Factors Associated with Inconsistent Condom Use among Men Who Have Sex with Men in Cambodia.
BACKGROUND
Compared to the general population, men who have sex with men (MSM) are at greater risk for HIV and less understood due to their more hidden and stigmatized nature. Moreover, the discrepancy in findings in the literature merits further investigations in MSM populations from different cultures and settings. We therefore conducted this study to explore factors associated with inconsistent condom use among high-risk MSM in Cambodia.


METHODS
This cross-sectional study was conducted in 2014 among 367 MSM randomly selected from Battembang and Siem Reap using a two-stage cluster sampling method. A structured questionnaire was used for face-to-face interviews to collect information on characteristics of respondents, HIV testing history, self-perception of HIV risk, substance use, sexual behaviors, mental disorders, and HIV knowledge. Multivariable logistic regression analysis was performed to identify factors independently associated with inconsistent condom use.


RESULTS
On average, 62.3% of respondents reported that they always used condoms over the past three months. The rates varied with types of sexual partners; the proportion of respondents who reported always using condoms was 55.1%, 64.2%, 75.9%, 73.0%, 78.1%, and 70.3%, for sexual partners who were girlfriends, boyfriends, female sex workers, male sex workers, female clients, or male clients, respectively. After adjustment, inconsistent condom use was significantly associated with age of ≥25 (AOR = 1.77, 95% CI = 1.09-2.86), self-rated quality of life as good or very good (AOR = 4.37, 95% CI = 1.79-5.67), self-perception of higher HIV risk compared to the general population (AOR = 2.37, 95% CI = 1.35-4.17), illicit drug use in the past three months (AOR = 5.76, 95% CI = 1.65-10.09), and reported consistent lubricant use when selling anal sex to men in the past three months (AOR = 2.85, 95% CI = 1.07-8.12).


CONCLUSIONS
We found risky sexual behaviors to be considerably high among MSM in this study, especially among those who used illicit drugs or were older than 25. HIV education and social marketing should be expanded and specifically designed for MSM to better educate on the increased risk of HIV with unprotected anal sex and illicit drug use as risk factors, and the importance of the use of both condoms and lubricant during anal intercourse.
Research Center, KHANA, Phnom Penh, Cambodia; Center for Global Health Research, Public Health Program, Touro University California, Vallejo, California, United States of America.
Siyan
S
Yi
Research Center, KHANA, Phnom Penh, Cambodia.
Sovannary
S
Tuot
Research Center, KHANA, Phnom Penh, Cambodia.
Pheak
P
Chhoun
Research Center, KHANA, Phnom Penh, Cambodia.
Khuondyla
K
Pal
Research Center, KHANA, Phnom Penh, Cambodia.
Khimuy
K
Tith
Center for Global Health Research, Public Health Program, Touro University California, Vallejo, California, United States of America.
Carinne
C
Brody
D000293:Adolescent; D000328:Adult; D002160:Cambodia; D017280:Condoms / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000517:prevention & control* / Q000635:transmission; D018451:Homosexuality, Male / Q000523:psychology*; D006801:Humans; D008297:Male; D012309:Risk-Taking; D012725:Sexual Behavior / Q000523:psychology; D019966:Substance-Related Disorders / Q000523:psychology; D055815:Young Adult