Earlier Sexual Debut and Anti-Gay Victimization Among Men Who Have Sex With Men (MSM) in Kazakhstan

Abstract

Limited research has examined predictors of anti-gay victimization among men who have sex with men (MSM), despite anti-gay violence continuing to be a global problem. We conducted a secondary analysis of data from structured interviews with 600 MSM adults to examine anti-gay victimization and earlier sexual debut among MSM in Kazakhstan. Multiple linear regression was used to test for associations between earlier sexual debut—categorized as age of sexual onset between 13 and 15 years of age and prior to 13 years old, with ages 16 and older as the reference group—and recent and lifetime anti-gay victimization. Adjusted logistic regression models were used to assess earlier sexual debut and specific types of victimization. The majority of MSM reported lifetime (89%) or recent (68%) experiences of anti-gay victimization. Earlier sexual debut prior to 13 years of age was significantly associated with greater number of types of lifetime and recent reports of anti-gay victimization. Among specific types of anti-gay victimization, earlier sexual debut was associated with higher odds of experiencing verbal, physical, and sexual violence. Anti-gay violence in Kazakhstan is a significant and prevalent public health issue. Future research and clinical interventions addressing anti-gay victimization among MSM populations should consider the lifetime and current implications of consensual and non-consensual childhood and adolescent sexual experiences.

Keywords

violence against sexual assault GLBT internet and abuse sexual harassment male victims

Introduction

Globally, sexual and gender diverse (SGD) populations continue to face many pervasive forms of discrimination, including physical, emotional, and sexual violence (Bostwick et al., 2014; Handlovsky et al., 2018; Herek, 2017; Herek & Berrill, 1990; Hong et al., 2016). Gay, bisexual, and other men who have sex with men (MSM) are highly stigmatized populations within Kazakhstan, yet empirically assessed prevalence rates of anti-gay forms of violence and victimization in the region are relatively unknown (Latypov et al., 2013; Paine et al., 2021).

Anti-Gay Victimization

Evidence suggests that SGD people are at increased risk of experiencing anti-gay violence and victimization across the life span within both their interpersonal relationships and within the greater society (Balsam et al., 2005). Anti-gay forms of discrimination and victimization are critical and well-documented environmental contributors to health disparities among SGD populations (Bostwick et al., 2014; Clark, 2014). However, reports and documentation of anti-gay victimization can vary widely depending on complex cultural, political, and geographic factors (Balsam et al., 2005; Herek, 2017). Direct academic research and data collection of victim-reported experiences is important because it can bypass structural barriers within law enforcement and state-controlled systems to contribute key information about the effects and pervasiveness of anti-gay violence within global regions underrepresented in research (Herek, 2017).

In Kazakhstan, homophobia has been attributed to widespread Russian colonial influence within the region and is a socially and politically constructed environmental risk factor for SGD people (Levitanus, 2022; Wilkinson, 2020). As a result of anti-gay social norms, SGD people have reported experiences of violence and discrimination from family members, employers, and members of the state (Amnesty International, 2017; Latypov et al., 2013; Levitanus, 2022; Paine et al., 2021). SGD Kazakhstani people are not legally protected from discrimination on the basis of sexual orientation and gender identity, and are restricted from freedom of peaceful assembly, association, and expression in part by censored state-controlled media (Amnesty International, 2017). Although consensual same-sex sexual behavior among men was decriminalized in 1998, same-sex marriage remains illegal in Kazakhstan (Amnesty International, 2017; Wilkinson, 2020). Homophobic social attitudes and norms in Kazakhstan have been associated with violent crimes against SGD people, and survivors of anti-gay violence risk inadequate and abusive responses from police, prosecutors, judges, and other members of the legal system (Amnesty International, 2017; Levitanus, 2022). The nascent empirical research literature on SGD people in Kazakhstan has primarily focused on the harms of substance use and HIV, and less is known about violence against MSM and other SGD groups in Kazakhstan (Berry et al., 2012; Paine et al., 2021).

