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Harris CL, Blair CS, Segura ER, Gutiérrez J, Lake JE, Cabello R, Clark JL. Sexual network characteristics, condomless anal intercourse, and the HIV care cascade among MSM living with controlled versus uncontrolled HIV infection in Lima, Peru: a population-based cross-sectional analysis. LANCET REGIONAL HEALTH. AMERICAS 2024; 32:100722. [PMID: 38629029 PMCID: PMC11019357 DOI: 10.1016/j.lana.2024.100722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 03/08/2024] [Accepted: 03/12/2024] [Indexed: 04/19/2024]
Abstract
Background Despite high rates of HIV transmission among men who have sex with men (MSM) in Lima, Peru, limited data exist on the sexual network characteristics or risk factors for secondary HIV transmission among MSM with uncontrolled HIV infection. We report the frequency of serodiscordant, condomless anal intercourse (CAI) and associated sexual network characteristics among MSM in Lima with detectable HIV viremia and compare to those with undetectable viremia. Methods This cross-sectional analysis includes MSM who tested positive for HIV-1 during screening for a trial of partner management and STI control (June 2022-January 2023). Participants were tested for HIV, gonorrhoea, chlamydia, and syphilis, and completed questionnaires on their demographic characteristics, sexual identity and behaviour, sexual network structures and engagement in HIV care. Findings Of 665 MSM, 153 (23%) had detectable (>200 copies/mL) viremia. 75% (499/662) of men living with HIV were previously diagnosed, with 94% (n = 469/499) reporting that they were on ART, and 93% (n = 436/469) virally suppressed. 96% (n = 147/153) of men with detectable viremia reported serodiscordant CAI with at least one of their last three sexual partners, and 74% (n = 106/144) reported the same with all three of their recent partners. In contrast, 62% (n = 302/489) of men with undetectable viral load reported serodiscordant CAI with all of their last three partners (p < 0.01). Interpretation 23% of men living with HIV in Peru had detectable viremia, of whom almost all (96%) reported recent serodiscordant CAI. The primary gap in the HIV care cascade lies in awareness of HIV serostatus, suggesting that improved access to HIV testing could be a key prevention strategy in Peru. Funding Funding for this study was provided by NIH/NIMH grants R01 MH118973 (PI: Clark) and R25 MH087222 (PI: Clark).
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Affiliation(s)
- Carlyn L. Harris
- Emory University School of Medicine, Atlanta, GA, USA
- South American Program in HIV Prevention Research, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Cherie S. Blair
- Department of Medicine, David Geffen School of Medicine at UCLA, Division of Infectious Diseases, Los Angeles, CA, USA
| | - Eddy R. Segura
- Facultad de Ciencias de la Salud, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | | | | | | | - Jesse L. Clark
- Department of Medicine, David Geffen School of Medicine at UCLA, Division of Infectious Diseases, Los Angeles, CA, USA
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Freese J, Segura ER, Gutierrez J, Lake JE, Cabello R, Clark JL, Blair C. Sexual network characteristics and partnership types among men who have sex with men diagnosed with syphilis, gonorrhoea and/or chlamydia in Lima, Peru. Sex Transm Infect 2024; 100:84-90. [PMID: 38124224 PMCID: PMC10922481 DOI: 10.1136/sextrans-2023-055910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 11/16/2023] [Indexed: 12/23/2023] Open
Abstract
OBJECTIVES Sexual networks are known to structure sexually transmitted infection (STI) transmission among men who have sex with men (MSM). We sought to estimate the risks of STI diagnosis for various partnership types within these networks. METHODS Our cross-sectional survey analysed data from 1376 MSM screened for a partner management intervention in Lima, Peru. Participants were tested for HIV, syphilis, gonorrhoea (NG) and chlamydia (CT) and completed surveys on their demographics, sexual identity/role, HIV status, partnership types and sexual network from the prior 90 days. χ2 and Wilcoxon rank-sum tests compared participants without an STI to those diagnosed with (1) syphilis, (2) NG and/or CT (NG/CT) and (3) syphilis and NG/CT coinfection (coinfection). RESULTS 40.8% (n=561/1376) of participants were diagnosed with an STI (syphilis: 14.9%, NG/CT: 16.4%, coinfection: 9.5%). 47.9% of all participants were living with HIV and 8.9% were newly diagnosed. A greater proportion of participants with syphilis and coinfection were living with HIV (73.5%, p<0.001; 71.0%, p<0.001) compared with those with NG/CT (47.8%) or no STI (37.8%). Participants with syphilis more often reported sex-on-premises venues (SOPVs) as the location of their last sexual encounter (51.7%, p=0.038) while those with NG/CT tended to meet their last sexual partner online (72.8%, p=0.031). Respondents with coinfection were the only STI group more likely to report transactional sex than participants without an STI (31.3%, p=0.039). CONCLUSIONS Sexual networks and partnership types of Peruvian MSM are associated with differential risks for STIs. Participants diagnosed with syphilis tended to meet single-encounter casual partners at SOPV, while MSM with NG/CT were younger and often contacted casual partners online. Coinfection had higher frequency of transactional sex. These findings suggest the potential importance of public health interventions through combined syphilis/HIV screening at SOPV, syphilis screening at routine clinic appointments for MSM living with HIV and directed advertisements and/or access to NG/CT testing through online platforms.
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Affiliation(s)
- Jonathan Freese
- University of Nebraska Medical Center, Omaha, Nebraska, USA
- Department of Medicine, Division of Infectious Diseases, South American Program in HIV Prevention Research, Los Angeles, California, USA
| | - Eddy R Segura
- Facultad de Ciencias de la Salud, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | | | | | | | - Jesse L Clark
- Department of Medicine, Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, Los Angeles, California, USA
| | - Cherie Blair
- Department of Medicine, Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, Los Angeles, California, USA
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Garcia-Rabines D. Love in the Gay World: Negotiating Intimate Relationships in Lima´s Middle-Class Gay Scene. JOURNAL OF HOMOSEXUALITY 2022; 69:1097-1118. [PMID: 33818315 DOI: 10.1080/00918369.2021.1905383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
This article explores how young gay men who are involve in Lima's middle-class gay scene made sense of their intimate relationships regarding discourses about sexuality, intimacy, and love. Drawing on in-depth interviews with 14 such men, I found that diverse and seemingly conflicting discursive configurations coexisted and intertwined within aspects of their relationships such as monogamy, sex-role positioning, and interpretations of sexual intimacy. Although participants mostly endorsed "modern" categories, more attuned with global messages of gender equality and egalitarianism, they also combined them with discourses that were more "traditional"-gendered and related to romantic love. Participants negotiated these tensions through a pattern of reflexive and unreflexive (dis)identifications, which were embedded in structural socioeconomic conditions. These findings acknowledge the complexities of Latin American middle-class gay sexualities and challenge rigid models of same-sex desire, as well as arguments about the exceptionally reflexive qualities of "modern" gay identities.
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Affiliation(s)
- Diego Garcia-Rabines
- Grupo de Investigación en Comunicación y Salud, Instituto de Investigación Científica, y Facultad de Psicología, Universidad de Lima, Lima, Perú
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Parchem B, Aguayo-Romero RA, Alizaga NM, Poppen PJ, Cecilia Zea M. Sexual Role Identity and Anal Sex Positioning among Brazilian, Colombian, and Dominican Immigrant Sexual Minority Men. JOURNAL OF SEX RESEARCH 2022; 59:632-642. [PMID: 34080929 PMCID: PMC8639841 DOI: 10.1080/00224499.2021.1922574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Sexual role identities for anal sex and anal sex positionings are often conflated in research. This study aimed to identify profiles of sexual minority men based on sexual role identity and anal sex positioning and determine correlates of these profiles, including individual (i.e., HIV-status identity, condom use, partner type, sexual orientation) and cultural (i.e., same-race partnering, country of birth, acculturation) factors. A sample of Brazilian, Colombian, and Dominican immigrant sexual minority men (n = 480) living in New York City were surveyed about identity and positioning at the two most recent encounters. Individual and cultural factors were examined as correlates of profiles identified through latent class analysis. Four latent classes were identified: No Labels (12%), Receptive Bottoms (16%), Insertive Tops (23%), Insertive and Receptive Versatiles (49%). We found a concordance rate of ~70% between identity and behavior. A proportion (12%) of behaviorally versatile men chose not to use sexual role labels. Living with HIV was associated with receptive and versatile classes, sex with main partners was associated with versatility, and sexual orientation differed across classes. Identity and behavior should not be used interchangeably in research or applied domains, particularly given the complexities of versatility and men who prefer to not use labels.
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Affiliation(s)
- Benjamin Parchem
- Department of Psychological and Brain Sciences, The George Washington University, Washington, DC
| | - Rodrigo A. Aguayo-Romero
- Department of Psychological and Brain Sciences, The George Washington University, Washington, DC
- Brigham and Women’s Hospital/ Harvard Medical School/ The Fenway Institute, Boston, MA
| | | | - Paul J. Poppen
- Department of Psychological and Brain Sciences, The George Washington University, Washington, DC
| | - Maria Cecilia Zea
- Department of Psychological and Brain Sciences, The George Washington University, Washington, DC
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Satcher MF, Segura ER, Silva-Santisteban A, Reisner SL, Perez-Brumer A, Lama JR, Operario D, Clark JL. Exploring Contextual Differences for Sexual Role Strain Among Transgender Women and Men Who Have Sex with Men in Lima, Peru. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:1977-1991. [PMID: 35290540 PMCID: PMC9387938 DOI: 10.1007/s10508-021-02181-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 07/21/2021] [Accepted: 10/09/2021] [Indexed: 05/03/2023]
Abstract
Sexual and gender politics inform relational expectations surrounding sexual experiences of Peruvian transgender women (TW) and men who have sex with men (MSM). We used the framework of sexual role strain, or incongruence between preferred sexual role and actual sexual practices, to explore potential conflicts between personally articulated identities and externally defined norms of gender and sexuality and its potential to increase HIV/STI risk. Cross-sectional individual- and dyad-level data from 766 TW and MSM in Lima, Peru were used to assess the partnership contexts within which insertive anal intercourse was practiced despite receptive role preference (receptive role strain), and receptive anal intercourse practiced despite insertive role preference (insertive role strain). Sexual role strain for TW was more common with non-primary partners, while for MSM it occurred more frequently in the context of a primary partnership. Receptive role strain was more prevalent for TW with unknown HIV status (reference: without HIV) or pre-sex drug use (reference: no pre-sex drug use). For homosexual MSM, receptive role strain was more prevalent during condomless anal intercourse (reference: condom-protected) and with receptive or versatile partners (reference: insertive). Among heterosexual or bisexual MSM, insertive role strain was more prevalent with insertive or versatile partners (reference: receptive), and less prevalent with casual partners (reference: primary). Our findings suggest TW and MSM experience different vulnerabilities during sexual role negotiation with different partner-types. Future studies should explore the impact of sexual role strain on condom use agency, HIV/STI risk, and discordances between public and private presentations of gender and sexual orientation.
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Affiliation(s)
- Milan F Satcher
- Department of Community and Family Medicine, Dartmouth-Hitchcock Medical Center, One Medical Center Dr., Lebanon, NH, 03766, USA.
- Geisel School of Medicine at Dartmouth College, Hanover, NH, USA.
| | - Eddy R Segura
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | - Alfonso Silva-Santisteban
- Unit of Health, Sexuality and Human Development, Cayetano Heredia University School of Public Health, Lima, Peru
| | - Sari L Reisner
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Amaya Perez-Brumer
- Social and Behavioral Health Sciences Division, University of Toronto Dalla Lana School of Public Health, Toronto, ON, Canada
| | - Javier R Lama
- Asociación Civil Impacta Salud Y Educación, Lima, Peru
| | - Don Operario
- Brown University School of Public Health, Providence, RI, USA
| | - Jesse L Clark
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
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PEREZ JUSTIN. Peche
problems. AMERICAN ETHNOLOGIST 2022. [DOI: 10.1111/amet.13068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- JUSTIN PEREZ
- Department of Latin American and Latino Studies University of California, Santa Cruz
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Parchem B, Aguayo-Romero RA, del Río-González AM, Calabrese SK, Poppen PJ, Zea MC. Perceptions of power and sexual pleasure associated with sexual behaviour profiles among Latino sexual minority men. CULTURE, HEALTH & SEXUALITY 2021; 23:1344-1360. [PMID: 32744462 PMCID: PMC7855680 DOI: 10.1080/13691058.2020.1781263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 06/08/2020] [Indexed: 06/11/2023]
Abstract
In a body of research typically focused on risk reduction and disease prevention, other factors motivating the sexual behaviours of Latino sexual minority men, such as resource-based power and sexual pleasure, are less well understood. To this end, Latino immigrant sexual minority men living in New York City were surveyed about their sexual behaviours, perceived power differentials, and pleasure from insertive and receptive anal intercourse. Power and pleasure were examined as associations with behavioural profiles identified through latent class analysis, adjusting for age and partner type. Four latent classes of Latino sexual minority men were identified based on behaviours reported during the most recent sexual event: behaviourally insertive (14.2%), behaviourally versatile (25.9%), behaviourally receptive (29.2%), and limited penetrative behaviour (30.7%). Participants who derived pleasure from insertive and receptive anal intercourse had higher odds of belonging in the behaviourally insertive and behaviourally receptive class, respectively. Perceptions of resource-based power were not associated with class membership. Findings highlight the importance of sexual pleasure as a driver of sexual behaviour, irrespective of power dynamics. Sexual health curricula and interventions for sexual minority men should consider sexual pleasure and sex-affirmative frameworks when providing sexuality education and promoting sexual wellbeing.
