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HIV/STI Testing among MSM in Lima, Peru: opportunities for treatment and risk modification

HIV/STI Testing among MSM in Lima, Peru: opportunities for treatment and risk modification. RG Deiss, ER Segura, JL Clark, S Leon, KA Konda, CF Caceres, TJ Coates Meeting of the American Public Health Association October 29, 2012. No Disclosures. Background.

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HIV/STI Testing among MSM in Lima, Peru: opportunities for treatment and risk modification

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  1. HIV/STI Testing among MSM in Lima, Peru: opportunities for treatment and risk modification RG Deiss, ER Segura, JL Clark, S Leon, KA Konda, CF Caceres, TJ Coates Meeting of the American Public Health Association October 29, 2012

  2. No Disclosures

  3. Background • “Test and Treat” forms a key component of HIV prevention • Beyond the benefit of suppressing community viral load, several studies have found that individuals modify sexual risk behaviors after learning they are HIV+ • “Repeat testers” nonetheless may continue to engage in higher frequency of sexual risk behaviors

  4. HIV/STI Testing in Peru • HIV prevalence of 11% among MSM in Peru • High prevalence of syphilis (10-29%), HSV (45%) and other STIs • Prior studies have reported testing rates of ~50% among MSM UNAIDS. Global Report. 2012. Blas MM et al. PLoS ONE 2011;6(11):e27334. Caceres CF et al. AIDS Behav 2008;12:544–51. Clark JL et al. SexTransm Infect. 2008;84:449–54. : Lama JR. J Infect Dis: 2007;194(10):1459–66 Sanchez J et al. J AIDS. 2011:44(5):578–85.

  5. Data Collection Comunidades Positivas: Convenience sample from 16 neighborhoods of Lima, Peru (2008) Men 18-45 years of age with >1 sexual encounter with male/ transgender partner (TGP) in the past 12 months Acknowledged sexual preference toward men or TGP Live/work near the intervention area Plan to stay in the area for the whole study period (18 months) Willing/able to provide informed consent. STI Testing: HIV, HSV-2, Syphilis, oral/rectal GC/chlamydia

  6. Data Collection Computer-Assisted Personal Interview: sociodemographics, health care seeking behavior, sexual risk behaviors and substance use. Audio-assisted self interview: HIV history/status Questions on HIV testing: Most recent test Total times tested Reasons for being/not being tested Whether results were obtained

  7. Data Analysis Primary outcome variable: History of prior HIV testing To compare repeat testers versus non-repeat testers, we used descriptive statistics, along with Chi-square and Mann-Whitney tests

  8. Results

  9. Patterns of HIV testing • 77% of 718 individuals report prior HIV test (median 3 tests, IQR1:2,6) • Of these, 87% obtain results • No difference in HIV prevalence among repeat testers than first-time testers (17% vs 14%, p=0.34) • Excluding known HIV+ individuals, results do not appreciably change (12% among repeat testers, p=0.58) • Most common reasons for testing: • Routine exam (39%); • Unprotected encounter (33%); • Free testing (24%) 1Interquartile Range

  10. 1p<0.05

  11. ). MSM with a history of testing were significantly more likely to report a prior STI diagnosis (35% vs 16%, p<0.01), to abuse alcohol as defined by the CAGE questionnaire (62% vs 53%, p<0.05) and to receive compensation for sex (59% vs 39%, p<0.01) than others. MSM previously tested also reported a significantly (p<0.01) higher median number of partners over the past six months (6, IQR 2,20) and in their lifetimes (85, IQR 25,500) when compared with other participants (3, IQR 2,9) and (30, IQR 10,100), respectively.

  12. Conclusions High prevalence of sexual risk behaviors among individuals who had been tested previously for HIV Prior testing did not seem to impact many sexual risk behaviors among MSM Transactional sex High proportion of individuals who use condoms less than always Significantly higher prevalence of HSV-2 and syphilis infection among repeat testers

  13. Study Limitations Sub-analysis of a larger study Cross-sectional analysis, therefore causal inferences cannot be drawn Potential for reporting bias Limited data on psychosocial factors surrounding testing Importance of staying HIV-negative?

  14. Implications HIV/STI testing and treatment centers: important points of contact for high-risk populations including MSM Individuals with history of STI or current symptoms should be especially targeted for HIV prevention efforts Further study and interventions to reduce sexual risk behaviors among high-risk MSM in the context of STI testing and treatment programs are warranted.

  15. Acknowledgments NIH Grant R01MH078752 Project Staff and Co-Authors Most importantly, study participants who gave their time

  16. Thank you Autumn n Lima, Ohio

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