THE INCIDENCE OF BREAKING-UP WITH WOMEN ENGENDERS MEN HAVING SEX WITH MEN

Feny Wartisa1*, Aldo Yuliano Mas Putra2

1Department of Midwifery, Faculty of Health Science, STIKES Perintis Padang, Indonesia

2Department of Nursing Professionals, Faculty of Health Science, STIKES Perintis Padang, Indonesia

*Corresponding author’s email: fwartisa@gmail.com

ABSTRACT

MSM (men having sex with men) is counted for almost 17% of new HIV infections in the world. It revealedof MSM prevalence with HIV infection in Indonesia increased 2.5 times since 2013. Meanwhile, HIV prevalence in West Sumatra with MSM 2018 recorded 36% on risk factors. Bukittinggi, one of the biggest cities in those areas, is having the highest incidence rate (18.1%) against the population ratio on HIV positive cases. Thisstudy aims to determine the association of biological factors, a history of a breakup with female partners, peers influence, parenting styles, family father figures, history of sexual violence, history of migration, and utilization of social media on men who have sex with men incidence. This analytical study onthe mixed-method methodologyapplied a cross-sectional approach involving 456 population which recruited 69 people as a research sample. Using snowball sampling, questionnaires were mediated as data accumulation which then was analyzed using the Spearman Rho test. It verified that biological factors (p=0.044, r=0.243) and a breaking up with women status (p=0.000, r = -0.558) indicated of MSM incidence. On the other hand, peer relations, parenting style, lack of father's role in the family, the history of sexual violence, migrating status, and social media exertion showed no significant relation to MSM incidents. Eventually, it should embroil the parents, teachers, and related agency's role to reduce the MSM stimulation in the community, and reciprocally will decrease the chain of HIV/AIDS transmission.

Keywords: Biological Factors; Bukittinggi; Heartbreak; MSM

INTRODUCTION

HIV/AIDS is a serious health problem and challenging to world public health in modern and developing countries. In 2019,it has killed 33 million people worldwide, while 1.8 millionnew cases of HIV/AIDS, around 38 million people worldwide are living with HIV/AIDS(WHO, 2020). Men who have sex with men are one of the groups at risk of contractingHIV / AIDS(Kementerian Kesehatan RI & Pencegah, 2016). MSM accounts for about 17% of new HIV infections in the world. More than a half of new HIV infections in Western and Central Europe, 40% in Latin America, 30% in Asia and the Pacific, 22% in the Caribbean as well as in Eastern Europe and Central Asia, 18% in the Middle East and North Africa, and 17% In West and Central Africa (UNAIDS, 2019).

The prevalence of MSM infected with HIV in Indonesia increased 2.5 times from 2013(Kementerian Kesehatan RI & Pencegah, 2016). In Indonesia, MSM ranked third place as the highest risking factor of HIV positive percentage tested(Pusdatin Kemenkes RI, 2018). HIV among MSM prevalence in 2016 revealed 13,063 cases, even in 2017 and 2018 showing the decreasednumber to 11,630 and 9,522 cases, respectively. Specifically, the HIV prevalence in West Sumatra in 2018 was 624 cases which 224 cases from MSM risk factors, where Bukittinggi has the highest percentage of HIV positive incidence (18.1%) based on the of HIV positive incidence to the MSM population comparison(Kemenkes RI Dirjen P2 & PL, 2019).

MSM isdefined as gay, bisexual, and other men who have sex with men(CDC, 2018). The main risk factor forHIV transmission among MSM is risking sexual activity(Laksana & Lestari, 2010). Sexual intercourse among MSM has a greater risk of contracting HIV when compared to men who have sex with women because anal sex performed conditionally increases rectaltissue injury in accordance with of lack lubricant fluid, such as the vagina have(Yogiswara, 2017).

Previous research shows that parenting styles, psychological dynamics, and sexual experiences are factors inducing for MSM(Darmayanti & Sumitri, 2018). Besides, there is an offer to pay for sexual relations with the same sex and then get teased by their sexual partners(Sidjabat, Setyawan, Sofro, & Hadisaputro, 2017). Since childhood, some casesof MSM has had feelings for same-sex love, while the others had been raised in a feminist environment, lack of closeness to father, lower value of religious guidance, migration to cities (modern environment), urban interactions, or the role of internet influences, especially in social media(Latif, Fitriyani. & Dartiwen, 2018). Having experienced sexual violence in childhood(Khoury et al., 2019) and migration choice affect the incidence of MSM because of interestingjob offers, and free life-style culture(Huang, Wang, & Yang, 2020). MSM phenomenon has been conducted by other researchers with variables of parenting styles, history of sexual violence or sexual harassment, culture and peer influences, social media induction, migration to cities. However, the history of breakups with female partners variable, we noticed,has not been never studied.

