Informing HIV and STI prevention programs for men who sell sex to men in Mombasa, Kenya

Background: Despite anecdotal information regarding the existence of men who sell sex to men (MSSM) in Mombasa, Kenya, there has been no systematic data collected on this vulnerable population. Better understanding of MSSM sexual risk behaviors is needed to inform HIV and STI prevention programs, so their specific needs may be addressed.

Methods: In 2006, a cross-sectional survey of 425 MSSM in Mombasa District was conducted, utilizing a time-location sampling design. Using a structured questionnaire administered through handheld computers, data was collected on socio-demographic characteristics, sexual behaviors, prevention knowledge and practices, discrimination, and health service utilization. The survey was supplemented with 10 in-depth interviews and three focus group discussions.

Results: While 58% of respondents reported using a condom during anal sex with their last male client, only 36% reported consistent condom use. Only 15% reported using a water-based lubricant with their last male client. Of those who have ever used condoms, those who reported using water-based lubrication with their last male client were significantly less likely than those who used other lubrications—such as Vaseline—to have ever experienced condom breakage (46% vs. 61%, p=0.033). 35% of respondents did not know HIV can be transmitted via anal sex.

Recommendations: Existing HIV/STI prevention and care programs are failing to reach many MSSM. An HIV prevention program is currently being implemented by ICRH in Mombasa to address this gap via the opening of an MSM-friendly drop-in centre, condom and lubricant distribution, and prevention education through peer educators.