Background:
Most studies into Vulnerability and susceptibility chain (VASC) to HIV among Ugandan males, look into personality, biological and environmental factors around Prevention. It is default to assume that Ugandan sexually active males are inhibited from engaging in forms of sexual intercourse, other than heterosexual penile-vaginal kind. Yet, there are sexually active Straight males in Kampala who are disinhibited from engaging in insertive (Top) or receptive (Bottom) anal sex with other males or females. This practice exists but is less talked about. Heterosexual hegemony in Uganda further entrenched through patriarchal constructs makes sure this is so. The structures range from publicly displayed male-female gender dominant cultures, traditions, definitions, roles and political-legal codes that valorize as well make heterosexuality the expectation and default. This study seeks to use analytical conception of the process of anal sex debut (ex ante and ex post) among Kampala males and its implications for HIV Prevention. The aim is to identify the intrinsic subjective characters supporting or subverting disinhibition as a process of subsequent anal sexual events. This will add structural constructs to other studies looking into vulnerability to HIV and STIs.
In Uganda practices outside the parameters of Hegemonic heterosexuality are criminalized. Sexual activity is permissible only during marriage, the intrinsic mating MO is as follows: style is man on top of woman; typology is penile-vaginal sex; negotiation is that mostly males make advances; consent is expected and taken for granted in marriage among cohabiting partners. This has vicarious consequences for HIV Prevention where messaging is crafted around this normativity. This study has multiple implications for HIV Prevention in Uganda, by shining a light on other forms of sexual activity and highlighting the substantive characteristics subverting or supporting disinhibition for anal sexual events.
Methodology:
A mixed methods study (Interviews, anecdotal and desk report reviews) of 230 males aged 19 years to 45 years followed from 2000-2019. It linked Knowledge, Attitudes, Practices And behavioural themes. These were analysed qualitatively. The 230 MSM were were identified through 15 local receptive bottoms (Snowballing). Out of 230, only 115 Kampala male respondents were identified as eligible for the study. Literature review of 50 journal articles published between 2000-2019 was done to synthesize trends that inform HIV Prevention policy.
Eligibility was based on age; maintained contacts since 2000; all had used locations in Kampala for anal sexual intercourse events; maintained loosely networked membership in a group of more than 3 males with whom they shared anal sex experiences and were assured of confidentiality; had anal sex in the previous 3 months; had sexual events for more than 2 years after their first anal sex-debut; and willingly participated in this exploratory exercise.
Findings-General (Subjective Typology/Characteristics):
All respondents reported proximity, frequent interactions, availability of sexually active and consenting males strengthened bonding and made it possible for planned, regular anal sex events.
Conclusion:
Straight Males in Kampala who have sex with other males are not necessarily identifying as Gay. They are barely mentioned in mainstream narratives on Homosexuality /Same Sex Sexuality, yet they are key actors. This makes them largely invisible and most vulnerable, because HIV response cannot target invisible populations. Clearly defining the disinhibiting parameters of anal sex, stressing the likelihood of it being an HIV/STI transmission route, providing prevention prophylactics and Information, Education and Communication (IEC) will safeguard against HIV. The precise numbers of Straight males disinhibited from having anal sex are unknown and further examination of this less undocumented population group disaggregated by nationality, social and economic factors is needed.
*Study still developing
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