Transactional intercourse between MSM sex workers, women in Kenya may be frequent

More than half of male sex workers in Mombasa, Kenya who predominantly have male clients may also be having intercourse with women, according to findings presented at the 17th Conference on Retroviruses and Opportunistic Infections in San Francisco.

Adrian Smith, MSc, of the University of Oxford in the United Kingdom, said that as many as 59% of men who have sex with men sex workers may have regular transactional encounters with one or more female partners. “This fundamentally changes ideas on the directionality of sex work,” he said.

The aim of the study was to determine the nature of interactions between the HIV epidemics among MSM and heterosexual populations in Africa.

“We observed a lower HIV prevalence among MSM sex workers who had sex with women than in those who only had sex with men,” Smith said.

Eighty-three participating MSM sex workers completed questionnaires and recorded details of 1,014 sexual partners in a diary during the course of six weeks.

Data on 215 (17%) female partners were recorded.

Among 43 recent female partners, 81% were unmarried and 19% were married. Three of those women were spouses of MSM sex workers.

The workers received money for sex from 144 women. MSM sex workers paid the women for sex in 18% of the encounters.

Among single-episode contacts, 99 of 138 were paying female clients. Payment was given in 45 of 77 recurring sexual relationships.

Penetrative intercourse occurred in 99% of the sexual encounters between women and MSM sex workers. Those encounters were broken down as follows: 87% vaginal, 54% anal and 43% for both.

Among the sexual acts, unprotected penetrative vaginal sex occurred in 38% of encounters, and unprotected anal sex occurred in 46% of encounters.

“Most unprotected acts overall occurred in partnerships that were new and being paid for by the female partner,” Smith said. “However, the chance of an individual encounter being unprotected was highest in a regular partnership where no money changed hands. Condom use was lowest within enduring, nontransactional partnerships.”

According to Smith, public misconceptions about the safety of anal sex vs. vaginal sex may exist. “They may think that anal sex is not as dangerous,” he said.

“Little is known of the personal risk awareness and motivations for women seeking sex with MSM sex workers,” Smith said.

“These issues of risk are being overlooked by interventions targeting risk reduction between MSM alone. Interventionsshould consider that MSM sex workers may be having female partners.” — by Rob Volansky

For more information:

Smith A. #39. Presented at: 17th Conference on Retroviruses and Opportunistic Infections; Feb. 16-19, 2010; San Francisco.