“Manejar la Situacion”: Partner Notification, Partner Management, and Conceptual Frameworks for HIV/STI Control Among MSM in Peru

Abstract

Previous analyses of Partner Notification (PN) have addressed individual, interpersonal, social, and structural issues influencing PN outcomes but have paid less attention to the conceptual framework of PN itself. We conducted 18 individual interviews and 8 group discussions, in a two-stage qualitative research process, to explore the meanings and contexts of PN for sexually transmitted infections (STI) among men who have sex with men (MSM) and men who have sex with men and women (MSMW) in Lima, Peru. Participants described PN as the open disclosure of private, potentially stigmatizing information that could strengthen or disrupt a partnership, structured by the tension between concealment and revelation. In addition to informing partners of an STI diagnosis, the act of PN was believed to reveal other potentially stigmatizing information related to sexual identity and practices such as homosexuality, promiscuity, and HIV co-infection. In this context, the potential development of visible, biological STI symptoms represented a risk for disruption of the boundary between secrecy and disclosure that could result in involuntary disclosure of STI status. To address the conflict between concealment and disclosure, participants cited efforts to “manejar la situacion” [manage the situation] by controlling the biological risks of STI exposure without openly disclosing STI status. We use this concept of “managing the situation” as a practical and theoretical framework for comprehensive Partner Management for HIV/STI control systems among MSM in Latin America.

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 (Preprint)

“…These results are consistent with findings from our formative research, and reflect an absolute increase of 30% in the proportion of stable male partners notified and 15% among casual male partners (31). Synthesizing this data with our formative research findings, the positive effect of web-based-based systems on notification outcomes may be due to multiple factors, including the availability of an anonymous mechanism to notify partners of a potentially stigmatizing diagnosis, the ability to contact partners for whom only an e-mail address is known, and the opportunity to replicate existing methods of communication among young people already accustomed to communicating through online networks (30,43).…”

“…Our formative research with recently STI-diagnosed MSM from Lima, Peru found a high level of potential acceptability for web-based notification systems (30). In our study, availability of a website that could deliver anonymous notification messages was expected to significantly increase notification among men who would not expect to inform their partners under existing conditions (31).…”

“…The lack of an observed effect on downstream outcomes indicates the need for additional interventions to support partner management outcomes throughout the partner management cascade, beginning with notification, and culminating with linkage to and retention in HIV/STI care (45). While preliminary research on potential responses to hypothetical anonymous notification messages among MSM in Peru indicated that recipients would be motivated to seek medical attention after receiving an anonymous message, data from the U.S. has suggested the opposite, and our study did not collect any partner-confirmed information on post-notification behavior (30,46).…”

The power of partners: positively engaging networks of people with HIV in testing, treatment and prevention

“…transactional partnerships or drug‐sharing contacts) and community norms across populations may further influence the acceptability and delivery of PNS. Formative evidence indicates that PNS may be acceptable to some members of key populations in LMIC , but may be challenging in others . Encouragingly, PNS approaches have also been successfully provided to gay, bisexual, and other men who have sex with men (MSM) and people who inject drugs (PWID) in several high‐income countries for many years and lessons learned from these programmes may inform scale‐up in LMICs.…”

HIV Status Communication with Sex Partners and Associated Factors Among High-Risk MSM and Transgender Women in Lima, Peru

“…Status communication is considered to be socially risky as once a positive status is disclosed, it could be told to others and the information is no longer completely controlled by the positive individual(11, 13). In the Peruvian context, discussion of HIV status remains highly stigmatized; it is a taboo topic of conversation among MSM, particularly if they just met(18). Additionally many HIV positive people do not know their serostatus due to infrequent HIV testing(19).…”