Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

“I Couldn’t Afford to Resist”: Condom Negotiations Between Male Sex Workers and Male Clients in Mombasa, Kenya

Abstract

Male sex workers in Kenya face a disproportionate burden of HIV and often engage in condomless sex with their commercial partners, yet little is known about how condom negotiations between male sex workers and clients take place. We conducted semi-structured interviews with 25 male sex workers and 11 male clients of male sex workers in Mombasa, Kenya, to examine barriers and facilitators to condom use and how condom use negotiation takes place in these interactions. Participants reported positive attitudes toward condom use and perceived condom use to be a health-promoting behavior. Barriers to condom use included extra-payment for condomless sex, low perceived HIV/STI risk with some sexual partners, perceived reduced pleasure associated with using condoms, alcohol use, and violence against male sex workers by clients. Future interventions should address individual- and structural-level barriers to condom use to promote effective condom use negotiation between male sex workers and male clients.

Resumen

Los hombres trabajadores sexuales (HTS) en Kenia enfrentan una carga desproporcionada de VIH y frecuentemente tienen relaciones sexuales sin condón con sus parejas comerciales. Sin embargo, se sabe poco sobre cómo se llevan a cabo las negociaciones para usar condón entre los HTS y sus clientes. Realizamos entrevistas semiestructuradas con 25 HTS y 11 clientes masculinos de HTS en Mombasa, Kenia, para evaluar las barreras y los facilitadores al uso del condón e investigar como se llevan a cabo las negociaciones sobre el uso del condón. Los participantes informaron que tienen actitudes positivas hacia el uso del condón y percibían el uso del condón como un comportamiento que promueve la salud. El pago adicional por tener sexo sin condón, la baja percepción del riesgo de VIH/ITS con algunas parejas sexuales, la percepción de menos placer asociado con el uso del condón, el consumo de alcohol y la violencia de parte del cliente contra los HTS fueron barreras para el uso del condón. Las futuras intervenciones deben abordar las barreras a nivel individual y estructural para el uso del condón con el fin de promover una negociación efectiva para el uso del condón entre los HTS y sus clientes.

This is a preview of subscription content, log in to check access.

Fig. 1

References

  1. 1.

    Oldenburg CE, Perez-Brumer AG, Reisner SL, Mattie J, Bärnighausen T, Mayer KH, et al. Global burden of HIV among men who engage in transactional sex: a systematic review and meta-analysis. PLoS ONE. 2014;9(7):e103549.

  2. 2.

    Vu L, Adebajo S, Tun W, Sheehy M, Karlyn A, Njab J, et al. High HIV prevalence among men who have sex with men in Nigeria: implications for combination prevention. JAIDS. 2013;63(2):221–7.

  3. 3.

    Baral S, Burrell E, Scheibe A, Brown B, Beyrer C, Bekker L-G. HIV risk and associations of HIV infection among men who have sex with men in peri-urban Cape Town, South Africa. BMC Public Health. 2011;11(1):766.

  4. 4.

    Muraguri N, Tun W, Okal J, Broz D, Raymond HF, Kellogg T, et al. HIV and STI prevalence and risk factors among male sex workers and other men who have sex with men in Nairobi, Kenya. JAIDS. 2015;68(1):91–6.

  5. 5.

    Oldenburg CE, Perez-Brumer AG, Reisner SL, Mimiaga MJ. Transactional sex and the HIV epidemic among men who have sex with men (MSM): results from a systematic review and meta-analysis. AIDS Behav. 2015;19(12):2177–83.

  6. 6.

    Geibel S, Luchters S, King’ola N, Esu-Williams E, Rinyiru A, Tun W. Factors associated with self-reported unprotected anal sex among male sex workers in Mombasa, Kenya. Sex Transm Dis. 2008;35(8):746–52.

  7. 7.

    Mannava P, Geibel S, King’ola N, Temmerman M, Luchters S. Male sex workers who sell sex to men also engage in anal intercourse with women: evidence from Mombasa, Kenya. PLoS ONE. 2013;8(1):e52547.

  8. 8.

    Geibel S, King’ola N, Temmerman M, Luchters S. The impact of peer outreach on HIV knowledge and prevention behaviours of male sex workers in Mombasa, Kenya. Sex Transm Infect. 2012;88(5):357–62.

  9. 9.

    Baral S, Trapence G, Motimedi F, Umar E, Iipinge S, Dausab F, et al. HIV prevalence, risks for HIV infection, and human rights among men who have sex with men (MSM) in Malawi, Namibia, and Botswana. PLoS ONE. 2009;4(3):e4997.