Bukittinggi’s AIDS/ HIV Prevention Commission data, in 2018, calculated the MSM population was 383 people and having a decreasing trend to 307 cases in 2019(KPA, 2018). Based on the high number of MSM infected with HIV, it raises a worrying phenomenon thatcan refer to have negative impacts in both terms of reproductive health and social life. In the end, this study intended to determine the association of biological factors, history of a breakup with female partners, peers influence, parenting styles, family father figures, history of sexual violence, history of migration, and use of social media to the MSM incidence.

METHODOLOGY

This analytical study with a mixed-method research methodology wasutilizing a cross-sectional approach applying for a qualitative approach using in-depth interviews to emphasize and explain the quantitative results obtaineddeeply. The research population conducted in Bukiitinggi was 456 men who were at risk of becoming MSM. Furthermore, research samples were recruited for 69 people. We included sample’ criteria of men who have had sexual relations with other men, having a history of sexual violence, have been disappointed by women, and having a lack moment of male figures in the family. A snowball sampling technique applied with the Key Informant wasbeing reached atBukittinggi’sKPA department. Data were collected through direct interviews using Hartono’s (2013) adopted questionnaireswhich then analyzed to validate and tested the reliabilityfor value r=0.602 (Hartono,2013). Respondents were interviewed one by one who was gathered in cafes, KPA offices, and door to door visit.

Research variables involved biological factors, breaking-up with female partner'shistory, peers influence, parenting styles,father’ figure in the family, historical event of sexual violence, migration activity, and social media influences. Spearman Rho test calculated the quantitative data withthe computerized process while supporting qualitative data analysis using data reduction, presentation, and concluding/ verification. Ethical principles had been applied to meet the ethical clearance with No.001/KEPK.F1/ETIK/2020.

RESULT

Quantitative Research

Our research findings revealed that 20.3% of respondents had biological factors, in another meaning ofhaving the same sex since they were born. Having a miserable relationship with female partnerscounted 26.1% from samples while 36.2% of respondents were influenced by peers' friendship revealed from MSM samples. Parentingstyles, feminized behavior, lacked a father figure in the familycontributedby15.9%, 4.3%, and 33.3% sequentially. Sexual violence/ abuse induced 62.3% and having a history of migrating, while 71% of them influenced bysocial media (table 1).

Table 1: The Biological Factors, History of a Breakup with Women, Peers, Parenting Patterns, Father Figures In The Family, History of Sexual Violence, History of Migration, and Social Media Influences Association with MSM Incidence.

Eightvariables tested statistically, it found that the influencing factors someone becoming MSM are biological factors (p = 0.044; r = 0.243), and the historical event of breakup with a female partner (p = 0.000; r = -0.558). statisticaltest results did not have a associated value included peers (p = 0.085; r = 0.209), parenting styles (p = 0.952; r = 0.007), father figures in the family (p = 0.401; r = 0.103), history of sexual violence. (p = 0.831; r = 0.026), history of migrating (p = 0.575; r = 0.069), andthe social media effect (p = 0.236; r = -0.144).

Qualitative Research

This study complements the results of quantitative research with an in-depth explanation of factors causing MSM. In this data collection, we translated the interview scripts into the English language based on Bahasa they expressed.

Biological factors or having a crush on men since childhood:

“But maybe not knowing is also more problematic when knowing the men’s name is. When I am a teenager, I feel like I have started to like men. Don't know ... no ... don't know the point, it is hard to explain” (Dodo, 32)

History of a breaking-up with a female partner who abandoned him to another man, and had been dating for years: “At first I had a normal life. Having a girlfriend, and dating her quite a long time .. approximately 5 years. From the beginning she worked,I always beside her. When her work as a civil servant her suddenly cut ties, not for

long after, she married her office mate behind me. I've been heartbroken. Then, there was a man who was understanding and excited me. And I forget about her finally” (Rinaldi, 25)”

The peers' factor in the MSM environment:

“My family had a room to rent when I was in junior high school. Those who rented were“waria”. I liked to play with them. Furthermore, I loved seeing boys and started falling for them”

(Boni, 27 )”

Feminism since childhood and having the lack of male friends:

“In my house .. when i was a little, approximately 5 to 8 years old, I have people in the neighborhood where I live that there are not many boys. It has lots of girls. Since then, I start to feel like a girl too”

(Lion, 26).