Earlier Sexual Debut, Anti-Gay Stigma, and Victimization

One particular aspect of sexual development that is associated with experiences of violence and victimization among SGD people is earlier age of first partnered sexual activity, otherwise known as earlier sexual debut (Brown et al., 2015; Halkitis et al., 2021; Lowry et al., 2017). For many young people, sexual debut is considered to be a pivotal developmental milestone because it can represent a shift in personal identity, social status, and susceptibility to health risks (Golden et al., 2016; Lowry et al., 2017). However, compared to cisgender-heterosexual peers, SGD people’s sexual debut can be complicated by systemic forms of anti-gay discrimination and stigma that perpetuate harm and health disparities (Stout et al., 2023). Earlier sexual debut can contribute to additional risk for SGD people who are navigating stigmatized sexual relationships at a younger age (Outlaw et al., 2011; Stout et al., 2023). Risks related to earlier sexual debut among SGD people include disproportionate substance use and risky sexual behaviors, as well as experiences of violence and victimization (Outlaw et al., 2011; Tomori et al., 2016). Despite evidence that earlier sexual debut is linked to experiences of violence and victimization among SGD populations, limited research exists among MSM in Kazakhstan.

Global studies examining earlier sexual debut and experiences of victimization among SGD people often highlight child sexual abuse (CSA), sexual assault, and other forms of emotional and physical violence (Adeboye, 2017; Brown et al., 2015; Lowry et al., 2017; Pan et al., 2014). SGD people report disproportionately higher rates of CSA victimization, and earlier sexual debut is associated with CSA victimization among SGD populations (Biello et al., 2014; Brown et al., 2015; Lloyd & Operario, 2012; Mimiaga et al., 2009; Schafer et al., 2013; Thoma et al., 2021). Beyond CSA, earlier sexual debut among SGD people has been associated with increased risk of other forms of violence, including electronic bullying, suicidal thoughts/attempts, and having been threatened at school (Kattari et al., 2021; Lowry et al., 2017). No previous studies have examined earlier sexual behavior among MSM populations within Kazakhstan, nor any associations between these earlier sexual events and reports of victimization.

Risk Environment Theory

The present study utilizes risk environment theory, which suggests that harm is shaped by context-dependent environmental conditions including socially constructed beliefs about risk and morality (Lupton, 1993; Rhodes, 2002). Risk environment theory was developed in response to critiques that health research, particularly HIV research among marginalized populations, over-emphasizes individual-level factors, personal responsibility, and rational choice decision making and fails to adequately acknowledge the influence of socially-produced environmental and structural influences to health risk behaviors (Rhodes et al., 2012). HIV risk factors, such as earlier age of sexual debut and violent victimization, among SGD people are shaped not only by individual-level behaviors (e.g., sexual victimization) but by homophobic social, cultural, and political norms (e.g., limited legal protections for SGD victims of violence) (Amnesty International, 2017; Levitanus, 2022; Outlaw et al., 2011; Tomori et al., 2016). The authors theorize that links between earlier age of sexual debut and experiences of victimization among SGD populations are contextualized by anti-gay forms of systemic and structural violence and vulnerability.

Study Aims and Hypotheses

Limited research has examined the role of homophobic forms of victimization among MSM in Kazakhstan, and no previous research has examined associations between earlier sexual debut and anti-gay victimization among this population. The present study aims to investigate the relationship between earlier sexual debut and experiences of anti-gay violence and victimization among a sample of MSM from three metropolitan cities in Kazakhstan. Specifically, we test the hypotheses that earlier age of sexual debut is a predictor of both lifetime and recent experiences of anti-gay victimization. This study seeks to help address knowledge gaps about the role of sexual diverse people’s earlier sexual behavior and how it relates to lifetime and present-day experiences of harm and violence.

Methods

Data Collection and Procedures

This study is a secondary analysis of data obtained in a National Institute on Drug Abuse (NIDA)-funded clinical trial of a behavioral intervention that sought to increase the engagement of MSM who use substances in Kazakhstan in the HIV care continuum (Paine et al., 2021). Briefly, the clinical trial utilized a stepped-wedge design across three geographically disparate cities—Almaty, Nur-Sultan (formerly Astana), and Shymkent—to test the intervention. These cities were chosen based primarily on the following: (a) having high prevalence and incidence of HIV in the country; (b) preliminary work mapping venues and locations indicating an ability to reach MSM from a combination of traditional brick-and-mortar venues and digital social networking and dating services (Lee et al., 2022; Paine et al., 2021); and (c) being geographically disparate to minimize contamination given the parent study’s stepped-wedge randomized trial. The study utilized a combination of convenience, venue-based, and snowball (via referral from study participants) sampling (Lee et al., 2022; Paine et al., 2021) to recruit individuals who met the following eligibility criteria: ≥18 years old; identifying as male at any point in life or being assigned male at birth; having consensual sex with another man in the past 12 months; engaging in binge drinking, illicit drug use, or both in the past 90 days; and residing in one of the three study cities.