  10. 10.

    Okal J, Luchters S, Geibel S, Chersich MF, Lango D, Temmerman M. Social context, sexual risk perceptions and stigma: HIV vulnerability among male sex workers in Mombasa, Kenya. Cult Health Sex. 2009;11(8):811–26.

  11. 11.

    Luchters S, Geibel S, Syengo M, Lango D, King’ola N, Temmerman M, et al. Use of AUDIT, and measures of drinking frequency and patterns to detect associations between alcohol and sexual behaviour in male sex workers in Kenya. BMC Public Health. 2011;11(1):384.

  12. 12.

    Musinguzi G, Bastiaens H, Matovu JKB, Nuwaha F, Mujisha G, Kiguli J, et al. Barriers to condom use among high risk men who have sex with men in Uganda: a qualitative study. PLoS ONE. 2015;10(7):e0132297.

  13. 13.

    Okanlawon K, Adebowale AS, Titilayo A. Sexual hazards, life experiences and social circumstances among male sex workers in Nigeria. Cult Health Sex. 2013;15(sup1):22–33.

  14. 14.

    Baral SD, Friedman MR, Geibel S, Rebe K, Bozhinov B, Diouf D, et al. Male sex workers: practices, contexts, and vulnerabilities for HIV acquisition and transmission. Lancet (London, England). 2015;385(9964):260–73.

  15. 15.

    Oldenburg CE, Perez-Brumer AG, Reisner SL, Mayer KH, Mimiaga MJ, Hatzenbuehler ML, et al. Human rights protections and HIV prevalence among MSM who sell sex: cross-country comparisons from a systematic review and meta-analysis. Global Public Health. 2018;13(4):414–25.

  16. 16.

    Grov C, Wolff M, Smith MD, Koken J, Parsons JT. Male clients of male escorts: satisfaction, sexual behavior, and demographic characteristics. J Sex Res. 2014;51(7):827–37.

  17. 17.

    Prestage G, Jin F, Bavinton B, Hurley M. Sex workers and their clients among Australian gay and bisexual Men. AIDS Behav. 2014;18(7):1293–301.

  18. 18.

    Bloor MJ, Barnard MA, Finlay A, McKeganey NP. HIV-related risk practices among Glasgow male prostitutes: reframing concepts of risk behavior. Med Anthropol Q. 1993;7(2):152–69.

  19. 19.

    Browne J, Minichiello V. The social meanings behind male sex work: implications for sexual interactions. Br J Sociol. 1995;46:598–622.

  20. 20.

    Jana S, Basu I, Rotheram-Borus MJ, Newman PA. The Sonagachi Project: a sustainable community intervention program. AIDS Educ Prev. 2004;16(5):405–14.

  21. 21.

    Lippman SA, Donini A, Díaz J, Chinaglia M, Reingold A, Kerrigan D. Social-environmental factors and protective sexual behavior among sex workers: the Encontros intervention in Brazil. Am J Public Health. 2010;100(S1):S216–23.

  22. 22.

    Mimiaga MJ, Reisner SL, Closson EF, Perry N, Perkovich B, Nguyen T, et al. Self-perceived HIV risk and the use of risk reduction strategies among men who engage in transactional sex with other men in Ho Chi Minh City, Vietnam. AIDS Care. 2013;25(8):1039–44.

  23. 23.

    Shannon K, Strathdee SA, Goldenberg SM, Duff P, Mwangi P, Rusakova M, et al. Global epidemiology of HIV among female sex workers: influence of structural determinants. Lancet. 2015;385(9962):55–71.

  24. 24.

    George PE, Bayer AM, Garcia PJ, Perez-Lu JE, Burke JG, Coates TJ, et al. Is intimate partner and client violence associated with condomless anal intercourse and HIV among male sex workers in Lima, Peru? AIDS Behav. 2016;20(9):2078–89.

  25. 25.

    McKinnon LR, Gakii G, Juno JA, Izulla P, Munyao J, Ireri N, et al. High HIV risk in a cohort of male sex workers from Nairobi, Kenya. Sex Transm Infect. 2014;90(3):237–42.

  26. 26.

    Waldo CR, Coates TJ. Multiple levels of analysis and intervention in HIV prevention science: exemplars and directions for new research. AIDS (London, England). 2000;14:S18–26.

  27. 27.

    Kenya National Bureau of Statistics. Mombasa county statistical abstract. Nairobi: Kenya National Bureau of Statistics; 2015.

