Can oral sex be performed safely among men who have sex with men (MSM) and transgender women in Bangladesh? Challenges, complexities and the way forward

Introduction: There is currently ample research and intervention initiatives addressing anal sex and sexually transmitted infections (STIs) among gender and sexually diverse people (i.e., men who have sex with men (MSM) and transgender women). However, oral sex and oral STIs are not prioritized to the same extent, despite their concerning implications. This article aimed to delineate the underlying contexts of unprotected oral sex and the management challenges of oral STIs. Methodology: This qualitative study constituted 30 in-depth interviews, 14 focus group discus-sions, and 10 key-informant interviews with gender and sexually diverse people, service providers of HIV interventions and sexuality researchers. Thematic analysis conventions were applied. Results: Findings revealed various contexts of unprotected oral sex. In particular, we found a discordance between pleasure and protected sex where participants believed the two phenomena were mutually exclusive, therefore they did not want to compromise their pleasure by using condoms. Moreover, their low awareness, risk perception, and unchallenged misconceptions about the harms of unprotected oral sex fueled their hesitancy to use condoms during oral sex. Compared to anal sex and STIs, oral sex and STIs were less prioritized in the current HIV inter-vention modalities, where healthcare providers lacked adequate knowledge and training about oral sex and oral STIs, as well as their complexities. Conclusions: In Bangladesh and several other settings, oral sex is considered a taboo, thus imbuing silence about this issue and its complexities. In this context, it is integral to eradicate the taboos and silence surrounding oral sex and oral STIs in order to strengthen the overall STI management strategy. Therefore, HIV/STI prevention programs and mainstream healthcare facilities need to underscore oral STI interventions, otherwise this issue would remain under-prioritized.