Introduction Previous studies in Timor-Leste suggested a unique social and sexual dynamic between self-identifying men who have sex with men (MSM) and their straight-identifying male partners. As part of a national size estimation of key populations at risk, this qualitative study interrogated the dimensions of this dynamic to better inform HIV/STI-related services.
Methods Drawing on ethnographic approaches, semi-structured interviews were undertaken using field notes, including recording of verbatim quotes, with 27 self-identifying MSM, transgender people, straight-identifying MSM and relevant secondary informants across Timor-Leste. Interviews covered gender identity, intra-community social interaction and sexual practices. Data were analysed with involvement of author three (a local researcher who is well-connected to the populations) using an inductive thematic analysis approach where common themes and discrepant cases were coded with attention to the individuals’ reported experiences and key events.
Results Three identities among MSM/TG were most commonly reported: self-identifying MSM; transgender; and mane forte (lit.: ‘strong man’), or straight-identifying MSM. Self-identifying MSM and transgender-identifying people typically engaged only in sexual activity with straight-identifying MSM. Sex was often reported to have a transactional element, most commonly with MSM or transgender-identifying people providing low-value goods or pocket money to either their casual or long-term straight-identifying male partner/s. An imbalanced power dynamic was often reported between the two parties, with straight-identifying partners generally ‘calling the shots’ in decisions such as condom use. Straight-identifying men were less likely to interact with MSM HIV/STI services, typically tailored for those identifying as MSM or transgender.
Conclusion The degree to which financial/other incentives play a role in MSM/TG sexual practice is greater than previously reported. The reported power of straight-identifying MSM in sexual decision-making has implications for HIV/STI prevention initiatives, particularly given existing MSM services may not adequately serve straight-identifying MSM.
Disclosure of interest statement This project received funding from the Ministry of Health Timor-Leste under a grant from the Global Fund to fight AIDS, Tuberculosis and Malaria. No pharmaceutical grants were received in the development of this study.