  28. 28.

    Kenya National AIDS Control Council. Kenya AIDS response progress report 2016. Nairobi: Kenya National AIDS Control Council; 2016.

  29. 29.

    Hampanda KM. The social dynamics of selling sex in Mombasa, Kenya: a qualitative study contextualizing high risk sexual behaviour. Afr J Reprod Health/La Revue Africaine de la Santé Reproductive. 2013;17(2):141–9.

  30. 30.

    Kibicho W. Tourism and the sex trade in Kenya’s coastal region. J Sustain Tour. 2005;13(3):256–80.

  31. 31.

    Geibel S, van der Elst EM, King’ola N, Luchters S, Davies A, Getambu EM, et al. ‘Are you on the market?’: a capture–recapture enumeration of men who sell sex to men in and around Mombasa, Kenya. AIDS (London, England). 2007;21(10):1349–54.

  32. 32.

    Geibel S. Same-sex sexual behavior of men in Kenya: implications for HIV prevention, programs, and policy. Facts Views Vision ObGyn. 2012;4(4):285–94.

  33. 33.

    Masvawure TB, Mantell JE, Tocco JU, Gichangi P, Restar A, Chabeda SV, et al. Intentional and unintentional condom breakage and slippage in the sexual interactions of female and male sex workers and clients in Mombasa, Kenya. AIDS Behav. 2018;22(2):637–48.

  34. 34.

    Campbell JL, Quincy C, Osserman J, Pedersen OK. Coding in-depth semistructured interviews: problems of unitization and intercoder reliability and agreement. Sociol Methods Res. 2013;42(3):294–320.

  35. 35.

    Garrison DR, Cleveland-Innes M, Koole M, Kappelman J. Revisiting methodological issues in transcript analysis: negotiated coding and reliability. Internet High Educ. 2006;9(1):1–8.

  36. 36.

    Padilla M, Castellanos D, Guilamo-Ramos V, Reyes AM, Marte LES, Soriano MA. Stigma, social inequality, and HIV risk disclosure among Dominican male sex workers. Soc Sci Med. 2008;67(3):380–8.

  37. 37.

    Kong TS. Risk factors affecting condom use among male sex workers who serve men in China: a qualitative study. Sex Transm Infect. 2008;84(6):444–8.

  38. 38.

    Ford K, Wirawan DN, Fajans P, Thorpe L. AIDS knowledge, risk behaviors, and factors related to condom use among male commercial sex workers and male tourist clients in Bali, Indonesia. AIDS (London, England). 1995;9(7):751–9.

  39. 39.

    Shah M. Do sex workers respond to disease? Evidence from the male market for sex. Am Econ Rev. 2013;103(3):445–50.

  40. 40.

    Karim QA, Karim SS, Soldan K, Zondi M. Reducing the risk of HIV infection among South African sex workers: socioeconomic and gender barriers. Am J Public Health. 1995;85(11):1521–5.

  41. 41.

    Belza MJ, Llacer A, Mora R, Morales M, Castilla J, Fuente L. Sociodemographic characteristics and HIV risk behaviour patterns of male sex workers in Madrid. Spain. AIDS Care. 2001;13(5):677–82.

  42. 42.

    Crawford R. The boundaries of the self and the unhealthy other: reflections on health, culture and AIDS. Soc Sci Med. 1994;38(10):1347–65.

  43. 43.

    Sanders T. ‘It’s just acting’: sex workers’ strategies for capitalizing on sexuality. Gender Work Organ. 2005;12(4):319–42.

  44. 44.

    Biello KB, Colby D, Closson E, Mimiaga MJ. The syndemic condition of psychosocial problems and HIV risk among male sex workers in Ho Chi Minh City, Vietnam. AIDS Behav. 2014;18(7):1264–71.

  45. 45.

    Vu BN, Mulvey KP, Baldwin S, Nguyen ST. HIV risk among drug-using men who have sex with men, men selling sex, and transgender individuals in Vietnam. Culture Health Sex. 2012;14(2):167–80.

  46. 46.

    Patton MQ. Enhancing the quality and credibility of qualitative analysis. Health Serv Res. 1999;34(5 Pt 2):1189.

  47. 47.

    Elwood SA, Martin DG. “Placing” interviews: location and scales of power in qualitative research. Prof Geogra. 2000;52(4):649–57.

  48. 48.

