AIDS and Behavior

, Volume 19, Issue 9, pp 1630–1641 | Cite as

Sexual Violence Against Men Who Have Sex with Men in Brazil: A Respondent-Driven Sampling Survey

  • Meritxell Sabidó
  • Ligia Regina Franco Sansigolo Kerr
  • Rosa Salani Mota
  • Adele Schwartz Benzaken
  • Adriana de A. Pinho
  • Mark D. C. Guimaraes
  • Ines Dourado
  • Edgar Merchan-Hamman
  • Carl Kendall
Original Paper


We estimated the prevalence of sexual violence (SV) experience among men who have sex with men (MSM) in Brazil and identified its associated risk factors. We recruited 3859 MSM through respondent driven sampling. A multivariable hierarchical analysis was performed using an ecological model. The prevalence of having ever experienced SV was 15.9 % (95 % confidence interval [CI] 14.7–17.1). SV experience was independently associated with discrimination due to sexual orientation (odds ratio [OR] 3.05; 95 % CI 2.10–4.42), prior HIV testing (OR 1.81; 95 % CI 1.25–2.63), ≤14 years at first sex (OR 1.86; 95 % CI 1.28–2.71), first sex with a man (OR 1.89; 95 % CI 1.28–2.79), presenting STI symptoms (last year) (OR 1.66; 95 % CI 1.12–2.47), and having suicidal ideas (last 6 months) (OR 2.08; 95 % CI 1.30–3.35). The high levels of SV against MSM in Brazil place them at a markedly higher risk of SV than the general population. Homophobic prejudice is the strongest determinant of SV and urgently needs to be included at the forefront of the national response to SV.


Sexual violence Risk factors MSM Respondent-driven sampling Brazil 


Se estimó la prevalencia de haber experimentado violencia sexual (VS) entre hombres que tienen sexo con hombres (HSH) en Brasil y se identificó sus factores de riesgo. Se reclutó 3859 HSH mediante respondent driven sampling. Se realizó un análisis multivariado hierárquico usando un modelo ecológico. La prevalencia de experiencia de VS alguna vez fue 15.9 % (Intervalo de confianza [IC] 95 % 14.7–17.1). Los factores asociados independientemente con haber sufrido VS alguna vez fueron discriminación debida a orientación sexual (odds ratio [OR] 3.05; 95 % CI 2.10–4.42), haber realizado la prueba del VIH (OR 1.81; 95 % CI 1.25–2.63), ≤14 años de edad en la primera relación sexual (OR 1.86; 95 % CI 1.28–2.71), primera relación sexual con un hombre (OR 1.89; 95 % CI 1.28–2.79), presentar síntomas de ITS durante el último año (OR 1.66; 95 % CI 1.12–2.47), y tener ideas suicidas durante los últimos 6 meses (OR 2.08; 95 % CI 1.30–3.35). Los altos niveles de VS contra los HSH en Brasil sitúan este grupo ante un riesgo de VS superior que la población general. La homofobia es el determinante más importante y debe de encabezar urgentemente la respuesta nacional ante la VS.



This work was supported by the National Department on STD, AIDS, and Viral Hepatitis of the Ministry of Health through a Grant (CSV 234/07). The study site in Manaus received additional funding from the Joint United Nations Programme on HIV/AIDS (UNAIDS) in Brazil. Dr. Kerr thanks the Institute for Global Health of the University of San Francisco California where the original Project was conceived. Dr. Sabidó has a fellowship as a visiting senior researcher at the Fundação de Medicina Tropical. Dr. Heitor Vieira Dourado that is funded by the Foundation for Research Support of the Amazonas State (FAPEAM) through the Strategic Programme in Science, Technology & Innovation in Health Foundations (PECTI/AM SAÚDE).

Conflict of interest

The authors declare that they have no competing interest.


