Partnering Patterns and Sexual Behavior Among Korean Men Who Have Sex With Men
Identifiers and Pagination:Year: 2016
First Page: 104
Last Page: 112
Publisher Id: TOAIDJ-10-104
Article History:Received Date: 19/12/2015
Revision Received Date: 2/03/2016
Acceptance Date: 10/03/2016
Electronic publication date: 30/05/2016
Collection year: 2016
open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution-Non-Commercial 4.0 International Public License (CC BY-NC 4.0) (https://creativecommons.org/licenses/by-nc/4.0/legalcode), which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.
This qualitative study investigates the different methods for selecting sex partners by Korean homosexuals considering factors related to homosexual identity and sexual behavior. We take the approach of the grounded theory to examine the issue of sexual partnering of men who have sex with men (MSM). In-depth interviews of urban MSM and bisexual men were conducted. The snowball sampled through a MSM portal web site. Three key informants from the several areas were collected through a MSM portal website, and then, participants were gradually recruited with the snowball samplings in South Korea, 2011 (n=32). The results of coding the interviews based on the grounded theory approach identified three types of partnering: 1) MSM who do not prefer anal intercourse, but pursue safe sex in long-term relationships with fixed partners; 2) those who have fixed partners and perform anal sex, a category into which both MSM and bisexuals fall; and 3) those engaged in anal sex, but enjoy a concurrent sexual relationship without having fixed partners, which was common among bisexuals. The findings from this study elucidate several MSM and bisexual partnering types practice safe sex. This diversity in MSM partnering may increase the vulnerability of some MSM to HIV infection as safe-sex practices remain a matter of individual choice. Changes in Korean societal policies are necessary to enhance capacity building and encourage the practice of safe sex at the community level.
Previous research into the selection of a sex partner, particularly from the heterosexual perspective, focused on the formation of long-term relationships with few studies on the types of sexual partnering and factors affecting partnering in mem who have sex with men (MSM) [1-3]. Previous reports have indicated that people tend to seek those with backgrounds, personality attributes, and physical characteristics similar to their own . In particular, both males and females prefer partners with a charming appearance, nice personality, and a sense of humor, regardless of whether they are MSM or straight [1, 2]. It is also likely that partnering between MSM may be different from that of heterosexuals, given the nature and social context of homosexuality. Most previous partner selection studies have investigated Western and Hispanic populations rather than Asian populations [3, 5]. The current investigated various characteristics of such partnering and interpreted the observed partnering types according to existing theoretical concepts. Understanding the MSM community, defined as a social network of MSM who interact over time, can increase community capacity building directed at encouraging safe sex (i.e., promoting condom use) while mitigating social prejudice and stigma toward MSM in East Asia.
We applied a qualitative investigative methodology that included semi-structured and in-depth interviews. The in-depth interviews were conducted face-to-face in locations selected by the interviewee in South Korea, 2011. Interviews consisted of open-ended questions based on three self-perception topics: homosexuality, partner selection, and sexual behavior. The order of the questions was not predetermined, and, for the interviewees to express themselves naturally, the question order was adjusted by the interviewer during the interview. The interviewer possessed a government certificate in qualitative research methodology. The interviewer sought to promote comfortable conversations with the interviewees, by appropriately probing or recalling the discussion to the topic at hand. Interview duration was approximately 1.5 to 2 hours per person, and each interviewee received about 80 USD remuneration. The contents of the interviews were recorded if the interviewee consented to such recording; otherwise, the responses were directly entered into a computer during the interview. The information thus recorded was transcribed as stated by the interviewee and subsequently used in the analysis.
Over a one-month period in September 2011 we recruited subjects from three metropolitan cities in Seoul, Korea. Initially, three key informants, one from each of the three cities, were collected through a MSM portal website. Subsequently, additional participants were recruited through snowball sampling, beginning with these three key informants. The three MSM started referring other homosexual/bisexual men and then those men referred other homosexual/bisexual men. The sampling process continued until sample numbers reached theoretical sample saturation with regard to MSM partnering (minimum = 30). Participants were limited to men who described themselves as MSM or bisexual.
