HIV risk among male migrant workers in Central Asia: Do masculinity beliefs about sexuality and marriage matter?

Background: The world's HIV epidemic is growing fastest in Central Asia. Migration is an important source of HIV vulnerability and sexual risk behavior has been reported among migrant workers in large cities in the region. There is, however, limited research on how masculinity beliefs, roles, and expectations around marriage and sexuality among male migrant workers from Central Asia influence their sexual risk behavior.

Methods: In-depth interviews were conducted with 43 migrant workers employed at the Barakholka marketplace in Almaty, Kazakhstan. Eligible participants maintained permanent residency outside Almaty. Interview transcripts were analyzed for themes.

Results: Participants' average age was 28.5 years. Most (60.5%) were married, and largely ethnic Tajik (27.9%) or Kyrgyz (23.3%). Three themes emerged related to multiple sexual partnerships and transactional sex: beliefs about masculine expectations that promote premarital sexual relationships; beliefs about masculine sexuality that promote infidelity; and gender norms that facilitate transactional sex. Participants reported engaging in premarital sexual relations in order to prepare for marriage and meet societal expectations of masculine sexual performance. They expressed that wives could not fulfill what was viewed as a masculine need for diverse sexual experiences—including anal and oral intercourse. To obtain fulfillment, married participants sought casual partners and sex workers. Normative patronage of sex workers by male friends and colleagues at the marketplace also promoted transactional sex. Participants reported irregular condom use with their multiple partners

Conclusion: HIV prevention strategies in Central Asia need to incorporate masculinity beliefs regarding marriage and sexuality to provide a gender-specific response to the epidemic.