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We analyzed data from two surveys undertaken among male sex workers who sell sex to men in Mombasa. These surveys were carried out as part of a larger study evaluating the impact of peer outreach on HIV knowledge and behaviors among male sex workers, the detailed methodology of which is described elsewhere [21].
In brief, the surveys were carried out from October to December and February to April These male sex workers were recruited by trained peer mobilizers at known community sites which had been mapped in a previous study [22] : bars, nightclubs and discos, beach areas and beach bars, public streets, public parks, and other private brothels, businesses and estates. Sampling was based on a probability proportional to size approach from a time-venue sampling frame [25]. Peer mobilizers identified the male sex workers based on an initial visual characterization, followed by a casual conversation to confirm that the subject had recent history of and was currently willing to sell sex to men.
Male sex workers who agreed to participate were interviewed by trained interviewers at secure and centrally located venues. Statistical analysis was carried out using the Intercooled Stata To begin with, the socio-demographic characteristics and heterosexual behaviors of male sex workers were analyzed using descriptive statistics. Even though the and surveys were independent, some male sex workers may have participated in both surveys as personal identifiers were not used.
Thus, with the goal of combining both surveys for analysis, we first assessed socio-demographic characteristics and heterosexual behaviors for each survey separately, and compared differences in results using chi-squared tests for categorical variables and Wilcoxon rank-sum test for medians in order to determine whether data from both surveys could be combined in analysis.
Following this, the same descriptive analysis was carried out on the entire sample surveys combined. In a second analysis which included all participants from both surveys, socio-demographic characteristics associated with recent during the previous 30 days vaginal or oral sex, and with recent AI were identified in bivariate logistic regression. This definition did not exclude men who may have also recently practiced AI in addition to vaginal or oral sex.
As men who participated in the survey may have also participated in the survey, bivariate logistic regression was carried out after controlling for year of survey participation. This suggested that the data from both samples could be combined.
A total of male sex workers were surveyed in , and in One quarter of male sex workers stated that they had children of their own. Thirty-one percent had sex with both a female client and a non-paying partner. Table 2 shows the socio-demographic characteristics associated with report of recent AI in male sex workers who sell sex to men, after controlling for survey year in bivariate logistic regression. Characteristics associated with AI were being currently married OR, 2.
This study is one of the first to examine heterosexual AI behaviors among male sex workers who sell sex to men in Kenya. Our results show that whilst vaginal intercourse is the more widely practiced heterosexual behavior among male sex workers who sell sex to men in Mombasa, a substantial number of these men are also engaging in AI with women.
We also found that condom use in AI was lower than in vaginal intercourse, which may be due to a general perception that anal sex is safer than vaginal sex as was reported in qualitative discussions with the male sex workers [24]. These findings suggest that male sex workers who practice bisexual behaviors show closer interactions with women in their daily lives.
As mentioned previously, male sex workers in Mombasa who self-identify as basha, king, or bisexual are more likely to be an insertive partner during anal sex with men than other identities [25]. These male sex workers likely play a more masculine sexual role with both male and female partners, but more qualitative inquiry is needed to understand these complex social, sexual, and commercial interactions and their public health implications. Additional factors associated with heterosexual AI were being Muslim rather than Protestant, and decreased likelihood of having completed secondary or higher education compared to primary education.
More qualitative enquiry into this possible explanation is needed. Given that men who have sex with men are at higher risk of HIV infection than general populations [28] , these male sex workers may be acting as a bridge for HIV transmission between higher-risk and lower-risk heterosexual female populations.
Paying female clients may also be populations at higher risk of HIV than non-paying female partners. More detailed study of sexual networking among male sex workers, their male and female clients, and non-paying partners are needed to understand the dynamics of HIV transmission among these groups. The surveys were based on self-reported data of sexual behaviors that are stigmatized, and thus subject to underreporting. Similarly, recall bias may have also resulted in an overestimation or underestimation of the frequencies reported here.
Another limitation of this study was the inability to compare socio-demographic characteristics of male sex workers who only had anal sex with those who only had vaginal or oral sex, due to small sample sizes.
Lastly, whilst we attempted to address repeat participation in the surveys by controlling for year of the survey in logistic regression analyses, it must still be noted that combining both surveys may have also resulted in overestimation or underestimation of frequencies. To conclude, we found that male sex workers who sell sex to men in Mombasa are also engaging in sex with women, including AI. The reported low condom use in AI, coupled with the high rate of HIV transmission associated with the behavior, suggest that a potential route of HIV transmission is being overlooked.
Thus, there may be an under-assessment of heterosexual AI behaviors among different populations, requiring more research to inform HIV prevention programming. Kenya: issue of homosexuality among Coastal youths : Speaking in Mombasa during a leaders meeting, Ngilu said she was shocked by revelations that homosexuality among teenagers was rampant in Coastal towns She urged the provincial administration to crack down on tycoons who, she said, lured youths into homosexuality. Coast General Hospital chief administrator, Dr Khadija Shikelly, said schoolgirls engaged in anal sex to avoid getting pregnant.
The groups claim that homosexuality and immorality are on the rise in Kenya. Whilst the law in Kenya criminalizes homosexual acts between men, the law does not criminalize a community or an individual because of his or her sexual or gender identity. Gay bashing the new national pasttime in Kenya : When people use the term "gay bashing", they are often referring to gay people being physically attacked by bigots and the like.
But as any counsellor will tell you, physical attack is not the only way to cause hurt. Well-aimed and badly intentioned words can be just as vicious as a fist or a kick in the ribs. Homosexuality is against African norms and traditions, and even in religion it is considered a great sin,'' Arap Moi has been quoted saying i n Kenya's Daily Nation newspaper. But networks of men who have sex with men can be found across the continent.
And in Kenya, where homosexuality is a criminal offence, their voices are beginning to be heard. Statistics on the number of such men are hard to come by. Homosexuality and Aids: A double-edged sword As older women, known as mkungus, educate young girls in the duties of marriage, young homosexual men learn from male mkungus. Ahmed, 36, gives his pupils cooking lessons, advises them on perfumes that will please the "husband," and demonstrates how to wear a khanga flowered cloth in the house. At the end of the month's training he receives cloth and kitchen utensils as payment.
Three hundred miles away, in Nairobi, men come to a bar in a well-known public building for their "sun-downer"— the drink at the end of the day. Some are flamboyant, wearing makeup and jewelry. Jack, almost seven feet tall, is a year-old hairstylist who has been blackmailed and arrested several times by the police. Others are more discreet, such as Odongo, 42, a gas station attendant from near the Ugandan border who left his wife in his hometown and regularly pays for the company of young men Mke-si-mume: Neocolonialism and Sexual Practice in Kenya : Most men who have homosexual intercourse still tend to lead traditional Kenyan lives with a wife and children.
Some men who prefer sex with men claim that they are pressured into marriage. Several wives know of their husband's sexual and emotional relationships with other men, while others remain ignorant. Challenges in addressing counselling needs of MSM in highly stigmatized contexts: results of a qualitative study from Kenya : Participants expressed a range of attitudes to MSM from affirmation through tolerance to negative and stigmatizing, with some expressing that gayness was a disease that good counselling could change.
All said that they lacked skills to conduct effective risk- reduction counselling. Most had learned all they knew about MSM from male sex workers and mentioned triggers such as poverty, alcohol and drugs. Few linked risk taking behaviour with life issues, self worth and stigma. Skip to main content.
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