Thirty-two participants including seven who were HIV positive were enrolled in the study (Table 1). Participants’ age ranged from 22 to 55 years, with a median age of 34 years. Most participants were high school graduates or above, and most participants were in good health. Most first homosexual experiences occurred in the participants’ early 20s. Nineteen of the participants had a primary partner currently. In addition, 17 participants had bisexual experiences during lifetime, whereas 11 participants reported never experience with anal intercourse.
Demographic characteristics of participants for in-depth interviews (n = 32).
|Participant||Region||Age||Education||Bisexuality||Anal sex||Primary partners||HIV status|
Initially, we categorized the interview results into a series of similar themes . Then, we modified these categories to obtain coded data through the open coding, axial coding, and selective coding procedures described by Strauss and Corbin . The study used open coding to compare the primary categories with the raw interview data. We used axial coding to analyze each category's systematic connection with sexual behavior and partner selection processes. Selective coding was used to determine the core concept that offers the most integrated explanation of the relationships among the partnering categories. N vivo 8 software was used during the coding processes and for conceptual analyses. According to a methodological guideline presented by Frieze, NVivo 8 software eliminates specific coding process disparities . Inter-coder reliability, determined by calculating kappa values for each code, is summarized in the Appendix 1. We reviewed the credibility and fittingness of the analysis output by applying the evaluation criteria reported in a qualitative study reported by Sandelowski .
This study was approved by the institutional review boards of the College of Health Science at Korea University and is consistent with the principles of the Declaration of Helsinki. All participants gave written informed consent to participate.
Sexual Identity and Homosexuality
The social stereotype of MSM is based on femininity. When femininity is perceived by others, a person’s effeminate attitudes or tastes may result in distress about one’s sexual identity. Participant #1 spoke of how his sexual identity problems began with his feminine attitude (Appendix 2). MSM discover themselves to be different from others during the course of feeling affection for members of the same sex. The more patriarchal a society is, the stronger the relationship between sex and gender. Consequently, when gender roles are diminished, the possession of a MSM identity is accompanied by cognitive distress. Participant #2’s childhood experience included the painful episode (Appendix 2). However, contrary to stereotypical attitudes, MSM do not necessarily realize their sexual orientation through their femininity, nor are all of them effeminate. There are MSM who, although attracted to members of the same sex, have a weak identity as a MSM or have a macho attitude (Participant #13, Appendix 2). Nevertheless, most MSM experience affection when they have contact with men’s bodies and/or when they have experienced considerable psychological conflict. Some participants in this study ascertained they were MSM, whereas others determined they had a bisexual disposition (Participant #4, Appendix 2). Possessing an identity as a MSM can result in voluntarily adopting the everyday life activities, self-adornments, and interests of a MSM. In addition, when searching for MSM male partners, MSM actively pursue their preferred sexual orientation.
Partner Selection by MSM
In the MSM community or MSM social networks, partner-matching patterns are based on the process of sharing the features of a ‘minor culture.’ Such cultures are built on a social life basis that converges on a community in which similar outfits, gestures, and slang expressions exist. Participant #9 pointed out that as one becomes acquainted with different MSM people, an internal intimacy develops, and partnering occurs during that development (Appendix 2). However, such MSM partnering is often orientated toward sexual contact. Unlike the straight community, members of the MSM community do not have the opportunity to meet other MSM in a wide variety of places; thus, the basis of their social life activities is mainly directed at satisfying their sexual desires. They do not confine 'sex' to an activity for reproduction; rather they seek to attain sexual pleasure as a natural activity. After the advent of the Internet, it became easier to find MSM partners, and MSM partnering gained momentum (Participant #14, Appendix 2). A dominant feature of MSM partnering is that outward countenance has become an important criterion applied during partner selection. In the case of heterosexuals, socioeconomic factors other than outward countenance play a key role in partner selection, whereas sex appeal is an important factor in the MSM community. Regardless, partner selection reflects individual tastes rather than indicative of an ideal or standardized body shape (Participant #23, Appendix 2). Unlike straight relationships, sensual and sexual satisfaction have significance for MSM therefore, MSM may not prefer long-term or exclusive relationships with a partner. In the MSM community, MSM may participate in unrestrained and diverse types of partnering to maximize their sexual pleasure. Participant #14 described this phenomenon as a process that “forms sexual tension between men.”
