@article{fdi:010092583,
  title = {{M}arriage and steady relationships with women in men who have sex with men in {S}ub-{S}aharan {A}frica : a mixed-method systematic review and meta-analyses},
  author = {{F}iorentino, {M}arion and {M}azelier, {R}. {G}. {D}. and {Y}anwou, {N}. and {E}ubanks, {A}. and {R}oux, {P}. and {L}aurent, {C}hristian and {S}pire, {B}.},
  editor = {},
  language = {{ENG}},
  abstract = {{H}igh {HIV} prevalence in {S}ub-{S}aharan {A}frican ({SSA}) in men who have sex with men ({MSM}) leads to greater risk for their wives and other steady female partners because of prolonged exposure. {T}o provide insights into the context possibly contributing to the risk of {HIV} transmission from {MSM} to women, our mixed-method synthesis about {MSM}' marriage and steady relationships with cisgender women aimed to: (i) assess the extent of engagement in steady relationships with women and in risky behaviors with these women across {SSA}'s four regions; (ii) explore the underlying dynamics within these relationships by gathering qualitative information. {W}e used quantitative and qualitative data specifically pertaining to related to marriage or other steady relationships with women from a systematic review on men who have sex with both men and women ({MSMW}) in {SSA} ({PROSPERO}-{CRD}42021237836). {M}eta-analyses were performed on quantitative data for each region. {P}ooled proportions were calculated using random-effects models. {Q}ualitative data were analyzed using thematic synthesis. {D}ata were selected from 125 studies. {F}or {S}outhern, {E}ast and {W}est {A}frica, the estimated pooled proportions of married {MSM} were 4% (95% {CI} 2-8%; n = 10 studies; 4183 {MSM}), 8% (6-11%; 19; 7070), and 7% (6-9%; 13; 4705). {I}n {S}outhern {A}frica, 29% (11-56%; 5; 1667) of {MSM} had steady female partners. {I}n {E}ast {A}frica, 34% (14-61%; 5; 2003) were currently or previously married to women. {M}otives to marry women included a desire to have children, and to conform to heteronormative social norms and family pressure. {M}arriage was seen as a means to discontinue homosexual behaviors or, conversely, a way to secretly continue same-sex behaviors more freely. {P}rocreative intentions and a desire for secrecy often deterred {MSM} from using {HIV} prevention methods with their wives. {F}or some {MSM}, steady relationships with women provided them with mutual support. {H}owever, these relationships could also lead to stressful and conflict-ridden situations, potentially resulting in psychosocial and {HIV}-related risks for the {MSM} as well as their male and steady female partners. {S}teady relationships with women are common in {MSM} in {SSA}. {S}exuality concealment strategies with steady female partners depend on the circumstances that lead {MSM} to enter into these relationships, and have various implications on sexual behaviors with both male and female partners. {C}ommunity-based support, {HIV} research, prevention, and care programs should be adapted to {MSM}'s different life situations to reduce direct {HIV} transmission risk to steady female partners.},
  keywords = {{M}en who have sex with men ; {W}omen ; {M}arriage ; {B}isexual ; {A}frica ; {HIV} ; {AFRIQUE} {SUBSAHARIENNE}},
  booktitle = {},
  journal = {{A}ids and {B}ehavior},
  volume = {29},
  numero = {4},
  pages = {1041--1074},
  ISSN = {1090-7165},
  year = {2025},
  DOI = {10.1007/s10461-024-04517-6},
  URL = {https://www.documentation.ird.fr/hor/fdi:010092583},
}