Archives of Sexual Behavior

, Volume 40, Issue 2, pp 259–266

Correlates of Forced Sex Among Populations of Men Who Have Sex with Men in Thailand

  • Thomas E. Guadamuz
  • Wipas Wimonsate
  • Anchalee Varangrat
  • Praphan Phanuphak
  • Rapeepun Jommaroeng
  • Philip A. Mock
  • Jordan W. Tappero
  • Frits van Griensven
Original Paper


Although forced sex is a correlate of HIV infection, its prevalence and associated risks are not well described among men who have sex with men (MSM) in developing-country settings. Between March and October 2005, we assessed the prevalence of forced sex and correlates among populations of MSM (this includes general MSM, male sex workers, and male-to-female transgender persons) in Thailand using a community-based sample. Participants were enrolled from venues around Bangkok, Chiangmai, and Phuket using venue day-time sampling. Handheld computer-assisted self-interviewing was used to collect demographic and behavioral data and logistic regression evaluated factors associated with forced sex, defined as ever being forced to have sexual intercourse against one’s will. Of the 2,049 participants (M age, 24.8 years), a history of forced sex was reported by 376 (18.4%) men and, of these, most were forced by someone they knew (83.8%), forced more than once (67.3%), and had first occurrence during adolescence (55.1%). In multivariate analysis, having a history of forced sex was significantly associated with being recruited in Phuket, classification as general MSM or transgender (versus classification as male sex worker), drug use, increased number of male sexual partners, and buying sex. The findings in our assessment were consistent with assessments from Western countries. Longitudinal studies are needed to understand the mechanisms of the relationships between forced sex correlates found in our assessment and HIV acquisition and transmission risks.


