Bisexual and Bidirectional: Assessing the Potential for HIV Bridging in Mozambique

Abstract

African men who have sex with men (MSM) frequently, and often concurrently, have female partners, raising concerns about HIV sexual bridging. We explored potential HIV transmission in Mozambique from and to female partners of MSM focusing on preferred anal sex role and circumcision status. Data collected in a respondent-driven sampling study of MSM in 2011 in Maputo and Beira. Men who had oral or anal sex with other men 12 months prior completed a questionnaire and consented for HIV testing. Statistical analysis explored demographic/risk characteristics and associations among circumcision status, anal sex with men, sexual positions during anal sex with men and vaginal or anal sex with women. We identified 326 MSM in Maputo and 237 in Beira with both male and female partners 3 months before the study. Of these, 20.8% in Maputo and 36.0% in Beira had any receptive anal sex with men 12 months prior, including 895 unprotected sexual acts with males in Maputo and 692 in Beira. Uncircumcised and exclusively insertive males, 27.7% of the sample in Maputo and 33.6% in Beira, had the most unprotected sex with females: 1159 total acts in Maputo and 600 in Beira. Sexual bridging between MSM and women likely varies geographically and is probably bi-directional, occurring within a generalized epidemic where HIV prevalence is higher among reproductive-age women than MSM. Prevention strategies emphasizing correct and consistent condom use for all partners and circumcision for bisexual men should be considered.

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Acknowledgements

The authors are grateful to the members of the field teams for their dedication during the planning and implementation of this study. The authors also thank the study participants for their time. This research has been supported by the President’s Emergency Plan for AIDS Relief (PEPFAR) through the US Department of Health and Human Services and the Centers for Disease Control and Prevention (CDC) under the terms of Cooperative Agreement Number H-F3-MOZ-07-PTR-PWPS. The findings and conclusions presented in this manuscript are those of the authors and do not necessarily represent the official position of the CDC.

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Correspondence to Beverley Cummings.

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Cummings, B., Horth, R., McFarland, W. et al. Bisexual and Bidirectional: Assessing the Potential for HIV Bridging in Mozambique. AIDS Behav 22, 2189–2198 (2018). https://doi.org/10.1007/s10461-017-1994-0

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Keywords

  • Mozambique
  • Sexual bridging
  • MSM
  • HIV risk behavior
  • HIV transmission
  • Bisexuality