Partnering and Sexual Behavior
Compared to straight communities the MSM community has more partnering types. There are differences in individual’s inclinations to have primary partners between the MSM and straight communities. Among heterosexuals, engagement and marriage are important, and legal regulations and ethical codes exist to protect against extramarital affairs. For MSM, however, the period of partnering may be much shorter even with the selection of primary partners, and the rules and ethical codes are less strict. Participant #20 in his description of his relationship with his primary partner (Appendix 2). Having a primary partner does not necessarily mean MSM would not have concurrent sexual partnerships. Eleven of the 19 participants who said they had primary partners stated that they had more than ten sex partners in the past year. Some participants said that they had two or more primary partners. Thus, having a primary partner did not indicate exclusivity in their sexual relationships.
A primary partner may have a supportive role in maintaining a pattern of flexible, short-cycled serial monogamy. Participant #20 described temporal changes in his sexual partnering (Appendix 2). If a primary partner has a ‘relational date’ within a restricted period or a ‘relational lover,’ then multiple sexual relationships can develop in the absence of the other partner. In such situations there may be intentional shunning of the other partner; moreover, the primary partner may define themselves as having a bisexual identity. Such people clearly manifest a sexual desire for both sexes, and some have sexual experiences with both sexes while determining their sexual identity (Participant #18, Appendix 2). Another significant element in understanding partnering is the type of sexual behavior. Because MSM partners have the same body structure, they must develop sex techniques that allow each partner to achieve sexual pleasure. The participants offered many comments on this topic. In general, sexual behaviors exhibited within a relationship between partners were based on mutual consent and personal adjustment. With regard to anal intercourse, there was a difference among the participants between those that liked or disliked anal intercourse. Among the bisexual participants there was a preference for penetrative sex (Participant #13, Appendix 2).
MSM partnering is not solely dependent on having a primary partner. It can fall into various categories according to the number of concurrent sexual partnerships or to an individual’s sexual orientation, including bisexuality, and their preferred sexual behaviors. Partnering is also affected by individual attitudes toward condom use and sexually transmitted disease. Most interviewees expressed a worry about HIV infection, but there were large differences in their practice of safe sex (i.e., intercourse without a condom). Among those who have anal intercourse there was recognition of the necessity of condom and lubricant use. However, some participants attempted to prevent HIV infection by restricting their sexual partnering rather than by using a condom (Participant #14, Appendix 2). Thus, the MSM community and MSM social networks have relied on the use of individual behavioral preferences for HIV infection prevention rather than on developing specific community-based norms for safe sex. When it is difficult to communicate with a partner about the use of a condom, some MSM people will seek safety from infection by restricting their sexual relationships to reliable partners. However, this situation can be more difficult for those with HIV as it can lower their capacity to cope with social stigma and discrimination. Participant #32, who has AIDS, described his experience (Appendix 2). Consequently, solidarity in the approach to infection prevention in the MSM community is weakened by the differences in attitudes toward HIV infection within that community. Regardless, sexual relationships in the MSM community occur even though the community may not offer aid or capacity-building programs related to sexual partnering.
Types of MSM Partnering
The presence of a primary partnership and the practice of anal intercourse were the most influential factors in MSM partnering. Our analysis included positioning mapping, which placed each interviewee's stated sexual orientation and HIV infection status on two axes (Fig. 1). The results indicated the presence of three types of partnering. The first type represented MSM who have a primary partner and do not perform anal intercourse (group 1). Some members of that group had a large number of sex partners, but they also recorded a high level of safe sex. The second type included MSM and bisexuals who have a primary partner and perform anal intercourse (group 2 and 4). Despite their participation in that risky sexual activity, they exhibited restricted partnering. The third type included bisexuals without a primary partner (group 3). The majority of that group was HIV positive. Among the above three types, the group 1 members had the most cautious safe-sex relationships, whereas the group 3 bisexuals formed the least cautious safe-sex relationships.
Typology of sexual partnering patterns in this study a ●: HIV-negative MSM, ○: HIV-positive MSM, ▲: HIV-negative bisexuals, ∆: HIV-positive bisexuals MSM: men who have sex with men.