Sexual coercion Men who have sex with men Male sex workers Transgender Thailand 


  1. Bartholow, B. N., Doll, L. S., Joy, D., Douglas, J. M., Bolan, G., Harrison, J. S., et al. (1994). Emotional, behavioral, and HIV risks associated with sexual abuse among adult homosexual and bisexual men. Child Abuse & Neglect, 18, 747–761.CrossRefGoogle Scholar
  2. Beyrer, C., Eiumtrakul, S., Celentano, D. D., Nelson, K. E., Ruckphaopunt, S., & Khamboonruang, C. (1995). Same-sex behavior, sexually transmitted diseases and HIV risks among young northern Thai men. AIDS, 9, 171–176.PubMedGoogle Scholar
  3. Burke, L. K., & Follingstad, D. R. (1999). Violence in lesbian and gay relationships: Theory, prevalence, and correlational factors. Clinical Psychology Review, 19, 487–512.PubMedCrossRefGoogle Scholar
  4. Centers for Disease Control and Prevention. (2006). HIV prevalence among populations of men who have sex with men—Thailand, 2003 and 2005. Morbidity and Mortality Weekly Report, 55, 844–848.Google Scholar
  5. Chemnasiri, T., & Plipat, T. (2004). HIV-related risk behaviors among eleventh grade school students, Round 10, 2004. Weekly Epidemiological Surveillance Report, 10(suppl), S21–S28.Google Scholar
  6. Choi, K. H., Liu, H., Guo, Y., Han, L., Mandel, J. S., & Rutherford, G. W. (2003). Emerging HIV-1 epidemic in China in men who have sex with men. Lancet, 361, 2125–2126.PubMedCrossRefGoogle Scholar
  7. DiIorio, C., Hartwell, T., Hansen, N., & NIMH Multisite HIV Prevention Trial Group. (2002). Childhood sexual abuse and risk behaviors among men at high risk for HIV infection. American Journal of Public Health, 92, 214–219.PubMedCrossRefGoogle Scholar
  8. Dunkle, K. L., Jewkes, R. K., Brown, H. C., Gray, G. E., McIntryre, J. A., & Harlow, S. D. (2004). Gender-based violence, relationship power, and risk of HIV infection in women attending antenatal clinics in South Africa. Lancet, 363, 1415–1421.PubMedCrossRefGoogle Scholar
  9. Ellickson, P. L., Collins, R. L., Bogart, L. M., Klein, D. J., & Taylor, S. L. (2005). Scope of HIV risk and co-occurring psychosocial health problems among young adults: Violence, victimization, and substance use. Journal of Adolescent Health, 36, 401–409.PubMedCrossRefGoogle Scholar
  10. Friedman, M. S., Koeske, G. F., Silvestre, A. J., Korr, W. S., & Sites, E. W. (2006). The impact of gender-role nonconforming behavior, bullying, and social support on suicidality among gay male youth. Journal of Adolescent Health, 38, 621–623.PubMedCrossRefGoogle Scholar
  11. Friedman, M. S., Marshal, M. P., Guadamuz, T. E., Luby, S., Smith, H., Wong, C., et al. (March 6–9, 2008). Sexual orientation, child abuse, and health outcomes: A meta-analysis. International Counseling Psychology Conference, Chicago, IL, Abstract 53.Google Scholar
  12. Girault, P., Saidel, T., Song, N., De Van Lind Wijngaarden, J. W., Dallabetta, G., Stuer, F., et al. (2004). HIV, STIs, and sexual behaviors among men who have sex with men in Phnom Penh, Cambodia. AIDS Education and Prevention, 16, 31–44.PubMedCrossRefGoogle Scholar
  13. Gruskin, L., Gange, S. J., Celentano, D., Schuman, P., Moore, J. S., Zierler, S., et al. (2002). Incidence of violence against HIV-infected and uninfected women: Findings from the HIV epidemiology research (HER) study. Journal of Urban Health, 79, 512–524.PubMedGoogle Scholar
  14. Hoffman, S., O’Sullivan, L. F., Harrison, A., Dolezal, C., & Monroe-Wise, A. (2006). HIV risk behaviors and the context of sexual coercion in young adults’ sexual interactions: Results from a diary study in rural South Africa. Sexually Transmitted Diseases, 33, 52–58.PubMedCrossRefGoogle Scholar
  15. Holmes, W. C., & Slap, G. B. (1998). Sexual abuse of boys: Definition, prevalence, correlates, sequelae, and management. Journal of the American Medical Association, 280, 1855–1862.PubMedCrossRefGoogle Scholar
  16. Island, D., & Letellier, P. (1991). Men who beat the men who love them: Battered gay men and domestic violence. New York: The Haworth Press, Inc.Google Scholar
  17. Jackson, P. A., & Sullivan, G. (Eds.). (2000). Lady boys, tom boys, rent boys: Male and female homosexualities in contemporary Thailand. Chiangmai, Thailand: Silkworm Books.Google Scholar
  18. Johnson, R. J., Ross, M. W., Taylor, W. C., Williams, M. L., Carvajal, R. L., & Peters, R. J. (2006). Prevalence of childhood sexual abuse among incarcerated males in county jail. Child Abuse & Neglect, 30, 75–86.CrossRefGoogle Scholar
  19. Kitsiripornchai, S., Markowitz, L. E., Ungchusak, K., Jenkins, R. A., Leucha, W., Limpitaks, T., et al. (1998). Sexual behavior of young men in Thailand: Regional differences and evidence of behavior change. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology, 18, 282–288.PubMedGoogle Scholar
  20. Knodel, J., Gray, R. S., Sriwatcharin, P., & Peracca, S. (1999). Religion and reproduction: Muslims in Buddhist Thailand. Population Studies, 53, 149–164.CrossRefGoogle Scholar
  21. Koenig, M. A., Lutalo, T., Zhao, F., Nalugoda, F., Kiwanuka, N., Wabwire-Mangen, F., et al. (2004). Coercive sex in rural Uganda: Prevalence and associated risk factors. Social Science & Medicine, 58, 787–798.CrossRefGoogle Scholar
  22. Lenderking, W. R., Wold, C., Mayer, K. H., Goldstein, R., Losina, E., & Seage, G. R. III. (1997). Childhood sexual abuse among homosexual men: Prevalence and association with unsafe sex. Journal of General Internal Medicine, 12, 250–253.PubMedGoogle Scholar
