Correlates of anal sex roles among Malay and Chinese MSM in Kuala Lumpur, Malaysia

Identifying roles for anal sex is an important issue for populations of MSM. We describe the prevalence of identifying as being top', bottom', versatile', or don't know/not applicable' among Malay and Chinese MSM in Kuala Lumpur, Malaysia, and behavioural outcomes according to these labels for sexual role identity. Data analysis was conducted on a survey administered during weekly outreach throughout Kuala Lumpur in 2012. Pearson's Chi square tests were used to compare demographic and behavioural characteristics of MSM who reported roles for anal sex. Binary logistic regression was used to explore the odds of behavioural outcomes among MSM who identified as bottom', versatile,' and don't know' compared to MSM who reported that top' was their sexual role. Labels for anal sex roles were significantly associated with condom use for last anal sex. Among MSM who used labels for anal sex roles, MSM who identified as bottom' had highest level of not using condoms for last anal sex (24.1%, p=.045). In binary logistic regression model, identifying as top' was significantly associated with reporting using a condom during last anal sex and reported consistent condom use for anal sex in the past six months (p=.039 and .017, respectively). With regard to sexual role identity, some MSM may be a part of a special subgroup of at-risk men to be targeted. Future research should evaluate the origins, meanings, and perceptions of these labels, and the developmental process of how these MSM identify with any of these categories. Research should also uncover condom use decision making with regard to these labels for sexual positioning.