O2.2 - Relationships and risk: A mixed-methods study of perceptions and management of STI/HIV risk among heterosexual-identifying men who have sex with both men and women
Heterosexual-identifying men who have sex with both men and women (H-MSMW) are an under-researched population who may facilitate STI/HIV transmission between MSM and heterosexual sexual networks. Using a mixed-methods approach, we investigated perceptions and management of STI/HIV transmission risk among H-MSMW, and how their relationship status with women affected their sexual behaviour.
Methods:
We used an exploratory sequential mixed-methods design, comprising semi-structured qualitative interviews (SSIs) with 14 H-MSMW in England, and secondary quantitative analysis of data from 486 H-MSMW participants of the 2010 European Men-Who-Have-Sex-With-Men Internet Survey (EMIS-2010) from 17 Western European countries, including 315 (64.8%) H-MSMW in steady relationships with women at the time of survey. We analysed SSIs thematically to develop initial hypotheses, which we tested quantitatively, estimating prevalence ratios (PR) to measure associations between relationship status and sexual behaviour with male partners.
Results:
H-MSMW interview participants expressed concern about potential STI/HIV acquisition through sex with men, and the consequences of this for the health of, and their relationships with, steady female partners. This encouraged the use of strategies to mitigate STI/HIV acquisition and transmission risk, including sexual exclusivity with female partners, condom use, STI/HIV testing after episodes of potential exposure, and avoiding sex (with male or female partners) they considered “high” risk of STI/HIV transmission. Quantitative analyses of EMIS-2010 data corroborate some of these findings; among H-MSMW, having a steady female partner was associated with a reduced likelihood of reporting anal intercourse (AI) with recent male partners (PR=0.81; 95%CI:0.72–0.92) and inconsistent condom use with male AI partners (PR=0.74; 95%CI:0.56–0.97). However, reporting of testing in the previous year was low (HIV testing: 24.7%; STI testing: 17.5%) and not associated with relationship status.
Conclusion:
This innovative mixed-methods study showed that some H-MSMW recognise the need for, and actively employ, strategies to reduce STI/HIV transmission risk, especially where this may affect their relationships with female partners. The limited effectiveness of some strategies and low levels of STI/HIV testing in this population suggest that H-MSMW would benefit from targeted sexual health messaging that is relevant to sex with both men and women.
