A cross-sectional study of knowledge of sex partner serostatus among high-risk Peruvian men who have sex with men and transgender women: implications for HIV prevention

Abstract

BackgroundKnowledge of a sex partner’s HIV serostatus can influence sexual behavior and inform harm-reduction strategies. We sought to determine how often Peruvian men who have sex with men (MSM) and transgender women (TW) knew the HIV serostatus of their sex partners, if this knowledge was associated with any predictive factors or unprotected anal intercourse (UAI), and if UAI was associated with partner serostatus.MethodsWe analyzed data from the 2008 Peruvian MSM Sentinel Surveillance Survey. Data were collected by CASI about each participant’s three most recent male sex partners. Primary outcome was knowledge of a partner's HIV test result. Multivariate analysis assessed the effect of age, education, sexual identity, number of male partners, alcohol use during intercourse, type of partnership and length of partnership using logistic regression.Results735 participants provided data on 1,643 of their most recent sex partners from the last 3 months. 179/735 (24.4%) of all participants knew HIV test results for at least one of their 3 most recent partners, corresponding to 230/1643 (14.0%) of all sexual partnerships in the last 3 months. In multivariate analysis, casual (OR: 0.27, 95% CI: 0.17-0.42) and exchange sex (OR: 0.31, 95% CI: 0.11-0.88) partners, compared to stable partners, were negatively associated with knowledge of partner serostatus, whereas relationships lasting longer than one night (<3 months OR: 2.20, 95% CI: 1.39-3.51; 3 months to 1 year OR: 3.00, 95% CI: 1.80-5.01; ≥ 1 year OR: 4.13, 95% CI: 2.40-7.10) were positively associated with knowledge of partner serostatus. Knowledge of partner serostatus was not associated with unprotected anal intercourse with that partner.ConclusionsFew MSM and TW in Peru know their partners’ HIV serostatus. Our findings suggest that the type and length of partnership influence the likelihood of knowing a partner’s serostatus. Further research should explore the contexts and practices of partner communication, their effect on sexual behavior, and interventions to promote discussion of HIV testing and serostatus as an HIV prevention strategy in this population.

HIV epidemics among transgender women

“…More than 50% of the kathoey sex workers interviewed by Nemoto and colleagues in Bangkok had never been tested [18]. Also, data suggest that few transgender women know the HIV status of their sexual partners [29]. Lack of inclusion in HIV awareness and prevention campaigns as well as competing priorities in the lives of transgender women may contribute to low rates of HIV testing [30, 31].…”

Prevalence and Correlates of Knowledge of Male Partner HIV Testing and Serostatus Among African-American Women Living in High Poverty, High HIV Prevalence Communities (HPTN 064)

“…The negative association of two or more sexual partners and partner's concurrency with serostatus knowledge has been shown in other populations [1, 3, 7], and suggests that women with the riskiest behaviors are least likely to know of their infection risk. This may reflect fewer opportunities or expectations to discuss personal matters such as serostatus with increasing numbers of partners, particularly among those who are less well known [11, 23]. Prior research has suggested as well that intimacy, trust, and shared responsibility are often present among main and longer-term partners, and can reduce serostatus communication barriers due to fear or embarrassment [11, 24].…”

“…This may reflect fewer opportunities or expectations to discuss personal matters such as serostatus with increasing numbers of partners, particularly among those who are less well known [11, 23]. Prior research has suggested as well that intimacy, trust, and shared responsibility are often present among main and longer-term partners, and can reduce serostatus communication barriers due to fear or embarrassment [11, 24]. This may explain why women who were living with their most recent male sex partner were more likely to be aware of his HIV status, given the potential greater intimacy and stability of cohabitation.…”

“…Awareness of a partner's HIV status through disclosure and notification can lead to reductions in risky sexual behaviors, such as inconsistent or no condom use [3-10], multiple sex partners [3, 7, 9, 11], casual sex exchange [11], and substance abuse prior to or during sexual intercourse [7, 9, 11]. Knowledge of a sex partner's HIV status can also influence individuals' perception of sexual risk, facilitate joint sexual decision-making among couples, and motivate untested partners to use HIV testing and counseling services [1, 11, 12]. …”

“…There are also concerns that HIV-positive men who have sex with both men and women less often notify female sex partners of their seropositivity [17]. Other characteristics shown to be associated with not knowing a partner's serostatus include younger age, low education, being childless, short-term and extramarital relationships, having two or more sexual partners, lack of history of HIV testing, and inconsistent condom use [1, 3, 11]. However, most studies investigating characteristics associated with knowledge of partner serostatus have been conducted outside of the U.S. or focused on men who have sex with men (MSM), men who have sex with men and women (MSMW), transgender women, or HIV-seropositive individuals.…”