Purpose: Male sex workers (MSWs) face increased risks of HIV yet few studies have evaluated the role of the social environment in which their risk behaviors occurs. This exploratory research is one of the first studies to describe the social network characteristics of MSWs and identify individual and social network correlates of their sexual risk behaviors.

Methods: Using respondent driven sampling methods, 100 male sex workers were recruited in Beirut, Lebanon and asked to complete behavioral and egocentric network surveys. Multivariate logistic regression models were used to determine correlates of HIV testing history and recent unprotected anal intercourse with male partners while simultaneously considering individual and social network measures.

Results: Half of the study sample had ever tested for HIV, while more than three-fourths had engaged in at least one episode of unprotected anal intercourse in the past three months. Peers formed the core of MSWs social life, yet nearly two-thirds of named social network members (alters) never discussed sexual matters with respondents. Respondents perceived that almost one-fifth of alters never or rarely used condoms. In multivariate regression models, MSWs with higher HIV knowledge and homosexual orientation were more likely to get tested, and those with more motivation to engage in protective behavior were less likely to engage in unprotected anal intercourse. With respect to social network characteristics, lower social support and higher degree centralization were found to be marginally associated with a higher likelihood of engaging in unprotected anal intercourse.

Conclusion: Our findings suggest the need for prevention programs targeting MSWs to provide information and awareness about HIV risk and prevention, and to develop strategies that facilitate the development of favorable peer norms in this population. Future research should further explore the role of the social environment.