Understanding risky sexual behaviors assessment and factors among men engaging in sexual activities with other men (MSM) in Palembang city

Men who have sex with men (MSM) are often perceived as exclusively homosexual, although some identify as bisexual. Social and familial pressures may influence sexual behavior, contributing to engagement in high-risk sexual behaviors and increasing HIV transmission risk. This study aimed to describe risky sexual behaviors among MSM and identify associated psychosocial and demographic factors. A cross-sectional quantitative study was conducted in Palembang. Purposive sampling recruited 240 MSM participants. Risky sexual behaviors were assessed using a validated instrument adapted from previous studies. Logistic regression was used to identify factors associated with high-risk behaviors. Of the participants, 76.5% engaged in high-risk sexual behaviors. A majority of respondents who reported homosexual orientation also disclosed having experienced childhood sexual abuse; this experience was often mentioned as a meaningful life event shaping their self-perception.Self-efficacy was the strongest predictor of risky sexual behaviors: MSM with low self-efficacy had a 4.022 fold higher likelihood of engaging in high-risk behaviors compared to those with high self-efficacy (adjusted OR = 4.022, 95% CI: (2.408-7.899) The study may be subject to information bias, as respondents’ initial discomfort and fear could have affected the accuracy of self-reported sexual behaviors. The use of purposive sampling may also limit the generalizability of the findings. Risky sexual behaviors among MSM are significantly associated with sexual orientation and self-efficacy. Societal and familial pressures may compel homosexual-identified individuals to engage in heterosexual relationships. Interventions addressing psychosocial determinants and risk-reduction strategies are needed to mitigate HIV risk in this population.