Sexual Behaviors and Psychosocial Health Among Men Who Have Sex with Men with and without Female Partners in Kenya: Baseline Findings from the Tatu Pamoja Study

Globally, men who have sex with men (MSM) face significant sexual stigma and are at disproportionate risk of HIV and STIs. This cross-sectional study examined differences in HIV/STI-associated psychosocial characteristics and sexual behaviors among men who have sex with both men and women (MSMW) and men who have sex with men exclusively (MSME) in Kenya. MSM were categorized as either MSMW or MSME based on the reported sex of recent sexual partners. Depressive symptoms, alcohol use, and substance use were evaluated using the Patient Health Questionnaire 9 (PHQ-9), Alcohol Use Disorders Identification Test (AUDIT), and Drug Abuse Screening Test (DAST), respectively. Overall, 730 cisgender MSM were included in this analysis (405 MSMW and 325 MSME). MSMW reported twice as many partners as MSME in the last three months, while MSME were more likely to report engaging in receptive anal sex. MSMW were more likely to report hazardous alcohol and substance use. However, MSMW scored lower than MSME on the MSM Sexual Stigma Scale. These findings emphasize the need for socially aware, stigma-informed approaches that recognize how MSM may experience and manage sexual stigma differently, shaping their mental health, substance use, and sexual risk behaviors.