This study utilized self-reported data collected during structured screening interviews and baseline data collection conducted in Russian or Kazakh. Screening and baseline interviews were completed between July 2018 and September 2021 (N = 600). The sexual debut responses were collected from the screening interviews, and all other information was collected from the baseline interviews. All study procedures were approved by the Institutional Review Board (IRB) at Columbia University (Protocol # IRB—AAAQ7251) and the Local Ethical Committee at Al-Farabi Kazakh National University (Protocol # IRB—A052).

Participants

Participants included in this study are MSM adults who had completed both the screening and baseline surveys. Eligible participants were 18 years and older; identified as cisgender men; and reported having had consensual sex with a man in the past year (N = 600).

Measures

Earlier Sexual Debut

Age of sexual onset, or sexual debut, was measured using a screening survey question asking how old the participant was when they first had sex. The mean age of sexual debut in our MSM sample was 16 years old which determined the age cut-off point for the reference group used in all models. Earlier sexual debut was categorized into two subgroups (ages 12 and younger and ages 13–15) to assess possible differences in health behavior risk among those who were sexually active as a pre-teenager as opposed to an early adolescent teenager (Xavier Hall et al., 2021).

Anti-Gay Victimization

An adapted version of Herek and Berrill’s (1990) anti-gay violence and victimization survey instrument was used for assessment. Respondents were asked if they had experienced various forms of victimization due to their gender identity or sexual orientation recently (past 6 months) and within their lifetime. A total of 16 victimization questions were asked including whether or not they had ever been sexually assaulted or threatened with physical violence (see Table 2 for the complete list of items). Based on a more contemporary understanding and feedback from the study’s Community Advisory Board, the research team added items related to “outing” and being targeted on social media. Lifetime victimization was measured using the sum number of victimization types experienced ever. Recent victimization was measured using the sum number of victimization types experienced in the past 6 months.

Covariates

Sociodemographic characteristics included age, city (Almaty, Nur-Sultan, and Shymkent); marital status, highest educational attainment level, employment status, recent housing insecurity (past 6 months); lifetime polydrug use (reported illicitly using three or more types of drugs ever); and self-reported HIV status. Sexual orientation was self-reported by participants and identified as either gay, bisexual, heterosexual, or other sexual orientation. Income was self-reported by participants and was measured by their estimated monthly income during the past 6 months. Within bivariate and multivariable models, income was transformed using a natural log.

Statistical Analyses

Independent t-tests, one-way analysis of variance (ANOVA) tests, and Pearson correlations were used for bivariate analyses to determine differences between population characteristics and experiences of violence and victimization. Multiple linear regression was employed to assess the association between earlier sexual debut and victimization, with covariance adjustment for sociodemographic characteristics. Logistic regression was also used to determine associations between earlier sexual debut and specific types of victimization that occurred over the lifetime and in the past 6 months (e.g., whether or not they had ever been verbally insulted) and controlling for sociodemographic characteristics.

Results

Sociodemographic Characteristics

Categorical sociodemographic characteristics are listed in Table 1. Over a third of participants lived in Almaty (37%) and most had not recently experienced housing security (89%). Participants were primarily single (76%), employed full time (52%), and had a bachelor’s education or more (47%). The majority of participants reported identifying as gay (53%) and HIV-negative (62%). Approximately two-thirds of participants reported having a sexual debut when they were 16 years of age or older (62%). Regarding continuous population characteristics, the average age of our study participant was 28 years old and the average monthly income reported over the past 6 months was approximately 200,000 KZT (~500 USD based on the average exchange rate over the data collection period).

Table 1.

Categorical Sociodemographic Characteristics of the Sample of MSM in Kazakhstan, 2018 to 2021 (N = 600).

