Vulnerable men who have sex with men and women in Lima: feasibility of new strategies to reach them for prevention, care and research
Background: The HIV epidemic in Peru is driven by sex between men. HIV prevalence among MSM is 10-20%, 25-50 times higher than in the general population. 13-15% of adult men report ever having had sex with other men, and likewise 2-3 out of 4 MSM report ever having had sex with women, which explains a male:female ratio of 3:1. While many men have sex with men and women in Peru, most of them either self-identify as heterosexual or remain closeted, so that accessing them through strategies focused on MSM is unfeasible. New strategies are needed to reach men who have sex with men and women (MSMW) for prevention, care and research.
Methods: Based on preliminary ethnography, two recruitment approaches for MSMW were designed: (a) invitation cards delivered by gay- or transgender-identified partners in low income areas; and (b) internet-based announcements and chat-based contacts by gay- or transgender-identified staff. People were asked to attend one of three locales for a structured interview and voluntary counseling and testing for HIV/STI.
Results: In 1 month, 89 men came through personal invitations and 20 came through internet-based announcements. Most men reported no access to sexual health services where they could disclose their sexuality, and were generally receptive to both recruitment strategies for research and health care. Behavioral and biological indicators revealed high risk for HIV/STI: Prevalences for HIV (6/109, 5.5%), syphilis (6/109, 5.5%) and HSV-2 (22/109, 20%) were high; 28% and 3% reported no protection in last insertive and receptive anal sex with a male, respectively. Alcohol use (59%) and drug use (20%) in last sex with a man were very high.
Conclusions: This pilot study showed feasibility of both personal invitations and internet-based contacts to reach 2 groups of non-gay identified, vulnerable MSMW for prevention, care and research. Priority should be assigned to developing alternatives for this clearly underserved group.
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