    Restar AJ, Tocco JU, Mantell JE, Lafort Y, Gichangi P, Masvawure TB, et al. Perspectives on HIV pre- and post-exposure prophylaxes (PrEP and PEP) among female and male sex workers in Mombasa, Kenya: implications for integrating biomedical prevention into sexual health services. AIDS Educ Prevent. 2017;29(2):141–53.

  49. 49.

    Mimiaga MJ, Reisner SL, Tinsley JP, Mayer KH, Safren SA. Street workers and internet escorts: contextual and psychosocial factors surrounding HIV risk behavior among men who engage in sex work with other men. J Urban Health. 2009;86(1):54–66.

  50. 50.

    Galárraga O, Sosa-Rubí SG, González A, Badial-Hernández F, Conde-Glez CJ, Juárez-Figueroa L, et al. The disproportionate burden of HIV and STIs among male sex workers in Mexico City and the rationale for economic incentives to reduce risks. J Int AIDS Soc. 2014;17(1):19218.

  51. 51.

    Odek WO, Busza J, Morris CN, Cleland J, Ngugi EN, Ferguson AG. Effects of micro-enterprise services on HIV risk behaviour among female sex workers in Kenya’s urban slums. AIDS Behav. 2009;13(3):449.

  52. 52.

    Kerrigan DL, Fonner VA, Stromdahl S, Kennedy CE. Community empowerment among female sex workers is an effective HIV prevention intervention: a systematic review of the peer-reviewed evidence from low- and middle-income countries. AIDS Behav. 2013;17(6):1926–40.

  53. 53.

    Kerrigan D, Kennedy CE, Morgan-Thomas R, Reza-Paul S, Mwangi P, Win KT, et al. A community empowerment approach to the HIV response among sex workers: effectiveness, challenges, and considerations for implementation and scale-up. Lancet. 2015;385(9963):172–85.

  54. 54.

    Allan-Blitz L-T, Herrera MC, Calvo GM, Vargas SK, Caceres CF, Klausner JD, et al. Venue-based HIV-testing: an effective screening strategy for high-risk populations in Lima, Peru. AIDS Behav. 2019;23(4):813–9.

  55. 55.

    Kalichman SC. Social and structural HIV prevention in alcohol-serving establishments: review of international interventions across populations. Alcohol Res Health. 2010;33(3):184–94.

  56. 56.

    Morisky DE, Stein JA, Chiao C, Ksobiech K, Malow R. Impact of a social influence intervention on condom use and sexually transmitted infections among establishment-based female sex workers in the Philippines: a multilevel analysis. Health Psychol. 2006;25(5):595.

  57. 57.

    Kerrigan DL, Fonner VA, Stromdahl S, Kennedy CE. Community empowerment among female sex workers is an effective HIV prevention intervention: a systematic review of the peer-reviewed evidence from low- and middle-income countries. AIDS Behav. 2013;17(6):1926–40.

  58. 58.

    Reza-Paul S, Lorway R, O’Brien N, Lazarus L, Jain J, Bhagya M, et al. Sex worker-led structural interventions in India: a case study on addressing violence in HIV prevention through the Ashodaya Samithi collective in Mysore. Indian J Med Res. 2012;135(1):98.

Download references

Acknowledgements

We would like to thank the study participants for their time and input and the International Centre for Reproductive Health-Kenya (ICRH-K) for their support. We would also like to thank Alberto Edeza for translation of the abstract into Spanish.

Funding

This research and manuscript preparation was supported by a National Institute of Mental Health (NIMH) Grant, NIMH 5R01MH103034 (Principal Investigator: Joanne E. Mantell: A Structural Intervention for Most-At-Risk Populations in Mombasa, Kenya), and a NIMH Center Grant P30-MH43520 (Principal Investigator: Robert H. Remien, Ph.D). NIMH had no role in the conceptual and writing of this manuscript. This manuscript does not reflect the official views of NIMH.

Author information

Correspondence to Joanne E. Mantell.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Valente, P.K., Mantell, J.E., Masvawure, T.B. et al. “I Couldn’t Afford to Resist”: Condom Negotiations Between Male Sex Workers and Male Clients in Mombasa, Kenya. AIDS Behav 24, 925–937 (2020). https://doi.org/10.1007/s10461-019-02598-2

Download citation

Keywords

  • Men who have sex with men
  • Male sex work
  • Condom negotiations
  • HIV/AIDS
  • HIV prevention
  • Kenya

Palabras clave

  • HSH
  • Hombres trabajadores sexuales
  • Negociación para el uso del condón
  • VIH
  • Prevención del VIH
  • Kenia