Sociodemographic Characteristic	n (%)
City
Almaty	223 (37.2)
Astana	194 (32.3)
Shymkent	183 (30.5)
Marital status
Single	457 (76.2)
Married	44 (7.3)
No longer with spouse	53 (8.8)
Other	46 (7.7)
Highest educational attainment level
Ninth grade or less	39 (6.5)
High school or vocational	253 (42.2)
Bachelor’s degree or more	281 (46.8)
Other	27 (4.5)
Employment
Full time	311 (51.8)
Part-time	143 (23.8)
Unemployed	62 (10.3)
Other	84 (14.0)
Housing insecurity in the past 6 months
Yes	67 (11.2)
No	533 (88.8)
Self-reported HIV status
HIV-positive	46 (7.7)
HIV-negative	372 (62.0)
Unknown	182 (30.3)
Self-reported sexual orientation
Gay	317 (52.8)
Bisexual	256 (42.7)
Heterosexual	8 (1.3)
Other	19 (3.2)
Polydrug use
Yes	113 (18.8)
No	487 (81.2)
Sexual debut^a
Ages less than 13	64 (10.7)
Ages 13–15	162 (27.0)
Ages 16 and older	373 (62.2)

Note. The present table represents the observed percentage (%) of categorical sociodemographic characteristics within the sample of MSM adults. MSM = men who have sex with men.

One response for sexual debut was coded as missing.

Anti-Gay Victimization

Across all types, the vast majority (89%) of MSM in our sample had reported ever experiencing a form of anti-gay victimization. Among lifetime reports of specific types of victimization, verbal insults (69%) and insults on social media (62%) were most frequently reported by participants (see Table 2 for a complete list). In the bivariate analyses, the number of types of lifetime victimization differed significantly by recent housing status, region, income, polydrug use, and sexual orientation. Participants who reported experiencing recent housing insecurity were more likely to report higher mean lifetime victimization scores. Income was positively correlated with the number of types of lifetime victimization.

Table 2.

Anti-Gay Victimization Among MSM Adults in Kazakhstan, 2018 to 2021 (N = 600).

Experiences of Anti-Gay Victimization	Lifetime	Past 6 Months
Experiences of Anti-Gay Victimization	n (%)	n (%)
Verbal insults	415 (69.2)	198 (33.0)
Threatened with physical violence	271 (45.2)	100 (16.7)
Personal property damaged	215 (35.8)	95 (15.8)
Objects thrown	185 (30.8)	64 (10.7)
Chased or followed	198 (33.0)	89 (14.8)
Spat on	65 (10.8)	23 (3.8)
Punched, hit, kicked, or beaten	265 (44.2)	92 (15.3)
Assaulted or wounded with a weapon	134 (22.3)	30 (5.0)
Sexual harassment	239 (39.8)	102 (17.0)
Sexual assault	119 (19.8)	31 (5.2)
Harassed by police	103 (17.2)	31 (5.2)
Beaten or assaulted by police	57 (9.5)	14 (2.3)
Outed against their will	264 (44.0)	132 (22.0)
Threatened to be outed	219 (36.5)	108 (18.0)
Insulted on social media	371 (61.8)	251 (41.8)
Threatened with physical violence on social media	182 (30.3)	129 (21.5)

Note. The present table represents the observed percentage (%) of experiences of anti-gay victimization reported within the sample of MSM adults. MSM = men who have sex with men.

Across all types, approximately two-thirds (68%) of MSM in our sample had reported recently experiencing a form of anti-gay victimization. Among reports of specific types of recent victimization, insults on social media (42%) and verbal insults (33%) were most frequently reported by participants (see Table 2 for a complete list). In the bivariate analyses, the number of types of victimization experienced over the past 6 months differed significantly by recent housing status, region, education, polydrug use, and HIV status. Participants who reported recently experiencing housing insecurity were more likely to report higher mean victimization scores over the past 6 months. MSM with an unknown HIV status had significantly higher mean recent victimization scores compared to those with a negative HIV status.

Associations Between Earlier Sexual Debut and Anti-Gay Victimization

Earlier sexual debut was significantly associated with recent and lifetime measures of victimization in the bivariate analyses. After controlling for sociodemographic characteristics in the adjusted multiple linear regression models, earlier sexual debut before 13 years old was significantly associated with greater number of types of lifetime and recent victimization (β = 1.37, p < .01; β = 1.15, p < .01 respectively) (see Table 3). Multicollinearity was not found in either models; all variance inflation factor (VIF) values were less than 4 and no tolerance values were lower than 0.1.

Table 3.

Associations Between Earlier Sexual Debut and Reports of Anti-Gay Victimization Among MSM in Kazakhstan, 2018 to 2021.

