Risk factors for the spread of HIV and other sexually transmitted infections among men who have sex with men infected with HIV in Lima, Peru

Abstract

Objectives-To assess the prevalence of sexually transmitted infections (STIs), frequency of sexual risk behaviors, and relationship between knowledge of HIV infection status and sexual risk behavior among HIV-infected men who have sex with men (MSM) attending an STI clinic in Peru.Methods-We recruited a convenience sample of 559 MSM from a municipal STI clinic in Lima, Peru. Participants completed a survey and provided blood for HIV, Syphilis, and HSV-2 antibody testing, and urine for gonorrhea and chlamydia nucleic acid testing.Results-Among 124 HIV-infected MSM, 72.6% were aware of their HIV-infected status. Active syphilis (RPR≥1:8) was diagnosed in 21.0% of HIV-infected participants, HSV-2 in 79.8%, urethral gonorrhea in 1.6%, and chlamydia in 1.6%. Among 41 participants reporting insertive anal intercourse with their last sex partner, 34.2% did not use a condom. Of 86 participants reporting receptive anal intercourse, 25.6% did not use a condom. At least one episode of insertive unprotected anal intercourse (UAI) with an HIV-uninfected partner during the previous six months was reported by 33.6% (35/104) of participants, and receptive UAI with an HIV-uninfected partner by 44.6% Key Statements: Many HIV-infected MSM in Peru engage in sexual practices that carry a high risk of HIV transmission to uninfected partners. In a sample of MSM with previously diagnosed HIV infection, no evidence of serosorting or seropositioning harm reduction strategies was observed. No difference in the prevalence of high-risk sexual behavior was seen when comparing men with newly diagnosed HIV infection from those who were aware of their HIV infection status.

Vulnerability in the context of HIV and syphilis infection in a population of men who have sex with men (MSM) in Salvador, Bahia State, Brazil

“…Syphilis also shows high prevalence among MSM, and this sexually transmitted infection (STI) is an important biological factor associated with HIV infection 1,2 . Recent studies and literature reviews point to growing prevalence of syphilis in the MSM population 5,6,7,8,9 , exceeding 30% in some countries of Latin America 2,6,7,8 and Asia 9 , confirming a previously reported trend 2 . In Brazil, a 14% lifetime history of syphilis among MSM was recently estimated by the survey Behavior, Attitudes, Prac-…”

“…As for syphilis, the prevalence found in Salvador is close to that reported in the international literature 2,5,7,8,9 , including RDS studies with MSM 6,30 , and shows the high prevalence of syphilis among MSM interviewed.…”

One-Year Follow-Up of Relapse to Risky Behaviors and Incidence of Syphilis Among Patients Enrolled in the HIV Case Management Program

“…Our study revealed the prevalence of syphilis, as indicated by TPHA seroreactivity, was approximately 1 in 3 at baseline with 5.8 incident cases per 100 person-years of follow-up. By comparison, the 33% prevalence of syphilis among HIV-infected patients in Taiwan was considerably higher than 17.4% of HIVinfected MSM in Amsterdam [9], 4.8% in Thailand [2], or 2.9% in Los Angeles [8], but similar to 35.5% in Lima, Peru [29]. The observation that ten (10.4%) patients with new episodes of syphilis all were MSM, was consistent with other studies that have shown high incidence rates of syphilis among MSM with HIV in Los Angeles [8], Amsterdam [9], and London [10].…”

HIV, alcohol, and noninjection drug use

“…A recent study among HIV-infected MSM attending an STI clinic in Lima, Peru [23] showed that substance use prior to sex was common; however, substance use was not found to be significantly associated with recent unprotected anal intercourse. In Brazil, recent drug use, including marijuana, crack cocaine, amphetamines, and ecstasy, was significantly higher among MSM sex workers than among the general MSM population (56 vs. 27%, respectively) [24].…”