In a behavioral survey of a sample of men who have sex with men, respondents are asked about sexual partnerships in the preceding six months, about anal sex within those partnerships and about condom use when they last had anal sex.  Whenever possible, data for men who have sex with men should be collected through civil society organizations that have worked closely with this population in the field. Access to survey respondents as well as the data collected from them must remain confidential. Data for this indicator should be disaggregated by age (<25 years; 25+ years).  For more details on calculation and interpretation of the indicator, see PEPFAR (2009); UNAIDS (2009); WHO/UNICEF/UNAIDS (2011); WHO et al., (2006).

Data Source(s):

Behavioral surveys, special surveys including the Family Health International Behavioral Surveillance Survey for men who have sex with men (Family Health International, 2000).

Purpose:

This indicator provides good information on overall levels and trends of protected and unprotected sex in this population. Countries with generalized HIV epidemics may also have a concentrated subepidemic among men who have sex with men and it is valuable to calculate and report on this indicator for this subpopulation. Condoms can substantially reduce the risk of the sexual transmission of HIV and other sexually transmitted infections. Consequently, consistent and correct condom use is important for men who have sex with men because of the high risk of HIV transmission during unprotected anal sex (UNAIDS, 2009). In addition, men who have anal sex with other men may also have female partners, who also could become infected. Condom use with their most recent male partner is considered a reliable indicator of longer-term behavior. Where different sources of data exist, the best available estimate should be used. Information on the sample size, the quality and reliability of the data, and any related issues should be included with this indicator. To maximize the utility of these data, it is recommended that the same sample used for the calculation of this indicator be used for the calculation of the other indicators related to these populations (PEPFAR, 2009).

Issue(s):

Surveying men who have sex with men can be challenging. Consequently, data obtained may not be based on a representative sample of the national, most-at-risk population being surveyed. If there are concerns that the data are not based on a representative sample, these concerns should be reflected in the interpretation of the survey data. This indicator does not give any idea of high-risk sexual behavior with women among men who have sex with both women and men. In countries where men in the subpopulation surveyed are likely to have partners of both sexes, condom use with female as well as male partners should be investigated. In these cases, data on condom use should always be presented separately for female and male partners.

References:

Family Health International, 2000, Behavioral surveillance surveys (BSS/BBSS): Guidelines for repeated behavioral surveys in populations at risk for HIV. Arlington, VA, http://www.who.int/hiv/strategic/en/bss_fhi2000.pdf