Parenting style of parents who want a daughter:

“Hahaha …. it is me. My parents expected their first child to be a girl. Then, I was born, and since then, Iwas often bought doll toys. I kindalike it... sometimes I got pink clothes ... and dressed up using my mama's makeup. Furthermore, I was also spoiled by my parents. I felt that I was more suited to be a girl” (Ninoy, 27)

Having the weakfigure of the father in the family:

“Ooo ... my father died when I was 3 months baby. I live with my mom and my older sister. I'm the only boy in the family. I am 13 brothers. I like to see grown men. I want to be loved” (Fandi,18).

History of sexual violence/ harassment by loved ones, and the utilization of social media:

“So .. so .. my sister has a boyfriend who likes her. He often plays at my house and becominga close friend to me. Helikes my sister but his love is not accepted by my sister, but he still cameto my house. Previously, I was invited to visit his house. Saturday as I remember. His house is far away in the Payakumbuh area. The region or street name I forgot. The area is quiet and I don't know exactly where it was. Because it was late at night, I spent the whole night at his house. I was sleeping. At midnight, my hands were tied up and my pants were open, and he was naked. His hard penis was inserted into my anus ... repeatedly until it bled. After that... I shared on social media how I felt. Later on, someone contacted me via chatting messenger. I confided in him. I felt comfortable and started to get acquainted. It turned out that I confided in the wrong person… and at the end,the relationship continued until now like this” (Deni,22)

DISCUSSION

Factors indicated to influence sexual behavior for MSM individuals since adolescents are having same-sex favor feelings (Latif et al., 2018). Respondents' attracted to men has existed since childhood, however, they disposed to deny it because of not admitted those feelings. This is becominga personal conflict that relating to sexual depressionfor years (Bockting, Benner, Coleman, & Sexuality, 2009). What we found, respondents cannot explain the reason for their interest in men, continued to have sexual affairs then, especially having an opportunity to get acquainted with handsome and keep in touch with someone having a good physical fitness (muscular fitness and captivating appearance).

Based on several literaciesand what we noticed today, there is no similar study to investigate the breaking-ups with women'shistory has a direct effect on MSM. Previous research has been studied on MSM only revealed the subjects to avoid personal contact with women for potential heartbreak or rejection purposes(Parker et al., 2020). Meanwhile, what we revealed, respondents have had serious relationships with women and later on had experiencedbreaking-up with them. In our findings, those phenomenon affects the incidence of MSM where some of them having a frustrating relationship with women and even having a divorce. A feeling of being dumped by women triggered them to losing sense and interested in women, hereinafter, a man in the MSM community is taking chances and provide comforting solutions which make a better situation each. On the other hand, broke up with women triggered their spouse bad habits, such; money-oriented habits, cheating with others, superior needs, and luxury lifestyle starting on the salon needs, buying updated clothes and bags, new shoes, and so on. Meanwhile, respondents expressed that that condition would never discover from men to men affairs.

Our research results not linked to the cultural habits in MSM. It refers to friendship elements and their surrounding environment. Reposing to our in-depth interviews less than half of the respondents had affected cultural habitual. Contrary to Frye's finding, the environment and sexual elements associated with MSM behavior(Meanley et al., 2020).Another theory of factorscausing respondents became MSM is the environment and having a sexual sense element for MSM whichis associated with MSM behavior, especially peers (p = <0.01)(Qu et al., 2016). MSM and the transgender person reported that they engaged in behaviors associated with girl's habits (eg; playing with girl dolls)(Finlinson, 2008).