Sociodemographic Characteristics	Experiences of Victimization
	Number of Types Ever				Number of Types in the Past 6 Months
	β	SE	95% CI	p	β	SE	95% CI	p
Sexual debut (ref.: ≥16 years old)
Sexual debut less than 13 years old	1.37	0.50	[0.39, 2.35]	<.01	1.15	0.40	[0.36, 1.94]	<.01
Sexual debut 13–15 years old	.48	0.35	[−0.21, 1.17]	.17	.11	0.28	[−0.45, 0.67]	.70
Age	.02	0.02	[−0.02, 0.07]	.30	.01	0.02	[−0.03, 0.05]	.35
Income log2(n)	.08	0.06	[−0.05, 0.20]	.21	.05	0.05	[−0.05, 0.15]	.34
Region (ref.: Almaty)
Astana	−2.33	0.37	[−3.07, 1.60]	<.001	−.83	0.30	[−1.42, 0.23]	<.01
Shymkent	−2.13	0.38	[−2.87, 1.38]	<.001	.80	0.30	[0.20, 1.40]	<.01
Marital status (ref.: single)
Married	−.06	0.62	[−1.27, 1.15]	.92	−.06	0.50	[−1.03, 0.92]	.91
No longer with spouse	−.64	0.63	[−1.87, 0.60]	.31	−.53	0.51	[−1.53, 0.47]	.30
Other	.37	0.57	[−0.75, 1.49]	.52	−.23	0.46	[−1.14, 0.67]	.61
Highest educational attainment level (ref.: bachelor’s degree or more)
Higher secondary	.13	0.33	[−0.51, 0.77]	.69	.49	0.26	[−0.03, 1.01]	.06
Lower secondary	.38	0.67	[−0.92, 1.69]	.56	.61	0.54	[−0.44, 1.67]	.26
Other	2.23	0.75	[0.75, 3.71]	<.01	1.30	0.61	[0.10, 2.49]	.03
Employment (ref.: full time)
Part-time	−.24	0.38	[−0.99, 0.51]	.52	.14	0.31	[−0.47, 0.74]	.66
Unemployed	.53	0.53	[−0.51, 1.57]	.32	1.18	0.43	[0.34, 2.01]	<.01
Other	−.22	0.50	[−1.19, 0.76]	.66	.57	0.40	[−0.22, 1.35]	.16
Housing insecurity in the past 6 months (ref.: No)
Yes	2.64	0.49	[1.68, 3.59]	<.001	2.42	0.39	[1.65, 3.19]	<.001
Lifetime polydrug use (ref.: no)
Yes	1.61	0.39	[0.85, 2.38]	<.001	.62	0.32	[0.00, 1.24]	.05
Self-reported sexual orientation (ref.: gay identity)
Bisexual	−1.38	0.33	[−2.02, 0.74]	<.001	−.63	0.26	[−1.15, 0.11]	.02
Heterosexual	−.97	1.33	[−3.57, 1.64]	.47	−.16	1.07	[−2.26, 1.94]	.88
Other	−.40	0.88	[−2.13, 1.32]	.65	−.073	0.71	[−2.13, 0.66]	.30
Self-reported HIV status (ref.: HIV-positive)
HIV-negative	−.51	0.58	[−1.64, 0.62]	.38	−.06	0.46	[−0.97, 0.85]	.90
Unknown	−.45	0.62	[−1.67, 0.78]	.47	.46	0.50	[−0.53, 1.44]	.36

Note. β: Beta adjusted for age, income log2(n), city, marital status, education, employment, housing insecurity, sexual orientation, lifetime polydrug use, and HIV status. p-Values: significant values of p ≤ .05 are in bold. MSM = men who have sex with men; CI = Confidence interval.

We found that participants with an earlier sexual debut reported significantly higher odds of recent and lifetime forms of specific types of victimization compared to those with a sexual debut of 16 years or older. Sexual debut prior to 13 years old was significantly associated with increased odds of being threatened with physical violence ever and recently (aOR = 2.0, 95% CI [1.12, 3.64], p = .02; aOR = 2.1, [1.03, 4.13], p = .04); punched, kicked, hit, or beaten recently (aOR = 2.2, [1.05, 4.49], p = .04); lifetime sexual harassment (aOR = 2.2, [1.22, 3.79], p = .008); lifetime and recent sexual assault (aOR = 6.6, [3.56, 12.20], p < 001; aOR = 6.3, [2.08, 18.88], p = .001); being “outed” and threatened to be “outed” recently (aOR = 2.3, [1.21, 4.34], p = .01; aOR = 2.4, [1.23, 4.75], p = .01); as well as insulted on social media recently (aOR = 1.9, [1.05, 3.22], p = .04). Sexual debut between 13 and 15 years old was significantly associated with increased odds of ever being assaulted with a weapon (aOR = 1.7, [1.05, 2.77], p = .03).

