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 AssociationOctober 29, 2012

No Disclosures

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

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):1459–66Sanchez J et al. J AIDS. 2011:44(5):578–85.

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

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

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

Results

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

Demographics Repeat testers(n=548)

%

First-time testers(n=170)

%Age1 (median, IQR2) 29 (24,36) 27 (21,32)

Born outside of Lima 47 45

Completed high school 71 77

Self-identify as gay/bisexual 47 55

Self identify as transgendered/transsexual1 32 18

Median age at first sexual encounter (IQR) 15 (12,17) 14 (12,16)

1p<0.05

Health Care Repeat testers(n=548)

%

First-time testers(n=170)

%

P-value

Prior STI diagnosis 35 16 <0.01

HIV Infection 17 14 0.34

HSV-2 infection 70 52 <0.01

C. trachomatis infection (oral or rectal) 22 23 0.08

N. gonorrhea infection (oral or rectal) 14 9 0.13

History of syphilis infection (RPR/TPPA+)

26 17 0.01

Active syphilis infection (titer > 1:8) 11 8 0.27

Sexual Risk behavior Repeat testers(n=548)

%

First-time testers(n=170)

%

P-value

Failed to always use condoms in last 6 months 63 61 0.71

Received compensation for sex in last six months

59 39 <0.01

--Always used condom in these encounters 57 (n=331) 45 (n=62) 0.08

Paid for sex in last six months 25 18 0.07

--Always used condom in these encounters 58 (n=141) 59 (n=29) 0.96

Problem drinkers (CAGE questionnaire) 62 53 <0.05

Used alcohol at last sexual encounter 45 49 0.357

Used drugs at last sexual encounter 7 5 0.22

Median number of partners in last six months (IQR)

6 (2, 20) 3 (2,9) <0.01

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

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?

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.

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

their time

Thank you