XIX International Conference on AIDS Washington DC, US. 26 July 2012 Abstract THAC0305

1. Concurrent Drug Use and Sexual Risk Behavior Among Men Who Have Sex with Men in PeruPeinado J1, Lama JR1, Gonzales P1, Cabello R2, Sal y Rosas G1, Sanchez J1.1Asociacion Civil ImpactaSalud y Educacion2Asociación Via Libre XIX International Conference on AIDS Washington DC, US. 26 July 2012 Abstract THAC0305

2. Introduction • MSM and TGW are disproportionately by the HIV epidemic in Peru • High HIV prevalence (≈15-25%) and incidence rates (≈3-6 new cases for 100 p-y) are observed in most urban cities • HIV prevalence is <0.2% in the general population, and ≈1.5% in female sex workers • High levels of UAI are a particularly strong driver of HIV transmission this setting

3. Introduction • Yet to determine if the extent of UAI is mediated by the disinhibiting use of drugs • Drugs increase risk behaviors via: • Drug use environments • Expectancies about its enhancement of sex • Psychogenic effects on decision making

4. Introduction • 2005 national survey in the general population: Ever use of drugs • Marihuana 11.9% • Raw cocaine: 3.7% • Snort cocaine: 3.4% • No IV drug use/amphetamines • Understanding concurrent drug use and sex, including UAI, would contribute to develop tailored interventions for HIV prevention

5. Objectives • To estimate and characterize concurrent drug use and sexual behavior among MSM and TGW unaware of their HIV serostatus and at risk for HIV acquisition in Peru • Drug use before or during the last anal intercourse in the preceding three months • UAI in the last sexual anal intercourse when drugs were used

6. Methods Iquitos n = 597 Piura n = 598 Pucallpa n = 595 Lima N = 2,735 Ica n = 591 HIV sentinel surveillance conducted among MSM in Lima, Ica, Iquitos, Piura y Pucallpa in June-October 2011, to characterize the prevalence and correlates of HIV, STI and sexual risk behavior

7. Methods • Study population • Sexually active adult males • Unknown HIV serostatus or not having a positive HIV test in the previous 12 months • Any sexual risk behaviors in the previous 6 months • Diagnosis of a STI • Self-identification as a sex worker • No condom use at last anal intercourse • Anal intercourse with ≥5 partners • Sexual partner of an HIV-infected male

8. Methods • Study population (cont´d) • Recruitment was based on convenience sampling using peer-educator outreach in previously mapped socialization venues • Study procedures • Computer-assisted self-interview for demographics, sexual identification, role and risk behavior, and alcohol & drug use assessment • Venous blood drawn for HIV and syphilis diagnosis

9. Methods • Study procedures (cont´d) • Pre- and post-test counseling • Syndromic and etiologic treatment for STI • Referral for HIV health care • Provision of condoms and reimbursement for transportation • Statistical analysis • Logistic regression analysis to determine associations with demographics, sexual risk behavior, and alcohol use

10. Results

16. Summary High prevalence of drug use in the previous three months in comparison with historic data from the general population Drug use during the last sexual intercourse associated with less education level, sexual identity, sexual role, alcohol use disorder, and number of male sex partners Among MSM who used drugs in the last sexual intercourse, unprotected anal intercourse associated with sexual identity, sexual role, alcohol use disorder

17. Implications Tailored interventions for HIV prevention among MSM with high risk sex behaviors and drug use, should consider characteristics inherent to self-identification, sex role and number of sex partners