Sex Transm Infect 86:323-327 doi:10.1136/sti.2009.040162
  • Behaviour

Bisexual concurrency, bisexual partnerships, and HIV among Southern African men who have sex with men

Editor's Choice
  1. Stefan Baral1,7
  1. 1Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
  2. 2Center for the Development of People, Blantyre, Malawi
  3. 3Botswana Network on Ethics, Law, and HIV/AIDS, Botswana
  4. 4Department of Community Health, University of Malawi, College of Medicine, Blantyre, Malawi
  5. 5University of Namibia, Windhoek, Namibia
  6. 6The Rainbow Project, Windhoek, Namibia
  7. 7Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to Dr Stefan Baral, Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins School of Public Health, E7146, 615 N Wolfe Street, Baltimore, MD 21205, USA; sbaral{at}
  1. Contributors SB and CB designed the template protocol. CB led the writing of the manuscript, and SB led the data analysis. The in-country coordinators were FD in Namibia, GT in Malawi and FM in Botswana. EU and SI participated as coinvestigators providing in-country technical assistance and guidance on data analysis and the writing of the manuscript.

  • Accepted 9 February 2010
  • Published Online First 21 April 2010


Objectives The sexual behaviour of men who have sex with men (MSM) in southern Africa has been little studied. We present here the first data on bisexual partnerships and bisexual concurrency among MSM in Malawi, Namibia and Botswana.

Methods A cross-sectional probe of a convenience sample of 537 men who have ever reported anal sex with another man using a structured survey instrument and rapid-kit HIV screening.

Results 34.1% of MSM were married or had a stable female partner, and 53.7% reported both male and female sexual partners in the past 6 months. Bisexual concurrency was common, with 16.6% of MSM having concurrent relationships with both a man and a woman. In bivariate analyses, any bisexual partnerships were associated with lower education (OR 1.6, 95% CI 1.1 to 2.3), higher condom use (OR 6.6, 95% CI 3.2 to 13.9), less likelihood of having ever tested for HIV (OR 1.6, 95% CI 1.1 to 2.3), less likelihood of having disclosed sexual orientation to family (OR 0.47, 95% CI 0.32 to 0.67) and being more likely to have received money for casual sex (OR 1.9, 95% CI 1.3 to 2.7). Bisexual concurrency was associated with a higher self-reported condom use (OR 1.7, 95% CI 1.0 to 3.1), being employed (OR 1.8, 95% CI 1.2 to 2.9), lower likelihood of disclosure of sexual orientation to family (OR 0.37, 95% CI 0.22 to 0.65) and having paid for sex with men (OR 2.0, 95% CI 1.2 to 3.2).

Conclusions The majority of MSM in this study report some bisexual partnerships in the previous 6 months. Concurrency with sexual partners of both genders is common. Encouragingly, men reporting any concurrent bisexual activity were more likely to report condom use with sexual partners, and these men were not more likely to have HIV infection than men reporting only male partners. HIV-prevention programmes focussing on decreasing concurrent sexual partners in the African context should also target bisexual concurrency among MSM. Decriminalisation of same-sex practices will potentiate evidence-based HIV-prevention programmes targeting MSM.


  • Funding This study was supported by the Sexual Health and Rights Project (SHARP) of the Open Society Institute and the Open Society Initiative for Southern Africa (OSISA). (1) Open Society Initiative for Southern Africa12th Floor Braamfontein Centre, 23 Jorissen Street, Braamfontein, 2017, PO Box 678, Wits, 2050; (2) OSI—New York City.

  • Competing interests None.

  • Ethics approval Ethics approval was provided by the JHSPH, Botswana, Namibia.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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