Social, Relational and Network Determinants of Unprotected Anal Sex and HIV Testing Among Men Who Have Sex with Men in Beirut, Lebanon

Abstract

Social, relational and network determinants of condom use and HIV testing were examined among 213 men who have sex with men (MSM) in Beirut. 64% reported unprotected anal intercourse (UAI), including 23% who had UAI with unknown HIV status partners (UAIU); 62% had HIV-tested. In multivariate analysis, being in a relationship was associated with UAI and HIV testing; lower condom self-efficacy was associated with UAIU and HIV testing; gay discrimination was associated with UAIU; MSM disclosure was associated with UAI, UAIU and HIV testing; and network centralization was associated with HIV testing. Multi-level social factors influence sexual health in MSM.

HIV in men who have sex with men in Lebanon: clinical and psychosocial aspects

“…However, these data are now at least 7 years old. In a study of 213 MSM, a prevalence of 1.5% (3/197) was reported,2 while another study in 2017, using a similar sampling strategy, reported a prevalence of 12.3% in 292 MSM, 25% of whom were Syrian refugees 4. In short, we do not yet have reliable data on HIV epidemiology in MSM in Lebanon and other potential secondary makers of HIV infection, such as syphilis and gonorrhoea prevalence, are not reported to the NACP.…”

“…When compared with other MENA countries, Lebanon is one of the safest for sexual minority groups. Its capital city, Beirut, is one of the most socially progressive cities in MENA, with a vibrant MSM community and gay bars, clubs and community centres 2. Yet, we know little about HIV prevalence, incidence and risk factors in MSM in Lebanon, a group disproportionately affected by the condition.…”

“…The epidemic is concentrated in MSM and incidence has increased from at least 47.7% MSM of all HIV diagnoses in 2016 to at least 54.15% in 2017 (38.3% of the reported cases in 2016 had a 'not specified' sexual orientation vs 9.8% in 2017) 3. According to a data synthesis, 3500 people were estimated to be living with HIV in Lebanon in 2011 (less than 0.01% of the general population and 3.7% of MSM) 2. However, these data are now at least 7 years old.…”

“…However, these data may not be representative of MSM in Lebanon for at least two reasons. First, studies have generally included more MSM in relationships, who are much more likely to have tested for HIV than men not in relationships, potentially causing selection bias 2. Second, participant samples have included a large number of MSM engaged in sex work (36% according to one study) 6.…”

“…This group is less likely to use condoms and to access health services, due to socio-structural barriers such as poverty, stigma and legal issues. Furthermore, Wagner et al reported a testing rate of 62% in their study of 213 MSM from Beirut 2. Although the overall testing rates appear to have increased, there is a need to increase their prevalence and frequency in MSM.…”