  1. 1.
    Krug EG et al. World report on violence and health. Geneva, World Health Organization, 2002. Last accessed: 30 Jan 2014.
  2. 2.
    Randle AA, Graham CA. A review of the evidence on the effects of intimate partner violence on men. Psychol Men Masc. 2011;12:97–111.CrossRefGoogle Scholar
  3. 3.
    Stall R, Mills TC, Williamson J, et al. Association of co-occurring psychosocial health problems and increased vulnerability to HIV/AIDS among urban men who have sex with men. Am J Public Health. 2003;93:939–42.PubMedCentralCrossRefPubMedGoogle Scholar
  4. 4.
    Dunkle KL, Jewkes RK, Murdock DW, Sikweyiya Y, Morrell R. Prevalence of consensual male-male sex and sexual violence, and associations with HIV in South Africa: a population-based cross-sectional study. PLoS Med. 2013;10:e1001472.PubMedCentralCrossRefPubMedGoogle Scholar
  5. 5.
    Baral S, Trapence G, Motimedi F, et al. HIV prevalence, risks for HIV infection, and human rights among men who have sex with men (MSM) in Malawi, Namibia, and Botswana. PLoS One. 2009;4:e4997.PubMedCentralCrossRefPubMedGoogle Scholar
  6. 6.
    Lane T, Raymond HF, Dladla S, et al. High HIV prevalence among men who have sex with men in Soweto, South Africa: results from the Soweto men’s study. AIDS Behav. 2011;15:626–34.PubMedCentralCrossRefPubMedGoogle Scholar
  7. 7.
    Dunkle KL, Wong FY, Nehl EJ, et al. Male-on-male intimate partner violence and sexual risk behaviors among money boys and other men who have sex with men in Shanghai, China. Sex Transm Dis. 2013;40:362–5.CrossRefPubMedGoogle Scholar
  8. 8.
    Shaw SY, Lorway RR, Deering KN, et al. Factors associated with sexual violence against men who have sex with men and transgendered individuals in Karnataka, India. PLoS One. 2012;7:e31705.PubMedCentralCrossRefPubMedGoogle Scholar
  9. 9.
    Toro-Alfonso J, Rodriguez-Madera S. Domestic violence in Puerto Rican gay male couples: perceived prevalence, intergenerational violence, addictive behaviors, and conflict resolution skills. J Interpers Violence. 2004;19:639–54.CrossRefPubMedGoogle Scholar
  10. 10.
    Guadamuz TE, Wimonsate W, Varangrat A, et al. Correlates of forced sex among populations of men who have sex with men in Thailand. Arch Sex Behav. 2011;40:259–66.PubMedCentralCrossRefPubMedGoogle Scholar
  11. 11.
    Beyrer C, et al. The global HIV epidemics among men who have sex with men. Washington: The World Bank; 2011.CrossRefGoogle Scholar
  12. 12.
    Ellis CD. Male rape–the silent victims. Collegian. 2002;9(4):34–9.CrossRefPubMedGoogle Scholar
  13. 13.
    Feldman MB, Ream GL, Díaz RM, El-Bassel N. Intimate partner violence and HIV sexual risk behavior among Latino gay and bisexual men. J LGBT Health Res. 2007;3:9–19.CrossRefPubMedGoogle Scholar
  14. 14.
    Schraiber LB, D’Oliveira AF, França I Jr. Grupo de Estudos em População, Sexualidade e Aids. [Intimate partner sexual violence among men and women in urban Brazil, 2005]. Rev Saude Publica. 2008;42(Suppl 1):127–37.CrossRefPubMedGoogle Scholar
  15. 15.
    Finneran C, Chard A, Sineath C, Sullivan P, Stephenson R. Intimate partner violence and social pressure among gay men in six countries. West J Emerg Med. 2012;13:260–71.PubMedCentralCrossRefPubMedGoogle Scholar
  16. 16.
    Koblin BA, Torian L, Xu G, et al. Violence and HIV-related risk among young men who have sex with men. AIDS Care. 2006;18:961–7.CrossRefPubMedGoogle Scholar
  17. 17.
    World Health Organization. World report on violence and health: summary. Geneva, Switzerland, 2002. Accessed at 17 Dec 2013.
  18. 18.
    Kerr LR, Mota RS, Kendall C, et al. HIV among MSM in a large middle-income country. Aids. 2012;27:427–35.CrossRefGoogle Scholar
  19. 19.
    Barbosa A Jr, Pascom AR, Szwarcwald CL, Kendall C, McFarland W. Transfer of sampling methods for studies on most-at-risk populations (MARPs) in Brazil. Cad Saude Publica. 2011;27(Suppl 1):S36–44.Google Scholar
  20. 20.
    Johnston LG, Malekinejad M, Kendall C, Iuppa IM, Rutherford GW. Implementation challenges to using respondent-driven sampling methodology for HIV biological and behavioral surveillance: field experiences in international settings. AIDS Behav. 2008;12(4 Suppl):S131–41.CrossRefPubMedGoogle Scholar
  21. 21.
    Heacktorn DD. Respondent-driven sampling: a new approach to the study of hidden populations. Soc Probl. 1997;44:174–99.CrossRefGoogle Scholar
  22. 22.
    Salganik M, Heacktorn DD. Extensions of respondent driven sampling: analyzing continuous variables and controlling for differential recruitment. Sociol Methodol. 2007;37:151–207.CrossRefGoogle Scholar
  23. 23.