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Affiliation(s)
- Benjamin Parchem
- Department of Psychological and Brain Sciences, The George Washington University, Washington, DC, USA
| | - Rodrigo A. Aguayo-Romero
- Department of Psychological and Brain Sciences, The George Washington University, Washington, DC, USA
- Brigham and Women’s Hospital, Harvard Medical School, The Fenway Institute, Boston, MA, USA
| | | | - Sarah K. Calabrese
- Department of Psychological and Brain Sciences, The George Washington University, Washington, DC, USA
| | - Paul J. Poppen
- Department of Psychological and Brain Sciences, The George Washington University, Washington, DC, USA
| | - Maria Cecilia Zea
- Department of Psychological and Brain Sciences, The George Washington University, Washington, DC, USA
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Long JE, Montaño M, Sanchez H, Huerta L, Calderón Garcia D, Lama JR, Andrasik M, Duerr A. Self-Identity, Beliefs, and Behavior Among Men Who Have Sex with Transgender Women: Implications for HIV Research and Interventions. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:3287-3295. [PMID: 34617189 PMCID: PMC8784120 DOI: 10.1007/s10508-021-02019-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 04/12/2021] [Accepted: 04/16/2021] [Indexed: 05/13/2023]
Abstract
While transgender women have been identified as a global priority population for HIV prevention and treatment, little is known about the cisgender male partners of transgender women, including their sexual behavior and HIV prevalence. Previous research has suggested that these male partners have varied identities and sexual behavior, which make identifying and engaging them in research difficult. This paper describes interviews conducted with fifteen cisgender men who reported recent sexual activity with transgender women in Lima, Peru. The purpose of this research was to explore how these men reported their identities and sexual behavior, to better understand how they would interact with HIV outreach, research, and care. The major themes were sexual orientation and identity; view of transgender partners; social ties to transgender women and other men with transgender women partners; disclosure of relationships; HIV knowledge and risk perception; and attitudes toward interventions. We found that language used to assess sexual orientation was problematic in this population, due to lack of consistency between orientation and reported behavior, and unfamiliarity with terms used to describe sexual orientation. In addition, stigma, lack of knowledge of HIV prevention methods, and fear of disclosure of sexual behavior were identified as barriers that could impact engagement in HIV research, prevention, and care. However, participants reported social relationships with both transgender women and other men who have transgender partners, presenting possible avenues for recruitment into HIV research and healthcare services.
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Affiliation(s)
- Jessica E Long
- Department of Epidemiology, University of Washington, Box 351619, Seattle, WA, 98195, USA.
| | - Michalina Montaño
- Department of Epidemiology, University of Washington, Box 351619, Seattle, WA, 98195, USA
| | | | | | | | - Javier R Lama
- Asociación Civil Impacta Salud y Educación, Lima, Peru
| | | | - Ann Duerr
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
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9
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Let's Talk About Sex: The Impact of Partnership Contexts on Communication About HIV Serostatus and Condom Use Among Men Who Have Sex with Men (MSM) and Transgender Women (TW) in Lima, Peru. AIDS Behav 2021; 25:2139-2153. [PMID: 33411208 DOI: 10.1007/s10461-020-03144-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2020] [Indexed: 01/17/2023]
Abstract
Sexual communication with partners informs risk assessment and sexual practices. We evaluated participant, partner, and network factors associated with communication about condom use and HIV serostatus and explored their relationships with condomless anal intercourse (CAI) among 446 men who have sex with men (MSM) and 122 transgender women (TW) in Lima, Peru. Generalized estimating equations assessed contextual influences on communication and practices with recent sexual partners. More frequent HIV communication was reported by MSM who: identified as heterosexual, compared to bisexual or gay; characterized partnerships as stable, compared to casual, anonymous, or commercial; or discussed HIV/STIs with close social contacts (p < 0.05). TW in concurrent partnerships discussed condom use more frequently than those in monogamous relationships (p < 0.05). Condom use discussions and alcohol use among MSM were associated with CAI (p < 0.05). Findings highlight complexity in sexual decision-making and call for further study of conversation content and practices to inform HIV prevention messaging.
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Ayer A, Segura ER, Perez-Brumer A, Chavez-Gomez S, Fernandez R, Gutierrez J, Suárez K, Lake JE, Clark JL, Cabello R. Sexual health norms and communication patterns within the close social networks of men who have sex with men and transgender women in Lima, Peru: a 2017 cross-sectional study. BMC Public Health 2021; 21:1090. [PMID: 34098916 PMCID: PMC8186208 DOI: 10.1186/s12889-021-11091-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 05/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Social networks, norms, and discussions about sexual health may inform sexual practices, influencing risk of human immunodeficiency virus (HIV) or sexually transmitted infection (STI) acquisition. To better understand social networks of Peruvian men who have sex with men (MSM) and transgender women (trans women), we examined key social network members (SNMs), participant perceptions of these network members' opinions toward sexual health behaviors, and associations between network member characteristics and condomless anal intercourse (CAI). METHODS In a 2017 cross-sectional study, a convenience sample of 565 MSM and trans women with HIV-negative or unknown serostatus was asked to identify three close SNMs; describe discussions about HIV and STI prevention with each; and report perceived opinions of condom use, HIV/STI testing, and partner notification of STIs. Generalized estimating equations evaluated relationships between SNM characteristics, opinions, and discussions and participant-reported CAI. RESULTS Among participants who identified as MSM, 42.3% of key SNMs were perceived to identify as gay. MSM "never" discussed HIV and STI prevention concerns with 42.4% of heterosexual SNMs, but discussed them "at least once weekly" with 16.9 and 16.6% of gay- and bisexual- identifying SNMs, respectively. Among participants who identified as trans women, 28.2% of key SNMs were perceived as heterosexual; 25.9%, as bisexual; 24.7%, as transgender; and 21.2%, as gay. Trans women discussed HIV/STI prevention least with cis-gender heterosexual network members (40.2% "never") and most with transgender network members (27.1% "at least once weekly"). Participants perceived most of their close social network to be completely in favor of condom use (71.2% MSM SNMs, 61.5% trans women SNMs) and HIV/STI testing (73.1% MSM SNMs, 75.6% trans women SNMs), but described less support for partner STI notification (33.4% MSM SNMs, 37.4% trans women SNMs). Most participants reported CAI with at least one of their past three sexual partners (77.5% MSM, 62.8% trans women). SNM characteristics were not significantly associated with participant-reported frequency of CAI. CONCLUSIONS Findings compare social support, perceived social norms, and discussion patterns of Peruvian MSM and trans women, offering insight into social contexts and sexual behaviors. TRIAL REGISTRATION The parent study from which this analysis was derived was registered at ClinicalTrials.gov (Identifier: NCT03010020 ) on January 4, 2017.
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Affiliation(s)
- Amrita Ayer
- South American Program in HIV Prevention Research, University of California Los Angeles David Geffen School of Medicine, 10833 Le Conte Avenue, CHS 37-121, Los Angeles, CA, 90095, USA. .,University of California Los Angeles David Geffen School of Medicine, Los Angeles, USA.
| | - Eddy R Segura
- South American Program in HIV Prevention Research, University of California Los Angeles David Geffen School of Medicine, 10833 Le Conte Avenue, CHS 37-121, Los Angeles, CA, 90095, USA.,Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | - Amaya Perez-Brumer
- University of Toronto Dalla Lana School of Public Health, Toronto, Canada
| | | | | | | | | | - Jordan E Lake
- South American Program in HIV Prevention Research, University of California Los Angeles David Geffen School of Medicine, 10833 Le Conte Avenue, CHS 37-121, Los Angeles, CA, 90095, USA.,Department of Internal Medicine, Division of Infectious Diseases, McGovern Medical School at UT Health, Houston, USA
| | - Jesse L Clark
- South American Program in HIV Prevention Research, University of California Los Angeles David Geffen School of Medicine, 10833 Le Conte Avenue, CHS 37-121, Los Angeles, CA, 90095, USA.,Department of Internal Medicine, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, USA
| | - Robinson Cabello
- South American Program in HIV Prevention Research, University of California Los Angeles David Geffen School of Medicine, 10833 Le Conte Avenue, CHS 37-121, Los Angeles, CA, 90095, USA.,Asociación Civil Via Libre, Lima, Peru
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11
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Clark J, Reisner S, Perez-Brumer A, Huerta L, Sanchez H, Moriarty K, Luque MM, Okochi H, Salazar X, Mimiaga M, Sanchez J, Gandhi M, Mayer KH, Lama JR. TransPrEP: Results from the Pilot Study of a Social Network-Based Intervention to Support PrEP Adherence Among Transgender Women in Lima, Peru. AIDS Behav 2021; 25:1873-1883. [PMID: 33385279 PMCID: PMC8084919 DOI: 10.1007/s10461-020-03117-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2020] [Indexed: 01/02/2023]
Abstract
We conducted a pilot randomized controlled trial of a social network-based intervention to promote PrEP adherence among transgender women (TW) in Lima, Peru. We enrolled 89 TW from six social networks and cluster-randomized them 1:1 to standard of care (n = 44) or the TransPrEP intervention (n = 45). Core workshops discussed strategies to support PrEP adherence and defined group adherence objectives. Maintenance workshops discussed participants' experiences taking PrEP and collective adherence goals. At 3-month follow-up, we evaluated 40 participants and obtained 29 hair samples for tenofovir level measurements. Though no significant differences were observed, 36.4% (4/11) of participants of TransPrEP participants and 10.0% (1/10) of control participants had tenofovir levels > 0.023 ng/mg, consistent with ≥ 4 doses per week. 81.8% (9/11) of intervention and 40.0% (4/10) of control participants had any detectable tenofovir in their hair. Pilot assessment of our network-based intervention suggested a trend towards improved PrEP adherence, measured objectively, for TW in Peru.
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Affiliation(s)
- Jesse Clark
- UCLA Geffen School of Medicine, Los Angeles, CA, USA.
| | - Sari Reisner
- The Fenway Institute, Boston, MA, USA
- Boston Children's Hospital, Boston, MA, USA
| | - Amaya Perez-Brumer
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | | | | | | | | | | | - Ximena Salazar
- Instituto de Estudios de Salud Sexual y Derechos Humanos, Lima, Peru
| | - Matthew Mimiaga
- The Fenway Institute, Boston, MA, USA
- Brown University School of Public Health, Providence, RI, USA
| | - Jorge Sanchez
- Centro de Investigaciones Tecnológicas Biomédicas y Medioambientales, Universidad Nacional San Marcos, Lima, Peru
| | | | - Kenneth H Mayer
- The Fenway Institute, Boston, MA, USA
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Javier R Lama
- Asociacion Civil Impacta Salud y Educacion, Lima, Peru
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Torres TS, Luz PM, Marins LMS, Bezerra DRB, Almeida-Brasil CC, Veloso VG, Grinsztejn B, Harel D, Thombs BD. Cross-cultural adaptation of the Perceived Risk of HIV Scale in Brazilian Portuguese. Health Qual Life Outcomes 2021; 19:117. [PMID: 33836775 PMCID: PMC8033701 DOI: 10.1186/s12955-021-01760-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 03/31/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Valid and reliable instruments are needed to measure the multiple dimensions of perceived risk. The Perceived Risk of HIV Scale is an 8-item measure that assesses how people think and feel about their risk of infection. We set out to perform a cross-cultural adaptation of the scale to Brazilian Portuguese among key populations (gay, bisexual and other men who have sex with men and transgender/non-binary) and other populations (cisgender heterosexual men and cisgender women). METHODS Methodological study with cross-sectional design conducted online during October/2019 (key populations [sample 1] and other populations) and February-March/2020 (key populations not on pre-exposure prophylaxis [sample 2]). Cross-cultural adaptation of the Perceived Risk of HIV Scale followed Beaton et al. 2000 guidelines and included confirmatory factor analysis, differential item functioning (DIF) using the Multiple-Indicator Multiple-Cause model, and concurrent validity to verify if younger individuals, those ever testing for HIV, and engaging in high-risk behaviors had higher scores on the scale. RESULTS 4342 participants from key populations (sample 1 = 235; sample 2 = 4107) and 155 participants from other populations completed the measure. We confirmed the single-factor structure of the original measure (fit indices for sample 1 plus other populations: CFI = 0.98, TLI = 0.98, RMSEA = 0.07; sample 2 plus other populations: CFI = 0.97, TLI = 0.95, RMSEA = 0.09). For the comparisons between key populations and other populations, three items (item 2: "I worry about getting infected with HIV", item 4: "I am sure I will not get infected with HIV", and item 8: "Getting HIV is something I have") exhibited statistically significant DIF. Items 2 and 8 were endorsed at higher levels by key populations and item 4 by other populations. However, the effect of DIF on overall scores was negligible (0.10 and 0.02 standard deviations for the models with other populations plus sample 1 and 2, respectively). Those ever testing for HIV scored higher than those who never tested (p < .001); among key populations, those engaging in high-risk behaviors scored higher than those reporting low-risk. CONCLUSION The Perceived Risk of HIV Scale can be used among key populations and other populations from Brazil.
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Affiliation(s)
- Thiago S Torres
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil.
| | - Paula M Luz
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Luana M S Marins
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Daniel R B Bezerra
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | | | - Valdilea G Veloso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Daphna Harel
- Department of Applied Statistics, Social Science, and Humanities, New York University, New York, NY, USA
- Center for Practice and Research and the Intersection of Information, Society, and Methodology, New York University, New York, NY, USA
| | - Brett D Thombs
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
- Departments of Psychiatry; Epidemiology, Biostatistics and Occupational Health; Medicine; Psychology; Educational and Counselling Psychology, and Biomedical Ethics Unit, McGill University, Montréal, Québec, Canada
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13
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Passaro RC, Segura ER, Gonzales-Saavedra W, Lake JE, Perez-Brumer A, Shoptaw S, Dilley J, Cabello R, Clark JL. Sexual Partnership-Level Correlates of Intimate Partner Violence Among Men Who Have Sex with Men and Transgender Women in Lima, Peru. ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:2703-2713. [PMID: 32270400 PMCID: PMC7494565 DOI: 10.1007/s10508-020-01682-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 03/06/2020] [Accepted: 03/07/2020] [Indexed: 06/11/2023]
Abstract
To improve understanding of factors associated with intimate partner violence (IPV) and explore its role in sexually transmitted infection (STI) acquisition, we analyzed partnership-level correlates of IPV among men who have sex with men (MSM) and transgender women (TW) in Peru. In a 2017 cross-sectional study of rectal STI screening and HIV prevention, MSM/TW completed a sociobehavioral survey addressing demographic characteristics, sexual risk behaviors, and substance use, and were tested for rectal gonorrhea and chlamydia, syphilis, and HIV. Generalized estimating equations estimated individual- and partner-level correlates of IPV. Of 576 participants (median age, 27 years), 7.9% (36/456) of MSM and 15.0% (18/120) of TW reported IPV with ≥ 1 of their last three partners. MSM/TW reporting IPV were more likely to meet criteria for an alcohol use disorder (74.1%) than participants reporting no IPV (56.7%; p < .01). Physical violence (4.5% MSM; 9.2% TW) was associated with stable partnerships (aPR 3.79, 95% CI 1.79-8.04), partner concurrency (4.42, 1.19-16.40), and participant alcohol (4.71, 1.82-12.17) or drug use (5.38, 2.22-13.02) prior to sex. Psychological violence (4.5% MSM; 5.0% TW) was associated with stable partnerships (2.84, 1.01-7.99). Sexual IPV was reported by 1.1% of MSM and 5.0% of TW. Physical, psychological, and sexual IPV were reported in sexual partnerships of Peruvian MSM and TW, particularly with stable partners and in conjunction with substance use.
