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In 2013-2014, we conducted a qualitative study to explore the motivations, influences, and moderators of behaviour and health-care seeking among behaviourally bisexual men in Vientiane, the capital of Laos. This study extended on the findings of the 2010 sexual networking study of behaviourally bisexual men and their sexual partners .
Men who have sex with men in Vientiane are at increased risk of HIV, with HIV prevalence estimated to 5.6 percent in 2007 , compared to 0.2 percent among reproductive-aged adults .
Bisexual behaviour among men is common – in a study of young men, eight percent of men reported sex with at least one man and one woman in the past six months , and in a study of men who have sex with men, 39 percent also reported sex with a woman in the previous three months .
In the 2010 study, we found that behaviourally bisexual men reported high risk behaviours, including high rates of inconsistent condom use, high numbers of sexual partners and frequent alcohol use .
Further, the majority identified as being heterosexual, which may make them a harder group to identify and subsequently reach for HIV prevention outreach, education, and health services.
From mid-2013 to 2014, focus groups and in-depth interviews were conducted with behaviourally bisexual men (reported ever having anal or oral sex with men and/or male-to-female transgender people, and reported ever having anal or vaginal sex with women) in Vientiane, Laos.
Participants were recruited from bars, beer shops, nightclubs, university dormitories, and through peer referral. In addition, key experts were interviewed from health services, local and international non-governmental organisations, government, and community.
Participating behaviourally bisexual men ranged in age from 18 to 35 years. The majority were currently studying and described their sexual identity as “man” or “straight”.
 van Gemert, C., Vongsaiya, K., Hughes, C., Jenkinson, R., Bowring, A.L., Sihavong, A., Phimphachanh, C., Chanlivong, N., Toole, M. & Hellard, M. (2013). Characteristics of a Sexual Network of Behaviorally Bisexual Men in Vientiane, Lao PDR, 2010. AIDS Education and Prevention, 25, 232-243.
[2 Sheridan, S., Phimphachanh, C., Chanlivong, N., Manivong, S., Khamsyvolsvong, S., Lattanavong, P., Sisouk, T., Toledo, C., Scherzer, M., Toole, M. & van Griensven, F. (2009). HIV prevalence and risk behaviour among men who have sex with men in Vientiane Capital, Lao People’s Democratic Republic, 2007. AIDS, 23, 409-414.
 UNAIDS 2010. Global report: UNAIDS report on the global AIDS epidemic 2010. Geneva: Joint United Nations Programme on HIV/AIDS (UNAIDS).
 Toole, M., Coghlan, B., Xeuatvongsa, A., Holmes, W., Pheualavong, S. & Chanlivong, N. (2006). Understanding male sexual behaviour in planning HIV prevention programmes: lessons from Laos, a low prevalence country. Sex Transm Infect, 82, 135-138.
The findings demonstrate the complexity of sexual orientation in Laos. Young behaviourally bisexual men in Laos associated with different sexual identities and reported varying sexual preferences, but most commonly identified as heterosexual/straight. Bisexual men commonly reported multiple sex partners, concurrent male and female partners, inconsistent condom use, consuming alcohol before sex, and both buying and selling sex. Despite reporting high-risk sexual behaviours for HIV and STI, utilisation of healthcare services was low. Uptake of HIV testing was poor, and use of STI services limited to treatment when experiencing symptoms. Common barriers to testing were low perception of risk, expectation of symptoms, fear of HIV, shyness, anticipation of stigma, confidentiality concerns, and waiting times.
This research highlights the need for integrated HIV and STI services and improved health promotion targeting bisexual men in Laos. Strategies are needed to generate demand for both HIV and STI testing, improve the capacity of sexual healthcare providers, and promote available services. Heath promotion messages aimed at reaching bisexual men should emphasise the importance of consistent condom use with all sex partners, lubricant use and regular HIV and STI testing. These findings have practical implications for the delivery of HIV prevention and sexual health promotion in Laos and have the potential to reduce HIV and STI transmission in this high-risk group.
Nakhornphet Pasomsouk (Consultant)
This work formed part of the PhD of Anna Bowring, who was supported by an Australian Postgraduate Award (APA) through Monash University.