    Szwarcwald CL, de Souza PR Jr, Damacena GN, Junior AB, Kendall C. Analysis of data collected by RDS among sex workers in 10 Brazilian cities, 2009: estimation of the prevalence of HIV, variance, and design effect. J Acquir Immune Defic Syndr. 2011;57(Suppl 3):S129–35.CrossRefPubMedGoogle Scholar
  24. 24.
    Ministry of Health of Brazil, Health Surveillance Secretariat. Department of STD, aids and viral hepatitis. (Survey of knowledge, attitudes and practices related to STD and aids of the Brazilian population aged 15 to 64 years old, 2008). Brasília: Ministry of Health; 2011.Google Scholar
  25. 25.
    Victora CG, Huttly SR, Fuchs SC, Olinto MT. The role of conceptual frameworks in epidemiological analysis: a hierarchical approach. Int J Epidemiol. 1997;26:224–7.CrossRefPubMedGoogle Scholar
  26. 26.
    Venturi G, Recamán M, Oliveira S. A mulher brasileira nos espaços público e privado: Editora. Sao Paulo: Fundacao Perseu Abramo; 2004.Google Scholar
  27. 27.
    de Oliveira HN, Machado CJ, Guimaraes MD. Factors associated with self-report of sexual violence against men and women with mental disorders in Brazil. Soc Psychiatry Psychiatr Epidemiol. 2012;47:1567–79.CrossRefPubMedGoogle Scholar
  28. 28.
    Heintz AJ, Melendez RM. Intimate partner violence and HIV/STD risk among lesbian, gay, bisexual, and transgender individuals. J Interpers Violence. 2006;2:193–208.CrossRefGoogle Scholar
  29. 29.
    Watts C, Zimmerman C. Violence against women: global scope and magnitude. Lancet. 2002;359:1232–7.CrossRefPubMedGoogle Scholar
  30. 30.
    Barker G et al. Evolving men. Initial results from the international men and gender equality survey (IMAGES). Washington: International Center for Research on Women (ICRW) and Rio de Janeiro: Instituto Promundo, 2011. Last accessed at 2 Feb 2014.
  31. 31.
    Venturi G, Bokany V. Diversidade sexual e homofobia no Brasil. Editora Fundação Perseu Abramo, 2008.Google Scholar
  32. 32.
    Araujo MA, Montagner MA, da Silva RM, Lopes FL, de Freitas MM. Symbolic violence experienced by men who have sex with men in the primary health service in Fortaleza, Ceara, Brazil: negotiating identity under stigma. AIDS Patient Care STDS. 2009;23:663–8.CrossRefPubMedGoogle Scholar
  33. 33.
    King M, Woollett E. Sexually assaulted males: 115 men consulting a counseling service. Arch Sex Behav. 1997;26:579–88.CrossRefPubMedGoogle Scholar
  34. 34.
    Finneran C, Stephenson R. Gay and bisexual men’s perceptions of police helpfulness in response to male-male intimate partner violence. West J Emerg Med. 2013;14:354–62.PubMedCentralCrossRefPubMedGoogle Scholar
  35. 35.
    Welles SL, Corbin TJ, Rich JA, Reed E, Raj A. Intimate partner violence among men having sex with men, women, or both: early-life sexual and physical abuse as antecedents. J Community Health. 2011;36:477–85.CrossRefPubMedGoogle Scholar
  36. 36.
    Secretaria Nacional de Assistência Social (SNAS)/Ministério do Desenvolvimento Social e Combate à Fome (MDS). Orientações Técnicas: Centro de Referência Especializado de Assistência Social—CREAS. Brasília, 2011. Last accessed at 06 Dec 2014.
  37. 37.
    Ministério da Saúde do Brasil. Temático prevençao de violências e cultura de paz. VIII. Panei de indicadores do SUS. No: 5. Organizaçao Panamericana da Saúde. Brasília: 2008.
  38. 38.
    Lloyd S, Operario D. HIV risk among men who have sex with men who have experienced childhood sexual abuse: systematic review and meta-analysis. AIDS Educ Prev. 2012;24:228–41.CrossRefPubMedGoogle Scholar
  39. 39.
    Chan KL, Straus MA, Brownridge DA, Tiwari A, Leung WC. Prevalence of dating partner violence and suicidal ideation among male and female university students worldwide. J Midwifery Womens Health. 2008;53:529–37.CrossRefPubMedGoogle Scholar
  40. 40.
    Masho SW, Anderson L. Sexual assault in men: a population-based study of Virginia. Violence Vict. 2009;24:98–110.CrossRefPubMedGoogle Scholar
  41. 41.
    DeJong J, Mahfoud Z, Khoury D, Barbir F, Afifi RA. Ethical considerations in HIV/AIDS biobehavioral surveys that use respondent-driven sampling: illustrations from Lebanon. Am J Public Health. 2009;99:1562–7.PubMedCentralCrossRefPubMedGoogle Scholar
  42. 42.
    Johnston LG, Whitehead S, Simic-Lawson M, Kendall C. Formative research to optimize respondent-driven sampling surveys among hard-to-reach populations in HIV behavioral and biological surveillance: lessons learned from four case studies. AIDS Care. 2010;22:784–92.CrossRefPubMedGoogle Scholar
  43. 43.
    Ministério da Justiça. Secretaria de Estado dos Direitos Humanos. Departamento da Criança e do Adolescente. Plano Nacional de enfrentamento da violência sexual infanto-juvenil. Ministério da Justiça, Brasília: 2002. Last accessed at 05 March 2014.