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Affiliation(s)
- R Colby Passaro
- Department of Emergency Medicine, Los Angeles County and University of Southern California Medical Center, Los Angeles, CA, USA.
- South American Program in HIV Prevention Research, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave., CHS 37-121, Los Angeles, CA, 90095-1688, USA.
| | - Eddy R Segura
- South American Program in HIV Prevention Research, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave., CHS 37-121, Los Angeles, CA, 90095-1688, USA
- Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | | | - Jordan E Lake
- South American Program in HIV Prevention Research, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave., CHS 37-121, Los Angeles, CA, 90095-1688, USA
- Department of Internal Medicine, Division of Infectious Diseases, McGovern Medical School at UT Health, Houston, TX, USA
| | - Amaya Perez-Brumer
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Steven Shoptaw
- South American Program in HIV Prevention Research, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave., CHS 37-121, Los Angeles, CA, 90095-1688, USA
- Department of Family Medicine, Center for HIV Identification, Prevention, and Treatment Services, University of California Los Angeles, Los Angeles, CA, USA
| | - James Dilley
- Department of Psychiatry, University of California San Francisco School of Medicine, San Francisco, CA, USA
| | - Robinson Cabello
- South American Program in HIV Prevention Research, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave., CHS 37-121, Los Angeles, CA, 90095-1688, USA
- Asociación Civil Via Libre, Lima, Peru
| | - Jesse L Clark
- South American Program in HIV Prevention Research, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave., CHS 37-121, Los Angeles, CA, 90095-1688, USA
- Department of Family Medicine, Center for HIV Identification, Prevention, and Treatment Services, University of California Los Angeles, Los Angeles, CA, USA
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14
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Moriarty KE, Segura ER, Gonzales W, Lake JE, Cabello R, Clark JL. Assessing Sexually Transmitted Infections and HIV Risk Among Transgender Women in Lima, Peru: Beyond Behavior. LGBT Health 2020; 6:370-376. [PMID: 31618167 DOI: 10.1089/lgbt.2018.0087] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: The purpose of this study was to explore risk factors for HIV and sexually transmitted infections (STIs) among transgender women (TW) in Lima, Peru. Methods: HIV-negative or serostatus unknown TW reporting recent condomless receptive anal intercourse underwent testing for STIs and HIV and completed a sociobehavioral survey. Results: Among 120 TW, 29.6% had rectal Neisseria gonorrhoeae (GC) or Chlamydia trachomatis (CT) and 12.6% had HIV. Age and migrant status were associated with rectal GC/CT, and rectal GC/CT predicted HIV infection. Conclusions: Further study is needed to understand individual and social factors that contribute to HIV/STI vulnerability among TW.
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Affiliation(s)
- Kathleen E Moriarty
- South American Program in HIV Prevention Research (SAPHIR), Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California.,Alpert Medical School, Brown University, Providence, Rhode Island
| | - Eddy R Segura
- South American Program in HIV Prevention Research (SAPHIR), Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California.,Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | | | - Jordan E Lake
- South American Program in HIV Prevention Research (SAPHIR), Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California.,Division of Infectious Diseases, Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas
| | - Robinson Cabello
- South American Program in HIV Prevention Research (SAPHIR), Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California.,Asociación Civil Vía Libre, Lima, Peru
| | - Jesse L Clark
- South American Program in HIV Prevention Research (SAPHIR), Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
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15
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Tattsbridge J, Wiskin C, de Wildt G, Clavé Llavall A, Ramal-Asayag C. HIV understanding, experiences and perceptions of HIV-positive men who have sex with men in Amazonian Peru: a qualitative study. BMC Public Health 2020; 20:728. [PMID: 32429863 PMCID: PMC7238527 DOI: 10.1186/s12889-020-08745-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 04/21/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND HIV-related incidence and mortality is increasing across Peru, with highest mortality rates recorded in the Amazonian region of Loreto. This epidemic is concentrated in men who have sex with men, a population with 14% HIV treatment adherence despite free national provision. This study investigates barriers and facilitators to following healthcare advice through experiences and perceptions of HIV-positive men who have sex with men and healthcare professionals in Loreto. METHODS Twenty qualitative interviews with HIV-positive men who have sex with men and one focus group with HIV-specialist healthcare professionals were conducted in Loreto, January-February 2019. Interviews were transcribed per verbatim. Thematic content analysis and deviant case analysis were used. RESULTS A culture of isolation and discrimination was identified, propagated by poor public knowledge surrounding HIV transmission and treatment. Employment potential was hampered and 7/20 patients had suicidal thoughts post-diagnosis. Barriers to care included: shame, depression, travel cost/times, a preference for traditional plant-based medicine and side-effects of antiretroviral therapy. Facilitators included: education, family and clinic support, disease acceptance and lifestyle changes. CONCLUSION More effective, focussed community education and workplace discrimination investigations are recommended to reduce stigma and increase adherence to treatment in this population.
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Affiliation(s)
- Jasmine Tattsbridge
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK.
| | - Connie Wiskin
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - Gilles de Wildt
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - Anna Clavé Llavall
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - César Ramal-Asayag
- Department of Infectious Diseases, Regional Hospital of Loreto, Iquitos, Peru.,Department of Clinical Sciences, Universidad Nacional de la Amazonia Peruana, Iquitos, Peru
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16
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Huang D, Wang J, Yang T. Mapping the Spatial-Temporal Distribution and Migration Patterns of Men Who Have Sex with Men in Mainland China: A Web-Based Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17051469. [PMID: 32106473 PMCID: PMC7084445 DOI: 10.3390/ijerph17051469] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 02/19/2020] [Accepted: 02/23/2020] [Indexed: 11/16/2022]
Abstract
The human immunodeficiency virus (HIV) infection rate for men who have sex with men (MSM) has rapidly increased in recent years in China and the migrant population accounts for a large proportion of this increase. The migration of MSM not only poses difficulties for government departments charged with treating the disease, but also increases the spread of HIV in geographical space, so it is important to understand the geographical distribution and migrant patterns of MSM. We searched the largest dating website in China to obtain open information from all users in the Chinese mainland from January 2006 to August 2017. For the analysis, the datasets were merged according to units of time and administrative regions. In total, 1,356,609 records were obtained for this study. The main users of the website were single males aged 18-35 years old. Most of the users were located in the large and mid-sized cities of East China. The distribution of MSM was strongly associated with the distribution of the development of service industry in geographical space. The main flow of MSM are mainly located inside the province as internal flow. For those MSM who prefer to migrate to other provinces, the Beijing-Tianjin-Hebei area, the Yangtze River Delta, the Pearl River Delta, and Sichuan and Chongqing area were their primary destinations. The interprovincial migration behavior of MSM was closely related to an increased average income. MSM prefer to migrate to cities with developed economies and open cultures. It is important to strengthen the management of migrant MSM and increase their basic understanding of HIV.
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Affiliation(s)
- Dacang Huang
- State Key Laboratory of Resources and Environmental Information System, Institute of Geographic Science and Natural Resources Research, Chinese Academy of Sciences, Beijing 100101, China;
- University of Chinese Academy of Sciences, Beijing 100049, China;
| | - Jinfeng Wang
- State Key Laboratory of Resources and Environmental Information System, Institute of Geographic Science and Natural Resources Research, Chinese Academy of Sciences, Beijing 100101, China;
- University of Chinese Academy of Sciences, Beijing 100049, China;
- Correspondence:
| | - Tengfei Yang
- University of Chinese Academy of Sciences, Beijing 100049, China;
- Institute of Remote Sensing and Digital Earth, Chinese Academy of Sciences, Beijing 10094, China
- Aerospace Information Research Institute, Chinese Academy of Sciences, Beijing 10094, China
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17
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Liu J, Zhong X, Lu Z, Peng B, Zhang Y, Liang H, Dai J, Zhang J, Huang A. Anxiety and Depression Associated with Anal Sexual Practices among HIV-Negative Men Who Have Sex with Men in Western China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17020464. [PMID: 31936800 PMCID: PMC7014070 DOI: 10.3390/ijerph17020464] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 01/07/2020] [Accepted: 01/08/2020] [Indexed: 12/13/2022]
Abstract
This study aimed to explore the prevalence and influencing factors of anxiety and depression among human immunodeficiency virus negative (HIV-negative) men who have sex with men (MSM) based on anal sex roles, so as to provide a scientific basis for the management of mental health conditions. Data were obtained from the baseline in a cohort study with a two-year follow-up period in western China. The Self-Rating Anxiety Scale and Center for Epidemiological Studies Depression Scale were used to assess anxiety and depression symptoms, respectively. The prevalence of anxiety and depression in 1771 MSM was 26.03% and 37.83%. Among them, 182 anal sex role “0” MSM who only had receptive anal sex with men reported the highest prevalence of anxiety and depression (31.32% and 46.15%), 467 anal sex role “1” MSM who only had insertive anal sex with men (22.27% and 32.76%), and 1122 anal sex role “0.5” MSM who engaged equally in both insertive and receptive anal sex intercourse with men (26.74% and 38.59%), respectively. Logistic regression analysis revealed that the influencing factors of anxiety include anal sex role “0”/”0.5”, low educational level, female sexual partners, frequently searching partners on the Internet, sexually transmitted diseases (STD) diagnosed by doctors, and no HIV counseling. Anal sex role “0”/”0.5”, rural area, casual male partners, female partners, STD diagnosed by doctors, frequently searching partners on the Internet, no HIV counseling, no condom use, and daily alcohol use were found to be associated with depression. In conclusion, early identification and intervention of anxiety and depression symptoms in HIV-negative MSM should be carried out, especially for anal sex role “0” MSM. Furthermore, key intervention and psychological counseling should be taken into consideration for MSM with a low education level, high-risk behaviors, and high-risk perceptions.
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Affiliation(s)
- Jiaxiu Liu
- School of Public Health and Management, Chongqing Medical University, Chongqing 400016, China
| | - Xiaoni Zhong
- School of Public Health and Management, Chongqing Medical University, Chongqing 400016, China
- Correspondence:
| | - Zhuo Lu
- School of Public Health and Management, Chongqing Medical University, Chongqing 400016, China
| | - Bin Peng
- School of Public Health and Management, Chongqing Medical University, Chongqing 400016, China
| | - Yan Zhang
- School of Public Health and Management, Chongqing Medical University, Chongqing 400016, China
| | - Hao Liang
- Department of Epidemiology and Medical Statistics, School of Public Health, Guangxi Medical University, Nanning 520021, China
| | - Jianghong Dai
- Department of Epidemiology and Health Statistics, School of Public Health, Xinjiang Medical University, Xinjiang 830011, China
| | - Juying Zhang
- Department of Epidemiology and Medical Statistics, School of Public Health, Sichuan University, Chengdu 610041, China
| | - Ailong Huang
- Key Laboratory of Molecular Biology on Infectious Diseases, Ministry of Education, Chongqing Medical University, Chongqing 400016, China
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Clark JL, Perez-Brumer AG, Reisner SL, Salazar X, McLean S, Huerta L, Silva-Santisteban A, Moriarty KM, Mimiaga MJ, Sanchez J, Mayer KH, Lama JR. Social Network Organization, Structure, and Patterns of Influence Within a Community of Transgender Women in Lima, Peru: Implications for Biomedical HIV Prevention. AIDS Behav 2020; 24:233-245. [PMID: 30989553 PMCID: PMC6801001 DOI: 10.1007/s10461-019-02506-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Understanding social network structures can contribute to the introduction of new HIV prevention strategies with socially marginalized populations like transgender women (TW). We conducted 20 semi-structured interviews and four focus groups (n = 32) with TW from selected social networks in Lima, Peru between May and July, 2015. Participants described layers of social influence from diverse actors in their social networks. The majority identified a close relative as their primary social support, with whom they confided secrets but avoided issues of transgender identity, sexuality, and sex work. Participants described close circles of TW friends with whom they shared information about gender identity, body modification, and sexual partners, but avoided issues like HIV. Community leadership included political leaders (who advocated for transgender rights) as well as social leaders (who introduced TW to hormone therapy, body modification, and commercial sex). Detailed analysis of TW social networks can contribute to implementation and acceptability of new HIV prevention technologies.
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Affiliation(s)
- J L Clark
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine at UCLA, 10833 Leconte Avenue, CHS 37-121, Los Angeles, CA, 90095, USA.
| | - A G Perez-Brumer
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | - S L Reisner
- Department of Pediatrics, Harvard Medical School and Boston Children's Hospital, Boston, MA, USA
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - X Salazar
- Instituto de Estudios de Sexualidad y Derechos Humanos, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - S McLean
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - L Huerta
- Asociacion Civil Impacta Salud y Educacion, Lima, Peru
| | - A Silva-Santisteban
- Instituto de Estudios de Sexualidad y Derechos Humanos, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - K M Moriarty
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine at UCLA, 10833 Leconte Avenue, CHS 37-121, Los Angeles, CA, 90095, USA
- Brown University Alpert School of Medicine, Providence, RI, USA
| | - M J Mimiaga
- Center for Health Equity Research, Brown University, Providence, RI, USA
- Departments of Behavioral and Social Sciences and Epidemiology, Brown University School of Public Health, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Brown University Alpert School of Medicine, Providence, RI, USA
| | - J Sanchez
- Asociacion Civil Impacta Salud y Educacion, Lima, Peru
- CITBM, Universidad Nacional Mayor San Marcos, Lima, Peru
- Department of Global Health, University of Washington School of Medicine, Seattle, WA, USA
| | - K H Mayer
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - J R Lama
- Asociacion Civil Impacta Salud y Educacion, Lima, Peru
- Department of Global Health, University of Washington School of Medicine, Seattle, WA, USA
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19
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Passaro RC, Castañeda-Huaripata A, Gonzales-Saavedra W, Chavez-Gomez S, Segura ER, Lake JE, Cabello R, Clark JL. Contextualizing condoms: a cross-sectional study mapping intersections of locations of sexual contact, partner type, and substance use as contexts for sexual risk behavior among MSM in Peru. BMC Infect Dis 2019; 19:958. [PMID: 31711433 PMCID: PMC6849170 DOI: 10.1186/s12879-019-4517-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 09/27/2019] [Indexed: 12/14/2022] Open
Abstract
Background Condomless anal intercourse (CAI) appears to be increasing among men who have sex with men (MSM) globally, and is reported to be as high as 70% in recent studies in Peru. To improve understanding of the evolving context of CAI among MSM in Peru, we studied associations between partner type, substance use, and condomless anal intercourse (CAI) in locations where MSM commonly report having sexual encounters. Methods In a 2017 cross-sectional study of rectal STI screening and HIV prevention, a convenience sample of MSM recruited from community venues in Lima completed a survey of demographic characteristics and sexual risk behavior with their three most recent partners. Generalized estimating equations estimated correlations of CAI with location of last sexual contact, participant substance use prior to sex, and negotiation of condom use before or during sex. The network data integration application, Cytoscape, mapped intersections of partner type, sexual orientation, substance use, and CAI by four types of locations where sex occurred: 1) Home, 2) Hotel, 3) Sauna or Internet Cabin, and 4) Public Spaces. Results Of 447 MSM (median age 27 years), 76.9% reported CAI with ≥1 of their last three partners. Participants reported sex with casual partners most commonly in homes (64.6%) and hotels (60.4%), and with anonymous partners most often in saunas/Internet cabins (57.5%) and public spaces (52.6%). CAI was less commonly reported in hotels (aPR, 95% CI: 0.85, 0.75–0.97) compared to homes. Participants who used marijuana before sex at home were more likely to report CAI than MSM who did not use marijuana (1.36, 1.01–1.92). Partner alcohol use before sex was associated with CAI in saunas/Internet cabins (3.17, 1.45–6.91) and public spaces (2.65, 1.41–4.98). In the sexual network maps, almost all MSM who used drugs prior to their sexual encounters used drugs with more than one of their last three partners. Conclusions CAI was common and associated with different risk factors, like partner type and substance use, based on location where sex occurred. Novel combination HIV, STI, and substance use prevention interventions must consider how the social environments of MSM influence condom use and other sexual risk behaviors. Trial registration ClinicalTrials.gov Identifier NCT03010020, January 4, 2017.
