Category Archives: MCP

Men who have sex with men who have sex with men who have sex with women?

So according to the San Francisco Chronicle, a new study has found that almost half of gay men reported that they were in “open relationships”.  This, as we can gather pose a problem for HIV prevention.  While partners are free to make their own choices regarding the ground rules of their relationship, the investigator Colleen Hoff, states that HIV prevention efforts may need to address this growing population: partnered men who knowingly have sex outside of their relationship.  If I am partnered in a relationship for 5 years, am HIV negative, and go outside of the relationship with the knowledge of my partner, and have unprotected sex with an HIV positive man, I have contributed to the spread of the epidemic and put not only the myself but my partner at risk.  Presumably, there is no poster was up in the bath house that says  “Protect yourself when you have sex outside of your relationship” (although who knows there could be as I haven’t been to a bath house in ages).  Kudos to Ms. Hoff for receiving funding from NIMH to investigate HIV infection among these male couples

In the development world, there has been much talk about a similar theme – many have referred to the phonemon as “multiple concurrent partnerships” (MCP) (Here is a UNIADS article about MCP which actually contains a link regarding MSM underneath).  Generally, this has referred to “heterosexuals” who have more than one mate, and have sex with a partner outside their relationship.  This can be in the context of polygamy, or other arrangements.  As with the San Fran case described above, the same issues regarding HIV transmission present thenmselves.

Credit: http://misaccess.psi.org/bcc_catalog/web/files/sun02(1).jpgBUT, in the context of MCP in the developing  (AND devloped) world, I think public health programmers should realize that MCP can also occur when a “straight” identified man partnered with a woman has sex with other men.  And if the man is the receptive partner in anal sex, we know his risk of acquiring HIV is higher than if he is the insertive partner with another female (or another male), making these external male male relationships increase probablity of HIV transmission.  And in most cases, this is in secret, not openly nor discussed as in the case of Ms. Hoff’s research, so partners are not aware that they may need to be tested, or their partners are having sex outside of the relationship.  In the US we have referred to this as “on the down low”.  However, these arrangements have been documented to occur in South Africa (Note: HIV status has been associated with having a regular female partner), various parts of Asia (see p. 2 of APICOM articles), and probably hundreds of other places.

So not only men who are partnered with men have sex with other men, but men who have sex with women have sex with other men.  In both cases,  there needs to be appropriate and targeted HIV messaging.  While it is more difficult in the developing world due to to stigma and criminilization of homosexuality, it is clear that many men bring HIV into the relationship and to their female partners.

So, San Fransciscan gay males, you are not alone.  African, Asians, and Latin American males also have “open relationships”, which put both  female and male partners at risk for HIV.  However, as these relationships are not negotiated, many women may not know their husbands are sleeping with men and may not know they are at risk for HIV.

Solution: Education. Decriminilization and destigmatization of homosexual behavior. HIV prevention messaging targeted at those in open relationships/involved with MCPs: This includes gay open relationships, straight open relationships, and relationships where men are paired with women and have sex with other men outside of the relationship.

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