Sexual acts, masculinities and condom use among Hong Kong Chinese men who have sex with men (MSM)

This research aimed to explore perceptions and decisions of anal-sex-acts and examine correlations between anal-sex-acts, masculinity level, HIV knowledge, types of sexual partner and condom use self-efficacy among Hong Kong Chinese MSM. A total of 13 Hong Kong Chinese MSM were interviewed. Themes of Sexual Acts, Gender and Sexuality, Sexual Partners and Sexual Power as well as HIV and Condom Use were developed. The themes were evolved out of the findings and served as references for instrument development. An instrument of Masculinity and Condom-use scale (MCs) was developed and piloted with 32 Hong Kong Chinese MSM, it was then used to collect responses from 336 Hong Kong Chinese MSM for factor analysis and correlational studies. Results from the “perceptions of anal-sex-acts” analysis showed that many informants were socialized with binary gender ideology associated with their anal-sex-acts. Anal-inserters were generally perceived as masculine while anal-receptors were viewed as being feminine. Sexuality was associated with anal-inserters and receptors differently. It infers that the idea of hegemonic masculinity may influence how some informants perceived anal-sex-acts and sexuality. Results of “decisions of anal-sex-acts”, in casual relationships, showed that anal-inserters and anal-receptors sought compatible sexual partners using gender-based ideas, while anal-versatile adopted a flexible approach to match their own and their partners’ sexual needs. In stable relationships, most informants adopted compatible anal-sex-acts with their partners for reasons of love, egalitarian, and trust. Power dynamic was manifested through domination and being dominated during sex, power dynamic can be understood as negotiating masculinities because masculinities have often been embodied as a negotiation of power during penile-anal intercourse among the informants. “Enabling and constraining issues of condom use” was examined by four correlational studies with 336 Hong Kong Chinese MSM. First, the results demonstrated that anal-inserters have higher levels of masculinity than anal-receptors in stable and casual relationships. Second, Hong Kong Chinese MSM with higher levels of masculinity indicated a higher level of condom use self-efficacy in stable relationship, but not in casual relationships. Third, Hong Kong Chinese MSM with higher levels of HIV knowledge achieved a higher level of condom use self-efficacy in stable and casual relationships. Fourth, educational level, age, income, and religion did not show significances with HIV knowledge level. Future research is recommended on HIV sexual risk behaviours and its underlying reasons in stable and casual relationships separately. The study creates awareness of the issues surrounding the power dynamic between perceptions and decisions of anal-sex-act and condom use among MSM. The proposed perspective of this study has high public health significance in mapping out practical implications for designing future HIV preventive programs for MSM. The results of this research indicates significant differences of masculinity levels and condom use self efficacy between casual and stable relationships, future HIV preventive programs should be devised so that HIV educators target these two groups separately in order to fill the disparate needs of MSM. It is hoped that this research will contribute to HIV prevention efforts within the MSM community in Hong Kong and elsewhere.published_or_final_versionEducationDoctoralDoctor of Philosoph