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Affiliation(s)
- R Colby Passaro
- Department of Emergency Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA. .,South American Program in HIV Prevention Research, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
| | | | | | | | - Eddy R Segura
- South American Program in HIV Prevention Research, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.,Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | - Jordan E Lake
- South American Program in HIV Prevention Research, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.,Department of Internal Medicine, Division of Infectious Diseases, McGovern Medical School at UTHealth, Houston, TX, USA
| | | | - Jesse L Clark
- South American Program in HIV Prevention Research, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
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20
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Body Parts Matter: Social, Behavioral, and Biological Considerations for Urethral, Pharyngeal, and Rectal Gonorrhea and Chlamydia Screening Among MSM in Lima, Peru. Sex Transm Dis 2019; 45:607-614. [PMID: 30102262 DOI: 10.1097/olq.0000000000000816] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Gonorrhea (Neisseria gonorrhoeae [GC]) and chlamydia (Chlamydia trachomatis [CT]) disproportionately affect men who have sex with men (MSM), and public health implications vary by anatomic site and bacterial agent. Urethral and rectal GC and CT can increase risk of HIV transmission, whereas pharyngeal GC may be a reservoir for antimicrobial resistance. To define screening priorities in Latin America, we compare differences in the prevalence and correlates of urethral, pharyngeal, and rectal GC and CT among MSM in Peru. METHODS A cross-sectional sample of 787 MSM from Lima was screened between 2012 and 2014. We described prevalence of urethral, pharyngeal, and rectal GC and CT infection and conducted bivariate analyses of associations with social, behavioral, and biological characteristics. Poisson regression analyses assessed the correlates of each infection at each anatomic site. RESULTS The most commonly symptomatic infection (urethral GC; 42.1%) was the least prevalent (2.4%). The most prevalent infections were rectal CT (15.8%) and pharyngeal GC (9.9%). Rectal CT was the least commonly symptomatic (2.4%) infection, and was associated with younger age (adjusted prevalence ratio [95% confidence interval], 0.96 [0.94-0.98]), HIV infection (1.46 [1.06-2.02]), and pasivo (receptive; 3.59 [1.62-7.95]) and moderno (versatile; 2.63 [1.23-5.60]) sexual roles. CONCLUSIONS Results highlight limitations of current syndromic screening strategies for sexually transmitted diseases in Peru, wherein urethral CT and rectal GC and CT may be missed due to their frequently asymptomatic presentations. Successful management of GC and CT infections among MSM in low-resource settings requires differentiating between bacterial agent, symptomatic presentation, associated risk factors, and public health implications of untreated infection at different anatomic sites.
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Blair C, Passaro RC, Segura ER, Lake JE, Perez-Brumer AG, Sanchez J, Lama JR, Clark JL. Sexual network characteristics of men who have sex with men with syphilis and/or gonorrhoea/chlamydia in Lima, Peru: network patterns as roadmaps for STI prevention interventions. Sex Transm Infect 2019; 95:336-341. [PMID: 31010954 PMCID: PMC6642006 DOI: 10.1136/sextrans-2018-053865] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 03/04/2019] [Accepted: 04/02/2019] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE While men who have sex with men (MSM) are disproportionately affected by Peru's overlapping HIV and STI epidemics, there are few data on how partnership-level and network-level factors affect STI transmission in Peru. We explored partnership-level and network-level factors associated with gonorrhoea/chlamydia (Neisseria gonorrhoeae and/or Chlamydia trachomatis (NG/CT)) and/or syphilis infection among MSM in Peru. METHODS We present the results of a cross-sectional secondary analysis of MSM (n=898) tested for syphilis and NG/CT infection as part of the screening process for two STI control trials in Lima, Peru. Participants completed questionnaires on demographics, sexual identity and role, characteristics of their three most recent sexual partners (partner sexual orientation, gender, role, partnership type, partner-specific sexual acts) and 30-day sexual network characteristics (number of sexual partners, partnership types, frequency of anal/vaginal intercourse). Participants were tested for syphilis and urethral, rectal and oropharyngeal NG/CT. Differences in network characteristics were analysed with χ2 and Kruskal-Wallis tests. RESULTS Approximately 38.9% of participants had a new STI diagnosis (syphilis (rapid plasma reagin ≥16): 10.6%; NG/CT: 22.9%; syphilis-NG/CT coinfection: 5.4%). Condomless anal intercourse (CAI) was not significantly associated with an STI diagnosis. Gay-identified participants with exclusively homosexual networks had a higher prevalence of STIs (47.4%) than gay-identified MSM with only heterosexual/bisexual partners (34.6%, p=0.04), despite reporting fewer sexual partners (any partners: 2, 1-4 vs 3, 2-6; p=0.001; casual partners: 1, 0-3 vs 2, 1-4; p=0.001) and more stable partnerships (1, 0-1 vs 0, 0-1; p=0.003) in the last month. CONCLUSIONS Network size and the number of casual sexual partners were associated with NG/CT infection among MSM in Peru. Despite reporting fewer sexual risk behaviours (smaller network size, more stable partnerships, less CAI), MSM with homosexual-only sexual networks had a higher prevalence of NG/CT and syphilis. These findings suggest network composition among MSM in Peru plays an important role in the risk for STI acquisition.
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Affiliation(s)
- Cherie Blair
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Ryan Colby Passaro
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Eddy R Segura
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
- Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Perú
| | - Jordan E Lake
- Department of Internal Medicine, McGovern Medical School at UTHealth, Houston, Texas, USA
| | | | - Jorge Sanchez
- Centro de Investigaciones Tecnológicas, Biomédicas y Medioambientales, Callao, Peru
| | - Javier R Lama
- Asociacion Civil Impacta Salud y Educacion, Lima, Peru
| | - Jesse L Clark
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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Seekaew P, Lujintanon S, Pongtriang P, Nonnoi S, Hongchookait P, Tongmuang S, Srisutat Y, Phanuphak P, Phanuphak N. Sexual patterns and practices among men who have sex with men and transgender women in Thailand: A qualitative assessment. PLoS One 2019; 14:e0219169. [PMID: 31247030 PMCID: PMC6597192 DOI: 10.1371/journal.pone.0219169] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 06/18/2019] [Indexed: 12/17/2022] Open
Abstract
The global trend in HIV incidence overall is declining; however, there is a plateau in new HIV infection among men who have sex with men (MSM) and transgender women (TGW) despite extensive investment in HIV prevention targeting these populations. Many studies usually conflate these two groups together, which may overlook many disparate characteristics unique to each population, impeding the efficacy of HIV interventions. To better understand the vulnerable diversity that may put these individuals at risk of HIV infection, we conducted qualitative analysis among Thai MSM and TGW, aiming to identify sexual pattern themes of MSM and TGW in Bangkok in order to better understand their distinctive sexual life context. Convenient and purposive samplings were used to recruit Thai MSM and TGW aged ≥ 18 years old and living in Bangkok, Thailand, for focused group discussions and one-on-one in-depth interviews, respectively. Total of 12 MSM and 13 TGW participated in focused group discussions, which were conducted separately for MSM and TGW. Additionally, 5 MSM and 5 TGW were involved in one-on-one in-depth interviews. Thematic analyses were performed separately for MSM and TGW. The results show that MSM and TGW have distinct and diverse sexual patterns, and within the identified themes: partnering, partner finding, protection, and enhancing sexual pleasure (only for MSM). Participants reported having varying sexual experiences. Recognizing the difference and diversity in partnering and sexual practice of MSM and TGW is crucial in order to develop tailored interventions that suit the vulnerability of the key populations in Thailand.
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Affiliation(s)
- Pich Seekaew
- PREVENTION, Thai Red Cross AIDS Research Centre, Bangkok, Thailand
- * E-mail:
| | - Sita Lujintanon
- PREVENTION, Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | | | - Siriporn Nonnoi
- PREVENTION, Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | | | - Sumitr Tongmuang
- PREVENTION, Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | - Yarinda Srisutat
- PREVENTION, Thai Red Cross AIDS Research Centre, Bangkok, Thailand
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23
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Perez-Brumer AG, Passaro RC, Oldenburg CE, Garcia J, Sanchez J, Salvatierra HJ, Lama JR, Clark JL. Homophobia and heteronormativity as dimensions of stigma that influence sexual risk behaviors among men who have sex with men (MSM) and women (MSMW) in Lima, Peru: a mixed-methods analysis. BMC Public Health 2019; 19:617. [PMID: 31113398 PMCID: PMC6528354 DOI: 10.1186/s12889-019-6956-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 05/08/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Stigma differentially influences HIV and STI care among MSM, especially regarding partner notification practices. Recognizing the heterogeneous behaviors/identities within the category "MSM," we used mixed-methods to assess sexual risk behaviors among men who have sex with men only (MSMO) and behaviorally bisexual MSM (MSMW) with HIV and/or other STIs. METHODS MSMO/MSMW recently diagnosed (< 30 days) with HIV, syphilis, urethritis, or proctitis completed a cross-sectional survey assessing sexual risk behaviors, anticipated disclosure, and sexual partnership characteristics (n = 332). Multivariable generalized estimating equation models assessed characteristics associated with female compared to male partners in the last three partnerships. Follow-up qualitative interviews (n = 30) probed partner-specific experiences (e.g., acts and disclosure). RESULTS Among all participants, 13.9% (n = 46) described at least one of their last three sex partners as female (MSMW). MSMW (mean age of 31.8) reported a mean of 3.5 partners (SD = 4.5) in the past 3 months and MSMO (mean age 30.6) reported a mean of 4.6 partners (SD = 9.7) in the past 3 months. MSMW were more likely to report unprotected insertive anal sex (77.9%) than MSMO (43.1%; p < 0.01). Cisgender female partners were associated with condomless insertive sex in the last 3 months (aPR: 3.97, 95%CI: 1.98-8.00) and classification as a "primary" partnership (2.10, 1.34-3.31), and with lower prevalence of recent HIV diagnosis (0.26, 0.11-0.61). Planned notification of HIV/STI diagnoses was less common for female than for male partners (0.52, 0.31-0.85). Narratives illustrate internal (e.g., women as 'true' partners) and community-level processes (e.g., discrimination due to exposure of same-sex behavior) that position homosexual behavior and bisexual identity as divergent processes of deviance and generate vulnerability within sexual networks. CONCLUSIONS MSMW recently diagnosed with HIV/STI in Peru report varying partnership characteristics, with different partner-specific risk contexts and prevention needs. Descriptions highlight how behaviorally bisexual partnerships cut across traditional risk group boundaries and suggest that HIV/STI prevention strategies must address diverse, partnership-specific risks.
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Affiliation(s)
- Amaya G Perez-Brumer
- Columbia Mailman School of Public Health, Department of Sociomedical Sciences, 722 West 168th St., New York, NY, 10032, USA.
| | - Ryan C Passaro
- College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.,South American Program in HIV Prevention Research, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Catherine E Oldenburg
- Francis I Proctor Foundation, University of California, San Francisco, San Francisco, CA, USA
| | - Jonathan Garcia
- College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon, USA
| | - Jorge Sanchez
- Centro de Investigaciones Tecnologicas y Biomedicas Universidad Nacional de San Marcos, Lima, Peru
| | | | - Javier R Lama
- Asociación Civil Impacta Salud y Educación, Lima, Peru
| | - Jesse L Clark
- South American Program in HIV Prevention Research, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
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24
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Allan-Blitz LT, Herrera MC, Calvo GM, Vargas SK, Caceres CF, Klausner JD, Konda KA. Venue-Based HIV-Testing: An Effective Screening Strategy for High-Risk Populations in Lima, Peru. AIDS Behav 2019; 23:813-819. [PMID: 30506350 DOI: 10.1007/s10461-018-2342-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Venue-based testing may improve screening efforts for HIV and syphilis, thereby reducing transmission. We offered onsite rapid dual HIV and syphilis testing at venues popular among MSM and/or transgender women in Lima, Peru. We used Poisson regression to calculate adjusted prevalence ratios (aPRs) for factors associated with each infection. Most (90.4%) of the 303 participants would test more frequently if testing was available at alternative venues. New cases of HIV (69) and syphilis infection (84) were identified. HIV was associated with recent sex work (aPR 1.11; 95% CI 1.02-1.22), sex with a partner of unknown serostatus (aPR 1.18; 95% CI 1.09-1.27), exclusively receptive anal sex role (aPR 1.16; 95% CI 1.03-1.30) or versatile sex role (aPR 1.17; 95% CI 1.06-1.30) compared to insertive. Syphilis was associated with reporting role versatility (aPR = 2.69; 95% CI 1.52-5.74). Sex work venues had higher syphilis prevalence 47% versus 28% in other venues, p value = 0.012. Venue-based testing may improve case finding.
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Affiliation(s)
- Lao-Tzu Allan-Blitz
- David Geffen School of Medicine, University of California, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA.
| | - M Christina Herrera
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA
| | - Gino M Calvo
- Center for Interdisciplinary Investigation in Sexuality, AIDS, and Society and Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Silver K Vargas
- Center for Interdisciplinary Investigation in Sexuality, AIDS, and Society and Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Carlos F Caceres
- Center for Interdisciplinary Investigation in Sexuality, AIDS, and Society and Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Jeffrey D Klausner
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA
- Fielding School of Public Health, University of California, Los Angeles, USA
| | - Kelika A Konda
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA.
