Sexual identity, sexual role, sexual practices and risk for HIV/STI acquisition among men who have sex with men in Peru

Published: August 1, 2008

Sexual identity, sexual role, sexual practices and risk for HIV/STI acquisition among men who have sex with men in Peru

Background: Conflicting research concerning men who have sex with men (MSM) in Latin America has questioned the link between sexual identity and HIV/STI acquisition. Sexual role during anal intercourse (as activo/insertive, pasivo/receptive, or moderno/versatile) may more accurately indicate HIV/STI risk behavior among MSM.

Methods: MSM were recruited from a Lima, Peru STI clinic to complete a computer-based survey and provide blood for HIV (ELISA/Western Blot), syphilis (RPR/TPPA), and HSV-2 (ELISA) screening.

Results: Of 534 MSM, 31.8% identified as activo, 33.9% as pasivo, and 34.3% as moderno. Insertive anal intercourse with their last male sexual contact was reported by 92.5% of activos, 54.2% of modernos, and 1.1% of pasivos, and receptive anal intercourse by 7.3% of activos, 79.9% of modernos, and 97.8% of pasivos (p<0.001). Most heterosexual-identified men (90.1%) described themselves as activo, most transgenders (72.0%) as pasivo, and many gay or bisexual men as moderno (51.8% and 58.3%, respectively) or pasivo (39.2% and 29.7%, respectively) (p<0.001). HIV infection was diagnosed in 26.5% (48/181) of pasivo and 28.4% (52/183) of moderno men, but only 11.7% (20/170) of activos. Similarly. 74.3% of pasivos, 66.7% of modernos, but only 28.8% of activos were HSV-2 seropositive. Syphilis infection (RPR >1:8) was observed in 0.6% of activo men, but 15.1% of pasivos and 15.3% of modernos (all p values <0.001). Pasivo and moderno men had a greater number of recent sex partners than activos, and were more likely to engage in compensated sex (p<0.001). However, differences in HIV/STI prevalence according to sex role remained statistically significant after controlling for age, education, number of partners, and history of compensated sex in multivariate analysis.

Conclusions: Sexual role is a critical factor for HIV/STI acquisition among MSM in Peru. Understanding of the social and biological conditions associated with HIV/STI acquisition by pasivo and moderno MSM is essential to controlling HIV in Latin America.

-Abstract available at link below-

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