Nearly half of young men who have sex with men in Myanmar (YMSM) report experiencing problems with family members because of their sexual identity or orientation, according to a newly released study.
The study also found that most YMSM report having their first sexual encounter in their mid-teens and that the majority of them are knowledgeable about protective health measures such as condom use.
While previous studies had been carried out on men who have sex with men (MSM) in Myanmar, this was the first study to focus specifically on social and sexual risks and protective factors pertaining specifically to youth. The Department of Medical Research, Ministry of Health, carried out a survey of YMSM in Yangon and Monywa for the study, which was supported by UNESCO’s Bangkok and Yangon offices.
The findings from the study will form a baseline for monitoring and evaluation to identify gaps in existing programmes as well as to help develop high-standard targeted HIV prevention and improved healthcare programmes.
Two cross-sectional surveys were conducted in 2013-2014 among YMSM in Yangon and Monywa, which were chosen because of their large MSM populations. Located in lower Myanmar, Yangon is the country's former capital, with a population of approximately 7.3 million. Monywa, with an estimated population of 372,000, is in central Myanmar.
For the purposes of the study, YMSM were defined as persons between the ages of 16-28 years old, who had same-sex attractions, male-to-male sexual behaviours and/or practices which fell under one of three classifications identified in Myanmar culture and research:
(1) Apone: biological males who are perceived as masculine in their outward dress and behaviour. These males tend to not be open about their same sex attractions, and are more likely to also have relationships with females and to have families. In some cases these men may only maintain relationships with females in order to hide their same sex attractions.
(2) Apwint: biological males who openly behave and dress as women. This includes persons who have transitioned and have undergone sex reassignment survey, as well as well as those who dress and behave as females.
(3) Tha Nge: biological males who are perceived as masculine in their outward dress and behaviour. They may have sex with males and females and, in some cases, could be classified as bisexual. Their male sex partners are often Apwint or Apone.
Two hundred YMSM each in Yangon and Monywa were recruited using respondent driven sampling (RDS)*. Eligible YMSM who took part in the survey were screened, provided consent, and then gave face-to-face interviews with researchers about their background, sexual identity, sexual history, affiliations with organizations, relationships with family, sexual health and HIV testing.
Findings
YMSM in Yangon and Monywa had a median age of 21 and 23, respectively, and most had nuclear families with both parents being alive. Although most YMSM reported having a good relationship with their father and mother, less than half of YMSM in both townships reported that both of their parents were aware of their same-sex preferences or behaviours. Furthermore, just over 40% of YMSM in both townships reported having problems with family members because of their sexual identity or orientation.
The majority of YMSM in both townships had their first sexual experience when they were 16 years old or older. Close to one-third of YMSM in both townships had their first sexual experience at or before 15 years of age, 80% of them with a male partner. Among the three groups commonly recognized in Myanmar, Apwint YMSM had the highest percentages of early sexual debut. More than three quarters of YMSM were sexually active in the past month, with over half reporting having more than one partner.
There are indications that YMSM are knowledgeable about the protective factors of condom use, with 72% of respondents in Yangon and 79% in Monywa reporting using a condom the last time they had sex. Roughly half of YMSM reported having at some time joined a youth or religious organization; past involvement in these organizations led to lower odds of condom use but higher odds of HIV testing. Although drug use was low, YMSM in both townships had higher prevalence of smoking and alcohol use.
The three MSM types sampled in this survey (Apone, Apwint, Tha-nge) faced different risks. Apwint YMSM in both townships were the most likely to have been forced to have sex. Significantly fewer Apwint and Tha-nge youth said they used condoms the last time they had sex than did Apone youth. Apwint had a higher prevalence of alcohol use, whereas cigarette smoking was more prevalent among Tha-nge. Apone were the least likely to have had an HIV test.
Based on the research findings, the following recommendations are suggested to minimize HIV-related risks and to encourage protective measures among YMSM in Myanmar.
- Further research: Research areas could include parental acceptance, distinct intervention strategies to address the unique risks of each group of MSM, multiple partners among YMSM, having an MSM friend with many partners, condom use by type of MSM.
- Family intervention: The aim of this would be to for prevention and reduction of stigma around forced sex as well as to provide assistance to children who have experienced forced sex ; and
- Youth interventions.
For more information, please contact: Pyi Pyi Pyo (pp.phyo@unesco.org)
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(*) RDS is a chain-referral sampling method specifically designed to obtain probability-based samples of hard-to-reach populations that are socially networked.
