Peru's HIV care continuum among men who have sex with men and transgender women: opportunities to optimize treatment and prevention

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.

HIV testing and the care continuum among transgender women: population estimates from Rio de Janeiro, Brazil

“…However, little is known about HIV linkage and care outcomes for transwomen, in part, because data about trans women are usually grouped together with men who have sex with men (MSM). For example, a recently published study from Peru found low HIV status awareness, retention in care, uptake of ART and virologic suppression among transwomen and MSM [6]. …”

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

“…Additionally, only 60% of the participants reporting that they were HIV positive at baseline also reported being on ART (data not shown). The best estimate for the care cascade among MSM and transgender women in Peru is that 12% have achieved virologic suppression(26). Although HIV positive individuals on treatment with an undetectable viral load are much less likely to infect their partners(27), this can only work in the presence of effective treatment.…”

Individual-level characteristics associated with oral HIV test acceptability among Peruvian men who have sex with men and transgender women: a cross-sectional study

“…For TGW, the proportion that know their HIV serostatus is unknown because studies in Peru have often historically combined data specific to TGW under the ‘MSM’ label 10. A recent scoping literature review found that among Peruvian MSM and TGW living with HIV, only 24% knew their infection status, of which 13.6% were receiving ARV and 12% had achieved viral suppression 12. The authors point out that the largest ‘drop-off’ occurred at the beginning: identifying those who are infected with HIV.…”