HIV/STI transmission among HIV-positive men who have sex with men in Peru: a key area for prevention research
Background: Behavioral risk reduction for HIV-positive individuals (“prevention for positives”) is an important area of HIV/STI prevention research. We evaluated HIV-positive men who have sex with men (MSM) in Lima, Peru to assess STI prevalence, risk behaviors for HIV/STI transmission, and the relationship between knowledge of HIV status and sexual risk behavior.
Methods: A convenience sample of 549 MSM was recruited from an STI clinic in Lima, Peru. Participants completed a computer-based survey and provided blood for HIV-1 ELISA/Western Blot, Syphilis RPR/TPPA, and HSV-2 ELISA assays, and urine for gonorrhea/chlamydia nucleic acid testing.
Results: Among 124 HIV-positive MSM, 72.6% were previously aware of their HIV status. Syphilis (RPR³1:8) was diagnosed in 21.0% of HIV-positive participants, HSV-2 in 79.8%, gonorrhea in 1.6% and chlamydia in 1.6%. Among the 41 HIV-positive MSM reporting insertive anal intercourse with their last sex partner, 34.2% did not use a condom; 25.6% of the 86 reporting receptive anal intercourse did not use a condom. At least one episode of insertive unprotected anal intercourse (UAI) with an HIV-negative partner during the previous six months was reported by 33.6% (35/104); receptive UAI with an HIV-negative partner was reported by 44.6% (45/101). No difference in number of recent sex partners or in frequency of UAI, with HIV-negative or HIV-positive partners, was observed between men who knew or did not know their serostatus (all p-values >0.05). Men with known HIV infection reported insertive and receptive UAI with HIV-negative partners more often than with HIV-positive or unknown serostatus partners (p<0.001).
Conclusions: HIV-positive MSM in Peru frequently engaged in high-risk behaviors for HIV and STI transmission. Knowledge of HIV-positive status was not associated with a decrease in frequency of unprotected anal intercourse or other sexual risk behaviors. Educational strategies addressing the specific needs of HIV-positive MSM are essential to future HIV/STI prevention efforts in Peru.
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