HIV risk among male migrant workers in central Asia: do masculinity beliefs about sexuality and marriage matter? Felix Muchomba, Nabila El-Bassel, Louisa Gilbert, Leyla Ismayilova, Assel Terlikbayeva, Gaukhar Mergenova, Stacey Shaw, Natasha Merali Columbia University, New York, NY, USA Methods In-depth interviews were conducted with 43 migrant workers employed at the Barakholka marketplace in Almaty, Kazakhstan (Fig. 1). Eligible participants maintained permanent residency outside Almaty and spoke Russian fluently. Introduction The world's HIV epidemic is growing fastest in Central Asia. 1,2 Migration and mobility have been found to increase HIV vulnerability in the region. 3 There is, however, limited research on the drivers of HIV infection and transmission among migrant and mobile populations in Central Asia. This qualitative study with male migrant workers in Kazakhstan examines how beliefs about masculinity influence HIV sexual risk behavior among a sample of migrant workers recruited from the largest market place in Central Asia. Acknowledgements We thank the study participants without whom this work would not have been possible. This study was supported by a grant from the National Institute of Mental Health awarded to Dr. Nabila El-Bassel (Grant No. R01MH082684). Literature cited 1. Godinho J, Renton A, Vinogradov V, Novotny T, Rivers M. Reversing the tide: Priorities for HIV/AIDS prevention in central asia. Washington, D.C.: World Bank; 2005: UNAIDS/WHO. AIDS epidemic update Geneva, Switzerland: UNAIDS/WHO; 2009: El-Bassel N, Gilbert L, Terlikbayeva A, et al. Implications of mobility patterns and HIV risks for HIV prevention among migrant market vendors in kazakhstan. Am J Public Health. 2011;101(6): N (%) or Mean ± SD Participants43 (100%) Age, y28.5 ± 8.7 Marital status Married Single, never married Separated, widowed or divorced 26 (60.5%) 16 (37.2%) 1 (2.3%) Ethnicity Tajik Kyrgyz Uighur Kazakh Dungha Uzbek Other 12 (27.9%) 10 (23.3%) 5 (11.6%) 4 (9.3%) 4 (9.3%) 2 (4.7%) 6 (14.0%) Citizenship Kazakhstan Tajikistan Kyrgyzstan Uzbekistan 14 (32.6%) 11 (25.6%) 11 (25.6%) 7 (16.3%) Responsibility at market: Vendor Stall owner Carrier/Transport 24 (55.8%) 11 (25.6%) 11 (25.6%) Nights spent away from Almaty in past year38.4 ± 33.6 Results Three main themes emerged related to multiple sexual partnerships and transactional sex; Beliefs about masculine expectations in marriage that promote premarital sexual relationships Participants reported engaging in premarital sexual relations in order to prepare for marriage and meet societal expectations of masculine sexual performance. Sample quote: Beliefs about masculine sexuality that promote infidelity Participants expressed that wives could not fulfill what was viewed as a masculine need for diverse sexual experiences, such as anal and oral intercourse. To obtain fulfillment, married participants sought casual partners and sex workers. Sample quote: Gender norms that facilitate transactional sex Normative patronage of sex workers by male friends and colleagues at the marketplace also promoted transactional sex. Sample quote: Participants also reported irregular condom use with their multiple partners. FIGURE 1. Map of Central Asia. Study was conducted in Almaty, in southeastern Kazakhstan Participants' average age was 28.5 years and most (60.5%) were married (Table 1). Participants were largely ethnic Tajik (27.9%) or Kyrgyz (23.3%). Most participants (58.8%) were market vendors. Transcripts from the interviews were analyzed for themes. TABLE 1. Sociodemographic characteristics of male migrant market workers Conclusions Masculinity beliefs regarding marriage and sexuality promote HIV sexual risk behavior among migrant workers in Central Asia. HIV prevention strategies in Central Asia need to incorporate these beliefs to provide a gender-specific response to the epidemic. Further Information Felix Muchomba, MPH, Ph.D. Student Columbia University School of Social Work (212) Presented at AIDS 2012 – Washington, D.C., USA “A man must have sexual experience to know what he should do having intimacy after his marriage.” “Men say, ‘You do not want to eat the same dish every day. Your wife is always beside you but you want something new. You want to change your life.’” “We [friends in the market] call each other and go to cafes together. We go out to the city. We meet with young women. I can say that they are bad women. We find them on Seifulin Street, in Altyn Orda and hotels. We pay them money and they are ready to sleep with men.”