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“I Couldn’t Afford to Resist”: Condom Negotiations Between Male Sex Workers and Male Clients in Mombasa, Kenya

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Abstract

Male sex workers in Kenya face a disproportionate burden of HIV and often engage in condomless sex with their commercial partners, yet little is known about how condom negotiations between male sex workers and clients take place. We conducted semi-structured interviews with 25 male sex workers and 11 male clients of male sex workers in Mombasa, Kenya, to examine barriers and facilitators to condom use and how condom use negotiation takes place in these interactions. Participants reported positive attitudes toward condom use and perceived condom use to be a health-promoting behavior. Barriers to condom use included extra-payment for condomless sex, low perceived HIV/STI risk with some sexual partners, perceived reduced pleasure associated with using condoms, alcohol use, and violence against male sex workers by clients. Future interventions should address individual- and structural-level barriers to condom use to promote effective condom use negotiation between male sex workers and male clients.

Resumen

Los hombres trabajadores sexuales (HTS) en Kenia enfrentan una carga desproporcionada de VIH y frecuentemente tienen relaciones sexuales sin condón con sus parejas comerciales. Sin embargo, se sabe poco sobre cómo se llevan a cabo las negociaciones para usar condón entre los HTS y sus clientes. Realizamos entrevistas semiestructuradas con 25 HTS y 11 clientes masculinos de HTS en Mombasa, Kenia, para evaluar las barreras y los facilitadores al uso del condón e investigar como se llevan a cabo las negociaciones sobre el uso del condón. Los participantes informaron que tienen actitudes positivas hacia el uso del condón y percibían el uso del condón como un comportamiento que promueve la salud. El pago adicional por tener sexo sin condón, la baja percepción del riesgo de VIH/ITS con algunas parejas sexuales, la percepción de menos placer asociado con el uso del condón, el consumo de alcohol y la violencia de parte del cliente contra los HTS fueron barreras para el uso del condón. Las futuras intervenciones deben abordar las barreras a nivel individual y estructural para el uso del condón con el fin de promover una negociación efectiva para el uso del condón entre los HTS y sus clientes.

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Acknowledgements

We would like to thank the study participants for their time and input and the International Centre for Reproductive Health-Kenya (ICRH-K) for their support. We would also like to thank Alberto Edeza for translation of the abstract into Spanish.

Funding

This research and manuscript preparation was supported by a National Institute of Mental Health (NIMH) Grant, NIMH 5R01MH103034 (Principal Investigator: Joanne E. Mantell: A Structural Intervention for Most-At-Risk Populations in Mombasa, Kenya), and a NIMH Center Grant P30-MH43520 (Principal Investigator: Robert H. Remien, Ph.D). NIMH had no role in the conceptual and writing of this manuscript. This manuscript does not reflect the official views of NIMH.

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Authors and Affiliations

  1. Brown School of Public Health, Brown University, Providence, RI, USA

    Pablo K. Valente & Arjee J. Restar

  2. HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University Irving Medical Center, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA

    Pablo K. Valente, Joanne E. Mantell, Jack Ume Tocco, Arjee J. Restar & Theo G. Sandfort

  3. Department of Sociology and Anthropology, College of the Holy Cross, Worcester, MA, USA

    Tsitsi B. Masvawure

  4. International Centre for Reproductive Health-Kenya, Mombasa, Kenya

    Peter Gichangi & Sophie Vusha Chabeda

  5. International Centre for Reproductive Health-Ghent University, Ghent, Belgium

    Peter Gichangi & Yves Lafort

  6. Department of Anatomy, University of Nairobi, Nairobi, Kenya

    Peter Gichangi

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  1. Pablo K. Valente
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Correspondence to Joanne E. Mantell.

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Valente, P.K., Mantell, J.E., Masvawure, T.B. et al. “I Couldn’t Afford to Resist”: Condom Negotiations Between Male Sex Workers and Male Clients in Mombasa, Kenya. AIDS Behav 24, 925–937 (2020). https://doi.org/10.1007/s10461-019-02598-2

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