HIV and Sexually Transmitted Infection Incidence and Associated Risk Factors Among High-Risk MSM and Male-to-Female Transgender Women in Lima, Peru

Abstract

Background Men who have sex with men (MSM) and male-to-female transgender women (TW) are at increased risk of HIV and sexually transmitted infections (STIs). We evaluated factors associated with incidence of HIV, HSV-2, and chlamydia and gonorrhea (anal and pharyngeal). Methods We used data from the Comunidades Positivas trial with MSM/TW who have sex with men in Lima, Peru. Participants were asked about sexual risk behaviors and underwent HIV/STI testing at baseline and 9- and 18-month follow-ups. We used discrete time proportional hazards regression to calculate hazard ratios (HRs) for variables associated with incidence of each STI. Results Among 718 MSM/TW, HIV incidence was 3.6 cases per 100 person-years. HIV incidence was associated with having an incident STI (aHR 3.73). Unprotected receptive anal intercourse was associated with incident anal chlamydia (aHR 2.20). An increased number of sexual partners increased incident HSV-2 (aHR 3.15 for 6–14 partners and 3.97 for 15–46 partners compared to 0–2 partners). Risk of anal gonorrhea decreased with each sexually active year (aHR 0.94) and increased for unprotected compensated sex (aHR 2.36). Risk of pharyngeal gonorrhea also decreased with each year since sexual debut (aHR 0.95). Risk of anal chlamydia decreased with each sexually active year (aHR 0.96), risk increased with reports of unprotected sex work (aHR 1.61), and unprotected receptive anal sex (aHR 2.63). All aHRs have p-values < 0.05. Conclusion MSM/TW experience high incidence of HIV. Up-to-date prevalence and incidence information and identifying factors associated with infection can help develop a more effective combination prevention response.

HIV incidence among gay men and other men who have sex with men in 2020: where is the epidemic heading?

“…43 Another study conducted in Bangkok observed an overall HIV incidence of 5.9 per 100 person-years from 2006 to 2012, 44 whereas in northern Thailand, HIV incidence among a cohort 45 In a cohort of 510 MSM in Lima, Peru, the HIV incidence was 4 cases per 100 person-years, further indicating high risk as compared with other adults. 36 Furthermore, a 2012 review of 55 studies among MSM in China found a dramatic 3.3-fold increase in HIV incidence among MSM from 2.04 to 7.02 per 1000 person-years during 2002-2010. 46 Taken together, these data suggest that HIV incidence is more similar than different across varying income levels of countries.…”

Knowledge and preferences concerning acute HIV testing programs among both Peruvian men who have sex with men and transgender women

“…26,29 Understanding the factors impeding HIV testing is crucial because nearly 70% of participants with HIV in Lima were unaware of their positive serostatus. 39 This is often attributed to high testing-related stigma. 23 Education about AHI and the provision of AHI testing could ultimately reduce fear and stigma about HIV/AIDS, if early infection was marketed as an opportune time to initiate treatment, especially considering the high infectious potential.…”

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

“…That proportion, lower than figures from surveillance studies (62.5–90%), is similar to figures reported in other studies in STI clinics (28.8–30.0%). [6,16–19] However, it is important to recognize that due to the inclusion criteria of our cohort study favoring MSM and transgender women at higher risk of HIV and syphilis, the estimation of undiagnosed HIV-infection may not be representative.…”

“…[6,16,17] In contrast, studies occurring at STI clinics, where HIV testing is often sought after or recommended, have found rates of HIV-serostatus unawareness <30%. [18,19] …”