- Center for Interdisciplinary Investigation in Sexuality, AIDS, and Society and Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru.
- Fielding School of Public Health, University of California, Los Angeles, USA.
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25
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Reisner SL, Perez-Brumer A, Oldenburg CE, Gamarel KE, Malone J, Leung K, Mimiaga MJ, Rosenberger JG, Biello KB. Characterizing HIV risk among cisgender men in Latin America who report transgender women as sexual partners: HIV risk in Latin America men. Int J STD AIDS 2019; 30:378-385. [PMID: 30537903 PMCID: PMC9897015 DOI: 10.1177/0956462418802687] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Cisgender men (CM) who report transgender women (TW) as sexual partners are an understudied population in the HIV epidemic in Latin America. The current study sought to characterize this group in a 2012 cross-sectional online survey of Latin American CM who were members of a sexual networking website for men who have sex with men (N = 11,847). Multivariable logistic regression models were fit to estimate demographic, behavioral, and psychosocial correlates of having a TW sexual partner and engaging in condomless sex. Overall, 0.9% (n = 106) reported a TW sexual partner in the last 12 months; of these, 76.4% (n = 81) reported condomless sex in the last three months. Identifying as bisexual or heterosexual compared to gay, and specifying a versatile sexual role preference compared to insertive were associated with reporting a recent TW sex partner (all p < 0.05). HIV-negative serostatus, lifetime STI history, and alcohol dependence were associated with recent condomless sex (all p < 0.05). CM with TW sexual partners have distinct HIV-related vulnerabilities. Future research is needed to understand CM who report TW sexual partners, including their sexual preferences and practices, sexual networks, exposure to stigma, biomedical prevention interest and uptake, and acceptability of integrating alcohol abuse screening into sexual health services.
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Affiliation(s)
- Sari L Reisner
- Division of General Pediatrics, Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore MD
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | | | | | - Kristi E Gamarel
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Jowanna Malone
- Johns Hopkins Bloomberg School of Public Health, Baltimore MD
| | - Kingsley Leung
- Johns Hopkins Bloomberg School of Public Health, Baltimore MD
| | - Matthew J Mimiaga
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Departments of Behavioral and Social Sciences and Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Joshua G Rosenberger
- Department of Biobehavioral Health, Pennsylvania State University, University Park, PA, USA
| | - Katie B. Biello
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Departments of Behavioral and Social Sciences and Epidemiology, Brown University School of Public Health, Providence, RI, USA
- Department of Biobehavioral Health, Pennsylvania State University, University Park, PA, USA
- Center for Health Equity Research, Brown University, Providence, RI
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26
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Garcia J, Perez-Brumer AG, Cabello R, Clark JL. "And Then Break the Cliché": Understanding and Addressing HIV Vulnerability Through Development of an HIV Prevention Telenovela with Men Who Have Sex with Men and Transwomen in Lima, Peru. ARCHIVES OF SEXUAL BEHAVIOR 2018; 47:1995-2005. [PMID: 29464455 PMCID: PMC6082681 DOI: 10.1007/s10508-017-1119-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 11/07/2017] [Accepted: 11/14/2017] [Indexed: 06/08/2023]
Abstract
HIV and other sexually transmitted infections (STIs) continue to affect men who have sex with men (MSM) and transgender women (TW) in Peru at disproportionately high rates. The ineffectiveness of traditional prevention strategies may be due to the disconnect between health promotion messages and community-level understandings of sexual cultures. We conducted 15 workshops with MSM and TW to develop a community-based sexual health intervention. Intervention development consisted of focus groups and scenic improvisation to identify sexual scripts for an HIV prevention telenovela, or Spanish soap opera. Workshops were stratified by self-reported socioeconomic status, sexual orientation, and gender identity: (1) low-income MSM (n = 9); (2) middle/high-income MSM (n = 6); and (3) TW (n = 8). Employing a conceptual model based on sexual scripts and critical consciousness theories, this paper reports on three themes identified during the telenovela-development process as participants sought to "rescript" social and sexual stereotypes associated with HIV-related vulnerability: (1) management of MSM and TW social identities at the intersection of socioeconomic status, sexuality, and gender performance; (2) social constructions of gender and/or sexual role and perceived and actual HIV/STI risk(s) within sexual partnership interactions; and (3) idealized and actual sexual scripts in the negotiation of safer sex practices between MSM/TW and their partners. These findings are key to reframing existing prevention strategies that fail to effectively engage poorly defined "high-risk populations." Leveraging community-based expertise, the results provide an alternative to the static transfer of information through expert-patient interactions in didactic sessions commonly used in HIV prevention interventions among MSM and TW.
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Affiliation(s)
- Jonathan Garcia
- School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, 118C Milam Hall, Corvallis, OR, 97331, USA.
| | - Amaya G Perez-Brumer
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | | | - Jesse L Clark
- Department of Medicine/Division of Infectious Diseases, UCLA Geffen School of Medicine, Los Angeles, CA, USA
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27
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Niven H, Jose H, Rawstorne P, Nathan S. 'They love us just the way they love a woman': gender identity, power and transactional sex between men who have sex with men and transgender women in Timor-Leste. CULTURE, HEALTH & SEXUALITY 2018; 20:858-872. [PMID: 29108507 DOI: 10.1080/13691058.2017.1388928] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
There has been limited research on the experiences of men who have sex with men and transgender women in Timor-Leste. Previous research has suggested a phenomenon by which same-sex-attracted men and transgender women have sexual and intimate relationships with straight-identifying men or mane-forte. Transactional sex has also been reported to be common. This paper, which complements a larger national size estimation among key populations at risk of HIV, further investigates sexual and social identities and roles, including sexual practices, among men who have sex with men and transgender women in Timor-Leste. Fifteen interviews were conducted with a profile of participants from urban and rural settings. Using inductive thematic analysis, we found that gender identity played a significant role in sexual relationships, with mane-forte having power over their sexual partner(s). Transactional sex was also found to be customary. Some participants experienced stigma, discrimination, sexual coercion and violence, while others, such as mane-forte, did not. Our research suggests that gender identity and power are significant in sexual relationships between men who have sex with men and transgender women in Timor-Leste, have implications for HIV prevention efforts and may reflect gender norms within the broader community.
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Affiliation(s)
- Hamish Niven
- a School of Public Health and Community Medicine , UNSW Sydney , New South Wales , Australia
| | - Hayden Jose
- b Australasian Society for HIV , Viral Hepatitis and Sexual Health Medicine (ASHM) , Sydney , Australia
| | - Patrick Rawstorne
- a School of Public Health and Community Medicine , UNSW Sydney , New South Wales , Australia
| | - Sally Nathan
- a School of Public Health and Community Medicine , UNSW Sydney , New South Wales , Australia
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28
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Kunzweiler CP, Bailey RC, Mehta SD, Okall DO, Obondi E, Djomand G, Nyunya BO, Otieno FO, Graham SM. Factors associated with viral suppression among HIV-positive Kenyan gay and bisexual men who have sex with men. AIDS Care 2018; 30:S76-S88. [PMID: 30897938 PMCID: PMC10669762 DOI: 10.1080/09540121.2018.1510109] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Accepted: 08/01/2018] [Indexed: 10/27/2022]
Abstract
The UNAIDS 90-90-90 target has prioritized achieving high rates of viral suppression. We identified factors associated with viral suppression among HIV-positive gay, bisexual, and other men who have sex with men (GBMSM) in Kisumu, Kenya. HIV-positive participants in the Anza Mapema study were offered antiretroviral therapy (ART) regardless of CD4 count. HIV viral load was assessed at baseline and after 6 and 12 months of follow-up. Viral suppression was defined as <1,000 copies/mL. Sociodemographic, sexual behaviors, and psychosocial characteristics were assessed via audio computer-assisted self interview. We used generalized estimating equations to estimate the associations between baseline and time-dependent predictors and viral suppression at 6 and 12 months. Seventy-five HIV-positive men were enrolled in the Anza Mapema study, of which 63 had at least one viral load measured during follow-up. Among 52 men with a viral load measure at month 6, 37 (71%) were on ART and virally suppressed. Among 59 men with a viral load measure at month 12, 37 (63%) were on ART and virally suppressed. In the final multivariable model, men who reported receptive or versatile sexual position during anal intercourse with a male partner had reduced odds of viral suppression (aOR = 0.20; 95% CI: 0.08-0.50). Greater levels of coping self-efficacy were associated with increased odds of viral suppression (aOR = 1.10; 95% CI: 1.03-1.16). Despite extensive initiation, retention, and adherence support, the rate of viral suppression in this population did not meet the UNAIDS 90-90-90 target (81% for individuals aware of their HIV status). Pervasive stigma against male-male sex, especially men who practice receptive anal sex, may underlie our findings, which highlight the need for advocacy and stigma reduction efforts. Because coping self-efficacy was a protective factor, efforts to promote resilience in addition to healthy sexual identity development may lead to improved care outcomes among GBMSM in this area.
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Affiliation(s)
- Colin P. Kunzweiler
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
| | - Robert C. Bailey
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
| | - Supriya D. Mehta
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
| | | | - Eve Obondi
- Nyanza Reproductive Health Society, Kisumu, Kenya
| | - Gaston Djomand
- Division of Global HIV/AIDS and Tuberculosis, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Boaz Otieno Nyunya
- Division of Global HIV/AIDS, Centers for Disease Control and Prevention, Kisumu, Kenya
| | | | - Susan M. Graham
- Departments of Medicine, Global Health, and Epidemiology, University of Washington, Seattle, WA, USA
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29
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Jacques-Aviñó C, García de Olalla P, González Antelo A, Fernández Quevedo M, Romaní O, Caylà JA. The theory of masculinity in studies on HIV. A systematic review. Glob Public Health 2018; 14:601-620. [PMID: 29972098 DOI: 10.1080/17441692.2018.1493133] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
This study aimed to describe the methodological characteristics of publications on HIV and masculinity, to identify possible information gaps and determine the main thematic areas. A systematic review was conducted of gender, masculinity, HIV infection and other sexually-transmitted infections in original articles published between 1992 and 2015. Original studies published from Pubmed and Scopus were included. A total of 303 articles were identified, of which 187 were selected. Most of the studies were qualitative and the most widely used technique was the interview. Twenty-nine-point five percent of studies were performed in South Africa, 20.8% in the USA, and 3.2% in Europe. Fifteen percent of the studies were performed in heterosexuals, 12.8% in men who have sex with men, and 60% did not specify the sexual orientation of the population. Eight thematic areas were defined, the most frequent being sexuality and risk behaviours, defined by men's need to demonstrate they were sexually active and a breadwinner. Most studies on HIV and masculinity show a gender bias by not specifying the sexual identity of the population. Studies should consider diversity in sexual and cultural identity in different contexts, including in Europe, to carry out more effective HIV interventions from a masculinity perspective.
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Affiliation(s)
- Constanza Jacques-Aviñó
- a Servicio de Epidemiología , Agència de Salud Pública de Barcelona , Barcelona , Spain.,b Universitat Rovira i Virgili (URV) , Tarragona , Spain
| | - Patricia García de Olalla
- a Servicio de Epidemiología , Agència de Salud Pública de Barcelona , Barcelona , Spain.,c Epidemiología y Salud Pública , CIBER , Spain
| | - Alicia González Antelo
- d Servicio Medicina Preventiva y Epidemiología , Hospital Vall d'Hebrón , Barcelona , Spain
| | | | - Oriol Romaní
- c Epidemiología y Salud Pública , CIBER , Spain.,e Medical Anthropology Research Center (MARC- URV) , Tarragona , Spain
| | - Joan A Caylà
- a Servicio de Epidemiología , Agència de Salud Pública de Barcelona , Barcelona , Spain.,c Epidemiología y Salud Pública , CIBER , Spain
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30
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Clark JL, Segura ER, Oldenburg CE, Salvatierra HJ, Rios J, Perez-Brumer AG, Gonzales P, Sheoran B, Sanchez J, Lama JR. Traditional and Web-Based Technologies to Improve Partner Notification Following Syphilis Diagnosis Among Men Who Have Sex With Men in Lima, Peru: Pilot Randomized Controlled Trial. J Med Internet Res 2018; 20:e232. [PMID: 29970355 PMCID: PMC6053614 DOI: 10.2196/jmir.9821] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 02/28/2018] [Accepted: 03/13/2018] [Indexed: 12/02/2022] Open
Abstract
Background Patient-initiated partner notification (PN) following the diagnosis of a sexually transmitted infection is a critical component of disease control in men who have sex with men (MSM) sexual networks. Both printed and internet-based technologies offer potential tools to enhance traditional partner notification approaches among MSM in resource-limited settings. Objective This randomized controlled trial aimed to evaluate the effect of 2 different PN technologies on notification outcomes following syphilis diagnosis among MSM in Peru: a Web-based notification system and patient-delivered partner referral cards. Methods During 2012-2014, we screened 1625 MSM from Lima, Peru, for syphilis infection and enrolled 370 MSM with symptomatic primary or secondary syphilis (n=58) or asymptomatic latent syphilis diagnosed by serology (rapid plasma reagin, RPR, and Microhemagglutination assay for Treponema pallidum antibody; n=312). Prior to enrollment, potential participants used a computer-based self-interviewing system to enumerate their recent sexual partnerships and provide details of their 3 most recent partners. Eligible participants were randomly assigned to one of 4 intervention arms: (1) counseling and patient-initiated Web-based PN (n=95), (2) counseling with Web-based partner notification and partner referral cards (n=84), (3) counseling and partner referral cards (n=97), and (4) simple partner notification counseling (control; n=94). Self-reported partner notification was assessed after 14 days among 354 participants who returned for the follow-up assessment. Results The median age of enrolled participants was 27 (interquartile range, IQR 23-34) years, with a median of 2 partners (IQR 1-5) reported in the past month. Compared with those who received only counseling (arm 4), MSM provided with access to Web-based partner notification (arms 1 and 2) or printed partner referral cards (arms 2 and 3) were more likely to have notified one or more of their sexual partners (odds ratio, OR, 2.18, 95% CI 1.30-3.66; P=.003 and OR 1.68, 95% CI 1.01-2.79; P=.045, respectively). The proportion of partners notified was also higher in both Web-based partner notification (241/421, 57.2%; P<.001) and referral card (240/467, 51.4%; P=.006) arms than in the control arm (82/232, 35.3%). Conclusions Both new Web-based technologies and traditional printed materials support patient-directed notification and improve self-reported outcomes among MSM with syphilis. Additional research is needed to refine the use of these partner notification tools in specific partnership contexts. Trial Registration ClinicalTrials.gov NCT01720641; https://clinicaltrials.gov/ct2/show/NCT01720641 (Archived by WebCite at http://www.webcitation.org/70A89rJL4)
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Affiliation(s)
- Jesse L Clark
- David Geffen School of Medicine, Division of Infectious Diseases, Department of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Eddy R Segura
- David Geffen School of Medicine, Division of Infectious Diseases, Department of Medicine, University of California, Los Angeles, Los Angeles, CA, United States.,Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | - Catherine E Oldenburg
- Francis I Proctor Foundation, University of California, San Francisco, San Francisco, CA, United States
| | | | - Jessica Rios
- Asociacion Civil Impacta Salud y Educación, Lima, Peru
| | - Amaya Gabriela Perez-Brumer
- Mailman School of Public Health, Department of Sociomedical Sciences, Columbia University, New York, NY, United States
| | | | | | - Jorge Sanchez
- Centro de Investigaciones Tecnológicas, Biomédicas y Medioambientales, Universidad Nacional Mayor San Marcos, Lima, Peru
| | - Javier R Lama
- Asociacion Civil Impacta Salud y Educación, Lima, Peru
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Lei Y, Zhang K, Xiao X, Tang C, Li X, Wang H. Sexual Roles, Risk Sexual Behaviours, and HIV Prevalence among Men who Have Sex with Men Seeking HIV Testing in Changsha, China. Curr HIV Res 2018; 16:174-181. [PMID: 29992887 PMCID: PMC6182933 DOI: 10.2174/1570162x16666180711101643] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 05/11/2018] [Accepted: 07/02/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND HIV infection is prevalent among men who have sex with men (MSM), and sexual roles may be important factors related to it. This study aims to describe the sexual roles, risky sexual behaviors and HIV prevalence among MSM, and to determine associated factors for HIV prevalence. METHODS A convenient sampling method was used to recruit participants in a non-government organization in Changsha, China. The participants were asked to complete a 38-item self-administered questionnaire regarding demographic characteristics and risky sexual behaviours before collecting blood samples for HIV testing. Chi-square tests and logistic regression analysis were conducted with the Statistical Package for the Social Sciences Version 18.0 and other indexes were statistically described. RESULTS A total of 601 MSMs who came to a local non-government organization for voluntary counseling and testing completed a pencil-and-paper survey and were tested for HIV. The overall HIV prevalence of this sample was 13.3%, and that of the bottoms (16.3%) was similar to the versatiles (15.9%) but higher than the tops (6.1%). Bivariate analyses showed that there were significant differences in age, marital status, monthly income, sexual orientation, age at first sex, sex of the first sex partner, sex with a woman in the last 6 months, oral sex with a man in the last 6 months and role of oral sex among 3 subgroups of MSM (p < 0.05). Multivariate analyses indicated that MSMs who played the role of either the bottoms or the versatiles were more likely to be HIV positive than the tops. While MSMs who used condoms in anal sex in the last 6 months, had sex with a woman in the last 6 months or had oral sex with a man in the last 6 months were less likely to be HIV positive. CONCLUSION Different sexual roles are associated with high-risk sexual behaviors among MSMs and their HIV infection status. Further research should target preventive interventions, and improve the effectiveness of the intervention according to the characteristics of the subgroups to reduce the HIV transmission among Chinese MSM.
