Sexual health, HIV/AIDS and human rights among gay, bisexual and other men who have sex with men (MSM) in Almaty, Kazakhstan

Background. Men who have sex with men (MSM) are at high risk for HIV, but most of the research on the HIV risk factors and outcomes for MSM has been performed in high-income countries. Research is lacking on the HIV risk factors of MSM in low- and middle-income countries, particularly Central Asia. MSM often have a different social environment in these countries compared to high-income countries, as same sex behavior is often stigmatized, leading to human rights violations and pushing men towards bisexual behavior.;Methods. This cross-sectional study used respondent-driven sampling to recruit MSM from Almaty, Kazakhstan to participant in interviewer-administered surveys. We performed log binomial and logistic regressions to determine the risk factors for unprotected anal intercourse (UAI) with multiple male partners. We also stratified by whether the participants had sex with men only or were bisexual. We also developed a human rights index with 14 questions, to determine the relationship between human rights violations and HIV risk behavior and used different methods to estimate the number of MSM in Almaty.;Results. The study enrolled 400 MSM. There were strong associations between UAI with multiple male partners and sex with a trade sex partner, poor access to water- or silicon-based lubricants, used injection or noninjection drugs, or had ongoing concurrent sexual partnerships. More than 28% of participants reported experiencing at least one of the human rights violations in the index. Having been raped or threatened/assaulted by a government official were statistically significantly associated with high-risk sex. There were also differences in the sexual risk factors when comparing bisexual men to men who only had sex with men.;Conclusion. This exploratory study found high levels of multiple HIV risk behaviors in MSM, representing a population that is at high risk for HIV infection. There was also a statistically significant association between some forms of human rights violations and high-risk sex, which supports an argument for the protection of the rights of MSM. The sexual risk factors between bisexual men and homosexual men varied, which should be considered when planning public health interventions.