High proportion of West African men who have sex with men engaging in transactional sex

Researchers working through CohMSM, an HIV prevention and care pilot programme for men who have sex with men (also known as MSM) based in cities in Burkina Faso, Côte d’Ivoire, Mali and Togo, found just under half of participants engaged in transactional sex. They also identified significant differences in socio-demographic characteristics and sexual behaviours among those who did and did not engage in the practice.

Each country reports high HIV prevalence among men who have sex with men, estimated at 22% in Togo, 13.7% in Mali, 11.2% in Côte d'Ivoire and 3.6% in Burkina Faso. Men who have sex with men involved in transactional sex are particularly at risk of acquiring and transmitting HIV. However, until this study, research on the factors associated with transactional sex among this population group in West Africa did not exist.

The study involved 630 HIV-negative men who have sex with men who participated in CohMSM between 2015 and 2018. Face-to-face interviews were conducted with all participants at enrolment (baseline), at six months with 463 participants, at 12 months with 410 participants and at 18 months with 244 participants. The median age of participants was just below 24. All men remained HIV-negative throughout the study.

Around 46% of participants reported regularly or occasionally having sex with a man in order to receive money, accommodation or any other benefit in the past six months. Around a third of these participants (31.5%) engaged in transactional sex regularly, a third (31.1%) engaged in it occasionally, 18% reported transactional sex at some point during the 18-month study and 19% stopped engaging in transactional sex after the baseline interview.

Younger men who have sex with men were significantly more likely to practice transactional sex. A strong association was also found between transactional sex and stigma; the more a participant had experienced stigmatisation in the past six months, the more likely they were to engage in the practice.

Those who had lower educational levels and who were unmarried were also significantly more likely to engage in transactional sex.

In terms of sexual behaviours, those who had multiple male sexual partners, engaged in group sex with men, practised receptive or versatile anal sex with a man, and reported alcohol consumption and/or drug use during sex were all significantly more likely to practice transactional sex. Interestingly, those who gave benefits in exchange for sex with a man were also more likely to receive benefits, suggesting an overlap of the two sub-groups.

Participants who reported condom use during anal sex were significantly less likely to practice transactional sex.

The fact that respondents participated in face-to-face interviews means some may have underreported risky sexual behaviours. However, this issue was taken into consideration by the study team and potentially minimised by the fact that all research assistants came from recognised non-governmental organisations and were directly involved with MSM-communities.

A close-to 69% decrease was observed in reported transactional sex after six months compared to baseline, which could be linked to the package of sexual health services offered by CohMSM. These included STI diagnosis, risk-reduction counselling specific for MSM, and the provision of condoms and lubricants. However, after 18 months the level of transactional sex was found to have increased.