  23. Leventhal, B., & Lundy, S. E. (Eds.). (1999). Same-sex domestic violence: Strategies for change. Thousand Oaks, CA: Sage Publications.Google Scholar
  24. Lichtenstein, B. (2005). Domestic violence, sexual ownership, and HIV risk in women in the American deep south. Social Science & Medicine, 60, 701–714.CrossRefGoogle Scholar
  25. London, A. S., VanLandingham, M. J., & Grandjean, N. (1997). Socio-demographic correlates, HIV/AIDS related cofactors, and measures of same-sex sexual behavior among northern Thai male soldiers. Health Transition Review, 7, 33–60.PubMedGoogle Scholar
  26. MacKellar, D., Vallerot, L., Karon, J., Lemp, G., & Janssen, R. (1996). The young men’s survey: Methods for estimating HIV seroprevalence and risk factors among young men who have sex with men. Public Health Reports, 3, 138–144.Google Scholar
  27. Maman, S., Campbell, J., Sweat, M., & Gielen, A. C. (2000). The intersections of HIV and violence: Directions for future research and interventions. Social Science & Medicine, 50, 459–478.CrossRefGoogle Scholar
  28. Manopaiboon, C., Kilmarx, P. H., Limpakarnjanarat, K., Jenkins, R. A., Chaikummao, S., Supawitkul, S., et al. (2003). Sexual coercion among adolescents in northern Thailand: Prevalence and associated factors. Southeast Asian Journal of Tropical Medicine and Public Health, 34, 447–457.PubMedGoogle Scholar
  29. Mansergh, G., Naorat, S., Jommaroeng, R., Jenkins, R. A., Jeeyapant, S., Kanggarnrua, K., et al. (2006). Adaptation of venue-day-time sampling in Southeast Asia to access men who have sex with men for HIV assessment in Bangkok. Field Methods, 18, 135–152.CrossRefGoogle Scholar
  30. Moore, T. M., & Stuart, G. L. (2005). A review of the literature on masculinity and partner violence. Psychology of Men & Masculinity, 6, 46–61.CrossRefGoogle Scholar
  31. Nelson, K. E., Eiumtrakul, S., Celentano, D. D., Beyrer, C., Galai, N., & Khamboonruang, C. (2002). HIV infection in young men in northern Thailand, 1991–1998: Increasing role of injection drug use. Journal of Acquired Immune Deficiency Syndrome, 29, 62–68.Google Scholar
  32. Ompad, D. C., Ikeda, R. M., Shah, N., Fuller, C. M., Bailey, S., Morse, E., et al. (2005). Childhood sexual abuse and age at initiation of injection drug use. American Journal of Public Health, 95, 703–709.PubMedCrossRefGoogle Scholar
  33. Paul, J. P., Catania, J., Pollack, L., & Stall, R. (2001). Understanding childhood sexual abuse as a predictor of sexual risk-taking among men who have sex with men: The Urban Men’s Health Study. Child Abuse & Neglect, 25, 557–584.CrossRefGoogle Scholar
  34. Pisani, E., Girault, P., Gultom, M., Sukartini, N., Kumalawati, J., Jazan, S., et al. (2004). HIV, syphilis infection, and sexual practices among transgenders, male sex workers, and other men who have sex with men in Jakarta, Indonesia. Sexually Transmitted Infections, 80, 536–540.PubMedCrossRefGoogle Scholar
  35. Ratner, P. A., Johnson, J. L., Shoveller, J. A., Chan, K., Martindale, S. L., Schilder, A. J., et al. (2003). Non-consensual sex experienced by men who have sex with men: Prevalence and association with mental health. Patient Education and Counseling, 49, 67–74.PubMedCrossRefGoogle Scholar
  36. Stall, R., Friedman, M., & Catania, J. A. (2008). Interacting epidemics and gay men’s health: A theory of syndemic production among urban gay men. In R. J. Wolitski, R. Stall, & R. O. Valdiserri (Eds.), Unequal opportunity: Health disparities affecting gay and bisexual men in the United States (pp. 251–275). New York: Oxford University Press.Google Scholar
  37. van Griensven, F., Kilmarx, P. H., Jeeyapant, S., Manopaiboon, C., Korattana, S., Jenkins, R. A., et al. (2004). The prevalence of bisexual and homosexual orientation and related health risks among adolescents in northern Thailand. Archives of Sexual Behavior, 33, 137–147.PubMedCrossRefGoogle Scholar
  38. van Griensven, F., Thanprasertsuk, S., Jommaroeng, R., Manseigh, G., Naorat, S., Jenkins, R. A., et al. (2005). Evidence of a previously undocumented epidemic of HIV infection among men who have sex with men in Bangkok, Thailand. AIDS, 19, 521–526.PubMedCrossRefGoogle Scholar
  39. Vlahov, D., Wientge, D., Moore, J., Flynn, C., Schuman, P., Schoenbaum, E., et al. (1998). Violence among women with or at risk for HIV infection. AIDS and Behavior, 2, 53–60.CrossRefGoogle Scholar
  40. Wolfe, D. A., Francis, K. J., & Straatman, A. (2006). Child abuse in religiously-affiliated institutions: Long-term impact on men’s mental health. Child Abuse & Neglect, 30, 205–212.CrossRefGoogle Scholar
  41. Zierler, S., Feingold, L., Laufer, D., Velentgas, P., Kantrowitz-Gordon, I., & Mayer, K. (1991). Adult survivors of childhood sexual abuse and subsequent risk of HIV infection. American Journal of Public Health, 81, 572–575.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Thomas E. Guadamuz
    • 1
    • 2
  • Wipas Wimonsate
    • 1
  • Anchalee Varangrat
    • 1
  • Praphan Phanuphak
    • 3
  • Rapeepun Jommaroeng
    • 4
  • Philip A. Mock
    • 1
  • Jordan W. Tappero
    • 1
    • 5
  • Frits van Griensven
    • 1
    • 6
  1. 1.Thailand Ministry of Public Health–U.S. Centers for Disease Control and Prevention CollaborationNonthaburiThailand
  2. 2.Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  3. 3.AIDS Research CentreBangkokThailand
  4. 4.Rainbow Sky Association of ThailandBangkokThailand
  5. 5.Global AIDS ProgramCenters for Disease Control and PreventionAtlantaUSA
  6. 6.Division of HIV/AIDS PreventionCenters for Disease Control and PreventionAtlantaUSA

Personalised recommendations