This grounded theory–based study explored sexual behaviors and partnering types among Korean MSM. The identity of MSM is manifested by their feminine or macho propensities within a typically patriarchal Korean culture. This study revealed three types of partnering. First, partnerships with primary partners who practiced anal intercourse were common among MSM and bisexuals. Second, partnerships among MSM who did not practice anal intercourse and who preferred to form long-term, safe-sex partnerships. Third, partnerships among bisexuals without a primary partner, a partnering type that included risky sexual behaviors like anal intercourse and relationships with multiple partners. These partnering types illustrate the diversity of sexual behaviors being exhibited at the community level.
The results of the present study suggest that Asian societies need to consider MSM sexual behaviors in terms of their sexual script. A ‘cultural script’ indicates the widespread presence of institutional norms in a society, whereas an ‘interpersonal script’ indicates the development of norms from within individual relationships . Such norms are manifested by an ‘intrapsychic script’ and by interpersonal relationships; that is, there are individual inner motives for an individual’s sexual behaviors. The ‘love script’ for homosexuals in Korean society is restricted because homosexuals are generally excluded from communities due to the predominance of homophobia [11-13]. In a society that exhibits a predominantly patriarchal culture and largely consists of a single ethnicity, treatment of MSM as ‘others’ and hostility against MSM weakens their identity. MSM bashing and ‘antipathy toward effeminate men’  continues to exist in South Korean society .
Therefore, a specific script for homosexuality may not be acceptable at the cultural level in Korea with its limited ethnic variety and patriarchal order. However, such a script may be acceptable at the community level . The nature of partnering among immigrant workers and female sex workers, who face discrimination similar to that faced by MSM, is also varied [15, 16]. The presence of markets for sexual consumption has prompted the MSM community to form its own sex market.
The presence of a sex market has probably helped define the nature of the MSM partnering at the community level in Asia. Usually, the MSM community tends to isolate itself geographically into gay bar districts [17, 18]. In South Korea, interpersonal scripts for MSM have developed since the late 1990s . It is believed that members of group one (see Fig. 1) maintain themselves through the help of interpersonal scripts. As new areas were created for the formation of casual partnerships, such as those created by the Internet or gay bar districts, the partner selecting criteria of the MSM community expanded . The emergence of public bath houses and Internet social gathering sites during the mid-1990s helped some MSM find partners at a low cost. Furthermore, through such facilities some MSM have been introduced to other communities such as those formed by group two and group four members. As MSM relationship types changed, one-night stands and anal intercourse became popular. This is consistent with previous studies suggesting that scripts at the community level have an impact on the partnering types of sexual minorities . This study found that diverse partnering types are present in the MSM community, contrary to previous research indicating that capacity building has increased in the MSM community.
This study has limitations related to forming generalizations from the results because our analysis is based on partnering data from a small number of samples obtained within a restricted period. Therefore, follow-up studies with large sample sizes and quantitative analyses are required to substantiate the partnering types detected in this study. Furthermore, empirical evidence is needed to assess temporal changes in MSM partnering.
This study revealed three types of partnering in Korean MSM: 1) MSM who form long-term relationships with primary partners and do not prefer anal intercourse; 2) those who have primary partners and perform anal intercourse, a category that includes both MSM and bisexuals; and 3) those who have concurrent sexual relationships without primary partners and who engage in anal intercourse, a type that was common among bisexuals. The findings from this study elucidate several MSM and bisexual partnering types practice safe sex. This diversity in MSM partnering may increase the vulnerability of some MSM to HIV infection as safe-sex practices remain a matter of individual choice. Changes in Korean societal policies are necessary to enhance capacity building and encourage the practice of safe sex at the community level.
Basic parameters of rock mass and rock bolt.
|Super-category||Main categories (k = .87)||Sub-categories|
|Sexual identity categories||Feminine attitude
(k = .75)
|Attraction to men|
|Feminine and masculine|
(k = .71)
|Disagreement between sex and gender|
|Affections of the body|
|Partner selection categories||MSM recognition
(k = .64)
|Outfits, gesture, and slangs|
(k = .79)
(k = .67)
(k = .76)
(k = .80)
|Pain and pleasure|
(k = .84)
|Communicate with a partner|
k: kappa values for inter-coder reliability.
MSM: men who have sex with men.
