have HIV laboratory testing and thus more likely to be unaware of an HIV infection.…”

COVID-19-related attitudes, risk perceptions, preventive behaviours and economic impact in sub-Saharan African countries: implementing a longitudinal phone-based survey protocol in rural Senegalese households

“…While these categories are consistent with those adopted in some Northern countries, they will be grouped into broader categories if necessary (such as Employed, Seeking employment, and Other, inactive (Students, Pensioners)) and then considered in relation to educational level. 27 …”