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Affiliation(s)
| | | | | | | | | | - Honghong Wang
- Address correspondence to this author at Xiangya School of Nursing of Central South University, 172 Tong Zi Po Road, Changsha 410013, Hunan, China; Tel: 86-731-82650270; Fax: 86-731-82650266; E-mail:
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Zeglin RJ, Hergenrather KC, Poppen PJ, Choi J, Reisen C, Zea MC. Latino Sexual Beliefs Scale: An Exploratory Factor Analysis of Latino Men Who Have Sex With Men. ARCHIVES OF SEXUAL BEHAVIOR 2018; 47:299-308. [PMID: 28585155 DOI: 10.1007/s10508-017-0988-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 02/28/2017] [Accepted: 04/03/2017] [Indexed: 06/07/2023]
Abstract
The catalyzing forces behind risky sexual behavior are a rich area of interest for public health researchers concerned with reducing HIV risk. Social cognitive theory would suggest that sexual beliefs are a viable example of one such influential agent. Recognizing that culture plays an important role in forming such sexual beliefs, and seeking to understand the unique HIV risks present for Latino men who have sex with men (MSM), this article presents an exploratory factor analysis of the 13-item Latino Sexual Beliefs Scale (LSBS) created as part of a larger study to investigate predictors of condom use among a sample of 482 MSM born in Brazil, Colombia, and the Dominican Republic and living in the U.S. The current analysis identified two psychometric factors in the LSBS as Romantic Exigency (containing six items with a mean loading of .62) and Sexual Acquiescence (containing seven items with a mean loading of .57). This is the first factor analysis conducted on the 13-item LSBS and represents the first known quantitative measure of Latino cultural sexual beliefs related to condom use for Latino MSM. Implications for future research include further validation, use in studies exploring the role of sexual beliefs on condom use, and possible thematic targets in HIV risk reduction interventions.
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Affiliation(s)
- Robert J Zeglin
- Department of Public Health, Brooks College of Health, University of North Florida, Jacksonville, FL, 32224, USA.
| | - Kenneth C Hergenrather
- Department of Counseling and Human Development, The George Washington University, Washington, DC, 20037, USA
| | - Paul J Poppen
- Department of Psychology, The George Washington University, Washington, DC, 20037, USA
| | - Jaehwa Choi
- Department of Educational Leadership, The George Washington University, Washington, DC, 20037, USA
| | - Carol Reisen
- Department of Psychology, The George Washington University, Washington, DC, 20037, USA
| | - Maria Cecilia Zea
- Department of Psychology, The George Washington University, Washington, DC, 20037, USA
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Treponema pallidum pallidum Genotypes and Macrolide Resistance Status in Syphilitic Lesions among Patients at 2 Sexually Transmitted Infection Clinics in Lima, Peru. Sex Transm Dis 2017; 43:465-6. [PMID: 27322050 DOI: 10.1097/olq.0000000000000465] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We report the circulating genotypes and the frequency of macrolide-resistance patterns among Treponema pallidum pallidum DNA isolated from syphilitic lesions from patients who attended 2 sexual health clinics in Lima, Peru. We implemented and used a molecular typing scheme to describe local T. pallidum pallidum strains. Among 14 specimens, subtype 14d/f was the most prevalent strain in 7 fully typed T. pallidum DNA specimens obtained from men who have sex with men and transgender women presenting with chancre-like lesions. No macrolide-resistance mutations were found in T. pallidum DNA from 10 lesions.
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Braun HM, Segura ER, Lake JE, Gandhi M, Rios J, Villaran MV, Sanchez J, Lama JR, Clark JL. Individual and partnership factors associated with anticipated versus actual partner notification following STI diagnosis among men who have sex with men and/or with transgender women in Lima, Peru. Sex Transm Infect 2017; 94:607-610. [PMID: 29191814 DOI: 10.1136/sextrans-2017-053292] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 10/10/2017] [Accepted: 11/11/2017] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES A detailed understanding of intentions and practices related to partner notification (PN) following STI diagnosis can improve control strategies. We assessed participant-level and partner-level factors guiding notification behaviour among men who have sex with men and/or with transgender women (MSM-TW) in Lima, Peru, including discordances between anticipated and actual notification. METHODS Men newly diagnosed with gonorrhoea, chlamydia and/or syphilis between 2012 and 2014 reported recent partners' characteristics, anticipated PN practices, and actual PN outcomes following diagnosis. Generalised estimating equation Poisson regression analyses assessed factors guiding PN outcomes. RESULTS Participants (n=150) predominantly identified as homosexual (70%) and moderno (versatile sexual role, 55%); 55% of partners (n=402) were casual. Among all sexual partners, 35% were notified of the STI diagnosis, though only 51% of predicted PN occurred and 26% of actual notifications were unanticipated. 47% of participants notified no partners, while 24% notified all partners. PN was more common with stable versus casual (adjusted prevalence ratio (aPR), 95% CI: 0.53, 0.39 to 0.73) or commercial (aPR, 95% CI: 0.38, 0.12 to 1.21) partners, and among participants who perceived PN as normative among their peers (aPR, 95% CI: 1.96, 1.37 to 2.82). A trend towards greater notification following condom-protected intercourse was observed (aPR, 95% CI: 1.33, 0.98 to 1.81). PN frequency did not differ by type of STI diagnosed.Anticipated notification predicted actual notification (aPR, 95% CI: 1.67, 1.19 to 2.33) only imperfectly: 81 (54%) participants' PN practices did not match their anticipated behaviour. Successful notification despite anticipated silence (40 participants, 63 partners) was associated with stable partnerships and a normative perception of PN. Non-notification despite intention (43 participants, 73 partners) frequently occurred among participants reporting exclusively oral sex with the partner or with partners identified as activo (insertive role). CONCLUSIONS Anticipated notification imperfectly reflects actual PN behaviour. Future interventions to improve PN among MSM-TW in Peru need to acknowledge partnership contexts.
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Affiliation(s)
- Hannan M Braun
- School of Medicine, University of California, San Francisco, San Francisco, California, USA.,Department of Medicine, Division of Infectious Diseases, South American Program in HIV Prevention Research, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Eddy R Segura
- Department of Medicine, Division of Infectious Diseases, South American Program in HIV Prevention Research, David Geffen School of Medicine, University of California, Los Angeles, California, USA.,Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | - Jordan E Lake
- Department of Medicine, Division of Infectious Diseases, South American Program in HIV Prevention Research, David Geffen School of Medicine, University of California, Los Angeles, California, USA.,Department of Internal Medicine, Division of Infectious Diseases, McGovernMedical School at UTHealth, Houston, Texas, USA
| | - Monica Gandhi
- Division of HIV, Infectious Diseases and Global Medicine, University of California, San Francisco, California, USA
| | - Jessica Rios
- Asociación Civil Impacta Salud y Educación, Lima, Peru
| | | | - Jorge Sanchez
- Asociación Civil Impacta Salud y Educación, Lima, Peru.,Department of Global Health, University of Washington, Seattle, Washington, USA.,Centro de Investigaciones Tecnológicas, Biomédicas y Medioambientales, Lima, Peru
| | - Javier R Lama
- Asociación Civil Impacta Salud y Educación, Lima, Peru.,Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Jesse L Clark
- Department of Medicine, Division of Infectious Diseases, South American Program in HIV Prevention Research, David Geffen School of Medicine, University of California, Los Angeles, California, USA
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Allan-Blitz LT, Konda KA, Calvo GM, Vargas SK, Leon SR, Segura ER, Caceres CF, Klausner JD. High incidence of extra-genital gonorrheal and chlamydial infections among high-risk men who have sex with men and transgender women in Peru. Int J STD AIDS 2017; 29:568-576. [PMID: 29183269 DOI: 10.1177/0956462417744098] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Extra-genital Neisseria gonorrhoeae and Chlamydia trachomatis infections are associated with antimicrobial resistance and HIV acquisition. We analyzed data from a cohort of men who have sex with men (MSM) and transgender women followed quarterly for two years in Peru. Incident cases were defined as positive N. gonorrhoeae or C. trachomatis nucleic acid tests during follow-up. Repeat positive tests were defined as reinfection among those with documented treatment. We used generalized estimating equations to calculate adjusted incidence rate ratios (aIRRs). Of 404 participants, 22% were transgender. Incidence rates of rectal N. gonorrhoeae and C. trachomatis infection were 28.1 and 37.3 cases per 100 person-years, respectively. Incidence rates of pharyngeal N. gonorrhoeae and C. trachomatis infection were 21.3 and 9.6 cases per 100 person-years, respectively. Incident HIV infection was associated with incident rectal (aIRR = 2.43; 95% CI 1.66-3.55) N. gonorrhoeae infection. Identifying as transgender versus cisgender MSM was associated with incident pharyngeal N. gonorrhoeae (aIRR = 1.85; 95% CI 1.12-3.07) infection. The incidence of extra-genital N. gonorrhoeae and C. trachomatis infections was high in our population. The association with incident HIV infection warrants evaluating the impact of rectal N. gonorrhoeae screening and treatment on HIV transmission.
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Affiliation(s)
- Lao-Tzu Allan-Blitz
- 1 Division of Infectious Diseases: Department of Medicine, 12222 David Geffen School of Medicine, University of California Los Angeles, USA
| | - Kelika A Konda
- 1 Division of Infectious Diseases: Department of Medicine, 12222 David Geffen School of Medicine, University of California Los Angeles, USA.,2 Center for Interdisciplinary Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Gino M Calvo
- 2 Center for Interdisciplinary Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia, Lima, Peru.,3 Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Silver K Vargas
- 2 Center for Interdisciplinary Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia, Lima, Peru.,3 Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Segundo R Leon
- 3 Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Eddy R Segura
- 1 Division of Infectious Diseases: Department of Medicine, 12222 David Geffen School of Medicine, University of California Los Angeles, USA
| | - Carlos F Caceres
- 2 Center for Interdisciplinary Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Jeffrey D Klausner
- 1 Division of Infectious Diseases: Department of Medicine, 12222 David Geffen School of Medicine, University of California Los Angeles, USA.,4 Department of Epidemiology, Fielding School of Public Health, 12222 University of California Los Angeles , USA
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Galea JT, León SR, Peinado J, Calvo G, Zamora J, Sánchez H, Brown BJ. HPV knowledge, burden and genital wart location among heterosexually identified versus homosexually identified men who have sex with men in Lima, Peru: cross-sectional results from a cohort study. BMJ Open 2017; 7:e017338. [PMID: 29070638 PMCID: PMC5665270 DOI: 10.1136/bmjopen-2017-017338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES The relationship between sexual practices, identity and role among Latino men who have sex with men (MSM) and HIV risk is the subject of ongoing investigation but less is known about how these aspects of sexuality relate to human papilloma-virus (HPV), an independent risk factor for HIV. This observational study investigated the relationship between HPV and sexual practices, identity and role as well as other sexually transmitted infection (STI)/HIV risk factors among HIV-negative heterosexually and homosexually identified Peruvian MSM. SETTING Community-based clinic for MSM in Lima, Peru. PARTICIPANTS 756 subjects were screened based on inclusion criteria of: born anatomically male; age ≥18 years; had any anal intercourse with a man during the previous 12 months; residing in metropolitan Lima; HIV negative; willing to commit to twice-yearly clinic visits for 24 months; had not participated in an HIV or HPV vaccine study. 600/756 participants met the inclusion criteria and were enrolled, of whom 48% (284) identified as homosexual and 10% (57) as heterosexual, the basis of the analyses performed. RESULTS Compared with homosexually identified MSM, heterosexually identified MSM had completed fewer years of formal education and were less likely to have: anogenital HPV or visible anal warts; given oral sex to a man; or used a condom with their most recent female sexual partner (all p<0.05). Conversely, heterosexually identified MSM were more likely to have: visible penile warts; used a condom during last anal intercourse; smoked cigarettes; had transactional sex; and used drugs during sex in the previous month (all p<0.01). There was no difference found between heterosexually and homosexually identified MSM by syphilis or high-risk HPV prevalence. CONCLUSIONS HPV burden, wart type (penile vs anal) and select HIV/STI risk behaviours differed between heterosexually and homosexually identified Peruvian MSM. Understanding the implications of these differences can lead to tailored HIV/STI prevention interventions for heterosexually identified MSM. TRIAL REGISTRATION NUMBER NCT01387412.
