A cross-sectional study of low HIV testing frequency and high-risk behaviour among men who have sex with men and transgender women in Lima, Peru

Abstract

BackgroundIncreased HIV testing frequency among high-risk populations such as men who have sex with men (MSM) and male-to-female transgender women (TW) can lead to earlier treatment and potentially reduce HIV transmission.MethodsWe analyzed baseline survey data from 718 high-risk, young (median age 29 [interquartile range 23–35]) MSM/TW enrolled in a community-based HIV prevention trial between 2008–2009. Participants were recruited from 24 neighborhoods in and around Lima, Peru. We assessed HIV testing frequency, testing behaviour, and motivations and barriers to testing. Multivariate analysis identified correlates to prior HIV testing.ResultsOverall, 79.6% reported HIV testing within their lifetimes, however, only 6.2% reported an average of two tests per year, as per Peruvian Ministry of Health guidelines. The most commonly reported motivators for testing were to check one’s health (23.3%), lack of condom use (19.7%), and availability of free testing (14.0%), while low self-perceived risk for HIV (46.9%), fear of a positive result (42.0%), and lack of access to testing services (35.7%) were the most frequently reported barriers. In multivariate analysis, factors independently associated with HIV testing included age [adjusted prevalence ratio (APR) 1.00, 95% CI (1.00-1.01)], transgender-identification vs. gay-identification [APR 1.11, 95% CI (1.03-1.20)], history of transactional sex [APR 1.16, 95% CI (1.07-1.27)], and prior sexually transmitted infection diagnosis [APR 1.15, 95% CI (1.07-1.24)].ConclusionsAn overwhelming majority of participants did not meet the standard-of-care for testing frequency. The reported motivations and barriers to testing highlight issues of risk perception and accessibility. Our findings suggest utilizing non-traditional outreach methods and promoting HIV testing as a routine part of healthcare in Peru to encourage testing and knowledge of HIV serostatus.

Impact of alcohol use on sexual behavior among men who have sex with men and transgender women in Lima, Peru

“…First, the proportion of recent condomless anal intercourse reported in this sample is not necessarily reflective of that among the larger population of MSM and TW in Peru since more than 5 episodes of condomless anal intercourse in the last 6 months was one of the seven possible eligibility criteria items and 74% of the participants reported this criterion at enrollment. However levels of condomless anal intercourse as high as 60-79% have commonly been reported in samples of Peruvian MSM and TW (Maguiña et al, 2013; Deiss et al, 2013b; Lee et al, 2015). Although this study’s eligibility criteria limits generalizability of the results, these criteria were chosen to conscientiously target a population where public health interventions should be focused.…”

Perceived Barriers and Facilitators to Integrating HIV Prevention and Treatment with Cross-Sex Hormone Therapy for Transgender Women in Lima, Peru

“…Other biobehavioral risk factors for HIV infection among TW in Peru have been documented, including high prevalence of bacterial sexually transmitted infections (STIs) and HSV-2 co-infection [12–14], condomless receptive anal intercourse with HIV unknown serostatus partners [15, 16], and low rates of HIV testing and serostatus awareness [3, 17–19]. Gendered power dynamics, including the need for feminine gender affirmation or validation, coercive behaviors of male partners, and cultural linkages of TW with the “feminine” receptive role during intercourse often limit TW’s control over condom use during sexual encounters [20–22].…”

Factors associated with previously undiagnosed human immunodeficiency virus infection in a population of men who have sex with men and male-to-female transgender women in Lima, Peru

“…[1] The Peruvian National Ministry of Health (MoH) program's guideline on periodic medical check-ups recommends quarterly visits for MSM and transgender women, with opt-in HIV testing and counseling, but few MSM and transgender women test more than once yearly. [1,13,14] A recent study showed only 6.2% of MSM and transgender women tested semi-annually in Lima. [13] Low testing frequency results in a higher proportion of HIV infected individuals who are unaware of their HIV-infection status.…”

“…[1,13,14] A recent study showed only 6.2% of MSM and transgender women tested semi-annually in Lima. [13] Low testing frequency results in a higher proportion of HIV infected individuals who are unaware of their HIV-infection status. Previous research has demonstrated that low testing frequency is correlated with low perceived HIV risk, limited access to testing services, fear of test results, unawareness of the availability of effective treatment, and perceived stigma associated with HIV and HIV testing.…”

“…Previous research has demonstrated that low testing frequency is correlated with low perceived HIV risk, limited access to testing services, fear of test results, unawareness of the availability of effective treatment, and perceived stigma associated with HIV and HIV testing. [1,13,15] …”