title: Heterosexual behaviours among men who sell sex to men in coastal Kenya.
abstract: OBJECTIVE
  African men who have sex with men often sell sex to men, and MSM who sell sex (MSM-SW) often also have female partners. We compared sexual risk behaviour of MSM-SW who were sexually active with female partners (bisexual MSW) to MSM-SW with only male partners (exclusive MSW).
  
  
  METHODS
  Descriptive behavioural study
  
  
  METHODS
  : A novel, validated daily event and partner diary self-completed by 82 MSM who sold sex over a follow-up period of 42 days with weekly review. Cumulative individual counts of sex and condomless sex were compiled by partner characteristics. The incidence of specific partnerships and sex acts were compared within and between bisexual and exclusive MSW.
  
  
  RESULTS
  Most (59%) MSM-SW reported female partners during follow-up. The majority of both male and female partners were cash-paying clients originating locally. Bisexual MSW reported a similar rate of condomless sex with male and female partners, but significantly fewer male partners than exclusive MSW. Bisexual MSW had lower HIV prevalence, were more likely to only report insertive anal sex roles, and reported lower frequencies of condomless receptive anal sex than exclusive MSW.
  
  
  CONCLUSIONS
  Bisexually active male sex workers in coastal Kenya create HIV and other sexually transmitted infection transmission pathways to partners and clients in both MSM and heterosexual networks, but differed from exclusive MSW in having lower HIV acquisition and transmission risks. Epidemiological projection methods are liable to overestimate bridging potential of MSM-SW and MSM populations without account for systematic differences in risk within these populations.
authors.affiliation: aNuffield Department of Population Health, University of Oxford, Oxford, UK bKenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya cDepartments of Medicine, Global Health and Epidemiology, University of Washington, Seattle, Washington, USA dCentre for Topical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK eDepartment of Global Health, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands.
authors.forename: Adrian D
authors.initials: AD
authors.lastname: Smith
authors.forename: Allan D
authors.initials: AD
authors.lastname: Muhaari
authors.forename: Carole
authors.initials: C
authors.lastname: Agwanda
authors.forename: Dickens
authors.initials: D
authors.lastname: Kowuor
authors.forename: Elise
authors.initials: E
authors.lastname: van der Elst
authors.forename: Alun
authors.initials: A
authors.lastname: Davies
authors.forename: Susan M
authors.initials: SM
authors.lastname: Graham
authors.forename: Harold W
authors.initials: HW
authors.lastname: Jaffe
authors.forename: Eduard J
authors.initials: EJ
authors.lastname: Sanders
mesh_terms: D000328:Adult; D001727:Bisexuality / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000635:transmission*; D020010:Heterosexuality / Q000523:psychology*; D018451:Homosexuality, Male / Q000706:statistics & numerical data*; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008297:Male; D015995:Prevalence; D012309:Risk-Taking; D057566:Self Report; D060386:Sex Workers / Q000706:statistics & numerical data*; D012747:Sexual Partners; D055815:Young Adult