Discussion

The majority of Kazakhstani MSM in our sample had experienced some form of anti-gay violence in their lifetime, as well as over the past 6 months. This study indicates that the prevalence rate of anti-gay victimization is higher than other major public health concerns for MSM in Kazakhstan, such as HIV, binge drinking, and illicit use of substances (Paine et al., 2021). The most frequently reported forms of lifetime and recent anti-gay victimization were verbal insults and insults on social media, suggesting that homophobic language is prevalent in Kazakhstan. It is possible that verbal and online insults are more frequently reported because these forms of harm are relatively easier to perpetrate compared to physical forms of abuse, such as assault with a weapon. Research about the context of verbal and online threats as well as other forms of anti-gay victimization is needed, in addition to online and offline anti-bullying interventions aimed at destigmatizing SGD populations in Kazakhstan.

Anti-Gay Victimization and Other Factors

In our final models, other factors such as housing insecurity, lifetime polydrug use, and sexual orientation were also significantly associated with anti-gay victimization among MSM in Kazakhstan. These results suggest that anti-gay victimization may be a more salient concern in Almaty, compared to Astana or Shymkent. However, this may be due to overall higher crimes rates in Almaty, compared to other major cities in Kazakhstan (Kenzhekhan, 2022). Further research is needed to understand anti-gay victimization disparities among cities in Kazakhstan.

Significant associations between sexual orientation and anti-gay victimization suggest that MSM who identify as gay experience a greater burden of anti-gay victimization compared to bisexual, heterosexual, or other identified MSM. Compared to other types of sexual orientation identities, gay identified MSM may be more “out” or visible as a potential target within a homophobic risk environment, which may account for these disparities.

Additionally, the significant associations found between anti-gay victimization and housing insecurity and lifetime polydrug use suggest that homelessness and substance use may be part of an overall environment of risk that also includes vulnerability to homophobic victimization. Overall, high prevalence rates of anti-gay victimization were reported among MSM which suggests a robust homophobic risk environment within Kazakhstan that needs to be addressed to improve the health and well-being of SGD communities.

Earlier Sexual Debut and Anti-Gay Victimization

Evidence from the present study suggests that sexual debut before 16 years old is associated with an increased risk of verbal, physical, and sexual anti-gay victimization among MSM in Kazakhstan. Specifically, MSM within the youngest sexual debut age category (i.e., before 13 years old) were particularly vulnerable to physical, sexual, and verbal forms of anti-gay violence compared to those reporting an older age of sexual onset. These results suggest that earlier onset of sexual activity among MSM is linked to a violent and homophobic risk environment that may extend from childhood throughout adulthood. MSM in Kazakhstan are vulnerable to complex and systemic homophobic violence that needs to be examined as a key contextual factor throughout the lifespan, beginning in childhood and early adolescence.

Earlier Sexual Debut and Sexual Victimization

Notably, earlier sexual debut prior to 13 years old was significantly associated with over six times higher odds of lifetime and recent sexual assault. This is consistent with previous research among sexually diverse populations linking earlier sexual debut to violent forms of victimization, including forced sexual intercourse (Lowry et al., 2017). Sexual activity before the age of 13 years old is highly suspected to be a result of sexual abuse, and additional research is needed to understand the context of childhood sexual debut among MSM (Wurtele & Kenny, 2011). Survivors of sexual abuse and violence are known to be at increased risk of sexual revictimization and sexuality-related discrimination (El Khoury et al., 2021). The significant associations found between earlier sexual debut and lifetime and recent sexual victimization may indicate a pattern of violence and revictimization that are connected to events dating back to childhood. Stigma related to sexual victimization may additionally be compounded by homophobic attitudes directed toward MSM survivors of sexual assault (Kiss et al., 2020). Additional research needs to examine the long-term health consequences of consensual and non-consensual earlier sexual debut among MSM, including sexual revictimization.

