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AIDS Behav. 2018 Jul;22(7):2189-2198. doi: 10.1007/s10461-017-1994-0.

Bisexual and Bidirectional: Assessing the Potential for HIV Bridging in Mozambique.

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Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Maputo, Mozambique.
Substance Abuse and Mental Health Services Administration, 9300 Pretoria Place, Dulles, VA, 20189, USA.
University of California San Francisco, San Francisco, USA.
Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Maputo, Mozambique.
Ministry of Health, National Institute of Health, Maputo, Mozambique.
San Francisco Department of Public Health, San Francisco, USA.


African men who have sex with men (MSM) frequently, and often concurrently, have female partners, raising concerns about HIV sexual bridging. We explored potential HIV transmission in Mozambique from and to female partners of MSM focusing on preferred anal sex role and circumcision status. Data collected in a respondent-driven sampling study of MSM in 2011 in Maputo and Beira. Men who had oral or anal sex with other men 12 months prior completed a questionnaire and consented for HIV testing. Statistical analysis explored demographic/risk characteristics and associations among circumcision status, anal sex with men, sexual positions during anal sex with men and vaginal or anal sex with women. We identified 326 MSM in Maputo and 237 in Beira with both male and female partners 3 months before the study. Of these, 20.8% in Maputo and 36.0% in Beira had any receptive anal sex with men 12 months prior, including 895 unprotected sexual acts with males in Maputo and 692 in Beira. Uncircumcised and exclusively insertive males, 27.7% of the sample in Maputo and 33.6% in Beira, had the most unprotected sex with females: 1159 total acts in Maputo and 600 in Beira. Sexual bridging between MSM and women likely varies geographically and is probably bi-directional, occurring within a generalized epidemic where HIV prevalence is higher among reproductive-age women than MSM. Prevention strategies emphasizing correct and consistent condom use for all partners and circumcision for bisexual men should be considered.


Bisexuality; HIV risk behavior; HIV transmission; MSM; Mozambique; Sexual bridging


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