Related to our result, the family parenting pattern is not associated with the incidence of MSM. Rothman's research having a similar tendency thatchildren's sexual behaviordoes not depend on how family nurturing their members (Rokhmah & Sudhirham, 2015). However, Darmayanti's findings argued that parents treated their children as girls would be parallel tothe incidence of MSM (Darmayanti & Sumitri, 2018). Although our findings showed without linkage variables, some respondents believed that a faint father’ figure in the family and a dominant female interaction would refer to have MSM circumstance sincethey reflected themselves as a woman even meeting witha mature male figure. They finally tends to fall in love or want to be loved, and another cases revealed that they have sense to fall in love the older one.

Statistical analysis also indicated sexual figures could not represent the MSMincidence. However, we could claim based on the record of the interviewof our MSM respondent had stated the lack of a father figure since he had 14 siblings. He never recognized his father figure since his father died when he was 3 months old. We have an identical theory to Heylens' research that someone with parents breakdown background ata young age will tend to imitate the daily attitude and behavior of his oldest sister which will emerge comfortable feeling and claimedto be a women(Heylens et al., 2012). Having the experience of being raisedby a temperamental father, the dominant role- taking place of the mother which increases of losing father figures (Rokhmah, 2016).

MSM sexual behavior / UAI (AOR: 5.85; 95% CI: 1.77-19.30)(Zhu, Liu, Chen, Zhang, & Qu, 2018). Older age (≥18 years) from the first homosexual relationship was negatively associated with physical violence (ORu = 0.3, 95% CI = [0.2, 0.7](Wei et al., 2019). The perpetrator of the respondent's sexual harassment is the closest person to the child(Quinn et al., 2015). Sexual abuse in childhood is very high in MSM with estimates ranging from 29.7% - 35.5%(Sweet & Welles, 2012)and is a very significant risk factor for risky sexual behavior syndrome(Alemu, Kisely, Calderon, Williams, & Moses, 2017). In this study, approximately 27.5% of MSM experienced sexual harassment in childhood and 5.8% of respondents experienced sexual harassment but did not become MSM because it was influenced by several factors such as religion, and had good self-coping management.

Research results showed that more than half of the respondents had a history of the migrating problem. From the results of statistical analysis, there was no relationship between the history of migrating and the incidence of MSM. However, from the results of interviews with respondents that the trigger reason for becoming MSM was socializing in new/ overseas places. Most of the informants who migrated from rural areas to cities when arrived would be affected by the association of MSM (11). Liu's study showed that migration influenced the incidence of MSM in China (p = 0.001)(Liu et al., 2017). MSM prefer to migrate to cities with developed economies and open cultures(Huang et al., 2020). Living in an urban setting can increase the risk of having adverse childhood experiences being identified as MSM(Giano & Hubach, 2019).

Social media has a big role in building communication between MSM. However, based on our statistical numbers, it shows nothing between social media influences the incidence of MSM. On the other hand, interview datastated that social media is a tool to find new acquaintances and new communities. African-American and Latino MSM use social networking technology to find and meet sexual partners, and those who use this technology are more likely to engage in risky behavior(Young, Szekeres, & Coates, 2013). The proportion of MSM was significantly larger in the use of social media(Gerke et al., 2020). MSM uses social media and dating apps for communication or finding new partners(Kesten et al., 2019). MSM spent an average of 34 hours per week accessing social media and 53% of MSM managing sexual relations online in the past 3 months(Broaddus et al., 2015).

Based on the results of this study, it shows a historical breakup with women causing the respondents to become MSM. Some respondents said that they were not interested in women because of had been disappointed by women, and stated that all women were the same. Also, social media and peers play a special role inheartbroken or disappointed men. When a woman tells and complains something active in their social media, most MSM actively in their own social media community which making them be easily finding new prey by becoming a close friend, a place of shares and complaining, and finally joining their world in MSM.

CONCLUSION

There is a relationship between biological factors and a history of a breakup with women to the incidence of MSM. There is no peer relationship, parenting style, lack of father's figures in the family, history of sexual violence, migrating status, and social media utilization with MSM incidents in Bukittinggi. It is expected that the role of parents, teachers, and related agencies in reducing the incidence of MSM, furthermoregiving an effort to eliminate the chain of HIV/AIDS transmission.

Conflict of Interests

The authors declare that they have no conflict of interest.

ACKNOWLEDGEMENT

The researcher would like to thank KEMERISTEK / BRIN for providing funding for this research with contract number 086 / SP2H / LT / DRPM / 2020.

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