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Affiliation(s)
- Jerome T Galea
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Department of Research, Socios En Salud, Lima, Peru
- Department of Research, Epicentro Salud, Lima, Peru
| | | | | | - Gino Calvo
- Department of Research, Epicentro Salud, Lima, Peru
| | | | - Hugo Sánchez
- Department of Research, Epicentro Salud, Lima, Peru
| | - Brandon J Brown
- Department of Social Medicine and Population Health, Center for Healthy Communities, School of Medicine, University of California, Riverside, California, USA
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Partner-Level Factors Associated with Insertive and Receptive Condomless Anal Intercourse Among Transgender Women in Lima, Peru. AIDS Behav 2017; 21:2439-2451. [PMID: 27639404 DOI: 10.1007/s10461-016-1503-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Condomless anal intercourse among transgender women (TW) in Peru has been shown to vary by the type of partner involved (e.g. primary vs. casual vs. transactional sex partner), but no previous studies have explored variations in partner-level patterns of condom use according to type of anal intercourse. We evaluated the relationship between partnership characteristics and condom use during insertive (IAI) versus receptive anal intercourse (RAI) among TW with recent, non-female partners. Condomless IAI was more common with transactional and casual sex partners and by TW who self-reported HIV-uninfected serostatus (p < 0.05), alcohol use disorders, or substance use before sex. Condomless RAI was more common with primary partners and by TW who described their HIV serostatus as unknown (p < 0.05). Examining partner-level differences between condomless IAI and RAI reveals distinct patterns of HIV/STI risk among TW, suggesting a need for HIV prevention strategies tailored to the specific contexts of partners, practices, and networks.
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Gasch Gallén Á, Tomás Aznar C, Rubio Aranda E. Assessing gender stereotypes and sexual risk practices in men who have sex with men. GACETA SANITARIA 2017. [PMID: 28648255 DOI: 10.1016/j.gaceta.2017.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To analyze the construct validity and the internal consistency of the 12-item Bem Sex Role Inventory (BSRI-12) questionnaire and to study the association between gender stereotypes and sexual risk practices in men who have sex with men (MSM). METHODS Cross-sectional study of 601 MSM who voluntarily and anonymously responded to an online survey on risk practices and gender stereotypes. The BSRI-12 was used to obtain gender stereotypes (masculine, feminine, undifferentiated and androgynous). For data analysis, exploratory factor analysis (EFA) of the BSRI-12 and logistic regression were performed. RESULTS Two main factors (Cronbach alpha 0.95 and 0.81) were obtained from the EFA. Using the androgynous roles as the reference category, we found lower odds of engaging in unprotected anal intercourse (UAI) among those who endorse feminine roles (OR: 0.53; 95%CI: 0.29-0.95). Endorsing masculine roles with alcohol consumption (OR: 1.92; 95%CI: 1.15-3.20) or the undifferentiated when not knowing the partner's serological status (OR: 1.55; 95%CI: 1.02-2.35) were associated with higher odds of UAI compared to those endorsing the androgynous roles. Undifferentiated participants also perform receptive UAI using poppers (OR: 2.19; 95%CI: 1.24-3.87), and insertive UAI not knowing the serological status of the sexual partner (OR: 1.69; 95%CI: 1.04-2.76) compared to androgynous participants. CONCLUSION The BSRI is a valid and consistent instrument for identifying gender stereotypes in MSM. A greater proportion of participants within the undifferentiated and the masculine category engage in risk practices with the influence of substance consumption and unawareness of their sexual partner's serological status. The information obtained may be useful to define intervention and prevention programs.
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Affiliation(s)
- Ángel Gasch Gallén
- Pyschiatry and Nursing Department, Faculty of Health Sciences, University of Zaragoza, Zaragoza, Spain.
| | - Concepción Tomás Aznar
- Pyschiatry and Nursing Department, Faculty of Health Sciences, University of Zaragoza, Zaragoza, Spain
| | - Encarnación Rubio Aranda
- Microbiology, Preventive Medicine and Public Health Department, Faculty of Medicine, University of Zaragoza, Zaragoza, Spain
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Clark JL, Segura ER, Oldenburg CE, Rios J, Montano SM, Perez-Brumer A, Villaran M, Sanchez J, Coates TJ, Lama JR. Expedited Partner Therapy (EPT) increases the frequency of partner notification among MSM in Lima, Peru: a pilot randomized controlled trial. BMC Med 2017; 15:94. [PMID: 28468648 PMCID: PMC5415724 DOI: 10.1186/s12916-017-0858-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 04/20/2017] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Expedited Partner Therapy (EPT) has been shown to improve treatment outcomes among heterosexual partners of individuals with curable sexually transmitted infections (STIs). Although the use of EPT with men who have sex with men (MSM) has been debated, due to the potential for missed opportunities to diagnose unidentified cases of HIV and syphilis infection in symptomatic partners, increases in partner notification (PN) resulting from use of EPT may promote testing and treatment of otherwise unidentified partners. We assessed the impact of EPT on self-reported PN among MSM in Peru with gonorrheal (GC) and/or chlamydial (CT) infection. METHODS We enrolled 173 MSM in Lima, Peru with symptomatic or asymptomatic GC and/or CT infection between 2012 and 2014. We enrolled 44 MSM with symptomatic urethritis/proctitis and 129 MSM with asymptomatic GC/CT infection, diagnosed based on nucleic acid testing (Aptima Combo 2 Transcription-Mediated Amplification [TMA]) from urethral, pharyngeal, and rectal sites. Eligible participants were randomly assigned to receive either standard PN counseling (n = 84) or counseling plus EPT (cefixime 400 mg/azithromycin 1 g) for up to five recent partners (n = 89). Self-reported notification was assessed by computer-assisted self-administered survey among 155 participants who returned for 14-day follow-up. RESULTS The median age of participants was 26 (interquartile range [IQR]: 23-31) with a median of 3 sexual partners (IQR: 2-4) in the previous 30-day period. Among all participants, 111/155 (71.6%) notified at least one partner at 14-day follow-up with a median of 1 partner notified per participant (IQR: 0-2). For participants randomized to receive EPT, 69/83 (83.1%) reported notifying at least one partner, compared with 42/72 (58.3%) of participants in the control arm (odds ratio = 3.52; 95% confidence interval [CI]: 1.68-7.39). The proportion of all recent partners notified was significantly greater in the EPT than in the control arm (53.5%, 95% CI: 45.0-62.0% versus 36.4%, 95% CI: 27.0-47.4%). CONCLUSIONS Provision of EPT led to significant increases in notification among Peruvian MSM diagnosed with GC/CT infection. Additional research is needed to assess the impact of EPT on biological outcomes, including persistent or recurrent infection, antimicrobial resistance, and HIV/STI transmission, in MSM sexual networks. TRIAL REGISTRATION ClinicalTrials.gov, NCT01720654 . Registered on 10/29/2012.
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Affiliation(s)
- Jesse L Clark
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA. .,Department of Medicine, Division of Infectious Diseases, UCLA Geffen School of Medicine, 10833 Leconte Avenue, CHS 37-121, Los Angeles, CA, 90095, USA.
| | - Eddy R Segura
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA.,Escuela de Medicina, Universidad de Ciencias Aplicadas, Lima, Peru
| | | | - Jessica Rios
- Asociacion Civil Impacta Salud y Educacion, Lima, Peru
| | | | | | | | - Jorge Sanchez
- Universidad Nacional Mayor San Marcos, Centro de Investigaciones Tecnológicas, Biomédicas y Medioambientales, Lima, Peru
| | - Thomas J Coates
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Javier R Lama
- Asociacion Civil Impacta Salud y Educacion, Lima, Peru
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Sexual Orientation, Gender Identity and Perceived Source of Infection Among Men Who Have Sex with Men (MSM) and Transgender Women (TW) Recently Diagnosed with HIV and/or STI in Lima, Peru. AIDS Behav 2016; 20:2178-2185. [PMID: 26767533 DOI: 10.1007/s10461-015-1276-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Risk perception and health behaviors result from individual-level factors influenced by specific partnership contexts. We explored individual- and partner-level factors associated with partner-specific perceptions of HIV/STI risk among 372 HIV/STI-positive MSM and transgender women (TW) in Lima, Peru. Generalized estimating equations explored participants' perception of their three most recent partner(s) as a likely source of their HIV/STI diagnosis. Homosexual/gay (PR = 2.07; 95 % CI 1.19-3.61) or transgender (PR = 2.84; 95 % CI 1.48-5.44) partners were more likely to be considered a source of infection than heterosexual partners. Compared to heterosexual respondents, gay and TW respondents were less likely to associate their partner with HIV/STI infection, suggesting a cultural link between gay or TW identity and perceived HIV/STI risk. Our findings demonstrate a need for health promotion messages tailored to high-risk MSM partnerships addressing how perceived HIV/STI risk aligns or conflicts with actual transmission risks in sexual partnerships and networks.
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Tucker C, Arandi CG, Bolaños JH, Paz-Bailey G, Barrington C. Understanding social and sexual networks of sexual minority men and transgender women in Guatemala city to improve HIV prevention efforts. J Health Care Poor Underserved 2016; 25:1698-717. [PMID: 25418236 DOI: 10.1353/hpu.2014.0163] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Sexual minority men and transgender women are disproportionately affected by HIV in Guatemala. Innovative prevention strategies are urgently needed to address these disparities. While social network approaches are frequently used to reach sexual minorities, little is known about the unique network characteristics among sub-groups. We conducted in-depth qualitative interviews with 13 gay-identifying men, eight non-gay-identifying men who have sex with men (MSM) and eight transgender women in Guatemala City. Using narrative and thematic coding procedures, we identified distinct patterns in the size, composition, and overlap between social and sexual networks across groups. Gay-identifying men had the largest, most supportive social networks, predominantly comprising family. For both non-gay-identifying MSM and transgender women, friends and sex clients provided more support. Transgender women reported the smallest social networks, least social support, and the most discrimination. HIV prevention efforts should be tailored to the specific sexual minority population and engage with strong ties.
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George PE, Bayer AM, Garcia PJ, Perez-Lu JE, Burke JG, Coates TJ, Gorbach PM. Is Intimate Partner and Client Violence Associated with Condomless Anal Intercourse and HIV Among Male Sex Workers in Lima, Peru? AIDS Behav 2016; 20:2078-89. [PMID: 26880321 PMCID: PMC4985504 DOI: 10.1007/s10461-016-1327-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Violence experience can increase HIV risk behaviors; however, literature is scarce on violence among male sex workers (MSWs) globally. In 2014, 210 Peruvian MSWs (median age 24.9) were interviewed about their experience of physical, emotional, and sexual violence and condom use with non-paying intimate partners and clients and were tested for HIV. Multivariable models examined relationships between violence in the past 6 months, condomless anal intercourse (CLAI) in the past 3 months and HIV infection. HIV infection (24 %), CLAI (43 %), being a violence victim (42 %) and perpetrator (39 %) were common. In separate multivariable models, being a violence victim [adjusted prevalence ratio aPR = 1.49 (95 % CI 1.09-2.03)] and perpetrator [aPR = 1.39 (1.03-1.87)] were associated with CLAI. Further, being a victim [aPR = 1.65 (1.04-2.62)] was associated with HIV infection. Violence, which was significantly associated with CLAI and HIV infection, is common among Peruvian MSWs, reinforcing the importance of violence awareness and prevention as HIV risk-reduction strategies.
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Affiliation(s)
- Paul E George
- Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, 10833 LeConte Ave., CHS 12-105, Los Angeles, CA, 90095, USA.
- Washington University in St. Louis School of Medicine, St. Louis, MO, USA.
| | - Angela M Bayer
- Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, 10833 LeConte Ave., CHS 12-105, Los Angeles, CA, 90095, USA
- Epidemiology, STD, and HIV Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Patricia J Garcia
- Epidemiology, STD, and HIV Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Jose E Perez-Lu
- Epidemiology, STD, and HIV Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Jessica G Burke
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Thomas J Coates
- Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, 10833 LeConte Ave., CHS 12-105, Los Angeles, CA, 90095, USA
| | - Pamina M Gorbach
- Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, 10833 LeConte Ave., CHS 12-105, Los Angeles, CA, 90095, USA
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
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Prevalence and associated risk characteristics of HIV infection based on anal sexual role among men who have sex with men: a multi-city cross-sectional study in Western China. Int J Infect Dis 2016; 49:111-8. [PMID: 27312581 DOI: 10.1016/j.ijid.2016.06.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Revised: 02/18/2016] [Accepted: 06/07/2016] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The HIV prevalence among men who have sex with men (MSM) in Western China is substantial and increasing at an alarming rate. The current HIV infection prevalence among MSM in Western China and its associated risk characteristics were explored by looking at different anal sexual roles separately. METHODS A total 1245 MSM recruited by convenience sampling from multiple sources and areas in the Chongqing and Sichuan region were interviewed using an anonymous self-administered questionnaire with the assistance of investigators and then underwent HIV testing. Multivariate logistic regression was used to identify factors independently associated with HIV infection. RESULTS Of the 1235 respondents who reported their sexual roles during anal sex with men, the overall HIV antibody positive rate was 21.21% (262/1235). With regard to the different anal sex roles, HIV-positive rates were significantly higher among men who played the '0.5' role (versatile, equal) and '0' role (only bottom or versatile, but mostly bottom) during anal sex with men than among those who played the '1' role (only top or versatile, but mostly top) (26.41% for '0.5' role, 26.20% for '0' role, and 15.19% for '1' role; Chi-square=22.66, p<0.0001). Statistically significant differences were not found between the '0.5' role and '0' role groups (p > 0.05). The '1' role MSM who had an education level lower than senior high school, a rural household registration, and low self-perceived severity status of AIDS, the '0.5' role MSM who had an education level lower than senior high school and had not undergone HIV testing in the recent 1 year, and the '0' role MSM who were retired or unemployed and had been diagnosed with a sexually transmitted disease by a doctor in the recent 6 months were more likely to be HIV-infected. CONCLUSIONS In this study, the HIV prevalence among MSM was alarmingly high. Moreover, the '0.5' and '0' role MSM were found to have a higher risk of infection compared to the '1' role MSM, while respective risk characteristics were not completely the same across the three groups. Along with routine preventive intervention services, more focused and specific interventions are needed to target anal sex role classes separately.