Limitations

There are several limitations to the present study. The study design was cross-sectional and cannot determine a causal relationship between earlier sexual behavior and experiences of violence and victimization. Earlier sexual debut and the models used in this study do not control for or distinguish between consensual and non-consensual sexual onset. In this secondary analysis, variables describing sexual debut acts (e.g., anal intercourse, oral sex) and sexual debut partner information (e.g., gender, age) were not available. This sample only included cisgender MSM and did not include any other sexual or gender diverse populations. Lastly, social-desirability bias may have influenced self-reporting of socially sensitive behavior, such as sexual activity during childhood and experiences of anti-gay violence.

Future Research and Recommendations

Additional research is needed to better elucidate homophobic environmental contexts that shape earlier sexual experiences and how they relate to reports of lifetime and recent physical, sexual, and verbal anti-gay victimization among MSM as well as other SGD populations in Kazakhstan. Future MSM sexual debut research should also include contextual information regarding specific sexual behaviors (e.g., anal intercourse), as well as information about the sexual partner(s) (e.g., age, gender, relationship to participant). Future research should also examine the impact of substance use, homelessness, and sexual orientation identity as factors associated with anti-gay victimization among MSM. Policy and clinical programing interventions aimed at addressing the needs of MSM survivors of sexual, physical, and verbal harm in Kazakhstan should investigate the role of anti-gay/homophobic environmental influences as well as inquire about any history of homelessness, substance use, and childhood sexual experiences.

Conclusion

Experiences of anti-gay victimization are prevalent among MSM in Kazakhstan. Earlier sexual debut is associated with both recent and lifetime experiences of anti-gay victimization among MSM in Kazakhstan. Specifically, earlier sexual debut is associated with increased risk of verbal, physical, and sexual forms of victimization. Systemic forms of anti-gay victimization among SGD adults in Kazakhstan need to be better addressed across the lifespan, with a specific focus on investigating the role of consensual and non-consensual sexual experiences of children and younger adolescents.

Footnotes

Acknowledgements

In addition to the co-authors, this work was made possible only by the research staff who showed tremendous dedication, skill, and sensitivity—Gassan Akhmedov, Karina Alipova, Farruh Aripov, Dilara Belkesheva, Daniyar Bekishev, Ferangiz Hazanova, Altynay Kambekova, Saltanat Kuskulova, Aitkul Nazarova, Syrim Omirbek, Olga Balabekova, Sultana Kali, Aidar Yelkeyev, Saida Yessenova, Valeria Davydova, and Aizhan Toleuova—and, most importantly, the time and trust given by the participants. The findings and conclusions in this report do not necessarily represent the views of NIDA, the Columbia University School of Social Work, or the Global Health Research Center of Central Asia.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interests with respect to the authorship and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research and/or authorship of this article: The data for this study were obtained as part of a study funded by the National Institute on Drug Abuse (NIDA; ), grant # R01DA040513. Additionally, Emily Allen Paine’s time was partly supported by a grant from NIMH (K01MH128117).

ORCID iD

Caitlin I. Laughney

Author Biographies

Caitlin I. Laughney, MSW, is a doctoral candidate in the School of Social Work at Columbia University. Her research focuses on earlier sexual behavior during childhood and adolescence, and subsequent higher-risk behaviors, such as substance use and exchange sex, among global sexual and gender diverse populations.

Yong Gun Lee, MSW, is a doctoral candidate in the School of Social Work at Columbia University. His research focuses on HIV prevention and overall health promotion among sexual and gender diverse individuals.

Guakhar Mergenova, MD, MS, is a Project Director at the Columbia University Global Health Research Center of Central Asia.

Vitaliy Vinogradov, is a Project Director at the Columbia University Global Health Research Center of Central Asia.

Gulnara Zhakupova, MSW, is a graduate of the School of Social Work at Columbia University. She is an independent consultant based in Almaty, Kazakhstan.

Emily Allen Paine, PhD, is a T32 Postdoctoral Research Fellow at the HIV Center for Clinical and Behavioral Studies.

Sholpan Primbetova, MSSW, is the Regional Deputy Director of the Columbia University Global Health Research Center of Central Asia.

Assel Terlikbayeva, MD, MS, is the Regional Director of the Columbia University Global Health Research Center of Central Asia.

Elwin Wu, PhD, is a Co-Director of the Social Intervention Group at Columbia University School of Social Work and a Co-Director of the Columbia University Global Health Research Center of Central Asia.

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