Alcohol, fear, trust and money make condomless sex more likely

A large survey in Zimbabwe among men who have sex with men has provided new insight into the factors behind condomless sex. 

What is the research about?

Researchers surveyed 1,511 men who have sex with men in Harare and Bulawayo in 2019. The survey included questions and HIV testing. It is the largest of its kind in the country to provide detailed information on condom use among men who have sex with men. 

Why is this research important?

In 2021, HIV prevalence among men who have sex with men in Zimbabwe was estimated at just below 50%. Homosexuality is criminalised in the country. The fear of arrest and widespread homophobia stops many men who have sex with men from accessing condoms and other HIV prevention services, HIV testing and treatment. There is also a major lack of data to inform targeted HIV programming. 

What did they find out?

HIV prevalence among survey respondents was 22.5%. 

Men in the study with HIV reported a mean average of five male sexual partners in the past six months. This was higher than men in the study without HIV, who had a mean average of three male partners. At least half of all respondents had also had sex with a woman at some point in their life.

At least 30% of all respondents did not use a condom when having anal sex. 

In some circumstances, men with HIV were less likely to use a condom than men without HIV. Four factors were identified in relation to this. These were:

1. Alcohol

Around one-third (35%) of men with HIV had sex without a condom when they were drunk, compared to one-quarter (25%) of men without HIV. 

2. Fear 

Among men with HIV, 13% had condomless sex because they were scared of their partner, compared with 9% of men without HIV. 

3. Trust 

Trusting a partner led 10% of men with HIV to have condomless sex, compared to 6% of men without HIV.

4. Money 

A large minority of respondents had sex for money (37% of men with HIV; 23% of men without HIV). Among men with HIV, 10% had sex without a condom after being offered more money, compared to 6% of men without HIV.

Respondents gave other reasons for having condomless sex. These include knowing their partner’s HIV status, not having a condom, getting carried away, disliking condoms, being in prison, thinking that anal sex is safe, having a partner that pulls out before ejaculating, having an attractive partner, being embarrassed to get a condom, and condoms causing a rash. 

One in five had used PrEP at some point in their life. This rate was 31% among men without HIV, and 22% among men with HIV (who had presumably used PrEP before getting HIV). 

What does this mean for HIV services?

There is an urgent need to make it easier for men who have sex with men to access HIV prevention services and accurate HIV information.

HIV-positive men who have sex with men need to be able to access HIV treatment. This is essential for individual health and to reduce people’s viral load to an untransmittable rate. Men in this group also need regular access to free condoms and lubricants.

HIV-negative men who have sex with men need regular access to PrEP, condoms, lubricant and HIV testing.

Regardless of HIV status, all men who have sex with men need clear and targeted HIV information as well as well-being and mental health support. This can help men better understand their HIV risk and reduce the behaviours that can lead to HIV transmission.

Be in the KNOW has lots of useful information for men who have sex with men. This includes targeted sexual health advice, how to reduce HIV risk when drinking alcohol or taking drugs, and a video series on gay health, sex and HIV. You can also find tips on how to make services more inclusive of gay, bisexual and other men who have sex with men.