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Chow JY, Konda KA, Borquez A, Caballero P, Silva-Santisteban A, Klausner JD, Cáceres CF. Peru's HIV care continuum among men who have sex with men and transgender women: opportunities to optimize treatment and prevention. Int J STD AIDS 2016; 27:1039-1048. [PMID: 27099168 DOI: 10.1177/0956462416645727] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 03/29/2016] [Indexed: 01/23/2023]
Abstract
The HIV epidemic in Peru is concentrated in men who have sex with men (MSM) and transgender women (TW), who have an estimated prevalence > 10%, while the overall population prevalence remains < 1%. Because MSM and TW account for >60% of new infections, it is crucial to understand the full HIV continuum of care for these key populations. We performed a review of the peer-reviewed scientific and grey literature to determine the proportion of HIV-infected MSM and TW in Peru who are diagnosed, linked to and retained in care, are taking antiretroviral therapy (ART), and who have attained virologic suppression. Of the estimated 613,080 MSM and TW in Peru in 2015, approximately 63,981 are HIV-infected. Only 24.0% of HIV-infected MSM and TW are aware of their diagnosis, 15.6% are retained in care, 13.6% are on ART, and 12.0% have achieved adequate virologic control. The largest drop-off in the HIV care continuum occurs at the first step: diagnosis of HIV. Improving HIV serostatus awareness among MSM and TW is crucial to controlling Peru's HIV epidemic. In the era of 'treatment as prevention', understanding the full HIV care continuum may help guide efforts to curb transmission and reduce HIV-related morbidity and mortality.
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Affiliation(s)
- Jeremy Y Chow
- Division of Infectious Diseases, University of California, Los Angeles, CA, USA
| | - Kelika A Konda
- Division of Infectious Diseases, University of California, Los Angeles, CA, USA Center for Interdisciplinary Studies in Sexuality, AIDS and Society, and Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Annick Borquez
- Department of Infectious Disease Epidemiology, Imperial College London, UK Division of Global Public Health, University of California, San Diego, CA, USA
| | | | - Alfonso Silva-Santisteban
- Center for Interdisciplinary Studies in Sexuality, AIDS and Society, and Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Jeffrey D Klausner
- Division of Infectious Diseases, University of California, Los Angeles, CA, USA
| | - Carlos F Cáceres
- Center for Interdisciplinary Studies in Sexuality, AIDS and Society, and Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru
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Perez-Brumer AG, Oldenburg CE, Segura ER, Sanchez J, Lama JR, Clark JL. Anonymous partnerships among MSM and transgender women (TW) recently diagnosed with HIV and other STIs in Lima, Peru: an individual-level and dyad-level analysis. Sex Transm Infect 2016; 92:554-557. [PMID: 26912910 DOI: 10.1136/sextrans-2015-052310] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 12/16/2015] [Accepted: 01/23/2016] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Partner notification (PN) following sexually transmitted disease (STI) diagnosis is a key strategy for controlling HIV/STI transmission. Anonymous partnerships are an important barrier to PN and often associated with high-risk sexual behaviour. Limited research has examined the profile of men who have sex with men (MSM) and transgender women (TW) who engage in anonymous sex. To better understand anonymous partnership practices in Lima, Peru, we assessed participant-level and partnership-level characteristics associated with anonymous sex among a sample of MSM and TW recently diagnosed with HIV/STI. METHODS MSM and TW diagnosed with HIV/STI within the past month completed a cross-sectional survey regarding anticipated PN practices. Participants reported sexual partnership types and characteristics of up to three of their most recent partners. Using a Poisson generalised estimating equation model, we assessed participant-level and partnership-level characteristics associated with anonymous partnerships. RESULTS Among 395 MSM and TW with HIV/STI, 36.0% reported at least one anonymous sexual partner in the past 3 months (mean of 8.6 anonymous partners per participant; SD 17.0). Of the 971 partnerships reported, 118 (12.2%) were anonymous and the majority (84.8%) were with male partners, followed by 11.0% with female partners and 4.2% with transgender/travesti partners. Partner-level characteristics associated with increased likelihood of having an anonymous partner included female (adjusted prevalence ratio (aPR) 2.28, 95% CI 1.05 to 4.95, p=0.04) or transgender/travesti (aPR 4.03, 95% CI 1.51 to 10.78, p=0.006) partner gender. CONCLUSIONS By assessing both individual-level and dyadic-level factors, these results represent an important step in understanding the complexity of partnership interactions and developing alternative PN strategies for Latin America.
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Affiliation(s)
- Amaya G Perez-Brumer
- Department of Sociomedical Sciences, Columbia Mailman School of Public Health, New York, USA.,Department of Medicine and Program in Global Health, David Geffen School of Medicine at UCLA, Los Angeles, USA
| | | | - Eddy R Segura
- Department of Medicine and Program in Global Health, David Geffen School of Medicine at UCLA, Los Angeles, USA
| | - Jorge Sanchez
- Asociación Civil Impacta Salud y Educación, Lima, Peru.,Department of Global Health, University of Washington, Seattle, USA
| | - Javier R Lama
- Asociación Civil Impacta Salud y Educación, Lima, Peru.,Department of Global Health, University of Washington, Seattle, USA
| | - Jesse L Clark
- Department of Medicine and Program in Global Health, David Geffen School of Medicine at UCLA, Los Angeles, USA
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Zeglin RJ. Assessing the role of masculinity in the transmission of HIV: a systematic review to inform HIV risk reduction counseling interventions for men who have sex with men. ARCHIVES OF SEXUAL BEHAVIOR 2015; 44:1979-1990. [PMID: 25917411 PMCID: PMC5502076 DOI: 10.1007/s10508-015-0501-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 01/24/2015] [Accepted: 01/28/2015] [Indexed: 05/31/2023]
Abstract
HIV affects over 1.2 million people in the United States; a substantial number are men who have sex with men (MSM). Despite an abundance of literature evaluating numerous social/structural and individual risk factors associated with HIV for this population, relatively little is known regarding the individual-level role of masculinity in community-level HIV transmission risk. To address this gap, the current analysis systematically reviewed the masculinity and HIV literature for MSM. The findings of 31 sources were included. Seven themes were identified: (1) number of partners, (2) attitudes toward condoms, (3) drug use, (4) sexual positioning, (5) condom decision-making, (6) attitudes toward testing, and (7) treatment compliance. These factors, representing the enactment of masculine norms, potentiate the spread of HIV. The current article aligns these factors into a masculinity model of community HIV transmission. Opportunities for counseling interventions include identifying how masculinity informs a client's cognitions, emotions, and behaviors as well as adapting gender-transformative interventions to help create new conceptualizations of masculinity for MSM clients. This approach could reduce community-level HIV incidence.
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Affiliation(s)
- Robert J Zeglin
- Department of Counseling and Human Development, George Washington University, 2134 G St. NW, 3rd Floor, Washington, DC, 20037, USA,
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Fleming PJ, Agnew-Brune C. Current Trends in the study of Gender Norms and Health Behaviors. Curr Opin Psychol 2015; 5:72-77. [PMID: 26075291 DOI: 10.1016/j.copsyc.2015.05.001] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Gender norms are recognized as one of the major social determinants of health and gender norms can have implications for an individual's health behaviors. This paper reviews the recent advances in research on the role of gender norms on health behaviors most associated with morbidity and mortality. We find that (1) the study of gender norms and health behaviors is varied across different types of health behaviors, (2) research on masculinity and masculine norms appears to have taken on an increasing proportion of studies on the relationship between gender norms and health, and (3) we are seeing new and varied populations integrated into the study of gender norms and health behaviors.
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Affiliation(s)
- Paul J Fleming
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, 302 Rosenau Hall, Chapel Hill, NC 27599-7440, (tel) 630-777-0160, (fax) 919-966-2921
| | - Christine Agnew-Brune
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, 302 Rosenau Hall, Chapel Hill, NC 27599-7440
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McLean SA, Galea JT, Prudden HJ, Calvo G, Sánchez H, Brown B. Association between sexual role and HIV status among Peruvian men who have sex with men seeking an HIV test: a cross-sectional analysis. Int J STD AIDS 2015; 27:783-9. [PMID: 26187903 DOI: 10.1177/0956462415596300] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 06/18/2015] [Indexed: 11/15/2022]
Abstract
In Latin America, sexual role, sexual identity and sexual practices are intricately related; the roles activo, pasivo and moderno often encompass sexual identity and sexual practices. We aimed to understand the association between sexual role and HIV status in Peruvian men who have sex with men. HIV-testing services at Epicentro Salud, a Peruvian gay men's health centre, were paired with clinic data on demographics and sexual behaviour. Bidirectional stepwise logistic regression was conducted to determine associations between sexual role and HIV status. Of 366 clients who underwent HIV testing, 86 (23.5%) tested positive. There was a strong association between sexual role ('activo' or typically insertive, 'pasivo' or typically receptive, 'moderno' or typically versatile) and a positive HIV test (p = 0.002). Compared to clients with an activo role, those who reported a pasivo (OR = 6.14) and moderno (OR = 6.26) role were more likely to test positive for HIV. Sexual role was associated with sexual identity (gay, straight and bisexual) and gender of partners in the past six months. Self-reported pasivo and moderno sexual roles were strongly associated with a positive HIV test result. Further research should examine differences in sexual practices between sexual role groups.
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Affiliation(s)
- Sarah A McLean
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Holly J Prudden
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Brandon Brown
- University of California Riverside, Riverside, CA, USA
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Brito MO, Hodge D, Donastorg Y, Khosla S, Lerebours L, Pope Z. Risk behaviours and prevalence of sexually transmitted infections and HIV in a group of Dominican gay men, other men who have sex with men and transgender women. BMJ Open 2015; 5:e007747. [PMID: 25926151 PMCID: PMC4420963 DOI: 10.1136/bmjopen-2015-007747] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES The objectives of this study were to estimate the point prevalence of sexually transmitted infection (STI) and to investigate the sexual practices and behaviours associated with STIs in a group of gay men, other men who have sex with men and transgender women (GMT) in the province of La Romana, Dominican Republic. DESIGN A cross-sectional study of a convenience sample of GMT persons. SETTING The study was conducted in the province of La Romana, Dominican Republic, in June-July 2013. PARTICIPANTS Out of 117 GMT persons screened, a total of 100 completed the study. Participants had to be at least 18 years of age, reside in La Romana and have had sex with another man in the preceding 12 months. All participants were interviewed and tested for STI. PRIMARY OUTCOME MEASURE The main outcome of interest was the detection of any STI (HIV, herpes simplex virus type 2 (HSV-2), syphilis, hepatitis B or C) by serology. RESULTS Among 100 participants, the median age was 22 years (range 18-65). One-third had consumed illicit drugs the preceding year and only 43% consistently used condoms. Prevalence was 38% for HSV-2, 5% for HIV and 13% for syphilis. There were no cases of hepatitis B or C. Factors associated with the odds of a STI were age >22 years (OR=11.1, 95% CI 3.6 to 34.5), receptive anal intercourse (OR=4.2, 95% CI 1.3 to 13.6) and having ≥2 male sexual partners during the preceding month (OR=4, 95% CI 1.3 to 12.5). CONCLUSIONS In this group of GMT persons, seroprevalence of STI was high, and a number of risk behaviours were associated with STI. These preliminary data will help inform policy and programmes to prevent HIV/STI in GMT persons in the region.
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Affiliation(s)
- Maximo O Brito
- Division of Infectious Diseases, University of Illinois, Chicago, Illinois, USA
| | - David Hodge
- Division of Infectious Diseases, University of Illinois, Chicago, Illinois, USA
| | - Yeycy Donastorg
- HIV Vaccine Trial Unit, Instituto Dermatólogico y Cirugía de Piel, Santo Domingo, Dominican Republic
| | - Shaveta Khosla
- School of Public Health, University of Illinois, Chicago, Illinois, USA
| | | | - Zachary Pope
- School of Public Health, University of Illinois, Chicago, Illinois, USA
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Julio RS, Friedman RK, Cunha CB, De Boni RB, Cardoso SW, Torres T, Alves CA, Castro C, Fernandes NM, Veloso VG, Grinsztejn B. Unprotected sexual practices among men who have sex with women and men who have sex with men living with HIV/AIDS in Rio de Janeiro. ARCHIVES OF SEXUAL BEHAVIOR 2015; 44:357-365. [PMID: 25318623 DOI: 10.1007/s10508-014-0357-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Revised: 03/19/2014] [Accepted: 05/26/2014] [Indexed: 06/04/2023]
Abstract
Combined antiretroviral therapy is now acknowledged for preventing new HIV infections, besides decreasing mortality and morbidity. However, in many Latin America countries the epidemic is still driven by unprotected sexual intercourse. This study aims to describe sexual practices related to HIV/STD and to evaluate factors associated to unprotected sex among men who have sex with women (MSW) and men who have sex with men (MSM) under care at a reference center for HIV in Rio de Janeiro, Brazil. A cross-sectional study, nested in a Brazilian clinical cohort, evaluated the sexual practices of 404 sexually active HIV-positive MSW and men who have MSM. Approximately 30 % of them reported unprotected sexual practices during the 6 months prior to the interview. Most frequent risky practices reported were unprotected vaginal sex among MSW and unprotected receptive anal sex among MSM. Factors increasing the chance of unprotected sexual practices among MSW were the partner's desire of becoming pregnant (OR 2.81; CI 95 %: 1.36-5.95). To have received comments about excessive consumption of alcohol (OR 2.43; CI 95 %: 1.01-5.83), illicit drug use (OR 4.41; CI 95 %: 1.75-11.60) and lived in marital situation (OR 2.10; CI 95 %: 1.09-4.08) were significantly associated with unsafe sexual practices among MSM. The results highlight that health care of men living with HIV, as well as the prevention strategies, must consider the particularities of sexual behavior practiced by people who differ in sexual orientation.
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Affiliation(s)
- Renata Siqueira Julio
- Superintendência Regional de Saúde de Varginha/Centro Universitário do Sul de Minas, Varginha, Minas Gerais, Brazil
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