Appendix 2. Recorded interviews of study participants
I actually didn't know I was feminine. But when I entered high school, I only hung out with other boys who were my seniors, and they made me aware of it by saying things like I was acting very cute and I was very feminine. That's around the time when I started to worry about things like ‘Do I want to become a woman?’ or ‘Am I attracted to men?’ (Participant #1, bisexual, age 30)
I had two older brothers at home, and my father often demanded that I act like them and be manly. But I didn't. I had more fun cutting out paper dolls and dressing them up … then one day he caught me and beat the hell out of me. (Participant #2, bisexual, age 43)
When I entered high school I became close buddies with a student… it was weird when it was just the two of us. I wanted to touch his body … and then I kissed him. After that I think I did a lot of soul-searching (about who I was). But I didn't really get involved in any BBS (bulletin board system) activities, and I didn't only date other men … so I think of myself as a bisexual. (Participant #4, bisexual, age 31)
Before, there were a few designated places for cruising. You strolled around those places and recognized (gays) by the way they dressed. Then, in the 90's, hangout places like gay bars opened around Itaewon, a commercial space for gays where you didn't have to hide who you were and you could sing and drink … (Participant #9, MSM, age 36)
Typically, a lot of the kids that are macho have both feminine and masculine sides to them. Kids who are just strongly feminine really aren't popular in the gay community. So it's not so simple to talk about (what gay identity is). (Participant #13, bisexual, age 37)
Men who dislike anal intercourse never do it. With me too, often it was just going along with what the other men wanted rather than liking anal intercourse itself … once the other men was at the bottom but it was so painful that I stopped in the middle. But if you do it several times you just become accustomed to it … with bisexuals, it feels like you’re missing something if you don’t have that. (Participant #13, bisexual, age 37)
Before, I used to go to bath houses or saunas to satisfy my sexual urges but these days … I think I enjoy the process of dating a bit more. You can easily meet new people when you go to an Ivan City’s chatting room … and that can lead to a one-night stand or you can begin to date. If it feels good you keep seeing each other … but that doesn't mean it's easy to find someone who's right for you. So you just go to places like bath houses or saunas. At those places you can just hook up and satisfy your (sexual urges). (Participant #14, MSM, age 35)
When I used a condom, it lessened the anxiety but I also couldn’t concentrate. So I have thought about which was more important … I almost never do anal intercourse so I just want to feel more … and so I look for someone who I can trust who will not get me infected (with HIV). (Participant #14, MSM, age 35)
Perhaps I should say my eyes opened to sex a bit earlier … I worried about homosexuality quite a bit once I got into middle school and then I had a girlfriend … I don’t think there was any division. I just had both sexual drives, so I concluded that I must be bisexual. […] More than the penetration itself, I liked meeting new people and having different types of experiences. (Participant #18, bisexual, age 25)
In the gay community it's common for you to have a lover and still go to bath houses or see other men. Of course you tell your partner it’s him you love. But unless you can't play the game anymore 'cause you're too old, you don't limit yourself to just your primary partner. (Participant #20, MSM, age 29)
This time I’ve been dating pretty long-term, about three years. As I age, I think the relationship itself becomes more important than the sexual aspect. There’s no institutional recognition but (our relationship) is like that of straight couples. It’s like family … there’s a period of boredom too … you become accustomed to the relationship and come to fit each other perfectly. (Participant #20, MSM, age 29)
With us, appearance is most important. It's not like we'll marry, so things like money or family background, they don't mean anything, really. It's not like we'll have children … so it's just your body or looks that makes you sexually appealing. But when we say appearance, we don't necessarily mean someone who's handsome or muscular like a statue. (Participant #23, MSM, age 26)
If you have AIDS, telling the truth and revealing yourself within the gay community isn’t something you get criticized for, but it’s also true that people are reluctant to do that. What can you expect? If I am having a difficult time, they’ll give me encouragement … but if someone shares such things, then regular people will stigmatize gays all the more. […] Among gays too, the infected are more like ghosts. Since it’s a small community, it’s difficult to tell one’s partner the truth … […] It’s likely that most of them don’t have primary partners. (Participant #32, bisexual, age 38)
CONFLICT OF INTEREST
The author confirms that this article content has no conflict of interest.
This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.