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Meritxell Sabidó
    • 1
    • 2
  • Ligia Regina Franco Sansigolo Kerr
    • 3
  • Rosa Salani Mota
    • 4
  • Adele Schwartz Benzaken
    • 5
    • 6
  • Adriana de A. Pinho
    • 7
  • Mark D. C. Guimaraes
    • 8
  • Ines Dourado
    • 9
  • Edgar Merchan-Hamman
    • 10
  • Carl Kendall
    • 11
  1. 1.Fundação de Medicina Tropical Doutor Heitor Vieira Dourado (FMT-HVD)ManausBrazil
  2. 2.TransLab. Department of Medical SciencesUniversitat de GironaGironaSpain
  3. 3.Departamento de Saúde ComunitáriaUniversidade Federal do CearáFortalezaBrazil
  4. 4.Departamento de Estatística e Matemática AplicadaUniversidade Federal do CearáFortalezaBrazil
  5. 5.Fundação Alfredo da MataManausBrazil
  6. 6.Departamento de DST, Aids e Hepatites Virais, Secretaria de Vigilância em SaúdeMinistério da SaúdeBrasíliaBrazil
  7. 7.Escola Nacional de Saúde PúblicaFundação Oswaldo Cruz (FIOCRUZ)Rio De JaneiroBrazil
  8. 8.Departamento de Medicina Preventiva e Social, Faculdade de MedicinaUniversidade Federal de Minas GeraisBelo HorizonteBrazil
  9. 9.Instituto de Saúde ColetivaUniversidade Federal da BahiaSão SalvadorBrazil
  10. 10.Departamento de Saúde ColetivaUniversidade de BrasíliaBrasíliaBrazil
  11. 11.Department of Global Community Health and Behavioral SciencesTulane University School of Public Health and Tropical MedicineNew OrleansUSA

Personalised recommendations