One of the first reports on homosexuality in Cambodia has revealed an alarming contradiction between the theory and practice of safe sex, in a group at high risk of infection from HIV/AIDS: Although the majority of gay men understand the risks of unprotected sex, very few are choosing to use condoms.
The study, conducted by the Khmer HIV/AIDS Alliance, or Khana, interviewed 370 men who have sex with men, or MSM, in Phnom Penh, Siem Reap and Battambang in late September. The report is only the second to be conducted on the subject, and fills what health workers have described as a gaping statistical hole in their understanding of homosexual activity.
The results show that levels of safe-sex education are high among many men who have sex with men: 88 percent of respondents said they knew that sex without a condom can lead to the transmission of HIV/AIDS.
Despite this, only 12 percent said they always use a condom when having anal sex, while 11 percent said they never use a condom at all.
The problem is not one of availability: The survey found 86 percent of the men interviewed knew where to buy condoms, 82 percent said they were readily available, while 82 percent claimed they always check the expiration date on the condoms they buy.
The reason given by many respondents for not using condoms was that they are uncomfortable; a claim supported by the fact that only half said they used a lubricant when having protected sex.
And yet without a lubricant, condoms are likely to tear during anal sex, rendering them useless. Advice like this, which is specific to the gay community, proves why it is imperative that sex education be given to sexually active gay men by sexually active gay men, according to Pok Panhavichetr, Khana’s executive director.
“We need more programs that meet the specific needs of men who have sex with men,” she said. “The more MSM involved in the design and running of these programs, the stronger they will be.”
This self-support approach is also backed up by the survey’s findings, which report that although sexually active gay men face high levels of discrimination from society in general, the support network within the gay community is strong, with many respondents reporting high levels of emotional support from friends and co-workers.
Because most Cambodian homosexuals choose to keep their sexual orientation secret and are often married, bisexual activity among the men surveyed was found to be very common: 40 percent said they had sex with both men and women in the past month.
This is another cause for concern for health workers, as it means risky sexual behavior in the gay community has the potential to fuel a far broader HIV/AIDS epidemic.
Overall, the report paints a picture of a sexual scene in which no easy boundaries or categories can be drawn.
If HIV/AIDS prevention programs for men who have sex with men are to succeed, they must also work beyond the boundaries of conventional sexual roles, said Chawalit Natpratan, country director of Family Health International, which also recently published a study of homosexuality, conducted in 1999.
“One of the things we have learned from these studies is that HIV does not discriminate,” he said. “And because the virus doesn’t discriminate, we can’t afford to discriminate in our prevention programs either. Effective prevention among MSM will have a positive impact on HIV prevention in all communities.”
